Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives

Open Access journalBackground Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders“ understanding of the meaning of quality in the context of CAMHS. Method The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant’s views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. Results An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. Conclusions No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area

A qualitative exploration of how adopted children and their parents conceptualise mental health difficulties.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Adopted children tend to have high levels of emotional, behavioural and developmental need and are more likely to present to a range of services, including Child and Adolescent Mental Health Services (CAMHS). Although research exploring adopted children’s’ perspectives is growing, it remains limited. Furthermore, there has been little work t0 engage adopted children in research. Our project aimed to examine adopted children’s viewpoints of mental health and services alongside those of their adoptive carers. Results indicated that, although there were some similarities between carer and child perspectives, they also frequently differed. They provided different constructions of the problem but agreed that family relationships were strained. Some acknowledgement of the role of the school was offered and other external sources of support cited. Coping was considered to be complex and, while some issues were analogous to ‘normal’ family life, much was inherent to the adoption status

How do Muslim service users, caregivers, and community members in Malappuram, Kerala, use their faith to address the challenges associated with mental ill health?

Our aim was to explore the role religion and spiritual beliefs play in dealing with the challenges associated with mental ill health among the Muslim community in Malappuram, Kerala. Twenty-four interviews were conducted with patients of Islamic faith diagnosed with a mental health condition (n = 10) in urban (Ponnani) and rural (Vailathur) area of Malappuram, a Muslim majority district in Kerala, their family carers (n = 8) and community members (n = 6). Four key themes were derived, namely (1) Attribution to supernatural factors, (2) Relying on “God’s will”, (3) Prayer, and (4) Traditional healing. Faith was seen to be a prerequisite for any treatment, including modern medicine, to work. Even within a single faith group there can be considerable variation in belief and practice, with more pious participants disapproving of the reliance on local traditional healers and belief systems, highlighting the value of paying attention to the detail of local beliefs and practices

Whose responsibility is adolescent's mental health in the UK? The perspectives of key stakeholders

The mental health of adolescents is a salient contemporary issue attracting the attention of policy makers in the UK and other countries. It is important that the roles and responsibilities of agencies are clearly established, particularly those positioned at the forefront of implementing change. Arguably, this will be more efective if those agencies are actively engaged in the development of relevant policy. An exploratory study was conducted with 10 focus groups including 54 adolescents, 8 mental health practitioners and 16 educational professionals. Thematic analysis revealed four themes: (1) mental health promotion and prevention is not perceived to be a primary role of a teacher; (2) teachers have limited skills to manage complex mental health difculties; (3) adolescents rely on teachers for mental health support and education about mental health; and (4) the responsibility of parents for their children’s mental health. The research endorses the perspective that teachers can support and begin to tackle mental well-being in adolescents. However, it also recognises that mental health difculties can be complex, requiring adequate funding and support beyond school. Without this support in place, teachers are vulnerable and can feel unsupported, lacking in skills and resources which in turn may present a threat to their own mental well-being

What Is a Group? : Young Children’s Perceptions of Different Types of Groups and Group Entitativity

To date, developmental research on groups has focused mainly on in-group biases and intergroup relations. However, little is known about children’s general understanding of social groups and their perceptions of different forms of group. In this study, 5- to 6-year-old children were asked to evaluate prototypes of four key types of groups: an intimacy group (friends), a task group (people who are collaborating), a social category (people who look alike), and a loose association (people who coincidently meet at a tram stop). In line with previous work with adults, the vast majority of children perceived the intimacy group, task group, and social category, but not the loose association, to possess entitativity, that is, to be a ‘real group.’ In addition, children evaluated group member properties, social relations, and social obligations differently in each type of group, demonstrating that young children are able to distinguish between different types of in-group relations. The origins of the general group typology used by adults thus appear early in development. These findings contribute to our knowledge about children's intuitive understanding of groups and group members' behavior

Schoolchildren’s perspectives on the meaning of mental health.

Purpose – Mental health of children and young people is often discussed in terms of mental illness, however, such an approach is limited. The purpose of this paper is to explore young people's views of what mental health is and how to stay mentally healthy. Design/methodology/approach – The paper investigated young people's views on these two issues through a series of workshops. In total 218, 13-year-old schoolchildren produced posters with their impressions of the issues. Themes that young people identified were then discussed with them in terms of the existing Bright Futures definition of mental health. Poster responses were subsequently transcribed and thematically analysed. Findings – The paper identified a number of themes for each question. Mental health was viewed in terms of personal attributes of an individual, illness, ability for personal management and establishing social relations. Young people saw mental health maintained through a combination of lifestyle choices, personal attributes, management of self and environment, social support and relationships, as well as treatment of illness. These themes corresponded to the ones identified by the Bright Futures. Research limitations/implications – This study highlights the complexity of young people's views on the meaning of mental health. They were also more positive, open and competent in discussing mental health than previously suggested. However, a more systematic investigation of views and attitudes is necessary, including younger children. Additionally, health care professionals are likely to benefit from young people's engagement in planning and implementing strategies for better mental health. Originality/value – This paper is one of the few to investigate the positive meaning of mental health with young people

Research and partnerships with schools

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Purpose Despite the quantity of research on child and adolescent mental health being done in schools, little out- put has focused on the practical aspects of recruiting schools and students into a study. Furthermore, there is limited knowledge on how to develop and sustain pro- ductive and mutually beneficial partnerships with schools after the project finishes. Methods A large study examining prevalence of mental health problems in young people involving nine schools is used as an example for the procedure of recruitment and carrying out a research project, while developing and sustaining partnerships with schools. Results While recruiting the schools, a three-stage model was developed that corresponded closely to the school’s needs and existing demands. The suggested procedure for the study, thus, closely reflected the varying existing cul- tures of participating schools. Partnerships, developed as a result of the project, were used in developing further pro- jects and interventions for promoting good mental health in schools. Conclusions Rather than a blanket research recruitment and procedural approach with an end to school involve- ment at the end of the project, the paper advocates for a deeper understanding of the schools’ internal culture for improved recruitment and study outcomes. Developed partnerships, when sustained past the completion of research, prove to be a useful tool in applying the findings in promoting good mental health in schools and continuing research further

Egocentrism and cyberbullying: Imaginary audience and personal fable ideation predict cyberbullying and cyber victimisation in adolescents and emerging adults.

Egocentrism and cyberbullying: Imaginary audience and personal fable ideation predict cyberbullying and cyber victimisation in adolescents and emerging adults. Objectives: The imaginary audience and personal fable, or the egocentric beliefs in being the centre-of-attention and special respectively, are prominent in adolescence and emerging adulthood. The main focus of this research is to determine whether egocentric beliefs are associated with engaging in cyberbullying behaviour or being a victim of cyberbullying. Furthermore, the research also aimed to determine whether cyberbullying and victim behaviour differed according to age. Design: The study employed a cross-sectional questionnaire-based design, investigating whether cyberbullying behaviour or perceived cyber victimisation could be predicted from the imaginary audience, personal fable, and age. Methods: Fifty-two 14-15 year olds (attending school) and fifty 18-25 year olds (attending University) completed questionnaires measuring cyberbullying and cyber victim behaviour, the personal fable, the imaginary audience, and basic demographic information. Results: Multiple regression analysis showed that imaginary audience (β=.355, t(101)=3.97, p<.001), and age (β=.249, t(101)=2.80, p=.006) positively predicted cyberbullying behaviour. Cyber victim behaviour was positively predicted by the imaginary audience (β=.369, t(101)=3.98, p<.001) and negatively predicted by the personal fable (β=-.238, t(101)=-2.57, p=.012). Independent samples t-tests confirmed that emerging adults cyberbullied more than adolescents (t(100)= -2.32, p=.022; emerging adult mean = 6.58, adolescent mean = 4.50). Conclusions: Those higher in imaginary audience reported higher levels of both cyber victim and cyberbullying behaviour, whilst those higher in personal fable reported being a victim of cyberbullying less. Perhaps surprisingly, emerging adults cyber bullied more than adolescents. Aspects of developmental change, specifically egocentric ideation, could have importance to cyberbullying perpetration and victimisation