A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Community Psychology) in the Department of Psychology University of Zululand, South Africa, 2003. / The state has committed itself to the integration of mental health and primary health care services in order to utilise resources more efficiently and to provide comprehensive care to the population. Primary health care nurses are generally lacking in mental health skills. The provision of training for them has been identified as being essential if integration is to succeed. The various provinces have differed from each other in their approaches to integration and training. In Kwa Zulu-Natal, no training programs had been introduced by the provincial health authorities until recently. This study aimed to provide a training program in child mental health for primary health care nurses in the Ugu region. A group of fourteen nurses were trained in the diagnosis and management of four frequently occurring child mental health problems. Their knowledge prior to training was assessed and compared to that of a group of psychiatric nurses and a group of primary care nurses undergoing training in a general mental health program conducted by the Department of Health. Their attitude towards integration was also compared to that of the group of psychiatric nurses. It was found that prior to training, both groups of primary care nurses knew significantly less about these conditions than did the group of trained psychiatric nurses. After training, the group that had been trained in the writer's program were found to have improved their knowledge to a level similar to that of the psychiatric nurses. The group undergoing training in the department's program made no significant gains in knowledge when compared to the other two groups. It was concluded that the department's program may be deficient in certain aspects and needs to be reviewed. Both primary health care nurses and trained psychiatric nurses anticipate various problems related to the proposed integration of services. It is argued that for integration to be successful these concerns and issues need to be urgently addressed.

This document is a review of literature on needs assessments and the benefits of conducting one. Communicare is a mental health agency that serves the Lincoln Trail Region. Currently, most of the revenue from their children programs comes from Medicaid, which is a fee-for-services payer source. The Kentucky Medicaid Program is in the process of contracting with managed care organizations to oversee services that have been paid directly from Kentucky Medicaid. With these changes, mental health organizations must identify specific community service needs as well as expanding revenue sources. Applying for grants is one way mental health agencies can expand revenue sources. Communicare has identified the KY SEED grant that focuses on prevention and providing services to early childhood programs as a potential funding source. A needs assessment was conducted to gather information on children services implemented by Communicare. It was conducted in order to assess current programs and seek out potential areas of future program growth. The needs assessment further sought to identify gaps in services for the early childhood programs and assist in the grant application process. A review of existing data on children’s services offered at Communicare, including a satisfaction survey and a System of Care Assessment Report, was conducted as part of the needs assessment. A Community Forum with community partners from the Lincoln Trail region was held to gather additional data for the needs assessment.

Background: The consideration of impairment plays a crucial role in detecting significant mental health problems in children whose symptoms do not meet diagnostic criteria. The assessment of impairment may be particularly relevant when only short screening instruments are applied in epidemiological surveys. Furthermore, differences between childrens’ and parents’ perceptions of present impairment and impairing symptoms are of interest with respect to treatment-seeking behaviour. Objectives: The objectives were to assess parent- and self-reported impairment due to mental health problems in a representative sample of children and adolescents; to describe the characteristics of highly impaired children with normal symptom scores; and to investigate the associations between symptoms in different problem areas and impairment. Methods: The mental health module of the German Health Interview and Examination Survey for Children and Adolescents (the BELLA study) examined mental health in a representative sub-sample of 2,863 families with children aged 7–17. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children 11 years and older. Results: Considerable levels of distress and functional impairment were found with 14.1% of the boys and 9.9% of the girls being severely impaired according to the parental reports. However, self-reported data shows a reversed gender-difference as well as lower levels of severe impairment (6.1% in boys; 10.0% in girls). Six percent of the sampled children suffer from pronounced impairment due to mental health problems but were not detected by screening for overall symptoms. Childrens’ and parents’ reports differed in regard to the association between reported symptom scores and associated impairment with children reporting higher impairment due to emotional problems. Conclusions: The assessment of impairment caused by mental health problems provides important information beyond the knowledge of symptoms and helps to identify an otherwise undetected high risk group. In the assessment of impairment, gender-specific issues have to be taken into account. Regarding the systematic differences between childrens’ and parents’ reports in the assessment of impairment, the child’s perspective should be given special attention.