Annotation: Pathways to care for children with mental health problems.
ABSTRACT Although many children with mental health problems are in contact with primary health care services, few receive appropriate help.
Using a pathways to care model, this paper systematically reviews the literature relating to access to services. It separates out the various stages of help-seeking: parental perception of problems, use of primary care services, recognition within primary care, and referral to or use of specialist health services.
Following parental awareness of child symptoms, parental perception of problems is the key initial step in the help-seeking process. Although children with mental health problems or disorders are regular attenders within primary care and most parents acknowledge that it is appropriate to discuss concerns about psychosocial issues in this setting, few children are presented with mental health symptoms even if their parents have such concerns. Subsequently, less than half of children with disorders are recognised in primary care. Amongst recognised children, about half are referred to specialist services. Overall, up to one-third of children with disorders receive services for mental health problems. Factors such as the type and severity of disorder, parental perceptions, child age and gender, and family and social background factors determine which affected children access services.
As there are inequities in patterns of service use, a greater emphasis on developing resources at population and primary care levels is required. Barriers involving parental perceptions and expression of concerns within consultations should be minimised at these levels. This requires both public education approaches and improved training and specialist support for primary care services to enhance their ability to provide for these children.
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ABSTRACT: TAKECARE is a prospective cohort study designed in The Netherlands to obtain evidence on the care chain for children and adolescents with psychosocial problems, and its long-term outcomes. Little is known about the content of care as offered and on whether the care is adequate. The cohort consists of children and adolescents entering care for psychosocial problems (care sample, n = 1382) and a random sample of the general population (community sample, n = 666). Children were eligible for participation if they were aged 4-18 years (inclusive) and had estimated IQs of 70 and over. The care sample covers the fields of Preventive Child Healthcare (PCH), Child and Adolescent Social Care (CASC) and Child and Adolescent Mental Healthcare (CAMH). Children, parents or guardians and involved practitioners completed five questionnaires (baseline, and at 3, 12, 24 and 36 months thereafter). The main categories of data concern the sociodemographic characteristics of children and their parents or guardians, the characteristics of entry into care and care content, and intermediate and final treatment outcomes. Information about data access can be requested by e-mail: firstname.lastname@example.org. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.International Journal of Epidemiology 12/2014; · 9.20 Impact Factor
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ABSTRACT: To identify sociodemographic, child, parent, and day care provider factors at age 4 that predict Norwegian children's service use for mental health problems at age 7. Two birth cohorts of 4-year-old children and their parents living in the city of Trondheim, Norway, were invited (82% consented). We successfully interviewed 995 parents among 1250 drawn to participate using the Preschool Age Psychiatric Assessment to set diagnoses and record parental burden and service use. Information concerning sociodemographics, child impairment, parental social support, and child need for mental health services according to parents, day care teacher, and health nurse were obtained. Rate of service use among those with a behavioral or emotional disorder was 10.7% at age 4 and 25.2% at age 7. Behavioral disorders (odds ratio [OR] 2.6, confidence interval [CI] 1.3-5.3), but not emotional disorders, predicted service use. When adjusted for incapacity (OR 1.3, CI 1.2-1.6), disorders were no longer predictive. Incapacity, in turn, was not predictive once parental burden (OR 1.1, CI 1.0-1.1) and parents' (OR 2.7, CI 1.0-7.9) and day care teachers' (OR 2.1, CI 1.4-3.2) judgment of child need of help were included. Lower socioeconomic status predicted more service use over and beyond these factors (OR 3.0, CI 1.5-6.1). Behavioral disorders may instigate service use if they result in impairment, and such impairment may operate via increased parental burden and parent and caregiver problem recognition. Service use may be increased through effective screening programs and efforts to increase day care teachers' recognition of emotional problems.PEDIATRICS 05/2014; · 5.30 Impact Factor
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ABSTRACT: Blood transfusion scientists have different definitions of ‘clinical significance’. For instance, is clinical significance judged by shortened RBC survival, laboratory evidence of haemolysis (e.g. increased bilirubin, LDH, etc.), and/or clinical signs (e.g. jaundice) of a haemolytic transfusion reaction (HTR)? Are one, two, or all three of these criteria needed to make an antibody significant? For instance, is a shortened RBC survival with no obvious laboratory abnormalities and/or or clinical signs really clinically significant? The answer may be different for a haematology patient requiring regular transfusions and a surgical patient with normal erythropoiesis. It is important to answer these questions in one’s own institution as they are the basis for our choice of compatibility tests and needed for interpretation of assays predicting clinical significance.Several approaches are valuable in predicting clinical significance: (1) specificity and thermal amplitude of the antibody; (2) 1 h survival of 51Cr-labelled incompatible RBCs; (3) functional cellular assays. Only antibodies reactive at 37°C in vitro are of potential significance. The 51Cr survival and cellular assays [e.g. monocyte monolayer assay (MMA)] are usually used to help decide if incompatible RBCs can be transfused to patients with antibodies to high-incidence antigens that are sometimes significant but often are not. When the MMA = 5·1–20%, 33% of patients showed no clinical reactions, but 67%, with no clinical signs showed laboratory signs of a reaction. If the MMA is >20%, most patients show clinical (64%) or laboratory (75%) reactions. It is of interest to note that regardless of MMA or 1 h 51Cr results, most patients with antibodies to high-incidence antigens have abnormal full RBC survival studies (T50Cr), but only one-third show any clinical signs of a reaction. Thus, when interpreting results for clinicians, it is important to clearly define what you mean by ‘clinical significance’ so that they can balance decisions of transfusing incompatible blood versus time and expense of obtaining rare units lacking the cognate antigen. Cellular assays are not available for many people, so historical data on whether certain specificities have caused HTRs are the only practical approach for many.ISBT Science Series 07/2012; 7(1).