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This brief commentary article considers the implications of intensive outcome monitoring which is central to children and young people's Improving Access to Psychological Therapies (CYP IAPT) in England and Wales. Services are being provided with a range of free software solutions to enable data collection, and guidance on interpretation of the measures, but there will still be some burden of data entry and collation for already overstretched services. It may be that the utility of the feedback will go some way to offset the sense of burden but this remains to be seen. Whether commissioners and others will rise to the challenge of supporting this aspect may prove crucial to the success or otherwise of such intensive ROM use. Many aspects of the CYP IAPT approach are new and whilst drawing on experience from earlier pilots of session by session monitoring in CAMHS both in the UK and abroad, and from Adult IAPT, there is likely to be much for us to learn. Time will tell whether the approach helps to improve the care children and young people receive but we are cautiously optimistic.

Evidence for the association between mental health difficulties and academic outcomes is sparse and shows mixed results. The aim of this study was to investigate the association between educational attainment, absenteeism and mental health difficulties while controlling for various child characteristics such as special educational needs and socioeconomic background. 15,301 Year 7 pupils (mean age 11.91; SD = 0.28) from England completed the Strengths and Difficulties Questionnaire. Attainment, persistent absenteeism and child characteristics were derived from the National Pupil Database. Multilevel regression analysis showed that mental health difficulties were negatively associated with attainment and positively associated with persistent absenteeism. When all mental health difficulties were modelled simultaneously, behavioural difficulties, hyperactivity/attention difficulties and difficulties with peers were negatively associated with attainment. Emotional difficulties and hyperactivity/attention difficulties were positively associated with persistent absenteeism. The results of the current study highlight the importance of integration between mental health support and policy creation in relation to mental health difficulties and wellbeing in schools.

ObjectiveWe assessed whether maternal mental health problems increased rates for child injury during the preschool years and mid-childhood, and the extent to which associations could be accounted for by a range of potential explanatory factors.DesignWe analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Multinomial regression was used to investigate whether two measures of maternal mental health (diagnosed depression/anxiety and psychological distress) were associated with subsequent childhood injury. Models adjusted for sociodemographics, parenting and child externalising behaviours.Main outcome measureMaternal report of unintentional injuries (none, 1, 2+) recorded at three data collection periods (3–5 years; 5–7 years; 7–11 years).ResultsThe analytic sample comprised n=9240 families who participated 3–11 years with complete data on exposures and outcomes (multiply imputing missing covariates). Exposure to maternal mental health problems was associated with increased rates of subsequent childhood injuries. Associations attenuated after adjustment for potential explanatory factors, although they remained elevated. For example, high maternal distress was associated with injuries 3–5 years (adjusted relative risk ratio (aRRR): 1 injury=1.18, 95% CI 0.86 to 1.61; 2+ injuries=2.22, 95% CI 1.22 to 4.02); injuries 5–7 years (aRRR: 1 injury=1.31, 95% CI 0.97 to 1.76; 2+ injuries=1.84, 95% CI 1.09 to 3.09); and injuries 7–11 years (aRRR: 1 injury=1.03, 95% CI 0.81 to 1.31; 2+ injuries=1.33, 95% CI 0.97 to 1.81).ConclusionsChildren exposed to mothers with mental health problems had higher rates of childhood injury than those not exposed. If further investigation of this association suggests causality then it will be important to test measures that address mothers’ mental health issues with a view to reducing injuries among their children.

BackgroundPsychological distress is common among women of childbearing age, and limited longitudinal research suggests prolonged exposure to maternal distress is linked to child mental health problems. Estimating effects of maternal distress over time is difficult due to potential influences of child mental health problems on maternal distress and time-varying confounding by family circumstances.MethodsWe analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Adopting a marginal structural modelling framework, we investigated effects of exposure to medium/high levels of maternal psychological distress (Kessler-6 score 8+) on child mental health problems (Strengths and Difficulties Questionnaire borderline/abnormal behaviour cut-off) using maternal and child mental health data at 3, 5, 7 and 11 years, accounting for the influence of child mental health on subsequent maternal distress, and baseline and time-varying confounding.ResultsPrior and concurrent exposures to maternal distress were associated with higher levels of child mental health problems at ages 3, 5, 7 and 11 years. For example, elevated risks of child mental health problems at 11 years were associated with exposure to maternal distress from 3 years [risk ratio (RR) 1.27 (95% confidence interval (CI) 1.08–1.49)] to 11 years [RR 2.15 (95% CI 1.89–2.45)]. Prolonged exposure to maternal distress at ages 3, 5, 7 and 11 resulted in an almost fivefold increased risk of child mental health problems.ConclusionsPrior, concurrent and, particularly, prolonged exposure to maternal distress raises risks for child mental health problems. Greater support for mothers experiencing distress is likely to benefit the mental health of their children.

OBJECTIVES: To explore paediatric hospital staff members’ perceptions of the emerging benefits and challenges of the huddle, a new safety improvement initiative, as well as the barriers and facilitators to its implementation. DESIGN: A qualitative study was conducted using semi-structured interviews to explore staff perspectives and experiences. SETTING: Situation Awareness For Everyone (SAFE), a safety improvement programme, was implemented on a sample of National Health Service (NHS) paediatric wards from September 2014 to June 2016. Previously untested in England, the huddle was a central component of the programme. PARTICIPANTS: Semi-structured interviews were conducted with 76 staff members on four wards ~4 months after the start of the programme. RESULTS: A thematic analysis showed that staff perceived the huddle as helping to increase their awareness of important issues, improve communication, facilitate teamwork, and encourage a culture of increased efficiency, anticipation and planning on the ward. Challenges of the huddle included added pressure on staff time and workload, and the potential for junior nurses to be excluded from involvement, thus perhaps inadvertently reinforcing medical hierarchies. Staff also identified several barriers and facilitators to the huddle process, including the importance of senior nursing and medical staff leadership and managing staff time and capacity issues. CONCLUSIONS: The findings point towards the potential efficacy of the huddle as a way of improving hospital staff members’ working environments and clinical practice, with important implications for other sites seeking to implement such safety improvement initiatives.

Background‘Situation Awareness For Everyone’ (SAFE) was a 3-year project which aimed to improve situation awareness in clinical teams in order to detect potential deterioration and other potential risks to children on hospital wards. The key intervention was the ‘huddle’, a structured case management discussion which is central to facilitating situation awareness. This study aimed to develop an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle.MethodsA cross-sectional observational design was used to psychometrically develop the ‘Huddle Observation Tool’ (HOT) over three phases using standardised psychometric methodology. Huddles were observed across four NHS paediatric wards participating in SAFE by five researchers; two wards within specialist children hospitals and two within district general hospitals, with location, number of beds and length of stay considered to make the sample as heterogeneous as possible. Inter-rater reliability was calculated using the weighted kappa and intraclass correlation coefficient.ResultsInter-rater reliability was acceptable for the collaborative culture (weighted kappa=0.32, 95% CI 0.17 to 0.42), environment items (weighted kappa=0.78, 95% CI 0.52 to 1) and total score (intraclass correlation coefficient=0.87, 95% CI 0.68 to 0.95). It was lower for the structure and risk management items, suggesting that these were more variable in how observers rated them. However, agreement on the global score for huddles was acceptable.ConclusionWe developed an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle. Future research should examine whether observational evaluations of huddles are associated with other indicators of safety on clinical wards (eg, safety climate and incidents of patient harm), and whether scores on the HOT are associated with improved situation awareness and reductions in deterioration and adverse events in clinical settings, such as inpatient wards.

In England, clinicians and professional organisations report that higher numbers of adolescents with more severe psychosocial difficulties are accessing specialist services. A lack of national data on patterns of access to specialist services means there is limited information to inform policy. We examined whether severity of psychosocial difficulties in adolescents accessing mental healthcare has changed over time. Adolescents seen in specialist child mental healthcare in 2009 vs. 2014 were matched on demographics and problem types using propensity score matching; final sample N = 2776 adolescents. We found: 1) stability over time in overall severity of difficulties, 2) an increase in severity of young women's emotional problems, and 3) a decrease in adolescents' conduct problems. The findings suggest the intriguing possibility that the criteria for accessing mental healthcare are not universally rising, but rather the patterns in access to specialist services may mirror epidemiological changes in severity of psychosocial difficulties in the population.

SummaryCurrent mental health provision for children is based on estimates of one in ten children experiencing mental health problems. This study analyses a large-scale community-based dataset of 28 160 adolescents to explore school-based prevalence of mental health problems and characteristics that predict increased odds of experiencing them. Findings indicate the scale of mental health problems in England is much higher than previous estimates, with two in five young people scoring above thresholds for emotional problems, conduct problems or hyperactivity. Gender, deprivation, child in need status, ethnicity and age were all associated with increased odds of experiencing mental health difficulties.Declarations of interestNone.

Mental health difficulties are childhood-onset with lifelong health, social and economic consequences. Children spend a large amount of time in schools, making schools an important context for mental health prevention and support. We examine how school composition and school climate, controlling for individual child-level characteristics, are associated with children's mental health difficulties (emotional and behavioural difficulties). Data from 23,215 children from 648 primary schools in England were analysed to examine the associations of school composition (size, gender, socioeconomic and ethnicity) and school climate with mental health (emotional symptoms, behavioural symptoms and above clinical cut-off scores) adjusting for individual child socio-demographic characteristics. We find that between 3% and 4.5% of the variation in children's mental health outcomes could be attributed to schools. Of this, small proportions were explained by school composition (1.4 to 3.8%) and larger proportions were explained by school climate (29.5 to 48.8%). Lower school socio-economic status was associated with higher behavioural symptoms (coef = 0.02 [95%CI: 0.01–0.04]) and slightly raised odds of high mental health difficulties (OR = 1.05, 95% CI: 1.01,1.09). More positive school climate was associated with lower emotional (coef = −0.09 [95%CI:-0.11,-0.08]) and behavioural (coef = −0.13 [95% CI,-0.15:-0.11]) symptoms and lower odds of mental health difficulties (OR = 0.78, 95%CI:0.74,0.81). Some associations between school factors and mental health were moderated by child sex and SES. School composition factors were weakly associated with children's mental health, whereas school climate explained a larger amount of between-school variation and appears a good target for universal prevention of mental health difficulties in children.

Background: Research investigating the role of emotion regulation (ER) in the development and treatment of psychopathology has increased in recent years. Evidence suggests that an increased focus on ER in treatment can improve existing interventions. Most ER research has neglected young people, therefore the present meta-analysis summarizes the evidence for existing psychosocial intervention and their effectiveness to improve ER in youth. Methods: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Twenty-one randomized-control-trials (RCTs) assessed changes in ER following a psychological intervention in youth exhibiting various psychopathological symptoms.Results: We found moderate effect sizes for current interventions to decrease emotion dysregulation in youth (g=-.46) and small effect sizes to improve emotion regulation (g=0.36). Significant differences between studies including intervention components, ER measures and populations studied resulted in large heterogeneity. Conclusion: This is the first meta-analysis that summarizes the effectiveness for existing interventions to improve ER in youth. The results suggest that interventions can enhance ER in youth, and that these improvements correlate with improvements in psychopathology. More RCTs including larger sample sizes, different age groups and psychopathologies are needed to increase our understanding of what works for who and when.

BACKGROUND Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. OBJECTIVE The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. METHODS The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. RESULTS There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. CONCLUSIONS It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.7019

Purpose The purpose of this paper is to determine the efficacy of the Peer Education Project (PEP), a school-based, peer-led intervention designed to support secondary school students to develop the skills and knowledge they need to safeguard their mental health and that of their peers. Design/methodology/approach Six schools from across England and the Channel Islands took part in an evaluation of the PEP across the 2016/2017 academic year. In total, 45 trained peer educators from the sixth form and 455 Year 7 students completed pre- and post-questionnaires assessing their emotional and behavioural difficulties, perceived school climate, and knowledge, skills and confidence related to mental health. Findings Results indicate that participation in the PEP is associated with significant improvement in key skills among both peer educators and student trainees, and in understanding of key terms and readiness to support others among trainees. Most students would recommend participation in the programme to other students. Originality/value While peer education has been found to be effective in some areas of health promotion, research on the effectiveness of peer-led mental health education programmes in schools is limited. This study contributes evidence around the efficacy of a new peer education programme that can be implemented in secondary schools.

Goal formulation and tracking may support preference-based care. Little is known about the likelihood of goal formulation and tracking and associations with care satisfaction. Logistic and Poisson stepwise regressions were performed on clinical data for N = 3757 children from 32 services in the UK (M age = 11; SDage = 3.75; most common clinician-reported presenting problem was emotional problems = 55.6%). Regarding the likelihood of goal formulation, it was more likely for pre-schoolers, those with learning difficulties or those with both hyperactivity disorder and conduct disorder. Regarding the association between goal formulation and tracking and satisfaction with care, parents of children with goals information were more likely to report complete satisfaction by scoring at the maximum of the scale. Findings of the present research suggest that goal formulation and tracking may be an important part of patient satisfaction with care. Clinicians should be encouraged to consider goal formulation and tracking when it is clinically meaningful as a means of promoting collaborative practice.

Background Early identification of children with potential development delay is essential to ensure access to care. The Ages & Stages Questionnaires (ASQ) is used as population outcome indicators in England as part of the 2.5-year review. Method The aim of this article was to systematically review the worldwide evidence for the psychometric properties of the ASQ third edition (ASQ-3TM) and the Ages & Stages Questionnaires®: Social-Emotional (ASQ:SE). Eight electronic databases and grey literature were searched for original research studies available in English language, which reported reliability, validity or responsiveness of the ASQ-3TM or ASQ:SE for children aged between 2 and 2.5 years. Twenty studies were included. Eligible studies used either the ASQ-3TM or the ASQ:SE and reported at least one measurement property of the ASQ-3TM and/or ASQ:SE. Data were extracted from all papers identified for final inclusion, drawing on Cochrane guidelines. Results Using ‘positive’, ‘intermediate’ and ‘negative’ criteria for evaluating psychometric properties, results showed ‘positive’ reliability values in 11/18 instances reported, ‘positive’ sensitivity values in 13/18 instances reported and ‘positive’ specificity values in 19/19 instances reported. Conclusions Variations in age or language versions used, quality of psychometric properties and quality of papers resulted in heterogeneous evidence. It is important to consider differences in cultural and contextual factors when measuring child development using these indicators. Further research is very likely to have an important impact on the interpretation of the ASQ-3TM and ASQ:SE psychometric evidence.

The study investigated the associations between social and psychological factors in childhood and adulthood and the occurrence of adulthood hay fever in a longitudinal birth cohort study. A total of 5780 participants with data on parental social class, childhood hay fever up to age 7 years, childhood cognitive ability at age 11 years, educational qualifications at age 33 years, personality traits, occupational levels and adult hay fever (all measured at age 50 years) were included in the study. Using logistic regression analyses, results showed that childhood hay fever identified by medical doctors and traits Emotional Stability and Conscientiousness were significantly and independently associated with the occurrence of hay fever in adulthood.

The aim of the present research was to explore clinician attitudes to outcome measures and, in particular, the facilitators and barriers to implementing outcome measures. An up-to-date exploration of clinician attitudes is especially needed in the context of recent policies on the implementation of outcome measures in child and adolescent mental health services (CAMHS), and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. Semi-structured interviews were conducted with nine CAMHS clinicians from a Mental Health Trust in South London. Two levels of implementation emerged from the analysis: (1) the service level, regarding the implementation of outcome measures across a service to inform service improvement and (2) the session level, regarding the implementation of outcome measures within individual clinical sessions. The present research described training and ongoing support as a crucial facilitator of use at both service and session levels. This included help overcoming local contextual barriers, such as resources, information systems and administrative processes. The research showed that a balance is needed between a mandatory and uniform approach across a service and providing clinicians with support to use outcome measures with all service users for whom they are appropriate.

Objectives Creation of linked mental health, social and education records for research to support evidence-based practice for regional mental health services. Setting The Clinical Record Interactive Search (CRIS) system was used to extract personal identifiers who accessed psychiatric services between September 2007 and August 2013. Participants A clinical cohort of 35 509 children and young people (aged 4–17 years). Design Multiple government and ethical committees approved the link of clinical mental health service data to Department for Education (DfE) data on education and social care services. Under robust governance protocols, fuzzy and deterministic approaches were used by the DfE to match personal identifiers (names, date of birth and postcode) from National Pupil Database (NPD) and CRIS data sources. Outcome measures Risk factors for non-matching to NPD were identified, and the potential impact of non-match biases on International Statistical Classification of Diseases, 10th Revision (ICD-10) classifications of mental disorder, and persistent school absence (

Psychosocial functioning is considered an important and valued outcome in relation to young people’s mental health as a construct distinct from psychiatric symptomology, especially in the light of an increasing focus on transdiagnostic approaches. Yet, the level of psychosocial functioning is rarely directly asked of young people themselves, despite the widespread recognition that the young person’s perspective is valuable and is often at odds with those of other reporters, such as parents or professionals. One possible reason for this is that the field lacks a clear agreed tool to capture this information in a non-burdensome way. To begin to address this gap, this paper describes psychometric analysis of the Child Outcome Rating Scale (CORS), a brief and highly accessible self-report measure of young people’s psychosocial functioning already used extensively by mental health professionals around the world but with only limited data on psychometric robustness. Using large community (n = 7822) and clinic (n = 2604) samples, we explore the factor structure, construct validity, internal consistency, differential item functioning, and sensitivity of the CORS. We found that the CORS stands up to psychometric scrutiny, having found satisfactory levels of reliability, validity, and sensitivity in this sample. We also found that the CORS is suitable for use with young people as old as 15 years old. That the CORS has been found to be psychometrically robust while being highly feasible (brief, simple, easy to administer) for use in busy clinical settings, combined with the fact that the CORS has already been widely adopted by clinicians and young people, suggests CORS may be an important tool for international use.

Due to recent increases in the use of feedback from outcome measures in mental health settings, we systematically reviewed evidence regarding the impact of feedback from outcome measures on treatment effectiveness, treatment efficiency, and collaborative practice. In over half of 32 studies reviewed, the feedback condition had significantly higher levels of treatment effectiveness on at least one treatment outcome variable. Feedback was particularly effective for not-on-track patients or when it was provided to both clinicians and patients. The findings for treatment efficiency and collaborative practice were less consistent. Given the heterogeneity of studies, more research is needed to determine when and for whom feedback is most effective. Electronic supplementary material The online version of this article (doi:10.1007/s10488-015-0710-5) contains supplementary material, which is available to authorized users.

Abstract. This study investigated the factor structure, internal consistency, and known-groups validity of the 4-item Perceived Stress Scale in a large sample of 29,388 English adolescents. Results indicated that the original unidimensional structure was not viable and instead provided support for a two-factor structure. Examination of a bifactor-( S − 1) model indicated that this multidimensionality can be attributed to reverse-worded items; however, beyond method effects, these factors appear to capture distinct, though inter-related, constructs. As this multidimensional structure relies on 2-item factors, we advise use of longer versions of this measure where possible.

Background/objectives Maternal psychological distress is associated with a range of adverse child outcomes. We sought to determine whether children’s exposure to medium or severe distress at 5 years was associated with increased risks of overweight and obesity when they were aged 11 years. We also investigated whether any association was attenuated after accounting for potential confounding and mediating factors. Subjects/methods We analysed data from the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood, imputing missing covariates (analytic sample: n = 9206). Multinomial regression was used to examine whether maternal psychological distress (Kessler-6 scale, using medium and severe score thresholds) at 5 years of age predicted children’s objectively measured overweight and obesity at 11 years, adjusting for sex and ethnicity. We then carried out a series of models incorporating potential confounders (early life and socio-demographic, recorded at 9 months) and mediators (physical activity and dietary factors, at 7 years) in turn, and then simultaneously. Results A third of mothers reported distress when their child was aged 5 years (29% medium; 4% severe distress), and over a quarter of children were overweight at 11 years (22% overweight; 6% obese). Risks of obesity at 11 years increased with severity of maternal distress at 5 years (medium distress: relative risk ratio (RRR) = 1.43, 95% confidence interval [CI] 1.17–1.75; severe RRR = 2.27, CI 1.42–3.63). Adjusting for each set of explanatory factors in turn (particularly early years and socio-demographic confounding factors) reduced but did not eliminate these elevated risks. However, risks were attenuated in the fully adjusted model (medium: RRR = 1.14, CI 0.92–1.41; severe: RRR = 1.26, CI 0.75–2.11). Conclusions We demonstrated that maternal psychological distress, particularly if severe, at 5 years was associated with risk of obesity (but not overweight) at 11 years. Accounting for potential explanatory factors attenuated this association to non-significance, suggesting a range of mechanisms may be implicated. Future research should seek to disentangle the potentially complex pathways linking explanatory factors, maternal distress and child obesity.

Background Most smokers initiate before the age of eighteen, and smoking in adolescence is strongly influenced by parental smoking habits. Despite this, few studies have examined factors which may protect teenagers against the risk of having a smoking parent. We investigated whether skills-based components of positive mental health in childhood (Mental Health Competence, MHC) modified the association between parent and teenager smoking, using contemporary data from the UK-representative Millennium Cohort Study (∼18 000 children, born 2000–2002; analytic sample: n=10,133). Methods Cohort members (CMs) reported whether they had ever smoked cigarettes or e-cigarettes at 14 years(y). A dichotomised variable indicated whether one or both parents reported their own tobacco use when CMs were 11 y. A four-class latent measure of MHC captured learning skills and prosocial behaviours at 11 y: High, High-Moderate, Moderate, Low. We examined effect modification in two ways. First, we compared risk differences (RD; estimated using binary regression) for CM smoking according to parental smoking, across levels of MHC. Second, we estimated RDs for CM smoking according to combinations of parental smoking and MHC. Confounding by socio-economic and demographic characteristics and parent’s mental health was adjusted for. Survey weights accounted for sample design and attrition; multiple imputation addressed item missingness. Results Similar proportions of CMs had ever smoked cigarettes (17%) and e-cigarettes (18%), although overlap was moderate (40% who had smoked either had smoked both). CMs were more likely to have ever smoked cigarettes if at least one parent smoked (RD: 16%[13–184]) (baseline: no parents who smoke[11%]). This elevated risk was observed across all levels of MHC, but was greatest for Low MHC (RD: 21%[11–31] (RDs in other MHC groups: 7%–12%). When combining parental smoking and MHC (baseline: no smoking parent, high MHC), those with Low MHC and a smoking parent had a RD of 28%(20–36). This was higher than the sum of RDs in CMs with Low MHC but a non-smoking parent (7%[1–14]) and with High MHC but a smoking parent (11% [7–15]). Thus, Low MHC carried an excess risk. There was little evidence of effect modification by Moderate or High-Moderate MHC. Results were similar for e-cigarettes. Conclusion The association between parent smoking and teenage smoking initiation was considerably stronger in those with Low MHC in contemporary, UK-representative data. These results require replication in other populations, and at older ages (examining progression to regular smoking), but imply that MHC improvement before transition to secondary school holds potential to buffer against an important smoking risk factor. The views expressed are those of the authors and not necessarily those of the funders.

BACKGROUND The association between mental health difficulties and academic attainment is well established. There is increasing research on mobile health (mHealth) interventions to provide support for the mental health and education of young people. However, nonadoption and inadequate implementation of mHealth interventions are prevalent barriers to such trials. OBJECTIVE The aim of this study was to bridge this gap and examine the implementation of an mHealth intervention, ReZone, for young people in schools. METHODS Preliminary data for 79 students collected as part of a larger trial were analyzed. We additionally conducted postimplementation consultations with teachers. RESULTS ReZone was used 1043 times by 36 students in the intervention arm during the study period. Postimplementation teacher consultations provided data on implementation strategies, barriers, and facilitators. CONCLUSIONS Implementation strategies, barriers, and facilitators for digital interventions need to be considered to limit nonadoption and inadequate implementation in larger trials. Important considerations involve tailoring the characteristics of the intervention to the requirements of the intended user group, the technology itself, and the organization in which it is implemented. CLINICALTRIAL International Standard Randomised Controlled Trial Number: 13425994; http://www.isrctn.com/ISRCTN13425994

Background Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and, therefore, develop evidence-based recommendations for practice. Objective This study aimed to determine the feasibility of undertaking a cluster randomized controlled trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. Methods Overall, 270 young people were screened for participation and 52.5% (142/270) were recruited and completed baseline measures across 8 specialist child mental health services (n=62, mean age 14.66 (SD 1.99) year; 52% [32/62] female) and 2 mainstream secondary schools (n=80; mean age 16.88 [SD 0.68] years; 46% [37/80] female). Young people received Power Up in addition to management as usual or received management as usual only. Posttrial interviews were conducted with 11 young people from the intervention arms (specialist services n=6; schools n=5). Results Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported (1) their motivation for use of Power Up, (2) the impact of use, and (3) barriers to use. Out of the 142 recruited participants, 45.0% (64/142) completed follow-up measures, and the approaches to increase retention agreed by the steering group are discussed. Conclusions The findings of this study indicate that the app is acceptable, and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized controlled trial. Trial Registration ClinicalTrials.gov NCT02552797; https://clinicaltrials.gov/ct2/show/NCT02552797 (Archived by WebCite at http://www.webcitation.org/6td6MINP0)

BACKGROUND Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and therefore, develop evidence-based recommendations for practice. OBJECTIVE To determine the feasibility of undertaking a cluster randomized control trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. METHODS Overall, 270 young people were screened for participation and 53% (N = 142) were recruited and completed baseline measures across eight specialist child mental health services (n = 62, mean (SD) age = 14.66 (1.99) years, 52% female) and two mainstream secondary schools (n = 80; mean (SD) age = 16.88 (0.68) years, 46% female). Young people received Power Up in addition to management as usual or received management as usual only. Post-trial interviews were conducted with 11 young people from the intervention arms (specialist services n = 6; schools n = 5). RESULTS Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported: 1) their motivation for use of Power Up, 2) the impact of use, and 3) barriers to use. Out of the 142 recruited participants, 45% (64/142) completed follow up measures, and the approaches to increase retention agreed by the steering group are discussed. CONCLUSIONS The findings of the present research indicate that the app is acceptable and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized control trial. CLINICALTRIAL ISRCTN: ISRCTN77194423, ClinicalTrials.gov NCT02552797

© 2017 The British Psychological Society There is a growing appreciation that child functioning in different domains, levels, or systems are interrelated over time. Here, we investigate links between internalizing symptoms, externalizing problems, and academic attainment during middle childhood and early adolescence, drawing on two large data sets (child: mean age 8.7 at enrolment, n = 5,878; adolescent: mean age 11.7, n = 6,388). Using a 2-year cross-lag design, we test three hypotheses – adjustment erosion, academic incompetence, and shared risk – while also examining the moderating influence of gender. Multilevel structural equation models provided consistent evidence of the deleterious effect of externalizing problems on later academic achievement in both cohorts, supporting the adjustment-erosion hypothesis. Evidence supporting the academic-incompetence hypothesis was restricted to the middle childhood cohort, revealing links between early academic failure and later internalizing symptoms. In both cohorts, inclusion of shared-risk variables improved model fit and rendered some previously established cross-lag pathways non-significant. Implications of these findings are discussed, and study strengths and limitations noted. Statement of contribution What is already known on this subject? Longitudinal research and in particular developmental cascades literature make the case for weaker associations between internalizing symptoms and academic performance than between externalizing problems and academic performance. Findings vary in terms of the magnitude and inferred direction of effects. Inconsistencies may be explained by different age ranges, prevalence of small-to-modest sample sizes, and large time lags between measurement points. Gender differences remain underexamined. What does this study add? The present study used cross-lagged models to examine longitudinal associations in age groups (middle child and adolescence) in a large-scale British sample. The large sample size not only allows for improvements on previous measurement models (e.g., allowing the analysis to account for nesting, and estimation of latent variables) but also allows for examination of gender differences. The findings clarify the role of shared-risk factors in accounting for associations between internalizing, externalizing, and academic performance, by demonstrating that shared-risk factors do not fully account for relationships between internalizing, externalizing, and academic achievement. Specifically, some pathways between mental health and academic attainment consistently remain, even after shared-risk variables have been accounted for. Findings also present consistent support for the potential impact of behavioural problems on children's academic attainment. The negative relationship between low academic attainment and subsequent internalizing symptoms for younger children is also noteworthy.

Sessional monitoring of patient progress or experience of therapy is an evidence-based intervention recommended by healthcare systems internationally. It is being rolled out across child and adolescent mental health services (CAMHS) in England to inform clinical practice and service evaluation. We explored whether patient demographic and case characteristics were associated with the likelihood of using sessional monitoring. Multilevel regressions were conducted on N = 2609 youths from a routinely collected dataset from 10 CAMHS. Girls (odds ratio, OR 1.26), older youths (OR 1.10), White youths (OR 1.35), and youths presenting with mood (OR 1.46) or anxiety problems (OR 1.59) were more likely to have sessional monitoring. In contrast, youths under state care (OR 0.20) or in need of social service input (OR 0.39) were less likely to have sessional monitoring. Findings of the present research may suggest that sessional monitoring is more likely with common problems such as mood and anxiety problems but less likely with more complex cases, such as those involving youths under state care or those in need of social service input.

© 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.

Adults from black and minority ethnic (BAME) backgrounds are less likely to access mental health services through voluntary care pathways and are more likely to access through compulsory ones. The aim of the present research was to explore the association between ethnicity and care pathway through child and adolescent mental health services (CAMHS), in terms of reason for referral and case closure, in children presenting with emotional problems. A sample of N = 11,592 children from 26 CAMHS was taken from a national routinely collected dataset (56 % female; 7 % aged 0–5 years, 40 % 6–12 years, 53 % 13–18 years, and

The Strengths and Difficulties Questionnaire (SDQ) is one of the most widely used measures of young people’s mental health difficulties in research and clinical decision-making. Although the SDQ is available in both paper and computer survey formats, cross-format equivalences have yet to be established. The current study aimed to assess the measure’s equivalence across paper- and computer-based survey formats in a community-based school setting. The study examined self-reported measures completed by a matched sample of 11–14 year olds in secondary schools in England (589 completed paper version; 589 online version). Analyses demonstrate that the factor structure, although did not vary by survey format, resulted in poorly fitting models limiting the use of model based invariance testing. Results indicate that the measure does not operate similarly across different formats, with scale-level mean differences observed for the hyperactivity scale, which also affects the total difficulties score, with higher scores seen in the paper version. Responses to the impact supplement were also influenced by survey format, with higher impact in specific domains disclosed on the computer-based measure. Item-level differential item functioning was observed for four items in the measure; two from the prosocial scale where the DIF is large enough to affect the scale (DTF, ν2 = 0.14). The inconsistency across survey formats highlights the need for more assessment of influences of different survey formats on young people, their perceived privacy and their mental health disclosures via different media. The findings also highlight the potential confounding effect of format when different methods of data collection are used, with a potentially substantive impact on cross-sample comparisons and within child clinical review.

BackgroundRecently, a general psychopathology dimension reflecting common aspects among disorders has been identified in adults. This has not yet been considered in children and adolescents, where the focus has been on externalising and internalising dimensions.AimsTo examine the existence, correlates and predictive value of a general psychopathology dimension in young people.MethodAlternative factor models were estimated using self-reports of symptoms in a large community-based sample aged 11–13.5 years (N= 23 477), and resulting dimensions were assessed in terms of associations with external correlates and future functioning.ResultsBoth a traditional two-factor model and a bi-factor model with a general psychopathology bi-factor fitted the data well. The general psychopathology bi-factor best predicted future psychopathology and academic attainment. Associations with correlates and factor loadings are discussed.ConclusionsA general psychopathology factor, which is equal across genders, can be identified in young people. Its associations with correlates and future functioning indicate that investigating this factor can increase our understanding of the aetiology, risk and correlates of psychopathology.

The effectiveness of evidence-based practice in the treatment of children with conduct disorder ( n = 186) or emotional disorders ( n = 490) in routine care was examined using naturalistic, previously collected data from 30 child and adolescent mental health services. Repeated measures analysis of covariance was used to compare the outcomes of children who received parent training for conduct disorder and cognitive behavioural therapy for emotional disorders (evidence-based practice) with children who did not receive these treatments (non-evidence-based practice). There was a relatively low occurrence of evidence-based practice, particularly for children with conduct disorder. Both the evidence-based practice and non-evidence-based practice groups improve over time, with moderate effect sizes, and there were greater improvements associated with evidence-based practice for children with emotional disorders, based on child self-reported symptoms but not on parent report. In the present sample, significant differences were not found for conduct disorder. Findings provide tentative support for evidence-based practice for the treatment of emotional disorders in routine care settings.

Patient Reported Outcome Measures (PROMs) are increasingly being used in Child and Adolescent Mental Health Services (CAMHS). The aim of this research was to explore change in standardized and idiographic outcome measures in CAMHS using naturalistic, routinely collected data.We explored change in psychosocial difficulties and impact on daily life as evaluated by a broad standardized measure, the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997, J. Child Psychol. Psychiatry, 38, 581) and progress toward goals as evaluated by a personalized idiographic measure, the Goal Based Outcomes tool (GBO) (Law, 2011, Goals and Goal Based Outcomes (GBOs): some useful information. London: CAMHS Press) in a sample of N = 137 CAMHS attenders.Psychosocial difficulties and impact on daily life showed less change over the course of treatment than progress toward goals in this study. Change in psychosocial difficulties and impact on daily life were also less strongly associated with change in clinician-reported functioning and satisfaction with care at time two than change in progress toward goals.Findings of the present research may support previous studies in which service users and clinicians report that idiographic measures are more capable than standardized measures of capturing relevant change for individuals.

We report on a randomized controlled trial of Targeted Mental Health in Schools (TaMHS), which is a nationally mandated school-based mental health program in England. TaMHS aimed to improve mental ...

Children with special educational needs (SEN) are more likely to experience victimisation at school and there is some evidence to suggest that these children are also more likely to engage in bullying behaviours; however, no measure of bullying experiences has been designed specifically for use with these children. The Bullying Behaviour and Experiences Scale (BBES) was specifically developed as a self-report measure of victimisation and bullying behaviour for children with SEN. This study examines the initial psychometric properties of the BBES using a sample of 348 children (67 of which had SEN, mean age = 10 years), and compares the incidence of both victimisation and bullying in children with SEN to their peers, controlling for behavioural and emotional difficulties. Overall, the BBES showed favourable psychometric properties using multi-group confirmatory factor analyses and differential item functioning. Comparing the frequency of victimisation and bullying using the BBES showed that children with SEN were not more likely to experience victimisation compared to their peers but when extant behavioural and emotional difficulties were controlled for then they were significantly more likely to report victimisation. Conversely, children with SEN were more likely to report bullying compared to their peers, but this effect disappeared when extant behavioural and emotional difficulties were controlled. Overall, the BBES appears to be a promising measure of victimisation and bullying for children with SEN. This study also highlights the need to consider SEN status independently of behavioural and emotional problems to help understand the nature and extent of bullying and victimisation in this important population of children.

Background Positive mental health (not simply absence of mental disorder) may hold potential for fostering resilience and reducing risks of poor health and well-being. However, it is challenging to define and measure. One promising conceptualisation is mental health competence (MHC), comprising age-relevant developmental tasks and abilities. To date MHC has not been investigated in UK children. Methods We developed a measure of MHC in the UK Millennium Cohort Study (MCS) (~18 000 children born 2000–2002) using seven items addressing learning skills and prosocial behaviours, reported by mothers at age 11 (n=12082). Latent class analysis (LCA) was used to identify classes of MHC, and children were assigned to the class they had the highest probability of belonging to. We investigated associations between MHC classes and child’s physical health (healthy weight, overweight or obese, based on measured heights and weights, using International Obesity Task Force cut-offs; maternal report of unintentional injuries since age 7 [none, 1, 2+]) and poor mental well-being (low self-esteem [SE] and low life-satisfaction [LS] reported by the child; maternal report of child’s emotional problems [EP], all dichotomised at the bottom decile of scores). Relative risk ratios (aRRR, 95% CI) and odds ratios (aORs, 95% CI) were used to examine three-category and binary outcomes respectively, adjusting for potential confounding. Survey weights accounted for sample design and attrition. Analyses were undertaken in Stata/SE 13.1. Results Four classes were identified (ranging from high to low MHC): “High learning skills and high prosocial behaviour” (37%), “Moderate learning skills and high prosocial behaviour” (36%), “Moderate learning skills and moderate prosocial behaviour” (19%), and “Low learning skills and moderate prosocial behaviour” (8%). Risks of 2+injuries were raised in “Moderate learning and high prosocial behaviour” (aRRR: 1.4 [95%CI:1.2–1.7]) and “Low learning skills and moderate prosocial behaviour” (aRRR: 1.4 [95%CI:1.1–1.9]) as compared to “High learning and high prosocial behaviour”. Associations with MHC were absent or weak for single injury, overweight and obesity. Compared to “High learning skills and high prosocial behaviour”, odds of poor mental well-being were elevated for children from all other classes, with highest odds for “Low learning skills and moderate prosocial behaviour” (SE: aOR: 2.9 [95%CI:2.3–3.6]; EP: aOR: 4.2 [95%CI:3.4–5.1]; LS: aOR: 3.0 [95%CI:2.4–3.7]). Conclusion Lower MHC, using a composite measure developed in a representative sample of UK children, was associated with injuries, low self-esteem and life-satisfaction, and emotional problems, but not overweight and obesity. Identifying and promoting MHC at the population-level may provide an opportunity to improve health in children and young people.

Background Evidence suggests that young people want to be active participants in their care and involved in decisions about their treatment. However, there is a lack of digital shared decision-making tools available to support young people in child and adolescent mental health services (CAMHS). Objective The primary aim of this paper is to present the protocol of a feasibility trial for Power Up, a mobile phone app to empower young people in CAMHS to make their voices heard and participate in decisions around their care. Methods In the development phase, 30 young people, parents, and clinicians will take part in interviews and focus groups to elicit opinions on an early version of the app. In the feasibility testing phase, 60 young people from across 7 to 10 London CAMHS sites will take part in a trial looking at the feasibility and acceptability of measuring the impact of Power Up on shared decision making. Results Data collection for the development phase ended in December 2016. Data collection for the feasibility testing phase will end in December 2017. Conclusions Findings will inform the planning of a cluster controlled trial and contribute to the development and implementation of a shared decision-making app to be integrated into CAMHS. Trial Registration ISRCTN77194423; http://www.isrctn.com/ISRCTN77194423 (Archived by WebCite at http://www.webcitation.org/6td6MINP0). ClinicalTrials.gov NCT02987608; https://clinicaltrials.gov/ct2/show/NCT02987608 (Archived by WebCite at http://www.webcitation.org/6td6PNBZM)

Objectives To understand the effects of personality traits on self-rated quality of life. Design This was the exploration of a large longitudinal data base. Methods This study explored a longitudinal data set of over 5000 adults examining the effects of childhood cognitive ability (measured at age 11), parental social class (measured at birth), personality, educational qualifications and current occupational attainment (all measured at age 50) on adult quality of life (measured at age 50). Results Correlational analysis showed childhood cognitive ability, parental social class, education and occupation, and personality traits (emotional stability, extraversion, conscientiousness) were all significantly associated with adult quality of life. The strongest correlates of adult quality of life were personality traits, followed by current occupational levels and educational qualifications, childhood ability, and parents’ social class. Structural equation modelling showed parental social class had modest but significant direct influence in adult levels of quality of life. Personality traits, educational qualifications and occupational attainment were also the direct predictors of adult quality of life, and the effect of childhood cognitive ability on adult quality of life was mainly through these variables. The implications for policy with respect to improving population level self-rated quality of life are discussed.

Background There is an international drive for routine use of Patient Reported Outcome Measures (PROMs) across all health services including in relation to Child and Adolescent Mental Health Services (CAMHS). A number of reviews have summarized the validity and reliability of well-being and mental health measures for children but there are fewer attempts to consider utility for routine use. Method This review considers four child self-report measures: the Strengths and Difficulties Questionnaire (SDQ), the Revised Child Anxiety and Depression Scale (RCADS), (Child) Outcomes Rating Scale (C/ORS) and Goals Based Outcomes (GBOs). It explores the strengths and limitations of each and considers how they can be used to support both clinical practice and service evaluation. Results There is evidence for the clinical utility of RCADS, C/ORS and GBOs, although the utility of the SDQ as a feedback measure remains unclear. For service evaluation, the SDQ has the greatest evidence for norms making it useful for comparison and there is evidence that the RCADS may be the most sensitive to change of the measures reviewed; C/ORS has issues around ceiling effect, data error and data manipulation. More research is required around GBOs before their use for service evaluation can be determined. Conclusions In summary, these different measures may be viewed as complementary tools and determining the best way to make use of them severally and individually in clinical and community settings is a current focus for child mental health practitioners.

ObjectivesTo analyse the language and conversation used in huddles to gain a deeper understanding of exactly how huddles proceed in practice and to examine the methods by which staff members identify at-risk patients.SettingPaediatric wards in four English hospitals, which were part of a 12-hospital cohort participating in the Situation Awareness for Everyone programme. Wards varied by geographical region and type of hospital.ParticipantsPaediatric staff on wards in four English hospitals.DesignEthnomethodology and conversation analysis of recorded safety huddles.MethodsThis study represents the first analysis of huddle interaction. All huddle meetings taking place on four wards across four different hospitals were audio recorded and transcribed. The research question examined was: how are staff identifying at-risk patients in huddles? The ethnomethodological conversation analytic approach was used to analyse the transcripts.ResultsHuddlers made use of categories that allowed them to efficiently identify patients for each other as needing increased attention. Lexicon included the use of ‘no concerns’, ‘the one to watch’, ‘watcher’ and ‘acute concerns’. Huddlers used the meetings to go beyond standardised indicators of risk to identify relative risk and movement in patients towards deterioration, relative to the last huddle meeting and to their usual practices. An implicit category, termed here ‘pre-concerns’, was used by staff to identify such in-between states. Sequential analysis also highlighted the conversational rights that were held implicitly by staff in different clinical roles.ConclusionPractical implications and recommendations for huddlers are considered. These included that for increased situation awareness, it is recommended that all staff are active in the huddle conversation and not only the most senior team members.

Early detection of child mental health problems in schools is critical for implementing strategies for prevention and intervention. The development of an effective measure of mental health and well-being for this context must be both empirically sound and practically feasible. This study reports the initial validation of a brief self-report measure for child mental health suitable for use with children as young as 8 years old (“Me & My School” [M&MS]). After factor analysis, and studies of measurement invariance, 2 subscales emerged: emotional difficulties and behavioral difficulties. These 2 subscales were highly correlated with corresponding constructs of the Strengths and Difficulties Questionnaire (SDQ) and showed correlations with attainment, deprivation, and educational needs similar to ones obtained between these demographic measures and the SDQ. Results suggest that this school-based self-report measure is psychometrically sound, and has the potential of contributing to school mental health surveys, evaluation of interventions, and recognition of mental health problems within schools.

Recent years have seen an increased focus on the high rates of psychiatric comorbidities in adults with chronic illness. This systematic review explored whether chronic illness in adolescents was similarly associated with poor psychiatric outcomes. The literature search identified 129 articles, only 5 of which were indicated to be at a low risk of methodological bias. Four of these articles found a strong relationship between asthma in adolescence and an increase in the prevalence of anxiety and depressive disorders, while the remaining article, which focused on diabetes mellitus, indicated similarly increased rates of psychiatric illness. Trends among the remaining studies suggested that many illnesses were not associated with poor adolescent mental health. Please note that chronic conditions with a neurological aetiology were excluded from the main review due to indications of qualitative differences in comorbidities. Findings highlight that the well-being of adolescents with chronic illness warrants a specific research focus.

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 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.

There is increasing emphasis on use of patient-reported outcome measures (PROMs) in mental health but little research on the best approach, especially where there are multiple perspectives.To present emerging findings from both standardized and idiographic child-, parent- and clinician-rated outcomes in child and adolescent mental health services (CAMHS) and consider their correlations.Outcomes were collected in CAMHS across the UK. These comprised idiographic measures (goal-based outcomes) and standardized measures (practitioner-rated Children's Global Assessment Scale; child- and parent-rated Strengths and Difficulties Questionnaire).There was reliable positive change from the beginning of treatment to later follow-up according to all informants. Standardized clinician function report was correlated with standardized child difficulty report (r = - 0.26), standardized parent report (r = - 0.28) and idiographic joint client-determined goals (r = 0.38) in the expected directions.These results suggest that routine outcome monitoring is feasible, and suggest the possibility of using jointly agreed idiographic measures alongside particular perspectives on outcome as part of a PROMs approach.

This study presents the findings of a systematic review of measures of social and emotional skills for children and young people. The growing attention to this area in recent years has resulted in the development of a large number of measures to aid in the assessment of children and young people. These measures vary on a number of variables relating to implementation characteristics and psychometric properties. The methodology of the review followed the general principles of systematic reviewing, such as systematic search of databases, the adoption of predetermined set of inclusion and exclusion criteria, and a multistage filtering process. The review process resulted in the retention of 12 measures, which are presented and discussed in relation to key issues in this area, including difficulties with the underlying theory and frameworks for social and emotional skills, inconsistent terminology, the scope and distinctiveness of available measures, and more practical issues such as the type of respondent, location, and purpose of measurement.