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Improving the quality of, and access to evidence-based interventions in child and youth mental health: Listening to service users (consumers and clinicians)

Renée Brown, Jill Ehrenreich-May, Ingrid Hawkins, Matthew Sanders, Tom Ollendick, Rachel Hiller, Sarah Halligan, Richard Meiser-Stedman, Elizabeth Elliott, Jerica Radez Speaker

Almost 1 in 7 children and adolescents meet criteria for at least one diagnosable mental disorder. And yet, only a minority of these youth receive any kind of intervention, let alone an evidence-based intervention. This symposium consists of 4 papers that attempt to increase our understanding of this critical dilemma. The papers are also linked by a focus on service user participation (where service users include children/adolescents; parents/caregivers; and mental health clinicians) to improve the quality of, and access to evidence-based interventions offered in child and adolescent mental health services. The first paper represents a systematic review of studies examining adolescents' perceptions of barriers and facilitators to their access of mental health services. The second paper focuses on (a) parents' perceptions of different intervention modalities in the treatment of their children's anxiety disorders; and (b) factors which are of importance to families when deciding to seek treatment for their child's anxiety disorder. The third paper focuses on some of the most vulnerable youth in the UK - children and adolescents living in out-of-home care. Qualitative data from foster carers and youth in care relating to their views on mental health support will be presented. The final paper approaches the problem from the perspective of mental health clinicians; presenting data relating to attitudes towards, experiences with and thoughts about evidence-based interventions from qualitative interviews conducted with clinicians working in the largest child and adolescent mental health service in Australia.

Convenor: Vanessa E. Cobham (1)

Authors: Renée Brown (1), Jill Ehrenreich-May (2); Ingrid Hawkins (1), Matthew Sanders (1), Tom Ollendick (3); Rachel Hiller (4), Sarah Halligan (4), Richard Meiser-Stedman (5), Elizabeth Elliott (4); Jerica Radez (6).

Authors' Affiliations:

1) School of Psychology, The University of Queensland, Australia.2) Department of Psychology, University of Miami, USA. 3) Psychology Department, Virginia Tech, USA. 4) Department of Psychology, University of Bath, England. 5 Department of Psychology, University of Reading, England.

Presentation 1: What do young people tell us about the barriers to help-seeking for their own mental health problems? A systematic review of qualitative and quantitative studies.

Jerica Radez, Doctoral Researcher, AnDY Research Clinic, University of Reading, UK

Recent epidemiological studies suggest that almost 1 in 7 of children and adolescents meet the criteria for mental health disorder. However, only minority of these young people access mental health treatment. An improved understanding of the reasons underlying the gap between the high prevalence of mental health disorders in young people and low rates of treatment access would inform targeted interventions designed to improve access to youth psychological treatment. In particular, it is important to establish the views of young people and parents on the factors that make it harder or easier for them to seek and access mental health treatment. This study extends a recent systematic review focusing on parents’ perceptions of barriers to accessing youth mental health treatment, and aims to systematically review studies examining young people’s perceived barriers and facilitators to accessing psychological treatment for a wide range of their own mental health problems. The review combines findings from over fifty qualitative and quantitative studies; and, the findings provide clear implications for ways to overcome barriers and improve access to youth mental health treatment.

 

Presentation 2: Attitudes towards evidence based treatments: A qualitative study of community child and youth mental health clinicians 

Cobham, Vanessa E.1,2, Brown, Renee1, Stathis, Stephen2,1, Ehrenreich-May, Jill3.

1University of Queensland, St. Lucia, QLD, 4072, Australia.

2Children’s Health Queensland (CHQ) Child and Youth Mental Health Service, South Brisbane, QLD, 4101, Australia.

3Department of Psychology, University of Miami, USA.

Forty-five community clinicians from six Community and Youth Mental Health Services (CYMHS) clinics were interviewed about their attitudes towards, experiences with and thoughts about evidence-based interventions. Overall, clinicians felt the populations used in research of psychological interventions did not reflect the CYMHS client populations of severe and complex cases; therefore, the evidence was not translatable. CYMHS client populations were identified as being characterised by non-attendance, ongoing presentation of crises, co-morbidities, deficits that made it difficult for clients to engage with cognitive behavioural interventions (e.g. cognitive deficits), and external factors that hindered engagement with such interventions (e.g. parental language barriers). As such, clinicians felt that many evidence-based interventions were both impractical and irrelevant for the CYMHS population, where clinicians instead used parts of different therapies as needed, adapted to the needs of the client, in response to the particular client’s presenting concerns.

Presentation 3: Listening to the parents:  perceived advantages and disadvantages when seeking treatment for anxiety disordered children.

Vanessa E. Cobham (1), Ingrid Hawkins (1), Thomas H. Ollendick (2), Matthew R. Sanders (1)

1)University of Queensland, St. Lucia, QLD, 4072, Australia.

2) Virginia Tech, Virginia, USA.

Aim:

Anxiety disorders represent one of the most common diagnostic presentations in children. Although supported by a strong evidence base, individual cognitive behavioral therapy (CBT) approaches pose significant barriers to families. Emerging literature has started to focus on parenting-based CBT approaches to reduce these barriers however logistical barriers still exist for parents. The current research aimed to investigate: (a) parents’ perceptions of the advantages and disadvantages associated with different intervention delivery styles (b) factors which are of importance to families when deciding to seek treatment for their child’s anxiety disorder.

Method:

Parents of 73 anxiety disordered children (6-12 years) were randomly assigned to one of two CBT parenting interventions. Parents were administered the CRS at post and 6m to identify perceived improvement. Additionally a satisfaction survey, fit of intervention and a perceived advantages and disadvantages survey was completed. 22 parents across the conditions and timepoints undertook a qualitative interview to identify key factors that impacted their decision to seek treatment.

Results: The delivery format of a brief parenting interventions appears to be highly acceptable to parents with common themes of reduced time pressure and less demand on the child.

Conclusion: Briefer version of a targeted CBT anxiety based parenting intervention may be one way to reduce barriers to treatment.

Presentation 4: Supporting the mental health needs of young people in out-of-home care: A qualitative study of the views of the young people and their carers

 Rachel M Hiller (1), Sarah L Halligan (1), Richard Meiser-Stedman (2), Elizabeth Elliott (1)

1) Department of Psychology, University of Bath;

2) Norwich Medical School, University of East Anglia

Young people in out-of-home care represent some of the most vulnerable youth in the UK. They have typically been removed from their family home due to the experience of significant and prolonged abuse or neglect and their mental health and functional outcomes are poor. While they are 5x more likely to meet criteria for a psychiatric disorder compared to their peers, they often struggle to access appropriate support. This study interviewed 21 foster carers and 20 young people in care about their own views of coping and mental health support, including their views on access and services offered via child and adolescent mental health services (CAMHS). Key themes showed carers significant dissatisfaction with services and their own subsequent difficulty managing the mental health needs of the young people in their care. Many discussed broken communication between social care and CAMHS, challenges in accessing appropriate support. Young people particularly highlighted reasons that they found it difficult to engage with mental health professionals and their views on what support was best. Findings provide insight into the views of service-users regarding both concerns with access to mental health services, engagement with professionals, and the day-to-day management of mental health needs.