Annotation: Pathways to care for children with mental health problems. J Child Psychol Psychiatry

Department of Child Psychiatry, Institute of Psychiatry, London, UK.
Journal of Child Psychology and Psychiatry (Impact Factor: 6.46). 08/2006; 47(7):649-59. DOI: 10.1111/j.1469-7610.2005.01543.x
Source: PubMed


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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    • "Families with children who had higher initial levels of disruptive behavior and those with the lowest SES showed the greatest use of community services as a result of engagement in the FCU. The finding that families with highly disruptive children engaged in more service use after the FCU is in line with findings that families with more disruptive child behavior engage more in the FCU (Connell et al., 2007), and with both theory and empirical findings that perception about family challenges is an important precursor of help-seeking behavior (e.g., Goldberg & Huxley, 1980; Sayal, 2006; Teagle, 2002). "
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    ABSTRACT: Integration of empirically supported prevention programs into existing community services is a critical step toward effecting sustainable change for the highest-risk members in a community. We examined if the Family Check-Up-known to reduce disruptive behavior problems in young children-can provide a bridge to the use of community treatment services among high-risk indigent families. The study's 731 income-eligible families with a 2-year-old child were screened and randomized to the Family Check-Up (FCU) intervention or a control condition. Families were provided yearly FCUs from age 2 through age 5. Regression analyses on families' service use at child age 7.5 revealed increased service use, compared with that of the control group. Child disruptive behavior and socioeconomic status moderated the effect of the intervention on service use. Families who reported higher levels of disruptive child behavior and lower socioeconomic status showed more service use, suggesting the intervention increased service use among the highest-risk families. Greater use of community services did not mediate the effect of the FCU on reduced oppositional-defiant child behavior. Implications of these findings for the design and ecology of community treatment services in the context of evidence-based practices are discussed.
    Prevention Science 03/2014; 16(3). DOI:10.1007/s11121-014-0479-x · 2.63 Impact Factor
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    • "Previous research found that an exploration of psychological issues does not always take place in GP consultations, even when the doctor feels that these are present and the adolescent is similarly aware [8,9]. In the US, the median rate of recognition of youth mental health problems by GPs was only 18%, and was often initiated as a result of parental concerns [10]. Findings from Fleury and colleagues (2012) suggested that GPs rarely used clinical screening tools or collaborated with other healthcare professionals, and tended to limit treatment options to monitoring medication or providing support therapy [11]. "
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    ABSTRACT: Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15-24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people's unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals' experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16-25 years) in primary care in deprived urban settings in Ireland. The chosen method for this qualitative study was inductive thematic analysis which involved semi-structured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres. We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care's longitudinal nature as a key asset in promoting treatment engagement. Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people's experience and developing complex interventions that promote early intervention are priorities. (350 words).
    BMC Family Practice 12/2013; 14(1):194. DOI:10.1186/1471-2296-14-194 · 1.67 Impact Factor
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    • "Less identification of depression among young adults is more plausible, reaching GPs’ difficulties to identify such state among young adults [42,43]. The recognition of existing psychological problems often depends on parental expressions of concern [44], as young adults are often reluctant to mention their personal emotional problems, because of more concerns about being viewed as weak or abnormal [17]. Stigmatization in young people towards people with mental disorders is still high [20]. "
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    ABSTRACT: Background Suicide is a major public health problem in young people. General Practitioners (GPs) play a central role in suicide prevention. However data about how physicians deal with suicidal youths are lacking. This study aims to compare young adult suicide attempters (from 18 to 39 years old) with older adults in a primary care setting. Methods A cross-sectional study was carried. All suicide attempts (N=270) reported to the French Sentinel surveillance System from 2009 to 2011 were considered. We conducted comparison of data on the last GP’s consultation and GPs’ management in the last three months between young adults and older adults. Results In comparison with older adults, young adults consulted their GP less frequently in the month preceding the suicidal attempt (40.9 vs. 64.6%, p=.01). During the last consultation prior to the suicidal attempt, they expressed suicidal ideas less frequently (11.3 vs. 21.9%, p=.03). In the year preceding the suicidal attempt, GPs identified depression significantly less often (42.0 vs. 63.4%, p=.001). In the preceding three months, GPs realized significantly less interventions: less psychological support (37.5 vs. 53.0%, p=.02), prescribed less antidepressants (28.6 vs. 54.8%, p<.0001) or psychotropic drugs (39.1 vs. 52.9%, p=.03) and made fewer attempts to refer to a mental health specialist (33.3 vs. 45.5%, p=.05). Conclusion With young adults who subsequently attempt suicide, GPs face particular difficulties compared to older adults, as a significant proportion of young adults were not seen in the previous six months, as GPs identified less depressions in the preceding year and were less active in managing in the preceding three months. Medical training and continuing medical education should include better instruction on challenges relative to addressing suicide risk in this particular population.
    BMC Family Practice 05/2013; 14(1):68. DOI:10.1186/1471-2296-14-68 · 1.67 Impact Factor
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