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Abstract: This paper describes scales available to assess the mental health of children and adolescents. These have generally been designed for research purposes but they can also be used clinically to document the quantity and quality of symptomatology, provided that undue emphasis is not placed on suggested cut-off scores. We outline general screening measures for psychiatric disorder, for emotional and externalizing disorders, for eating disorders, autism and for self-esteem. We also describe instruments used to document outcomes of contact with mental health services and case complexity. There are many scales that may be useful adjuncts to clinicians working within and outside child and adolescent mental health services. This contribution has discussed only a small proportion of those available. While these should not serve as a substitute for the clinical interview, they may inform diagnostic assessment and the monitoring of treatment response. [Copyright &y& Elsevier]

Background: Background High rates of depressive disorder have been documented amongst adolescents attending general practitioners (GPs) in urban areas. However, little is known about the associations of adolescent depression in primary care. Method: We completed a cross-sectional questionnaire survey of adolescents, their parents and general practitioners, following adolescent attendance at the surgery. Results: We found high levels of depressive symptoms to be present in adolescent attenders of a broad range of social backgrounds. Depressive symptoms were associated with the following demographic and contextual factors: older age, female gender and parental psychiatric symptoms. They were also associated with the presence of physical symptoms causing psychosocial impairment, with health risks (use of cannabis and exposure to drugs) and with use of services (both primary care and mental health services). Levels of depressive symptoms were similar in urban and suburban groups. However, associations of depressive symptoms with smoking, exposure to drugs, cannabis use and primary care attendance were demonstrated in the suburban group and not the urban group. Conclusion: Adolescent GP attenders have high levels of depressive symptomatology. GP recognition and intervention should have the potential to impact on adolescent depression and on associated risks. [ABSTRACT FROM AUTHOR]

macdonald w., bradley s., bower p., kramer t., sibbald b., garralda e. & harrington r. (2004) Journal of Advanced Nursing 46(1), 78–87 Primary mental health workers in child and adolescent mental health services The interface between primary care and specialist services is increasingly seen as crucial in the effective management of child and adolescent mental health (CAMH) problems. In the United Kingdom, a new role of primary mental health worker (PMHW), has been established in order to achieve effective collaboration across the interface through the provision of clinical care in primary care settings and by improving the skills and confidence of primary care staff. However, little is known about the development of this innovative role in service contexts. Issues raised during the early stages of implementation may have important implications for the preparation and development of professionals who undertake the role. The aim of this paper is to report on a study that examined key issues in implementation of the PMHW role in six health authorities in England. Case study evaluation was conducted, using thematic analysis of 75 qualitative interviews with key stakeholders from different professions (e.g. PMHWs, general practitioners, health visitors, psychiatrists and service managers) and representing different sectors (primary care, specialist services and community child health services). The study identified three models of organization (outreach, primary care-based and teams). Each was associated with different advantages and disadvantages in its effects on referral rates to specialist services and the development of effective working relationships with primary care providers. Problems associated with accommodation and effective integration of PMHWs with specialist services, and tensions caused by the two different roles that PMHWs could undertake (direct clinical care vs. consultation-liaison) were common across all sites. The PMHW role is an important development that may go some way towards realizing the potential of primary care services in CAMH. The implementation of new roles and models of working in primary care is complex, but may be facilitated by effective planning with primary care providers, clear goals for staff, and a long-term perspective on service development. [ABSTRACT FROM AUTHOR]

This paper examines how primary care can improve for teenagers who are experiencing mental or emotional turmoil. This is an important health issue because at least 15% of teenagers experience mental health problems at any one time, there are indications that this proportion is rising, and there is evidence that suicide rates are rising in young people. The paper discusses how troubled teenagers can be identified, cared for and managed by primary care providers within the UK, although some of the information presented is from other countries. It identifies inter-relationships with other health behaviours and risk factors. The GP's role in assessing a troubled teenager is discussed, as well as a consideration of individual and contextual issues to frame a ‘triple’ diagnosis, i.e. a diagnosis simultaneously in biomedical, individual and contextual terms. A review of present knowledge of management is presented. The paper concludes that there are several deficiencies at present, namely a lack of identification of teenage distress, a lack of training for GPs in teenage health, a lack of a research base, a lack of resources and finally a lack of information provided by any teenagers who have experienced turmoil and could give useful insights into their experience. [ABSTRACT FROM PUBLISHER]

Background Outcome measurement is an important component of health care service evaluation. The aim of this paper is to review child and adolescent mental health outcome measures and identify outcome measurement tools for use in routine clinical practice. Method A systematic literature review was undertaken, using Medline and Psych Info and supplemented by correspondence with relevant institutions and authorities in the field. The review identifies potential specific outcome measurement tools. These tools are evaluated using the scientific criteria of validity and reliability, responsiveness to change, and appropriateness of each tool's format for use in routine clinical practice. Results Three broad categories of outcome are identified: population outcomes, specific outcome and performance indicators. Nineteen specific outcome measurement tools are short-listed and compared in detail. No single tool is suitable for use as a comprehensive outcome measurement tool in routine clinical practice. Conclusions A combination of some of the tools shortlisted will cover all the necessary outcome items. However, the increase in assessment time will reduce clinical usefulness. Further research is needed to modify or create appropriate outcome measurement tools for use in routine clinical practice. [ABSTRACT FROM PUBLISHER]

Outcome auditing of specialist child and adolescent mental health services (CAMHS) is now well under way internationally. There is, however, debate about objectives and tools. A case is made for the achievable goal of enhancing service accountability through user satisfaction information and clinician-rated contextualised measures of improvements in symptoms and impairment. [ABSTRACT FROM AUTHOR]

Focuses on the special psychiatric needs and requirements of children. What psychiatric disorders tend to feature; Information on the psychiatric disorder amongst adolescents attending primary care; Failure of child mental health services to reach many children likely to benefit; Questions the possibility of primary care team being strengthened to attend to these children.