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

The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle

Background: Routine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research). Methods: With the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013. Results: The findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user. Conclusions: The findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers

Agreement on Web-based Diagnoses and Severity of Mental Health Problems in Norwegian Child and Adolescent Mental Health Services

Objective: This study examined the agreement between diagnoses and severity ratings assigned by clinicians using a structured web-based interview within a child and adolescent mental health outpatient setting. Method: Information on 100 youths was obtained from multiple informants through a web-based Development and Well-Being Assessment (DAWBA). Based on this information, four experienced clinicians independently diagnosed (according to the International Classification of Diseases Revision 10) and rated the severity of mental health problems according to the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Children’s Global Assessment Scale (C-GAS). Results: Agreement for diagnosis was κ=0.69-0.82. Intra-class correlation for single measures was 0.78 for HoNOSCA and 0.74 for C-GAS, and 0.93 and 0.92, respectively for average measures. Conclusions: Agreement was good to excellent for all diagnostic categories. Agreement for severity was moderate, but improved to substantial when the average of the ratings given by all clinicians was considered. Therefore, we conclude that experienced clinicians can assign reliable diagnoses and assess severity based on DAWBA data collected online

Specialists in ancient trees are more affected by climate than generalists

Ancient trees are considered one of the most important habitats for biodiversity in Europe and North America. They support exceptional numbers of specialized species, including a range of rare and endangered wood-living insects. In this study, we use a dataset of 105 sites spanning a climatic gradient along the oak range of Norway and Sweden to investigate the importance of temperature and precipitation on beetle species richness in ancient, hollow oak trees. We expected that increased summer temperature would positively influence all wood-living beetle species whereas precipitation would be less important with a negligible or negative impact. Surprisingly, only oak-specialist beetles with a northern distribu- tion increased in species richness with temperature. Few specialist beetles and no generalist beetles responded to the rise of 4°C in summer as covered by our cli- matic gradient. The negative effect of precipitation affected more specialist species than did temperature, whereas the generalists remained unaffected. In summary, we suggest that increased summer temperature is likely to benefit a few specialist beetles within this dead wood community, but a larger number of specialists are likely to decline due to increased precipitation. In addition, generalist species will remain unaffected. To minimize adverse impacts of climate change on this impor- tant community, long-term management plans for ancient trees are important

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

OC6 project Phase IV: Validation of numerical models for novel floating offshore wind support structures

\ua9 Copyright: This paper provides a summary of the work done within Phase IV of the Offshore Code Comparison Collaboration, Continued with Correlation and unCertainty (OC6) project, under International Energy Agency Wind Technology Collaboration Programme Task 30. This phase focused on validating the loading on and motion of a novel floating offshore wind system. Numerical models of a 3.6MW horizontal-axis wind turbine atop the TetraSpar floating support structure were compared using measurement data from a 1:43-Froude-scale test performed in the University of Maine\u27s Alfond Wind-Wave (W2) Ocean Engineering Laboratory. Participants in the project ran a series of simulations, including system equilibrium, surge offsets, free-decay tests, wind-only conditions, wave-only conditions, and a combination of wind and wave conditions. Validation of the models was performed by comparing the aerodynamic loading, floating support structure motion, tower base loading, mooring line tensions, and keel line tensions. The results show a relatively good estimation of the aerodynamic loading and a reasonable estimation of the platform motion and tower base fore-aft bending moment. However, there is a significant dispersion in the dynamic loading for the upwind mooring line. Very good agreement was observed between most of the numerical models and the experiment for the keel line tensions

On the use of reanalysis data for downscaling

In this study, a worldwide overview on the expected sensitivity of downscaling studies to reanalysis choice is provided. To this end, the similarity of middle-tropospheric variables—which are important for the development of both dynamical and statistical downscaling schemes—from 40-yr European Centre for Medium- Range Weather Forecasts (ECMWF) Re-Analysis (ERA-40) and NCEP–NCAR reanalysis data on a daily time scale is assessed. For estimating the distributional similarity, two comparable scores are used: the twosample Kolmogorov–Smirnov statistic and the probability density function (PDF) score. In addition, the similarity of the day-to-day sequences is evaluated with the Pearson correlation coefficient. As the most important results demonstrated, the PDF score is found to be inappropriate if the underlying data follow a mixed distribution. By providing global similarity maps for each variable under study, regions where reanalysis data should not assumed to be ‘‘perfect’’ are detected. In contrast to the geopotential and temperature, significant distributional dissimilarities for specific humidity are found in almost every region of the world. Moreover, for the latter these differences not only occur in the mean, but also in higher-order moments. However, when considering standardized anomalies, distributional and serial dissimilarities are negligible overmost extratropical land areas. Since transformed reanalysis data are not appropriate for regional climate models—in opposition to statistical approaches—their results are expected to be more sensitive to reanalysis choice