A controlled trial of implementing a complex mental health intervention for carers of vulnerable young people living in out-of-home care: the ripple project

BACKGROUND: Out-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required. This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC. METHODS: The study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts: 1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention. RESULTS: Early findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers. CONCLUSIONS: Implementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000501549 . Retrospectively registered 19 May 2015

On le croyait autiste, il était déprimé : un cas de psychiatrie du nourrisson

Dans un premier temps, nous passons en revue les études qui ont examiné les influences pathogènes des troubles psychiatriques parentaux sur le jeune enfant en général, et du trouble obsessionnel compulsif (TOC) en particulier. Puis nous présentons le cas d’un garçon de 2 ans et demi qui nous fut adressé, avec un diagnostic d’autisme et d’hyperactivité. La description du déroulement chronologique des séances thérapeutiques mère-enfant-père montre qu’il s’agissait en fait d’une dépression clinique de l’enfant provoquée par les conséquences d’un TOC grave et chronique maternel, resté secret jusque-là. Nous concluons par une réflexion sur l’entrée en constellation maternelle comme facteur d’aggravation de troubles mentaux préexistants d’un côté, et de motivation de demande de soins par ailleurs

Le couple : sa formation, sa destruction et ce qu’il y a entre les deux

La théorie de l’attachement représente un cadre théorique général à la compréhension de l’organisation des relations humaines tout au long de la vie et en particulier lors de l’adaptation aux situations de séparation. Si les premiers types de relations se reproduisent de manière générale au cours de la vie et dans les relations de couple en particulier, les expériences continuelles avec un conjoint - caractérisé par son propre type d’attachement - devenu une figure d’attachement importante, provoque la réactualisation du réseau de représentation interne (schémas internes actifs). Le type d’attachement de chaque partenaire influence donc le caractère de la relation de couple. Cet article décrit les différents types d’attachement d’individus et de couples et tente, d’une part, d’appréhender ce qui relie deux personnes, les attentes d’une relation, la capacité à créer une relation de proximité et d’intimité, et, d’autre part, de cerner les éléments qui éveillent les conflits, ceux susceptibles de briser la relation et ceux qui caractérisent le processus de séparation

Diffusion of efficacious interventions for children and adolescents with mental health problems

Background: Child and adolescent mental health problems are prevalent and require adequate interventions. Despite several evidence-based interventions for these problems described in the literature, few studies addressed strategies to diffuse efficacious interventions for child mental disorders especially in developing countries. Methods: An extensive but not systematic review of the literature was performed aiming to identify evidence-based interventions for children and adolescents with mental disorders, professionals to target in disseminating these interventions, and the available strategies to diffuse information. Results: Substantial evidence-based information is available to guide preventive, psychosocial and psychopharmacological interventions. the effectiveness of treatments in real-world settings and the cost-effectiveness of interventions are rarely tested. Professionals at different levels (teachers, school counselors, social workers, general practitioners, pediatricians, child psychologists and psychiatrists) should be targeted in diffusing efficacious interventions for child mental health problems worldwide. Telepsychiatry and the internet seem to be the most promising strategies to diffuse knowledge with lower costs. Conclusions: Medical and allied professionals must incorporate child and adolescent mental health issues in their under- and postgraduate curricula, and be better prepared to critically evaluate available information. Professionals need to disseminate evidence-based programs to guide parents and teachers in developing countries to deal with child and adolescent difficulties. Countries need to explore internet solutions for dissemination of medical information.Univ Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Serv Psiquiatria Infancia & Adolescencia, Child & Adolescent Psychiat Div, BR-90035003 Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Child & Adolescent Psychiat Div, São Paulo, BrazilUniv Ottawa, Mental Hlth Res Inst, Youth Unit, Ottawa, ON K1N 6N5, CanadaBalamand Univ, Inst Dev Res Advocacy & Appl Care, Fac Med,Dept Psychiat & Clin Psychol, St George Hosp,Univ Med Ctr, Lebanon, NH USAGeha Mental Hlth Ctr, Div Adolescent & Child, Petah Tiqwa, IsraelUniversidade Federal de São Paulo, Dept Psychiat, Child & Adolescent Psychiat Div, São Paulo, BrazilWeb of Scienc