Top PDF Occupational practice in children and young people's mental health

During my professional career as an occupational therapist I have come to understand childhood as a labyrinth of change influenced by intrinsic biological imperatives located in the person and extrinsic requirements situated in society and the environment. My understanding of young people’s lives has been supported by my knowledge of the universal theories of child development, the individual experiences of the young people I have worked with and my appreciation of the study of childhood in history, society and culture. In addition to these professional practice and academic perspectives, I do not need to look too far in the media to see current world-wide illustrations of children and young people, which range from obesity to starvation, and from computer game savvy to educationally deprived. My perspectives of children and young people in the United Kingdom holds sympathy with that of Prout and James (2015), whereby childhood is understood as a social construction, is a variable of social analysis, that children should be seen as active social agents, and that children’s relationships and cultures are worthy of study in their own right. I have observed how children and young people’s engagement in this postmodern globalised world appears to have brought with it both unification and fragmentation. My experience of working with children over the last fifteen years has certainly reflected this increasing global nature of childhood, from cyber bullying on Facebook for not wearing designer clothes, sexting on Blackberry Messenger, blended families, X-box addictions, and an increased sense of deserving independence but also an increased social diversity of friendships. My understanding of children and young people has also been influenced by occupational theories. I have been drawn to the work of influential children’s occupational therapist Case-Smith who contended that ecological and dynamic systems are important emerging theories for understanding children (Case-Smith, Law, Missiuna, Pollock & Stewart, 2010). I believe that children and young people develop occupational selves through a dynamic interaction between the person, the occupation and the environment (Law et al., 1996, Wiseman, Davis & Polatajko, 2005). My understanding of children and young people is therefore informed by developmental and sociological theories of childhood, but has most affinity with an occupational and ecological perspective.

But, too often, children and young people’s emotional wellbeing and mental health is not given the attention it needs. Far too many families have experienced poor children’s and adolescent mental health care. This isn’t endemic, and we have made great progress in the last few years, but it remains unacceptable that not every child or young person gets the help they need when and where they need it. Some don’t get any care at all, and their problems escalate to a crisis point. This isn’t due to lack of good will – there are many highly skilled and highly valued staff working with children and young people who want to make a real and lasting difference to their lives but there are barriers in the system itself which prevent change. I have been changing that system. Since 2011, my Department and NHS England have invested over £60 million in the Children and Young People’s Improving Access to Psychological Therapies programme. We have funded the development of MindEd – giving more advice to health professionals about how to help young people with mental ill-health. We have put more mental health beds for young people in the system, as well as training new case workers to offer help where it is needed. But this isn’t enough – we need to be ambitious if we want children and young people to live happy, healthy lives. This is why I set up the Children and Young People’s Mental Health and Wellbeing Taskforce. I wanted to identify what the problems were, what was stopping us

• This bespoke report outlines the Local Authority findings from a national stocktake of the Children and Young People’s mental health (CYP MH) workforce across England. The project was commissioned by Health Education England (HEE) and undertaken by the NHS Benchmarking Network (NHSBN). The project builds on a previous study undertaken by the NHSBN for HEE in 2016.

As advances in technology continue at an ever increasing pace around the world, it is vital that there is contemporaneous advancement in the practitioners’ awareness of the wide reaching scope of digital technology when working in the field of children and young people’s mental health. It is acknowledged that internationally, childhood is difficult to define and when planning age appropriate digital resources for self-assessment and help, caution must be exercised, as it is clear that one size does not fit all. Practitioners need to have detailed knowledge of child development theory and awareness that the widespread use of technology often begins in the pre-school years. The digital navigation skills of the young service user can outstrip those of the practitioners developing interventions aimed at offering mental health help. There can be a discontinuity in digital knowledge between practitioner and the young person, however, there can also be a digital divide within the young population itself, therefore consultation and collaboration may be one way forward incorporating the additional help of software designers.

A range of mental health services, in the community or in an outpatient setting, have been developed to manage young people with serious mental health problems who are at high risk of being admitted to an inpatient unit (DOH 2004; NSF 2004). These alternative services may prevent young people from developing a dependency on the hospital environment or from being stig- matised. In addition, they may facilitate the transfer of any ther- apeutic gains to the young person’s everyday environment, thus maximising the potential for sustaining improved health outcomes (Katz 2004) and for educational attainments to be less severely af- fected (Milin 2000). Examples include early intervention services in the community for young people with first episode psychosis (McGorry 2002), assertive outreach (McGorry 2002), dialectical behaviour therapy (Miller 2002), family therapy (Lock 2005) and multi-family therapy for anorexia nervosa (Scholz 2001). The way services are organised also differs. Service configurations include the provision of multi-agency integrated home care (DOH 2004), therapeutic units based in a day unit, or multi-agency services providing intensive specialist outpatient therapy for young people with severe mental health problems (Street 2003).

The Mental Health of Children and Young People (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from child benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and young people were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, young people and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer Assisted Self Interview (CASI), between January and October 2017. A short paper or online questionnaire was completed by a nominated teacher for children aged 5 to 16 years old. Data collection varied with the selected child’s age:

Most surveys measuring less common mental and neurodevelopmental conditions use short screening questionnaires to identify potential cases, these tend to overestimate prevalence. Other studies sift routine health and education data to identify recognised cases, but miss those children who were not recognised by services (Brugha et al., 2018). The last survey to have assessed the disorders covered in this report in a general population sample of children in England was the previous survey in this series, conducted in 2004. Change in rate since 2004 can be estimated because methods in those years were comparable, and our approach is less affected by changes in diagnostic criteria and clinical practice.

The Mental Health of Children and Young People (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from Child Benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and young people were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, young people and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer Assisted Self Interview (CASI), between January and October 2017. A short paper or online questionnaire was completed by a nominated teacher for children aged 5 to 16 years old. Data collection varied with the selected child’s age:

We would now like to ask for your consent to us contacting a teacher of your or your child’s choice who knows your child the best. We’ll send them an email with a secure link to a short online questionnaire that we’ll ask them to fill out and we’ll also send them a paper copy in the post. Their participation is invaluable and helps create a fuller picture of <child name>’s health and wellbeing. All information will remain confidential…

These terms are both used to indicate a number of disorders characterised by severe impairment in social interaction, communication, and the presence of stereotyped behaviours, interests, and activities. ‘Pervasive developmental disorder’ (PDD) is used in the ICD classificatory system, but was replaced in the Diagnostic and Statistical Manual (DSM-5) with ASD, the term used most in this report. The category as used here consists mostly of ICD-10 classifications of autism and Asperger’s syndrome, but also some cases of other pervasive developmental disorders. Symptoms include: language problems, difficulty relating to other people, unusual forms of play, difficulty with changes in routine, and repetitive movements or behaviour patterns.

The CAMH Service currently offers provision to children and young people up to 18 years if still at school with a range of presenting difficulties. All services are outpatient based and firmly located within their local community. Lanarkshire CAMHS has a strong history of multi-disciplinary and inter-agency working and systemic practice, all of which have been strongly recommended in Scottish Executive policy regarding CAMHS and Child Health Services. Current priorities for service development with NHS Lanarkshire CAMHS include the expansion of the Primary Mental Health Team to provide more comprehensive services to Tier 2 across Lanarkshire, establishing a new team to cover Cambuslang and Rutherglen and expanding the age range to 18 years in January 2015. . There are currently 2 Clinical Psychology posts within the Primary Mental Health Team and trainees would be placed within this team. The team’s focus is promotion, prevention and early intervention delivered via

Identified and synthesised interventions in this systematic review showed that most interventions could be applied to urgent and emergency mental health care with CYP. For example, both the Family-based crisis intervention and the SAFETY program are short-term in duration of treatment and such can be successfully delivered both in A&E and out- patient community settings and, therefore, reduce the need for hospitalisation and inpatient admission. Furthermore, these two interventions decrease the carer’s burden, while showing improvement in functioning and increased satisfac- tion by both CYP and their familes. When the whole fam- ily receives support and intervention during a crisis event, there is a visible improvement with levels of satisfaction with service provision, a reduction in both burden and stress in carers, empowerment of family members and improved communication and overall functioning [25, 31, 33, 45].

This approach has quality implications for other survey aims. For example, a survey of the resident population excludes those who were living in a care home (for example mental health units and young offender institutions). As discussed in this publication, people living in such settings are likely to have worse mental health than those living in private households, which may have an effect on the quality of the prevalence estimates produced by this survey. However, the proportion of the overall population not living in private households is so small that this would have little (or no significant) impact on the prevalence estimates for the disorders examined, as such the decision was made that the improvement in the survey’s ability to provide an estimate of the treatment gap justified this trade-off between these two survey outcomes. Details of the strengths and limitations of the results of this survey are detailed in full in the Survey Design and Methods Report.

Reviews and guidelines from the UK (NICE 2005, 2008, 2009), other European nations (Stengard & Appelqvist-Schmidlechner 2010), Canada (Zuckerbrot et al. 2007) and the USA (Olin & Hoagwood 2002, AACAP, 2009) recommend developing the capacity and quality of school- and primary care- based support for common mental disorders, with school nurses being key to this activity. However, there is relatively little research concerning school nurses and mental health work. Although studies have been conducted in the UK’s constituent countries and in Sweden and France, most work in this area has been undertaken in the USA. Puskar and Bernardo (2007), Bullock et al. (2002) and DeSocio et al. (2006), for example, provide evidence that school nurses can be successfully involved in mental health screening, promotion and early intervention activities.

In contrast to informal sources of help, professional sources of help often involve engaging with a person who is a stranger. It was very clear from the qualitative data collected in Study 11 that high school students did not like to share their most personal experiences with strangers. Students reported that they would be ‘afraid’, ‘too shy’, and ‘embarrassed’ to talk to a professional who they didn’t know. Lack of trust and not knowing how to talk to a stranger about personal issues were also problematic, which was evident through responses such as ‘lack of trust, I don’t really like them’, ‘wouldn’t know what to say’, ‘hard to talk to a stranger about my problems’, and ‘I wouldn’t know how to talk about personal things with a stranger’. Students in Study 7 confirmed that difficulty trusting professional sources of help and embarrassment were barriers to seeking professional help. Students were scared and shy about talking about their problems with a stranger, and did not want to share their emotions and personal experiences with someone they did not know and with whom they had not built a relationship. Such concerns inhibit professional help-seeking, suggesting that efforts to increase young people’s use of mental health services may benefit by strategies aimed at developing trusting and supportive relationships with professionals before the need arises, as well as providing opportunities for young people to practice verbalising to others their personal and emotional issues.

Resource use data collection tool The main focus will be on how to accurately identify, quantify and value costs of delivering Young SMILES as an addition to usual care, and its potential resource implications for the NHS, versus usual care alone, during our follow-up period. The Child & Adolescent Service Use Schedule tool has been adapted for use in the context of Young SMILES to capture resource use accurately by families in relation to children ’ s needs and services across the NHS, social care, and voluntary/third sector organisa- tions. We shall identify appropriate unit costs for each area of resource use, which will be obtained from a com- bination of local and national sources. We ill then assess the feasibility of this measure for use in a future eco- nomic evaluation. The corresponding preference weights will be applied to CHU-9D scores to calculate QALYs be- tween baseline and follow-up. Completion rates of the questionnaire will be assessed, along with correlations with the primary and secondary outcome measures, and changes in these measures over time. We shall rehearse the methods to estimate an incremental cost-effectiveness ratio for Young SMILES plus usual care versus usual care alone, in terms of HRQoL years gained.

Resource use data collection tool The main focus will be on how to accurately identify, quantify and value costs of delivering Young SMILES as an addition to usual care, and its potential resource implications for the NHS, versus usual care alone, during our follow-up period. The Child & Adolescent Service Use Schedule tool has been adapted for use in the context of Young SMILES to capture resource use accurately by families in relation to children’s needs and services across the NHS, social care, and voluntary/third sector organisa- tions. We shall identify appropriate unit costs for each area of resource use, which will be obtained from a com- bination of local and national sources. We ill then assess the feasibility of this measure for use in a future eco- nomic evaluation. The corresponding preference weights will be applied to CHU-9D scores to calculate QALYs be- tween baseline and follow-up. Completion rates of the questionnaire will be assessed, along with correlations with the primary and secondary outcome measures, and changes in these measures over time. We shall rehearse the methods to estimate an incremental cost-effectiveness ratio for Young SMILES plus usual care versus usual care alone, in terms of HRQoL years gained.

The Mental Health of Children and Young People (MHCYP) survey was conducted with 5 to 15 year olds living in Britain in 1999 and 5 to 16 year olds living in Britain in 2004. The 1999 and 2004 surveys sampled from Child Benefit records. For the 2017 survey a stratified multistage random probability sample of 18,029 children was drawn from NHS Patient Register in October 2016. Children and young people were eligible to take part if they were aged 2 to 19, lived in England, and were registered with a GP. Children, young people and their parents were interviewed face-to-face at home using a combination of Computer Assisted Personal Interview (CAPI) and Computer Assisted Self Interview (CASI), between January and October 2017. A short paper or online questionnaire was completed by a nominated teacher for children aged 5 to 16 years old. Data collection varied with the selected child’s age:

mental health problems in children and young people (WHO, 2004; Green et al; 2005; RCP 2010; DH 2015) over recent years. In addition to this, complaints of huge waiting lists children and young people are experiencing, as well as the number of referrals (23%) being rejected by specialist services for treatment and support is becoming ever increasingly apparent (Firth 2016).

Introduction: In recent years there has been an increase in the number of looked after children. Despite well documented vulnerabilities to mental health problems among this population, there continues to be poor uptake and utilisation of Child and Adolescent Mental Health Services (CAMHS). Aim: To elicit views of foster carers regarding the mental health needs of children and young people in their care and their experiences of accessing mental health services. Methods: A Grounded theory approach and semi-structured interviews with ten foster carers. Results: The experience of being a foster carer was the core category, with three major themes: 1) Foster carers’ psychological understanding of challenging behaviour; 2) Barriers to accessing CAMHS; 3) The importance of support. Discussion: A key finding of this research is that barriers to accessing CAMHS were not experienced at the point of referral, but later, once within the mental health system. A positive finding is that the foster carers demonstrated good mental health literacy and a pro-active approach to seeking help for the children in their care. The foster carers also expressed a need for more support structures related directly to the viability of the placement. Implications for practice: Mental health nurses have a pivotal role in providing: a more responsive and needs-led service for this population; professional support to foster carers to include facilitating peer support; and clinical interventions for the looked after children.