Determinants of parents' experiences with outpatient child and adolescent mental health services

<p>Abstract</p> <p>Background</p> <p>Few studies have investigated how demographic, clinical and organizational characteristics influence parents' experiences with child and adolescent mental health services (CAMHS). The objective of this study was to determine the effects of these characteristics on parents' experiences using data from a large national postal survey.</p> <p>Method</p> <p>A questionnaire was mailed to 17,871 parents or other primary caregivers whose children were attending 1 of the 86 outpatient CAMHS in Norway in 2006. Multiple regression analysis was used to explore the associations between demographic, clinical and organizational characteristics, and three scales of parents' experiences.</p> <p>Results</p> <p>The questionnaire was completed by 7906 parents (46%). Organizational characteristics such as involvement of the parents in treatment and accessibility to the clinic explained most of the variation in all three scales of parents' experiences. Although the effects of demographic and clinical characteristics of the children in some instances were statistically significant, they only accounted for a small amount of the total explained variance.</p> <p>Conclusion</p> <p>Accessibility to the clinic and involvement of the parents in treatment are much stronger predictors of parental experiences with outpatient CAMHS than are demographic and clinical variables. Accessibility and involvement are at least partly influenced by the clinics themselves, and hence parental satisfaction may be enhanced by making the clinics more accessible and by involving the parents/caregivers in the treatment.</p

Måleegenskaper ved den norske versjonen av Child Outcome Rating Scale (CORS)

-CORS ble opprinnelig utviklet i USA i 2003 av Duncan, Miller og Sparks for å måle selvrapporterte terapiresultater. Den norske versjonen kalles «Skala for endringsvurdering – barn og unge (CORS)». Den er oversatt av Anne-Grethe Tuseth, og kan lastes ned fra internett. CORS inneholder fire visuelle analoge skalaer som barn i alderen 6-12 år og/eller deres foresatte besvarer ved å markere hvor på en strek fra trist ansikt til glad ansikt barnet befinner seg. Administrering og skåring tar få minutter, og det stilles ingen kompetansekrav til testbrukere. Vårt systematiske litteratursøk etter dokumentasjon for måleegenskapene ved de skandinaviske versjonene av CORS identifiserte ingen relevante publikasjoner. Det foreligger ingen dokumentasjon for måleegenskapene ved den norske versjonen av CORS. Studier som undersøker måleegenskaper er derfor nødvendig

Outcomes for children who care for a parent with a severe illness or substance abuse

Quantitative studies of children’s caring activities during parental illness have increased in the past 10 years. However, the various outcomes for these children have been investigated less frequently. In the present study, we investigate whether the children have different outcomes when the parent has a severe physical illness, mental illness, or substance abuse and whether any factors are associated with the positive and negative outcomes of the children’s caregiving. This was a cross-sectional, multicenter study. We recruited parents who were out- or inpatients in five public hospitals in Norway as well as their children. The sample included 246 children ages 8–18 and 238 of their parents with a severe physical illness, mental illness, or substance abuse. Ten percent reported negative outcomes at a clinical level of concern, and nearly half of the children reported stress. However, the outcomes were not significantly different across parental illness groups. Positive and negative outcomes were associated with the nature of caring activities (e.g., personal care, financial and practical management, household management), social skills, and perceived external locus of control. Health professionals must provide a more comprehensive and overall assessment of both the parents’ and the children’s needs. To recognize the role taken by the child, an assessment of children’s caring activities and their need for adequate information should be performed. In particular, should the children’s need for follow-up regarding caring activities, respite, and emotional support be assessed to secure their necessary skills and feeling of mastery

Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

<p>Abstract</p> <p>Background</p> <p>Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units.</p> <p>Methods</p> <p>We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA <it>total score</it>) were analysed with a regression model.</p> <p>Results</p> <p>The sample comprised 192 adolescents admitted during one year (response rate 87%). Mean age was 15.7 years (range 10-18) and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean <it>intake </it>HoNOSCA <it>total score </it>was 18.5 (SD 6.4). The largest groups of main diagnostic conditions were <it>affective </it>(28%) and <it>externalizing </it>(26%) <it>disorders</it>. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA) at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement) in the HoNOSCA <it>total score </it>was 5.1 (SD 6.2), with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and <it>self-injury </it>and <it>emotional symptoms </it>were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA <it>total score </it>at intake, or involvement of the Child Protection Service predicted improvement during admission.</p> <p>Conclusions</p> <p>Acute psychiatric in-patient units for adolescents effectively meet important needs for young people with suicidal risks or other severe mental health problems. These units may act in suicide prevention, stabilizing symptom severity at a lower level within a short stay. It is important to explore the differences in outcome, compulsory admissions, and length of stay between units.</p

IQ as a moderator of outcome in severity of children's mental health status after treatment in outpatient clinics

Psychotherapy is an effective treatment for mental health disorders, but even with the most efficacious treatment, many patients do not experience improvement. Moderator analysis can identify the conditions under which treatment is effective or whether there are factors that can attenuate the effects of treatment. In this study, linear mixed model analysis was used to examine whether the Full Scale IQ (FSIQ), Performance IQ (PIQ) and Verbal IQ (VIQ) on the Wechsler Intelligence Scale for Children – Third Edition, moderated outcomes in general functioning and symptom load. A total of 132 patients treated at three outpatient child and adolescent mental health services (CAMHS) were assessed at three different time points. The Children’s Global Assessment Scale (CGAS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were used to measure the severity of impairments in general functioning and symptom load. IQ was assessed at the start of treatment. Moderator analysis revealed that the FSIQ × time interaction predicted changes in CGAS scores (p < .01), and that the PIQ × time interaction predicted changes in HoNOSCA scores (p < .05). The slopes and intercepts in HoNOSCA scores covaried negatively and significantly (p < .05). The same pattern was not detected for the CGAS scores (p = .08). FISQ and PIQ moderated change in general functioning and symptom load, respectively. This implies that patients with higher IQ scores had a steeper improvement slope than those with lower scores. The patients with the highest initial symptom loads showed the greatest improvement, this pattern was not found in the improvement of general functioning

Clinician-rated mental health in outpatient child and adolescent mental health services: associations with parent, teacher and adolescent ratings

<p>Abstract</p> <p>Background</p> <p>Clinician-rated measures are used extensively in child and adolescent mental health services (CAMHS). The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a short clinician-rated measure developed for ordinary clinical practice, with increasing use internationally. Several studies have investigated its psychometric properties, but there are few data on its correspondence with other methods, rated by other informants. We compared the HoNOSCA with the well-established Achenbach System of Empirically Based Assessment (ASEBA) questionnaires: the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR).</p> <p>Methods</p> <p>Data on 153 patients aged 6-17 years at seven outpatient CAMHS clinics in Norway were analysed. Clinicians completed the HoNOSCA, whereas parents, teachers, and adolescents filled in the ASEBA forms. HoNOSCA <it>total score </it>and nine of its scales were compared with similar ASEBA scales. With a multiple regression model, we investigated how the ASEBA ratings predicted the clinician-rated HoNOSCA and whether the different informants' scores made any unique contribution to the prediction of the HoNOSCA scales.</p> <p>Results</p> <p>We found moderate correlations between the total problems rated by the clinicians (HoNOSCA) and by the other informants (ASEBA) and good correspondence between eight of the nine HoNOSCA scales and the similar ASEBA scales. The exception was HoNOSCA scale 8 <it>psychosomatic symptoms </it>compared with the ASEBA s<it>omatic problems </it>scale. In the regression analyses, the CBCL and TRF <it>total problems </it>scores together explained 27% of the variance in the HoNOSCA <it>total scores </it>(23% for the age group 11-17 years, also including the YSR). The CBCL provided unique information for the prediction of the HoNOSCA <it>total score</it>, HoNOSCA scale 1 <it>aggressive behaviour</it>, HoNOSCA scale 2 <it>overactivity or attention problems</it>, HoNOSCA scale 9 <it>emotional symptoms</it>, and HoNOSCA scale 10 <it>peer problems; </it>the TRF for all these except HoNOSCA scale 9 <it>emotional symptoms; </it>and the YSR for HoNOSCA scale 9 <it>emotional symptoms </it>only.</p> <p>Conclusion</p> <p>This study supports the concurrent validity of the HoNOSCA. It also demonstrates that parents, teachers and adolescents all contribute unique information in relation to the clinician-rated HoNOSCA, indicating that the HoNOSCA ratings reflect unique perspectives from multiple informants.</p

Air temperature variations and gradients along the coast and fjords of western Spitsbergen

Daily temperature measurements from six meteorological stations along the coast and fjords of western Spitsbergen have been digitized and quality controlled in a Norwegian, Russian and Polish collaboration. Complete daily data series have been reconstructed back to 1948 for all of the stations. One of the station’s monthly temperature series has previously been extended back to 1898 and is included in this study. The long-term series show large temperature variability on western Spitsbergen with colder periods in the 1910s and 1960s and warmer periods in the 1930s, 1950s and in the 21st century. The most recent years are the warmest ones in the instrumental records. There is a positive and statistically significant trend in the annual times series for all of the stations; however, the strongest warming is seen in winter and spring. For the period 1979-2015, the linear trends range from 1.0 to 1.38°C/decade for the annual series and from 2.0 to 2.38°C/decade in winter. Threshold statistics demonstrate a decrease in the number of cold days per year and an increase in the number of warm days. A decreasing inter-annual variability is observed. In winter, spring and autumn, the stations in the northernmost areas of west Spitsbergen and in the innermost parts of Isfjorden are the coldest ones. In summer, however, the southernmost station is the coldest one

Mental health problems in children and adolescents referred to a national epilepsy center

-This study aimed to investigate the occurrence of psychiatric morbidity in children and adolescents referred to a tertiary national epilepsy center (inpatient unit) and the extent of the unmet need for psychiatric services in this group. Participants were 74 children and adolescents aged 9–15 referred from February 2001 to October 2002 (67% response rate). The multi-informant (parent, teacher, self-report) Strengths and Difficulties Questionnaires (SDQs) were answered before or at admission. Patients with severe mental retardation or pervasive developmental disorder were excluded. We found a large proportion (77%) with a possible or probable psychiatric disorder. The parents, teachers, and adolescents themselves had higher mean SDQ scores than a British community sample on total difficulties, emotional symptoms, conduct problems, hyperactivity–inattention, peer problems, and impairment, but not self-reported conduct problems. Nearly 80% of the children who probably had a psychiatric disorder had no contact with the psychiatric service