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The objective was to establish how stakeholders in low- and middle-income countries (LMIC) conceptualize child mental health impact. Semi-structured interviews were conducted with 18 stakeholders from disadvantaged urban communities in Kenya, South Africa, Turkey and Brazil. Participants represented education, welfare and health care agencies; as well as community and religious groups. Data were analysed through a thematic approach and three related themes were identified. Impact was defined as a process of change, with child-centred outcomes and measures that were broader than mental health symptoms improvement. Beneficiaries were identified at child, family, community and service level. Participants wished to see strategies that ensured sustainability of impact, namely child mental health policy, stakeholder engagement, interdisciplinary working, and capacity-building for all stakeholder groups. Child mental health service transformation in LMIC, especially in areas of deprivation, needs to build on existing resources and strengths by co-producing psychosocial outcomes with a range of professional and community stakeholders. Impact on children’s mental wellbeing can be achieved through a co-ordinated strategy that involves designated policy, capacity-building, and interdisciplinary networks with meaningful community involvement.

Child and adolescent psychiatry is in a unique position to respond to the growing public health challenges associated with the large number of mental disorders arising early in life, but some changes may be necessary to meet these challenges. In this context, the future of child and adolescent psychiatry was considered by the Section on Child and Adolescent Psychiatry of the World Psychiatric Association (WPA CAP), the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), the World Association for Infant Mental Health (WAIMH), the International Society for Adolescent Psychiatry and Psychology (ISAPP), the UN Special Rapporteur on the Right to Health, representatives of the WHO Department of Mental Health and Substance Abuse, and other experts. We take this opportunity to outline four consensus priorities for child and adolescent psychiatry over the next decade: increase the workforce necessary for providing care for children, adolescents and families facing mental disorders; reorienting child and adolescent mental health services to be more responsive to broader public health needs; increasing research and research training while also integrating new research finding promptly and efficiently into clinical practice and research training; Increasing efforts in advocacy.

Background Children in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children’s mental health outcomes from the effects of the adverse circumstances that led to their admission to care. Objective This research investigated the association between care placement and the presence of child mental health problems after controlling for children’s pre-care experiences. It also identified factors associated with mental health problems among children in care. Participants and Setting The sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159). Methods The mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers. Results The odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032). Conclusions These findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.

BackgroundExposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs).MethodsData were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms.ResultsThe most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria.ConclusionsNearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.

Children in low- and middle-income countries (LMIC), particularly those living in disadvantaged and conflict-ridden communities, are faced with extensive unmet health and social care needs (UNICEF, 2016). A substantial body of research has also provided evidence specifically relating to children's mental health, thereby increasing our understanding regarding the impact of cumulative and interlinked risk factors such as war, conflict and displacement, natural disasters, poverty, child labour and other forms of exploitation. Attempts to improve children's mental health in LMICs is, however, constrained by a range of factors including stigma relating to mental illness, limited policy input as reflected by the low level of specialist resources, lack of contextualised evidence regarding culturally appropriate psychosocial interventions (Patel & Rahman, 2015), and underrepresentation of LMICs in the research literature (Helal, Ahmed, & Vostanis, 2011).

Background Despite growing evidence on the extent of child mental health problems in low-middle-income countries, the gap between need and provision remains high. Previous research in high income countries has demonstrated that evidence-based interventions can be scaled-up through community consultation, particularly by engaging key stakeholders. Aims This study aimed to explore community stakeholders’ views on children's mental health needs and culturally acceptable interventions in Kenya, to ascertain how to integrate global service standards with culturally-specific expectations. Methods Focus groups were conducted with community stakeholders (seven young people 14–17 years, seven parents, nine teachers and 11 other professionals). These participants were recruited from an urban community of internally displaced and disadvantaged families in Nakuru. Results Results indicated that Kenya faced similar challenges in meeting mental health needs as in other countries, including economic constraints, limited knowledge, stigma and systemic issues, but that these were manifested in culturally specific ways that were linked to societal and professional's attitudes and local context. Conclusions Stakeholders’ views are important in informing the planning, delivery and evaluation of interventions. However, for such interventions to be sustained, a clear therapeutic framework, evidence-base and sociocultural adaptation are likely to be important factors.

Although there has been increasing attention on the impact of risk and resilience factors on refugee children’s mental health, there has been limited evidence on the role of parental factors to inform interventions, and this predominantly relies on adult reports. The aim was to investigate the relationship between perceived parenting styles and attachment relationships and child mental health, as reported by 322 Syrian refugee minors aged between 8 and 17 years in Turkey. Child-rated scales included the Children Revised Impact of Event Scale–8 (CRIES-8), Strengths and Difficulties Questionnaire (SDQ), Security Scale and Egna Minnen Betraffande Uppfostran for Children (EMBU-C), and were used as measures of post-traumatic stress disorder (PTSD), general mental health problems, attachment relationships and perceived parenting styles, respectively. Children with secure maternal and paternal attachment perceived their parents as less rejecting, while children with secure paternal attachment also reported their parents as emotionally warmer. Attachment relationships significantly contributed in predicting PTSD after controlling for age and gender, while conduct problems were predicted by lack of emotional warmth, rejection and over-protection by both parents, in addition to insecure attachment relationships. Refugee children’s views are essential in establishing their needs and planning interventions. These should address both the impact of trauma and current family relationships.

Self-harm amongst young people is an increasing problem, with looked-after young people at higher risk. Despite this, little research exists on what young people who self-harm find helpful.One hundred and twenty-six 11-21 year olds (53 who had experience of the care system and 73 who did not) were recruited from the community and NHS. All participants had self-harmed in the past 6 months. Participants completed an Audio Computer-Assisted Self-interview (ACASI) regarding their views about the support they had received, how helpful it was, and what further help they felt they needed.Looked-after young people reported the three most helpful sources of support were Child and Adolescent Mental Health Services (CAMHS), friends and pets and the least helpful were CAMHS, Accident and Emergency (AE) and Social services. For non-looked-after young people, CAMHS, counselling and Harmless (user-led support service for self-harm) were most helpful and CAMHS, cognitive behavioural therapy (CBT) and general practitioner (GP) were the least. Compared with the other group, more looked-after young people had received help from AE and CAMHS, whereas more non-looked-after young people had accessed GPs, parents, psychological therapies, self-help books and websites. More looked-after young people found support groups helpful, and more non-looked-after young people reported that distraction techniques, medication and their siblings were helpful.Young people who self-harm have mixed views about CAMHS. Differences in the pattern of access and preferences for support between looked-after and non-looked-after young people should be reflected in service availability and commissioning.Little is known about what young people who self-harm find helpful, particularly for looked-after young people. CAMHS was named amongst the most helpful and the least helpful services by both looked-after and non-looked-after young people. Social services and AE were frequently cited amongst the least helpful sources of support. Young people report finding informal support helpful, including family and friends. There appears to be a need for explorations of the reasons behind the apparent negative perception of statutory services in young people, and what is required to shift that.

Background: Children in the UK care system often face multiple disadvantages in terms of health, education and future employment. This is especially true of mental health where they present with greater mental health needs than other children. Although transition from care – the process of leaving the local authority as a child-in-care to independence – is a key juncture for young people, it is often experienced negatively with inconsistency in care and exacerbation of existing mental illness. Those receiving support from child and adolescent mental health services (CAMHS), often experience an additional, concurrent transfer to adult services (AMHS), which are guided by different service models which can create a care gap between services. Method: This qualitative study explored care-leavers’ experiences of mental illness, and transition in social care and mental health services. Twelve care-leavers with mental health needs were interviewed and data analysed using framework analysis. Results: Sixteen individual themes were grouped into four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. Conclusions: Existing social care and mental health teams can improve the care of care-leavers navigating multiple personal, practical and service transitions. Recommendations include effective Pathway Planning, multiagency coordination, and stating who is responsible for mental health care and its coordination. Participants asked that youth mental health services span the social care transition; and provide continuity of mental health provision when care-leavers are at risk of feeling abandoned and isolated, suffering deteriorating mental health and struggling to establish new relationships with professionals. Young people say that the key to successful transition and achieving independence is maintaining trust and support from services.

There is increasing interest in providing resilience-building interventions in low- and middle-income countries (LMIC), but limited evidence on how young people and their carers process mental health and related supports. The aim of this study was to establish stakeholders’ conceptualization of youth mental health in a disadvantaged area of Kenya through focus groups with 7 young people aged 14–17 years and their parents, 9 teachers and 11 practitioners or community leads. The four identified themes related to definitions of both mental well-being and mental health problems; a range of contributing factors related to identity resolution, parenting, poverty and social media; attribution of responsibility at different socio-ecological levels; and required awareness, supports and interventions at these levels. Stakeholders, notably young people, are thus essential in the development and planning of user-led and culturally appropriate interventions in LMIC.

Background Since 2010, the numbers of refugees have increased and around half are under 18 years of age. It is known that experience of organised violence, displacement and resettlement increases the risk for psychiatric disorders and psychosocial impairment. This review integrates recent research into the risk and protective factors for psychopathology with service and treatment issues. Methods We draw on and critically evaluate key systematic reviews in the selected areas, innovative robust studies and relevant government reports. Results Many refugee children show resilience and function well, even in the face of substantial adversities. The most robust findings for psychopathology are that PTSD, and posttraumatic and depressive symptoms are found at higher prevalence in those who have been exposed to war experiences. Their severity may decrease over time with resettlement, but PTSD in the most exposed may show higher continuity. More severe psychiatric disorders including psychosis may also occur. Service delivery needs to take into account socioeconomic and cultural influences but, given the high level of unmet need even in high-income countries, stepped care delivery is required. The evaluation of psychological interventions, often delivered in group settings, suggests that they can be effective for many distressed children; however, for the more impaired, a greater range of disorder-specific therapies will be required. Conclusions Child and adolescent mental health clinicians and service providers need to be aware of the specific needs of this population and systems for service delivery. There are significant knowledge gaps in understanding risk and vulnerability, service delivery and treatment effectiveness.

A cognitive-behavioural programme for the treatment of depressive disorders in child and adolescent psychiatric patients is described. The treatment is based on research findings from studies on cognitive abnormalities in adult depression and on similar abnormalities which have been described in child populations. Similar treatment programmes for adult depressed patients and children from non-clinical populations are also discussed. The aims of this treatment package are, the recognition and labelling of emotions, the change of negative cognitive attributions, and the enhancement of social skills. Each of the nine treatment sessions includes a review of previous homework, an introduction to the theme of the session, practice of tasks with the therapist, and homework assignments. The implications for future research are also discussed.

© 2015 Society for Adolescent Health and Medicine. Purpose Although extensive evidence indicates that being younger within a school cohort is associated with poorer academic functioning, much less is known about such relative age effects (RAEs) for mental health - the focus of the current investigation. Methods Data from 23,379 11- to 13-year-olds attending state-maintained secondary schools in England were analyzed to investigate RAEs on mental health measured using the Strengths and Difficulties Questionnaire. Participants were grouped into oldest, middle, and youngest thirds of their academic year based on their month of birth relative to their cohort. Hierarchical linear regression analysis evaluated RAEs and gender- or deprivation-related moderation of such effects. Results Relatively younger adolescents had significantly more emotional symptoms and peer problems compared with relatively older individuals in a year group, although effect sizes were small. These effects were not moderated by gender or deprivation. Impact of mental health difficulties on other aspects of functioning was also greater among relatively younger children. Larger RAEs are observed in the younger cohort (11-12 years) compared with those in the 12- to 13-year-olds, thereby indicating that RAEs might attenuate with age. Conclusions Being relatively younger than classmates is associated with increased internalizing symptoms, poorer peer relationships, and higher impact of mental health difficulties on functioning at school and home. The findings support wider inclusion of relative age in understanding mental health difficulties and its inclusion as a potential risk factor in studies investigating the development of psychopathology, especially for internalizing symptoms. Possible mechanisms of the effects detected are discussed.

Background Recent initiatives have emphasized the ongoing need to include children in healthcare research, which is relevant to the development of both paediatric and mental healthcare services. Our aim was to contribute children and their parents' perceptions and experiences of Child and Adolescent Mental Health Services (CAMHS), with the objective of providing guidance for those wishing to improve inclusivity and empowerment. Method We performed a thematic analysis of interview data taken from 11 children (9 boys, 2 girls, aged 8–12) and their parents (12 mothers, 2 fathers), who had recently been referred to CAMHS for mental health and educational problems. Results Three core themes emerged from the data. Fear of the unknown refers to emotional apprehension due to uncertainty of what happens in CAMHS. However children also provided useful reassurances for future service users. Therapeutic engagement refers to the importance of being listened to and building up good relationships with professionals. Finally making services acceptable was discussed in terms of issues of accessibility, session tolerances and suggestions for the development of child-centred services. Conclusions Children were able to provide potentially useful opinions of CAMHS. In a time of limited resources it is imperative that the voices of children and their parents are acknowledged in order to improve accessibility and experiences within CAMHS.

Quality of life is typically reduced in children with mental health problems. Understanding the relationship between quality of life and mental health problems and the factors that moderate this association is a pressing priority. This was a cross-sectional study involving 45,398 children aged 8-13 years from 880 schools in England. Self-reported quality of life was assessed using nine items from the KIDSCREEN-10 and mental health was assessed using the Me and My School Questionnaire. Demographic information (gender, age, ethnicity, socio-economic status) was also recorded. Quality of life was highest in children with no problems and lowest in children with both internalising and externalising problems. There was indication that quality of life may be reduced in children with internalising problems compared with externalising problems. Approximately 12 % children with mental health problems reported high quality of life. The link between mental health and quality of life was moderated by gender and age but not by socio-economic status or ethnicity. This study supports previous work showing mental health and quality of life are related but not synonymous. The findings have implications for measuring quality of life in child mental health settings and the need for approaches to support children with mental health problems that are at particular risk of poor quality of life.

Background: An increasing number of children are placed in foster care (i.e., a kin or nonkin family home other than the biological parent) due to experiences of physical, sexual, emotional, or psychological abuse, and/or neglect. Children in foster care are at increased risk for a host of negative outcomes encompassing emotional, behavioral, neurobiological, and social realms. Methods: Areas of risk and vulnerability among foster children are described, including emotional and behavioral deficits, impaired neurobiological development, and social relationship deficits. Evidence suggesting the significance of family placement changes and prenatal exposure to substances as contributing mechanisms is presented. Based on a systematic search of the PsycINFO database (to March 2012), eight efficacious evidence-based interventions for foster families are summarized. Findings: Although the development of evidence-based interventions that improve outcomes for foster children has lagged behind the delivery of interventions in other service sectors (e.g., mental health and educational sectors), several interventions across childhood and adolescence offer promise. Service system constraints offer both challenges and opportunities for more routine implementation of evidence-based interventions. Conclusions: Given the increased likelihood of poor outcomes for foster children, increased efforts to understand the pathways to vulnerability and to implement interventions shown to be effective in remediating risks and improving outcomes for this population are indicated. Evaluation of efficacious interventions in countries outside of the United States is also needed. © 2012 The Authors. Journal of Child Psychology and Psychiatry © 2012 Association for Child and Adolescent Mental Health.

Background Schools play an important role in promoting child mental health, but little is known about the approaches they undertake. Methods A scoping survey in England, involving 599 primary and 137 secondary schools. Results Although two thirds of school approaches focused on all pupils, these were predominantly reactive, rather than preventive interventions. They were also largely not evidence-based, were instead based on a plan while open to adaptation. Gaps were identified in teacher training and support. Conclusions The findings have implications on the use of preventive versus reactive approaches, staff training and consultation, use of evidence-based practice in schools and joint care pathways.

Background There is increasing international concern over the rising number of children involved in labour, particularly in developing countries. Despite the multitude of related risk factors, and some evidence on their social needs, there has been limited research on these children's mental health. Methods The aim of this study was to establish the association between labour‐related variables and mental health problems among 780 children in labour (aged 9–18 years, mean 15.8) in the Gaza Strip. Measures included a demographic checklist, the Strengths and Difficulties Questionnaire, the Spence Children's Anxiety Scale and the Depression Self‐rating Scale for Children. Results Children came from large families (73.2% had eight or more siblings), mainly worked to increase family income, worked an average 6.8 h per day (range 1–16), and only 37.1% had regular rest. Ratings of mental health problems were predicted by different factors, i.e. total difficulties scores by poor friendship relationships and lack of health insurance; anxiety scores by selling in the streets, working to help family, low family income and lack of health insurance; and depression scores by parents' dissatisfaction with the job and longer working hours. Conclusions Mental health problems of children in labour are likely to be associated with socio economic determinants, as well as factors related to their under age employment. Policy, legislation and preventive programmes from statutory and voluntary agencies should adopt an integrated approach in meeting their mental health needs, by enhancing protective factors such as return to school.

International audience; Previous research has provided evidence on the effectiveness of CBT in the symptomatic improvement of children with obsessive–compulsive disorders. There is also increasing recognition of the importance of involving parents and families in treatment. The aim of this study was to evaluate the short-term effectiveness of such an intervention that promoted family strengths [(quality of life therapy (QoLT)] for mothers of children with obsessive–compulsive disorders (OCD). The sample consisted of 40 children with OCD and their mothers, who had been referred to clinics in Esfahan city in Iran. Mothers were randomly allocated to an experimental (QoLT) and waiting list control group. Mothers participated in eight QoLT group sessions over 4 weeks. QoLT incorporated CBT techniques in managing OCD symptoms. Measures were completed pre- and post-intervention by both groups. Children completed the Yale–Brown obsession compulsion scale for Children, the Revised children's manifest anxiety scale, and the brief multidimensional student's life satisfaction scale; mothers completed the quality of life inventory (QoLI). QoLT was associated with decrease in OCD and anxiety symptoms and increase in children's satisfaction in the global, family and environment domains, as well as with increased QoLI scores in their mothers. Parenting interventions like QoLT can complement individual modalities such as CBT in the presence of family-related difficulties. This can be particularly applicable in countries and settings with limited resources and high stigma of child mental health problems.

Exposure to war trauma has been independently associated with posttraumatic stress (PTSD) and other emotional disorders in children and adults. The aim of this study was to establish the relationship between ongoing war traumatic experiences, PTSD and anxiety symptoms in children, accounting for their parents’ equivalent mental health responses. The study was conducted in the Gaza Strip, in areas under ongoing shelling and other acts of military violence. The sample included 100 families, with 200 parents and 197 children aged 9–18 years. Parents and children completed measures of experience of traumatic events (Gaza Traumatic Checklist), PTSD (Children’s Revised Impact of Events Scale, PTSD Checklist for parents), and anxiety (Revised Children’s Manifest Anxiety Scale, and Taylor Manifest Anxiety Scale for parents). Both children and parents reported a high number of experienced traumatic events, and high rates of PTSD and anxiety scores above previously established cut-offs. Among children, trauma exposure was significantly associated with total and subscales PTSD scores, and with anxiety scores. In contrast, trauma exposure was significantly associated with PTSD intrusion symptoms in parents. Both war trauma and parents’ emotional responses were significantly associated with children’s PTSD and anxiety symptoms. Exposure to war trauma impacts on both parents’ and children’s mental health, whose emotional responses are inter-related. Both universal and targeted interventions should preferably involve families. These could be provided by non-governmental organizations in the first instance.

Background: Many studies have described associations between adult psychiatric disorder among adults and their biographic, socio-demographic and social capital characteristics. Fewer studies have focused on children, and most of these have looked at structural indicators of the neighbourhood. Our objective was to examine one aspect of social capital – perceived neighbourhood trust and safety in relation to childhood psychopathology. Methods: Data on childhood psychopathology and perceived neighbourhood trust and safety were obtained on 3,340 11 to 16-year-olds included in a large survey of the mental health carried out in 426 postal sectors in Great Britain. Data were collected on biographic and socio-demographic characteristics of the child and the family, measures of social capital and neighbourhood prosperity. We entered all these variables into a logistic regression analysis to establish the strength of association between perceived neighbourhood trust and safety separately for emotional and conduct disorders. Results: Children's perception of their neighbourhoods in terms of the trustworthiness or honesty of the people who live there or feeling safe walking alone had a strong association with childhood psychopathology, particularly emotional disorders, rather than the nature of the neighbourhood itself. Children's behaviour, however, such as going to the park or shops alone, did not vary by measures of childhood psychopathology. Conclusions: Regeneration of less prosperous neighbourhoods is likely to increase children's positive perceptions of trust, honesty and safety which in turn can have a positive effect on their mental health.

The aim of this study was to investigate young homeless people's experiences of `Strong Minded', a new mental health service set up within selected homeless shelters and run by a voluntary sector organization. Semi-structured interviews were conducted with 19 residents from five homeless shelters across the UK. All of the young people who had accessed Strong Minded had benefited from their engagement. The young people also identified several key inherent and important aspects of Strong Minded relating to both the practical, supportive therapeutic approach and the flexibility of the interventions offered, which contributed to the service's success. This service model of engaging vulnerable young people in transition could have useful implications for the future interface between voluntary and statutory mental health services.

The aim of this study was to evaluate the short-term impact of two types of family support services (FSS) for children with behavioural problems ( N = 51 and 49 respectively). These were compared with children ( N = 40) matched for presenting problems and referred to specialist CAMHS in a locality without FSS. Pre and postintervention measures were the Health of the Nation Outcome Scales (HoNOSCA), the Strengths and Difficulties Questionnaire (SDQ), and a service utilization checklist. Although all three groups were associated with decrease of child behavioural scores, the two family support services provided an earlier response and resulted in significantly higher reduction of HoNOSCA and SDQ scores. The two FSS types implemented different ‘levels’ of interventions, as FSSB resulted in a more favourable short-term outcome and appeared to operate more closely to specialist services, while FSS-A appeared to adopt a more preventive role. Family support services have an important role within a comprehensive child mental health service, but the specificity of their interventions for different target client groups requires further investigation.

Children with behavioural problems are often referred to child mental health services without rationalization of criteria or referral routes. The aims of the present study were to establish the psychosocial characteristics of children with behavioural problems referred to a tertiary Day Resource, and to compare these with children referred for similar problems to a specialist outpatient child mental health service and a family support community service. Demographic data, the Strengths and Difficulties Questionnaire and the Health of the Nations Outcome scales for Children and Adolescents were used. Families attending the Day Resource were found to have more involvement with other agencies, and children showed higher levels of clinical severity and complexity. Most of this difference was accounted for by attentional difficulties, as well as communication and physical health problems. These findings confirmed the hypothesis that families seen at tertiary service level presented with more complex psychosocial needs and frequent child comorbidity, thereby justifying the multimodal treatment package developed at that service level. It is concluded that there is a need for this level of parenting interventions, but only for complex cases that have not responded to community interventions.

Health services’ input to the Youth Offending Teams (YOTs) is an integral component of the YOTs’ philosophy. Fifty young people aged 14–18 years, who attended two representative YOTs consecutively, completed a health checklist and a strengths and difficulties questionnaire. They were interviewed on the health of the nation outcome scales for children and adolescents and their perceptions of health needs and services. The young people reported high rates of accidents and injuries, admissions to hospital, emotional and peer relationships difficulties. Their perceptions of what mental illness means varied between stigma, aggression, lack of coping, previous experiences and physical ill-health. Only five young people expressed a wish to receive mental health help. The findings are discussed in relation to health services provision to the YOTs.

A mental health team for looked after children, and the evaluation of its first phase are presented. The team combines primary mental health worker, psychology and psychiatry skills. It offers telephone and face-to-face consultation to local authority staff, assessment, treatment and training. Forty-five children and their carers, who consecutively attended the service, were independently assessed by a researcher at the time of referral and at five-month follow-up. Outcome measures included the Strengths and Difficulties Questionnaire (SDQ), the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and a service satisfaction questionnaire. At 5 months, children had significantly improved on a number of HoNOSCA scales, and on the emotional SDQ scales. Carers perceived the interventions as targeting different aspects of the child’s functioning, but wished they were more involved in decision-making. Carers and children were generally positive about their clinical contact. The findings are discussed in the context of developing mental health services for vulnerable children and young people, and interagency partnership.

Objectives To study the services for pre-school children with behaviour problems in a Midlands city and the level of co-ordination and co-operation between providers. Setting A socially and ethnically diverse Midlands city in the UK. Methods Survey methods were employed with city health visitors in order to determine their role and identify service providers. Service providers from different agencies were interviewed and data collected related to service offered, materials used, theoretical basis of interventions, referrals to and from the service, inclusion and exclusion criteria and co-ordination and co-operation with other providers. Themes were identified related to the content and process of the services using qualitative data analysis methods. Frequencies of themes were estimated for different provider groups. Results Health visitors and nursery nurses working in the primary care services were the primary point of contact for children with pre-school behaviour problems. Nursery nurses were one of the major sources of referral for children with pre-school behaviour problems and a significant majority of these providers had not received any specific training for this role. The majority of the providers used evidence-based programmes but few adhered strictly to a particular programme and instead used a mixture of materials drawn from different programmes. Many health service providers in particular offered interventions to parents on a one-to-one basis only. Most providers used behaviour modification approaches. While many providers claimed to have knowledge of other local providers and have good links, there was little evidence of co-ordination within and between agencies. Conclusions While there appears to be high levels of activity by providers from both statutory and voluntary sectors in providing services for pre-school children with behaviour problems, there is evidence to suggest that some of the main providers of services are not being adequately prepared and supported in the role. There is a lack of co-ordination within and between services, and indication that evidence-based programmes are being modified and used in an ad hoc manner. It is concluded that surveys of this nature may be an important preliminary step in establishing co-ordinated services for the primary and secondary prevention of pre-school behaviour problems.

Children with conduct disorders and their families come into contact with a range of community and specialist agencies. The aim of this study was to establish the lifetime service utilisation rates among children with conduct disorders from the Great Britain National Study (N=10,438), and to examine the association between comorbid disorders, family and social factors, and service utilisation. The Development and Well-Being Assessment, a service checklist, and a battery of family and social functioning measures were used. The weighted prevalence of oppositional and conduct disorders was 5.4%. Within this group (N=403), 241 (59.8 %) had conduct disorder only, 79 (19.6 %) comorbid emotional, 72 (17.9 %) comorbid hyperkinetic, and 11 (2.7 %) comorbid emotional and hyperkinetic disorders. These subgroups were compared on service utilisation with children with other psychiatric disorders (N=351). Children with conduct disorders had significantly higher lifetime rates of utilisation of social and educational services than children with other psychiatric disorders. Contact with primary health, specialist health, and educational services was significantly associated with comorbid physical and psychiatric disorders. In contrast, contact with social services was associated with family discord and social sector tenancy. The findings are discussed in the context of organisation and co-ordination of health, other statutory, and nonstatutory services, also taking into account previous research on interventions for children with conduct disorders and their families.

This article describes the development of the primary mental health worker (PMHW) role within Child and Adolescent Mental Health Services (CAMHS) within the UK, and focuses on services in Leicester, Leicestershire and Rutland, an area with a general population of 900,000. The concept behind the PMHW role is described and the application of this to practice is outlined. The role consists of consultation, liaison, direct work and training. The described primary mental health team comprises 13 PMHWs and is an integral part of a comprehensive CAMHS. Its aim is to support and enable primary care professionals in their work with mental health issues in children and families, thus promoting early recognition and management of child mental health problems and filtering appropriate referrals for specialist CAMHS intervention.

Aims: To describe the characteristics of homeless children and families seen by the mental health outreach service (MHOS), to evaluate the impact of this service on the short term psychosocial functioning of children and parents, and to establish perceptions of, and satisfaction with, the service. Methods: Twenty seven children from 23 families who were in receipt of the MHOS and 27 children from 23 families residing in other hostels where no such service was available were studied. The MHOS was delivered by a clinical nurse specialist with expertise in child mental health, who offered the following interventions: assessment and brief treatment of mental health disorders in children; liaison with agencies; and training of homeless centre staff. Results: Children in the experimental group had a significantly higher decrease in Strengths and Difficulties Questionnaire (SDQ) total scores. Having received the intervention was the strongest predictor of improvement in SDQ total scores. There was no significant impact on parental mental health (General Health Questionnaire) scores. Homeless families and staff expressed high satisfaction with the MHOS. Conclusion: This MHOS for homeless families is an innovative intervention which meets the complex and multiple needs of a vulnerable population unable to access mainstream mental health services. The primary objective of the service was to improve child mental health problems; however, the service developed in a responsive way by meeting social and practical needs of families in addition to its clinical role.

An inter-agency training programme in child and adolescent mental health for primary care staff has been developed in a UK area serving a general population of 900 000. This was initiated with a training needs and resources analysis across all the joint strategy partners (three local authorities, one health authority and the voluntary sector). Training is provided to inter-agency groups of professionals in 12 localities. To date, 150 staff have been through the two-day introductory/foundation course, which is complemented by three subsequent training days on the assessment and management of children and families. Staff evaluation ratings are presented. On the whole, primary healthcare staff rated their awareness of mental health issues and their knowledge of staff roles within child mental health services significantly higher, in contrast with education staff who rated these components lower. Inter-agency training has been achieved with some difficulties needing to be overcome, but the participants’ feedback indicates that the expected output is beginning to be realized. The implications of the project are discussed.

This paper describes the care arrangements made for children when their mothers are admitted to psychiatric hospital. It also describes at admission, and at 3 months follow-up, the views and opinions of mothers and carers with regard to the admission, its impact on the family, and the service received. It was found that children are predominantly cared for within their family when their mother is admitted to hospital, and that mothers and carers are concerned about the impact of the admission and its associated problems.

Objective: To establish rates of posttraumatic stress disorder (PTSD) reactions and general mental health problems in children who had experienced war trauma. Method: A longitudinal study in the Gaza strip with 234 children aged 7 to 12 years, who had experienced war conflict, at 1 year after the initial assessment, that is, during the peace process. Children completed the Child Post Traumatic Stress Reaction Index (CPTS-RI), while the Rutter A2 and B2 Scales were completed by parents and teachers. Results: The rate of children who reported moderate to severe PTSD reactions at follow-up had decreased from 40.6% (N 5 102) to 10.0% (N 5 74). 49 children (20.9%) were rated above the cut-off for mental health problems on the Rutter A2 (parent) Scales, and 74 children (31.8%) were above the cut-off on the Rutter B2 (teacher) Scales. The total scores on all three measures had significantly decreased during the 1-year period. The total CPTS-RI score at follow-up was best predicted by the number of traumatic experiences recalled at the first assessment. Conclusions: PTSD reactions tend to decrease in the absence of further stressors, although a substantial proportion of children still present with a range of emotional and behavioral problems. Cumulative previous experience of war trauma constitutes a risk factor for continuing PTSD symptoms. © 2000 Elsevier Science Ltd

Children in care constitute a deprived and needy group of young people, who are at high risk of developing mental-health problems and disorders. This article describes the development of a direct access child and adolescent mental-health service for children living in residential units or with foster families, with data on the pattern and characteristics of referrals, and discussion on the arising difficulties. The main aims of this service are, to be responsive and flexible, to provide mental- health assessment and treatment, and to work with residential care staff, foster parents and field social workers. Young people referred to the mental-health service had high rates of abuse, history of offending behaviour, poor school attendance and frequent previous contacts with child mental-health services. There were also high rates of child mental-health disorders, particularly mixed conduct and depressive disorders, and history of self-harm. Anticipated benefits include a coordinated and cost-effective assessment, improved mental-health outcome, contribution to the care plan and prevention of further difficulties. Joint commissioning between health and local authorities should prioritize children in care. Different models of mental-health provision may be appropriate and require evaluation.

The aims of this study were to estimate the rate of post-traumatic stress reactions in Palestinian children who experienced war traumas, and to investigate the relationship between trauma-related factors and PTSD reactions. The sample consisted of 239 children of 6 to 11 years of age. Measures included the Rutter A2 (parent) and B2 (teacher) scales, the Gaza Traumatic Event Checklist, and the Child Post-Traumatic Stress Reaction Index. Of the sample, 174 children (72.8%) reported PTSD reactions of at least mild intensity, while 98 (41%) reported moderate/severe PTSD reactions. Caseness on the Rutter A2 scale was detected in 64 children (26.8%), which correlated well with detection of PTSD reactions, but not with teacher-detected caseness. The total number of experienced traumas was the best predictor of presence and severity of PTSD. Intervention programmes for post-war children need to be evaluated, taking into account developmental and cultural aspects, as well as characteristics of the communities involved.

The detection of major and minor depression in children and adolescents was evaluated in an outpatient sample of 113 children employing the Mood and Feelings Questionnaire (both child and parent versions) and the K-SADS interview. Differences between depressed and nondepressed groups, those with major or minor depression, and depressed children compared with those comorbid for anxiety, were examined. Our findings support the validity of the MFQ as a screening instrument for major and minor depression in a population with a high proportion of depressed cases. High agreement between parent and child ratings was found, with cognitive items being the best predictors of depression.

Cognitive-behavioural treatment (CBT) appears to have considerable value in the treatment of childhood depression. Its key components are self-monitoring, social problem-solving and cognitive restructuring. Such a treatment programme was compared with a non-focused control intervention (NFI) in 57 outpatient children and adolescents with depression. Both groups improved significantly on depressive and anxiety symptoms, self-esteem and social functioning, with the majority of children (87 percent of CBT subjects and 75 percent of controls) no longer being clinically depressed. Non-specific psychotherapeutic elements such as empathy, sympathetic listening, reassurance, reinforcement and indirect ways of achieving self-understanding and problem-solving may be involved in the recovery. In out-patient settings, we recommend that social problem-solving and cognitive restructuring be introduced during the first two to three sessions, which may help the young person gain self-control relatively early and engage more with the treatment.

Background Despite the available epidemiological evidence on the prevalence of mental health problems in childhood and adolescence, there is limited knowledge on whether there are differences in the level of need and service utilisation by young ethnic minority groups. Methods Adolescents of 13–15 years from nine schools in two English cities in which children of Indian ethnicity were over-represented (n=2900), completed rating scales on different types of mental health problems, contacts with services and informal supports. Results Indian adolescents scored significantly lower on general mental health and depression symptoms. They were also less likely than White adolescents to self-report having mental health problems, even for a similar level of need. Among those with mental health scores within the clinical range, Indian adolescents were less likely to have visited specialist services. Instead, they were more likely to first approach family members, teachers or general practitioners. Conclusions Rather than a blanket approach being applied to policy and service planning to meet the needs of diverse communities of young people, more specific evidence needs to be gained about patterns of referrals of minority groups and their strategy of accessing supportive adults.

In this follow-up study, mothers of 28 children with conduct disorders (CD) and 29 children with emotional disorders (ED) of 6-11 years of age, were interviewed and rated for expressed emotion 9 months after their first clinical assessment. Mothers of children with CD expressed significantly less criticism and higher warmth after 9 months. Initial externalizing scores in the CD group and initial internalizing scores in the ED group at the first assessment predicted symptomatic change, in contrast with EE scales. Initial externalizing scores and low levels of maternal warmth predicted presence of conduct disorder at the last contact with the clinician. The implications of the findings on the development of treatment techniques are discussed.

Recent policies recommend effective joint working between health and education; however, the views of service users are underrepresented, particularly opinions of young children.The project was operational from 2005-2008 when interviews were conducted with parents and children. The children were attending CAMHS for mental health and educational difficulties.Results indicated that they had a positive view of multiagency working. They consider that joint working is limited by a number of problems and make recommendations for improvement.Findings indicate that more effective communication between agencies is needed and this should be provided for parents in an accessible language. This has implications for training professionals together.

Summary The detection and diagnosis of autism may be delayed until middle childhood, 3–4 years after its onset. This is more likely in high-functioning autism and in cases of co-morbidity with mental retardation. Such delays have serious effects on children and their families as well as on the provision of clinical and educational resources. In addition to greater awareness among professionals and to the development of comprehensive services, early detection could be facilitated by screening for early signs and symptoms of autism. The instruments that have been developed to rate autistic behaviours, particularly in pre-school children, are reviewed in this paper. Although the majority of these observational or informant-based measures were not initially designed for screening purposes, previous research findings from their application could be useful in the future development of such a screening instrument. Relevant research findings are discussed and suggestions are made for further evaluation in appropriate populations.

Purpose The primary aim of this study is to examine the extent to which running away from home as a child is associated with behavioral problems and victimization during childhood and with suicidal behavior and substance abuse during early adulthood. Methods A random probability sample comprising 7,461 respondents was interviewed for the 2007 survey of psychiatric morbidity of adults in England. A subsample of 16- to 34-year-old individuals was selected for secondary analysis (N = 2,247). All survey respondents were asked whether they had run away from home and asked specific questions on being physically, emotionally and sexually abused as children. They were also asked about suicidal behavior and alcohol and drug dependence in early adulthood. Results Approximately 7% of 16- to 34-year-old individuals reported running away from home before the age of 16 years, with higher rates in women than in men (9.8% compared with 5.3%). Overall, 45.3% reported being bullied, 25.3% experienced violence at home, and 8.8% reported unwanted sexual intercourse. Runaways were far more likely than other children to have suffered victimization and family difficulties and to exhibit behavioral problems. Adults who reported running away from home were three times more likely than other adults to have thought about or attempted suicide, but the relationship with substance abuse was far less pronounced. Conclusions Sexual, physical, and emotional abuse, along with family difficulties, can all impact children who run away from home. Running away from home was strongly associated with suicidal behavior in adulthood, regardless of other childhood adversities.

The improved joint working between child and adolescent mental health services (CAMHS) and schools is a policy priority. Although there have been a range of school-based initiatives and studies on teachers’ awareness of mental health issues, there has been limited evidence on the training needs of CAMHS practitioners. The aim of this study was to explore how much CAMHS staff know about educational issues and how confident they feel working collaboratively with education colleagues. Ninety-six staff from four specialist CAMHS completed a questionnaire with 40 items on perceptions of knowledge, practice and attitudes towards educational issues and services, and three case vignettes. Despite the fact that participants reported frequent contact with children with education-related needs and with education services, they also highlighted concerns about their level of training and skills in this regard. Perceptions of knowledge and attitudes significantly predicted response to case vignettes. Previous training and experience were associated with knowledge, but did not predict case vignettes scores. The results suggest that training of CAMHS staff should be integral to all services in helping improve their understanding of school and education systems, improve clinical skills in detecting education-related mental health problems, and develop strategies in increasing joint working.

Children in public care and other vulnerable young groups (homeless, adopted, refugees) are increasingly becoming the focus of policy and service planning. There is strong evidence that all these client populations have high rates of mental health problems which are closely associated with other needs. We also have good knowledge on the factors that predispose individuals to and maintain mental health problems, as well as on the reasons for their not easily accessing and engaging with services. There is less evidence on the effectiveness of interventions or service models, although some interesting patterns are beginning to emerge. These include the need for inter-agency commissioning, clear care pathways, designated provision, applied therapeutic interventions, training for carers and frontline practitioners, and multi modal programmes. This paper discusses these issues, as well as ways forward, both for systems with relatively well developed child mental health services and for low-income countries. Service quality can be greatly strengthened by international collaboration on policy, practice and research networks, training and research.