Children’s Mental Health Service Use Across Service Sectors

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Health Affairs (Impact Factor: 4.97). 02/1995; 14(3):147-59. DOI: 10.1377/hlthaff.14.3.147
Source: PubMed


This DataWatch explores the roles of human service sectors (mental health, education, health, child welfare, and juvenile justice) in providing mental health services for children. The data are from the first wave of the Great Smoky Mountains Study of Youth, a population-based study of psychopathology and mental health service use among children. The results show somewhat higher rates of mental health service use than has been reported previously, while continuing to show a substantial amount of unmet need, even among children with both a psychiatric diagnosis and functional impairment. The findings point to a significant role for the education sector, suggesting that schools may function as the de facto mental health system for children and adolescents.

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Available from: Dalene Stangl, Aug 26, 2014
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    • "(Burns et al., 1995; Stiffman et al., 2000 "
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    ABSTRACT: Youth in the child welfare system (CWS) have substantially higher rates of mental health needs compared to the general population, yet they rarely receive targeted, evidence-based practices (EBPs). Caseworkers play the critically important role of "service broker" for CWS youth and families. This study examines preliminary caseworker-level outcomes of Project Focus Colorado (PF-C), a training and consultation program designed to improve access to EBPs for CWS youth. PF-C evaluation occurred in four child welfare offices (two intervention [n = 16 caseworkers] vs. two practice-as-usual, wait-list control [WLC; n = 12 caseworkers]). Receipt of PF-C was associated with significantly increased caseworker knowledge of (a) EBPs, (b) child mental health problems, (c) evidence-based treatment components targeting mental health problem areas, and (d) mental health screening instruments, compared to WLC. Dose of training and consultation was associated with greater ability to correctly classify mental health problems and match them to EBPs. These preliminary results suggest that targeted training and consultation help to improve caseworker knowledge of children's mental health needs, EBPs for mental health, and mental health screening instruments. © The Author(s) 2014.
    Child Maltreatment 12/2014; 20(1). DOI:10.1177/1077559514562448 · 2.77 Impact Factor
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    • "a school roll . The association between the use of child and adolescent mental health services ( CAMHS ) and specialist education services ( Ford et al . 2007 ) emphasises the need for joint collaborative working and a shared responsibility . In the USA , 70 – 80% of children who receive mental health services do so within the school environment ( Burns et al . 1995 ) . The costs of educating a child or young person in alternative provision vary but are high ( Taylor 2012 ; Centre for Social Justice 2011 ) and there are additional costs to CAMHS ."
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    ABSTRACT: Childhood psychiatric disorders are associated with a wide range of adverse outcomes including poor academic attainment. For some children these difficulties are recognised through school Special Educational Need procedures (SEN) but many others may remain unidentified and/or unsupported. In Britain, government data suggests disproportionate representation of children with a SEN among children permanently excluded from school. This review asks whether school-aged children with impairing psychopathology were more likely to be excluded from school than those without. Databases covering education, social sciences, psychology and medicine were searched, experts were contacted and bibliographies of key papers were hand-searched. Studies were included if the population covered school-aged children, and if validated diagnostic measures had been used to assess psychopathology. Children with impairing psychopathology had greater odds of exclusion compared to the rest of the school-age population: odds ratios range from 1.13 (95% CI: 0.55–2.33) to 45.6 (95% CI: 3.8–21.3). These findings however need to be considered in light of the paucity of the literature and methodological weaknesses discussed.
    Emotional and Behavioural Difficulties 09/2014; DOI:10.1080/13632752.2014.945741
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    • "In mental health in particular, very high scores for discrimination (e.g., >.8) are rare, partly because of the overlap in characteristics of community and clinical populations. Specifically, for mental health problems, being in a community sample does not indicate the absence of clinical problems and, correspondingly, a substantial proportion of young people who attend mental health services have no impairment or diagnosis [23]. Mean differences between the clinic and community sample were statistically significant with large effect sizes (d > 1.1) with individuals in the clinic sample being 4.5 times more likely to be above the threshold indicating problems on the emotional difficulties and 6 times more likely to be above the threshold indicating problems on the behavioural difficulties scale. "
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    ABSTRACT: Background The Me and My School Questionnaire (M&MS) is a self-report measure for children aged eight years and above that measures emotional difficulties and behavioural difficulties, and has been previously validated in a community sample. The present study aimed to assess its clinical sensitivity to justify its utility as a screening tool in schools. Methods Data were collected from service-users (n = 91, 8–15 years) and accompanying parent/carer in outpatient mental health services in England. A matched community sample (N = 91) were used to assess the measure’s ability to discriminate between low- and high-risk samples. Results Receiver operating curves (area under the curve, emotional difficulties = .79; behavioural difficulties = .78), mean comparisons (effect size, emotional difficulties d = 1.17, behavioural difficulties = 1.12) and proportions above clinical thresholds indicate that the measure satisfactorily discriminates between the samples. The scales have good internal reliability (emotional difficulties α = .84; behavioural difficulties α = .82) and cross-informant agreement with parent-reported symptoms is comparable to existing measures (r = .30). Conclusion The findings of this study indicate that the M&MS sufficiently discriminates between high-risk (clinic) and low-risk (community) samples, has good internal reliability, compares favourably with existing self-report measures of mental health and has comparable levels of agreement between parent-report and self-report to other measures. Alongside existing validation of the M&MS, these findings justify the measures use as a self-report screening tool for mental health problems in community settings for children aged as young as 8 years.
    Child and Adolescent Psychiatry and Mental Health 06/2014; 8(1):17. DOI:10.1186/1753-2000-8-17
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