A reforma psiquiátrica brasileira, na qualidade de um processo social e crítico, vem transformando o cenário da atenção psicossocial, tendo como norte a constituição de direitos das pessoas com sofrimento psíquico. A perspectiva da desinstitucionalização, alicerce desse processo, configura-se como um campo de saberes e práticas, comprometido com a criação de serviços e de novas formas de relação com a experiência do sofrimento psíquico. A constituição de um campo de atenção específico para crianças e adolescentes, alinhado a essa perspectiva, está em curso e é recente, sendo a criação de serviços e a promoção de debates para a formulação de políticas públicas marcos importantes. Contudo, mesmo com esses avanços significativos, há movimentos contrarreformistas em curso, expressos, por exemplo, na permanência da prática de internação de crianças e adolescentes em instituições psiquiátricas de caráter asilar. Em um horizonte que visa à transformação dessa situação é preciso compreender as premissas e as justificativas para essas internações. Assim, esse estudo objetivou identificar e analisar os motivos de internação de crianças e adolescentes em uma instituição psiquiátrica de caráter asilar do Estado de São Paulo segundo as perspectivas da instituição e, também, das crianças e dos adolescentes internados. No âmbito da pesquisa qualitativa, a partir da Hermenêutica Dialética enquanto norteador metodológico e abordagem de dados, foi realizada observação participante em uma instituição psiquiátrica durante um período de quatro meses. Ainda, foi feito o estudo de 45 documentos institucionais referentes aos sujeitos internados nesse período e foram feitas entrevistas abertas com oito adolescentes internados na instituição. Para a análise, foi determinado como Categoria Analítica o conjunto de conceitos e práticas da perspectiva da desinstitucionalização e, a partir do material de campo, foram eleitas Categorias Empíricas e Operacionais. Após a leitura transversal dessas categorias, foram constituídos quatro temas de discussão. O primeiro, relativo ao perfil das 45 crianças e dos adolescentes internados no período do estudo, indicou que são características centrais: situações de vulnerabilidade diversas, frágil rede social, de suporte e de serviços, baixo grau de escolarização, passagens por outras instituições, e atribuição de um conjunto de traços que definem os sujeitos como sendo desviantes em relação a uma norma; assim, podese afirmar que há uma carreira de internação e psiquiatrização da vida, que diz respeito às vicissitudes da vida e a uma série de passagens institucionais. O segundo tema, compreendeu a psiquiatria enquanto uma prática ideológica sustentada por dois mecanismos principais: a produção de um curto-circuito simplificador da vida, no qual a expressão de relações de agressividade determina a internação; e a atribuição de um diagnóstico psiquiátrico abrangente, o F.29, que ocupa a função de justificar e legitimar a internação. O terceiro tema apontou que a instituição tem um claro esquema institucionalizante, baseado em um princípio autoritário-hierárquico e determinado pelo regramento do cotidiano. O quarto tema assinalou que, nas diferentes situações de internação, há uma mesma lógica operando: o circuito do controle, constituído por meio de dependências recíprocas de aparatos institucionais, dentre os quais o que sustenta efetivamente esse circuito é a instituição psiquiátrica. Conclui-se que, mesmo em um cenário de avanços da reforma psiquiátrica, lógicas segregatórias e asilares permanecem nas relações entre sujeitos e entre instituições, o que coloca a necessidade de continuidade da luta pela efetivação da reforma psiquiátrica / The Brazilian psychiatric reform, as a social and critical process, is transforming the psicossocial attention scenario, taking into account the rights of people with psychic suffering. The perspective of deinstitutionalization, a field of practices and knowledges, is the base of this process and is committed with the creation of services and with singular rapports with the psychic suffering experience. The construction of a specific form of psicossocial attention for children and adolescents is new and is in progress; the establishment of services and the promotion of debates for public policy making are some of the action taken in this context. Yet, even though this significance advances, contrariwise reform movements are in course, as the permanency of internment practices of children and adolescents in psychiatric institutions with asylum characteristics. Regarding the transformation of this situation, it is necessary to understand the reasons and justifications of those internments. Therefore, this research aimed to identify and analyse the motives of internment of children and adolescents in a psychiatric institution with asylum characteristics, located at São Paulo, according to the perspectives of the institution and, also, of the children and adolescents. A qualitative research, in a Hermeneutic Dialectic approach, was performed: a participative observation within a four months period, a study of 45 institutional documents, and interviews with eight adolescents. For analysis, the concepts and practices of the deinstitutionalization perspective were determined as Analytical Categories and, as from the material of the study were chosen the Empirical and Operational Categories. Thereafter the transversal reading of these categories, were constituted four themes of discussion. The first, concerning the profile of the 45 interned children and adolescents in the study period, revealed as main characteristics: various vulnerability situations, a feeble social net, a low scholar degree, several institutional passages, and the attribution of various features that defines the person as a deviant of norms; hence, there is an internment and a psychiatric career in the lives of these children and adolescents, connected to the vicissitudes and events of life. The second theme asseverates that psychiatry seems to be an ideological practice, sustained by two main mechanisms: the production of a short circuit that simplifies life and on which the aggressiveness relations expressions imposes the internment; and the attribution of an extensive psychiatric diagnosis, F.29, that justifies and legitimates the internments. The third theme confirms the institutionalization scheme of the institution, based on an authoritarian and hierarchy scheme, determined by the quotidian regulation. The fourth theme, distinguishes that there is an alike logic on the several internment situations: the circuit control, which is composed by reciprocal dependencies of institutional equipments, among which the psychiatric institution is, indeed, responsible for the maintenance of this circuit. To conclude, regarding the relevant advances in psychiatric reform scenario, segregation and asylum logic\'s still happens, both in institutions and social relations. This fact put in place the necessity of keeping on the efforts for the psychiatric reform

Objective: Children and youth in the child welfare and juvenile justice systems or at risk of entering them are known to have high rates of mental health problems and psychiatric disorders. Many states are struggling with the provision of mental health services for these important populations, both providing timely and adequate access to services as well as providing evidence-based interventions to address their complex needs. The state of Tennessee developed a program of regional Centers of Excellence (COEs) based within pediatric tertiary centers that provide clinical and consultative services, and technical assistance to behavioral health providers and regional branches of the state child welfare agency. These are oriented to improve access, quality, and effectiveness of care. Methods: This manuscript briefly reviews the history and process of development for the Tennessee COEs for Children in State Custody. It also outlines their evolving clinical and consultative activities, and activities to develop services infrastructure on behalf of children in custody with complex behavioral health needs. Results: The COEs have provided a significant number of direct consultative and clinical services that have been formally evaluated as highly valuable by stakeholder agencies. They have also developed an infrastructure for training and dissemination of best practices and evidence-based interventions oriented to the special needs of children in state custody. Conclusions: The Tennessee COEs serve as a national model for the building and development of regional systems, both for children in state custody and for other children and youth with complex mental health needs.

Introduction: Young people with high functioning autism spectrum disorders (HFASD) are particularly vulnerable to developing comorbid depression. It has been suggested that young people with HFASD and comorbid mental health difficulties are likely to experience difficulties during the transition to adulthood. This transition involves significant changes in both services and daily routine, something which people with HFASD often find difficult. Aims: This thesis includes two distinct pieces of work. A systematic review aiming to understand the prevalence of depression in children and young people with HFASD. A qualitative study aiming to explore transition to adulthood from the perspectives of young people with HFASD, who currently attend child and adolescent mental health services (CAMHS), and their families. Methods: For the systematic review, literature reporting the prevalence of depression in children and young people with HFASD was systematically searched and reviewed. For the qualitative study, data collection and analysis followed the principles of Interpretative Phenomenological Analysis (IPA). Four dyads of a young person with HFASD and a parent were interviewed. Results: The systematic review identified 18 studies which described results from 17 independent samples. The prevalence reported varied from 0% to 83%. This variation is most likely explained by methodological differences between studies. In the qualitative study, transition to adulthood was described as a process during which the young person is developing independence, while parents continue to have a role in providing support. Current and future support needs were perceived differently by the young people with HFASD than their parents, with the young people reporting less need for support. Conclusions: Further research is needed to better understand how to assess depression in this population, as well as the impact of age, gender, setting, medication use and other comorbidities. Transition is a time of uncertainty and change for young people, during which they become more independent of their families. Services need to consider the impact of these processes and young people’s perceptions about what it means to receive support.

Magister Curationis - MCur / Mental health care for adolescents is currently provided in a range of settings world-wide. These include the pediatrics units, general hospitals and specialized in-patient units for adolescents. However, care in these specialized units has hitherto not been evaluated. A phenomenological approach as a method and design was chosen to enable participants to describe and explore the lived experiences of nurses caring for adolescents in specialized psychiatric units of the selected psychiatric hospital. A purposive sampling method was used to select respondents. In-depth interviews were conducted with nurses caring for adolescents with mental health problems. Data saturation was reached with seven respondents. Interviews were recorded with a tape recorder that was only accessible to the researcher. Data analysis followed Collazi’s style that included listening to the recorded data, transcribing, coding, and intuition, reflection, reducing and interpreting the data. Ethical clearance was obtained from University of the Western Cape Higher Degrees Committee. The researcher requested permission to conduct the study at selected Psychiatric hospital from the Medical Superintendent and research ethics committee. Informed consent was also sought for those who agreed to participate in the study. Participants remained anonymous as their identity was not revealed. Only information related to the study was collected. Anonymity was assured by omitting names from transcripts as participants were given numbers only rather than using their names. The in-depth interviews were conducted in a quiet office to ensure privacy and confidentiality.

A reforma psiquiátrica brasileira, na qualidade de um processo social e crítico, vem transformando o cenário da atenção psicossocial, tendo como norte a constituição de direitos das pessoas com sofrimento psíquico. A perspectiva da desinstitucionalização, alicerce desse processo, configura-se como um campo de saberes e práticas, comprometido com a criação de serviços e de novas formas de relação com a experiência do sofrimento psíquico. A constituição de um campo de atenção específico para crianças e adolescentes, alinhado a essa perspectiva, está em curso e é recente, sendo a criação de serviços e a promoção de debates para a formulação de políticas públicas marcos importantes. Contudo, mesmo com esses avanços significativos, há movimentos contrarreformistas em curso, expressos, por exemplo, na permanência da prática de internação de crianças e adolescentes em instituições psiquiátricas de caráter asilar. Em um horizonte que visa à transformação dessa situação é preciso compreender as premissas e as justificativas para essas internações. Assim, esse estudo objetivou identificar e analisar os motivos de internação de crianças e adolescentes em uma instituição psiquiátrica de caráter asilar do Estado de São Paulo segundo as perspectivas da instituição e, também, das crianças e dos adolescentes internados. No âmbito da pesquisa qualitativa, a partir da Hermenêutica Dialética enquanto norteador metodológico e abordagem de dados, foi realizada observação participante em uma instituição psiquiátrica durante um período de quatro meses. Ainda, foi feito o estudo de 45 documentos institucionais referentes aos sujeitos internados nesse período e foram feitas entrevistas abertas com oito adolescentes internados na instituição. Para a análise, foi determinado como Categoria Analítica o conjunto de conceitos e práticas da perspectiva da desinstitucionalização e, a partir do material de campo, foram eleitas Categorias Empíricas e Operacionais. Após a leitura transversal dessas categorias, foram constituídos quatro temas de discussão. O primeiro, relativo ao perfil das 45 crianças e dos adolescentes internados no período do estudo, indicou que são características centrais: situações de vulnerabilidade diversas, frágil rede social, de suporte e de serviços, baixo grau de escolarização, passagens por outras instituições, e atribuição de um conjunto de traços que definem os sujeitos como sendo desviantes em relação a uma norma; assim, podese afirmar que há uma carreira de internação e psiquiatrização da vida, que diz respeito às vicissitudes da vida e a uma série de passagens institucionais. O segundo tema, compreendeu a psiquiatria enquanto uma prática ideológica sustentada por dois mecanismos principais: a produção de um curto-circuito simplificador da vida, no qual a expressão de relações de agressividade determina a internação; e a atribuição de um diagnóstico psiquiátrico abrangente, o F.29, que ocupa a função de justificar e legitimar a internação. O terceiro tema apontou que a instituição tem um claro esquema institucionalizante, baseado em um princípio autoritário-hierárquico e determinado pelo regramento do cotidiano. O quarto tema assinalou que, nas diferentes situações de internação, há uma mesma lógica operando: o circuito do controle, constituído por meio de dependências recíprocas de aparatos institucionais, dentre os quais o que sustenta efetivamente esse circuito é a instituição psiquiátrica. Conclui-se que, mesmo em um cenário de avanços da reforma psiquiátrica, lógicas segregatórias e asilares permanecem nas relações entre sujeitos e entre instituições, o que coloca a necessidade de continuidade da luta pela efetivação da reforma psiquiátrica / The Brazilian psychiatric reform, as a social and critical process, is transforming the psicossocial attention scenario, taking into account the rights of people with psychic suffering. The perspective of deinstitutionalization, a field of practices and knowledges, is the base of this process and is committed with the creation of services and with singular rapports with the psychic suffering experience. The construction of a specific form of psicossocial attention for children and adolescents is new and is in progress; the establishment of services and the promotion of debates for public policy making are some of the action taken in this context. Yet, even though this significance advances, contrariwise reform movements are in course, as the permanency of internment practices of children and adolescents in psychiatric institutions with asylum characteristics. Regarding the transformation of this situation, it is necessary to understand the reasons and justifications of those internments. Therefore, this research aimed to identify and analyse the motives of internment of children and adolescents in a psychiatric institution with asylum characteristics, located at São Paulo, according to the perspectives of the institution and, also, of the children and adolescents. A qualitative research, in a Hermeneutic Dialectic approach, was performed: a participative observation within a four months period, a study of 45 institutional documents, and interviews with eight adolescents. For analysis, the concepts and practices of the deinstitutionalization perspective were determined as Analytical Categories and, as from the material of the study were chosen the Empirical and Operational Categories. Thereafter the transversal reading of these categories, were constituted four themes of discussion. The first, concerning the profile of the 45 interned children and adolescents in the study period, revealed as main characteristics: various vulnerability situations, a feeble social net, a low scholar degree, several institutional passages, and the attribution of various features that defines the person as a deviant of norms; hence, there is an internment and a psychiatric career in the lives of these children and adolescents, connected to the vicissitudes and events of life. The second theme asseverates that psychiatry seems to be an ideological practice, sustained by two main mechanisms: the production of a short circuit that simplifies life and on which the aggressiveness relations expressions imposes the internment; and the attribution of an extensive psychiatric diagnosis, F.29, that justifies and legitimates the internments. The third theme confirms the institutionalization scheme of the institution, based on an authoritarian and hierarchy scheme, determined by the quotidian regulation. The fourth theme, distinguishes that there is an alike logic on the several internment situations: the circuit control, which is composed by reciprocal dependencies of institutional equipments, among which the psychiatric institution is, indeed, responsible for the maintenance of this circuit. To conclude, regarding the relevant advances in psychiatric reform scenario, segregation and asylum logic\'s still happens, both in institutions and social relations. This fact put in place the necessity of keeping on the efforts for the psychiatric reform

Background Mental health stigma-reducing and awareness trainings encourage trainees to talk about mental health with the hope that increased discussions will lead to reduced stigma and increased access to mental health services. This survey study aimed to examine the current levels of confidence among participants, or “first aiders” who completed the Youth Mental Health First Aid (YMHFA) training in their ability to demonstrate the skills that were taught in the training. Additionally, this study examined the difference in levels of confidence between the YMHFA instructors and first aiders in the ability of the first aiders to demonstrate the skills that were taught in the training. We examined differences in levels of confidence among first aiders according to their socio-demographic and personal characteristics. Finally, we explored the ways in which first aiders who completed the course used their knowledge and skills after the training. Methods Seven hundred fifty-seven first aider participants were surveyed post-training and 129 first aider participants were surveyed at follow-up. Fourteen YMHFA instructors were surveyed. Results The data indicated that there was a significant decrease in confidence among first aiders between post-training and follow-up. With the exception of age, there were no statistically significant differences in levels of confidence among first aiders according to the following sociodemographic and personal characteristics: a.) gender; b.) race; c.) reason for attendance; d.) role of use. Survey data also indicated the various ways in which first aiders are currently using their training. Conclusions First aiders’ confidence declined after follow-up even though they reported various ways in which they are using their training. Instructors reported positive perceptions of the training and reported a high level of confidence in the ability of their trained first aiders to demonstrate the taught skills.

Therapeutic Day Treatment (TDT) is a community-based mental health treatment program regulated and funded by the Department of Medical Assistance Services (DMAS) in the Commonwealth of Virginia. This case study sought to understand how DMAS regulatory changes impacted the implementation of the TDT program in the Commonwealth between fiscal years 2004 and 2011. In an effort to respond to this question, sources of qualitative and quantitative data were collected including: TDT fee-for-service data, regulations in the Community Mental Health and Rehabilitative Services manual guiding the implementation of the TDT program, and structured interviews with eight key stakeholders who interface with the TDT program. The fee-for-services analysis found that there was a 269% increase in fee-for-service expenditures between fiscal years 2007 and 2011. The analysis of the regulations found DMAS added language to provide greater clarity to the existing regulators. Some of these changes include the implementation of the PA process with KePRO as well as the VICAP process. Additionally, staff requirements changed and paraprofessionals were no longer able to provide TDT programming. Caseload limits were also set for TDT programming. Four themes emerged through the analysis of the structured interviews. These themes include: 1) fraudulent practices and misuse of TDT services, 2) regulatory oversight, 3) cost containment, and 4) evaluation. Implications focused on the areas of policy, practice, and research by suggesting further research studies focusing on TDT and policy, offering the foundation of a more comprehensive theory focusing on policy implementation, and lastly the researcher provided a logic model for the TDT program in an effort to propel evaluation research forward.

Bakgrund: Psykisk ohälsa ökar bland barn och unga, medan väntetiderna på många enheter blir längre och längre. Psykisk ohälsa kan påverka barn och ungas välbefinnande samt hela barnets familj. Grundläggande omvårdnadsbehov kan bli lidande. Det satsas stora pengar inom området, men förändringarna har hittills uteblivit. Kan tidig intervention påverka barns psykiska ohälsa och därmed ge evidens för allvaret med de långa vårdköerna? Syfte: Att undersöka faktorer och dess påverkan på barn och unga samt deras föräldrar i samband med långa väntetider inom barn och ungdomspsykiatrin. Metod: Studien genomfördes genom en litteraturöversikt baserad på 15 vetenskapliga artiklar med båda kvalitativ och kvantitativ metod. Sökningarna genomfördes i databaserna Cinahl, PubMed och PsycINFO. Resultat: Resultat visar flera fördelar med tidig intervention i behandlingsresultatet av psykisk ohälsa hos barn och unga såsom minskad ångest/oro och depressiva symtom. Dessa fördelar har även visat sig hålla sig kvar under en längre tid efter avslutad behandling. Resultatet visar även på att väntetiderna har en betydande påverkan på föräldrarna till barn och unga med psykisk ohälsa. I resultatet framkommer det att korta behandlingstider med tidig intervention ger ett förbättrat mående.  Slutsats: Psykisk ohälsa innebär en utmaning för barn och unga. Det finns stora brister inom barn och ungdomspsykiatrin. Barn och ungas psykiska hälsa måste börja tas på allvar. Barn och unga är landets framtid och bygger en grund för en vidare fungerande samhällsstruktur. Barn och ungdomspsykiatrin är en viktig enhet för främjandet, utvecklandet och bibehållandet av barn och ungas psykiska hälsa. / Background: Mental illness increases among young people, while waiting times for treatments are getting longer. Mental illness can affect the well-being of young people and their family. Basic nursing needs can be suffering. The government is investing money, but so far has no changes been seen. Can early intervention affect children’s mental health and provide evidence for the seriousness with the long care queues? Aim: To investigate factors and their effect on children and adolescents and their parents in connection with long waiting times in child and adolescent psychiatry. Method: A literature review based on 15 scientific articles with qualitative and quantitative methods. The searches were performed in the databases Cinahl, PubMed and PsycINFO. Result: The results shows benefits of early intervention in the treatment outcome of mental illness in children and adolescents such as reduced anxiety and depressive symptoms. These benefits have also been shown to persist for an extended period after completion of treatment. Waiting times has a significant impact on the parents of children with mental illness. Short treatment times with early intervention in mental illness in children and adolescents provides an improved feeling. Conclusion: Mental illness is a challenge for young people. There are shortcomings in treatment for mental illnesses. Mental health of children and adolescents must begin to be taken seriously. Young people is the future of the country and build a foundation for a further functioning society. Psychiatry is an important unit for development and maintenance of young people’s mental health.

Der Tagungsband enthält das Programm und die Abstracts des 26. Symposiums der Fachgruppe Klinische Psychologie und Psychotherapie der Deutschen Gesellschaft für Psychologie, veranstaltet an der Universität Potsdam vom 1. bis 3. Mai 2008. Etwa 450 Kongressteilnehmer präsentieren den aktuellen Forschungs- und Wissensstand der Klinischen Psychologie und Psychotherapie in Deutschland. Grußworte halten die brandenburgische Ministerin für Arbeit, Soziales, Gesundheit und Familie, Dagmar Ziegler, die Präsidentin der Universität Potsdam, Prof. Dr.-Ing. Dr. Sabine Kunst, sowie Prof. Dr. Michael Linden als Vertreter der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN). Zu den Themenschwerpunkten des Kongresses gehören Einflussfaktoren auf die psychische Gesundheit Älterer, Impulsivität, Schlaf- und Traumforschung in der Klinischen Psychologie, Behandlung von Essstörungen, Wirksamkeitsstudien psychischer Störungen des Kindes- und Jugendalters, Angst und Depression, Behandlung von Kriegs- und Folteropfern, Risiko- und Schutzfaktoren der Kindesentwicklung sowie Adipositas im Kindes- und Jugendalter. Außer den Vorträgen gibt es eine Präsentation von etwa 150 Postern. Zum Programm der Tagung gehört ebenso die Verleihung des Klaus-Grawe-Awards for the Advancement of Innovative Research in Clinical Psychology and Psychotherapy an Prof. Dr. Timothy J. Strauman von der Duke University (USA), die Verleihung der Nachwuchswissenschaftler- und Posterpreise sowie ein Pre-conference Workshop für Doktorandinnen und Doktoranden der Klinischen Psychologie zum Thema "Verhaltens- und Molekulargenetik".

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