Chronic health problems are hypothesised to be a risk factor to child and adolescent mental health, due the consistent and continuing stress these health problems pose to normative patterns of development. However, this theory remains to be substantiated by empirical research. Moreover, a systematic review conducted as part of this research indicated that the empirical body is not one on which the validity of this theory can be adequately tested. The major question posed is whether the lack of high quality epidemiological data in the field is obscuring a true psychiatric risk associated with chronic illness in childhood and adolescence, or whether, in contrast, the theory of chronic health problems as a particular risk factor to child and adolescent mental health, is based on false premises. In order to provide a stronger insight into the association of chronic health problems to mental ill-health across the late childhood and adolescent period, this study used data from a large, representative British sample (the Avon Longitudinal Study of Parents and Children (ALSPAC)) and sensitive measures of mental health outcomes. Mediating factors in these associations were also identified, and a model of the association of chronic health problems to poor mental health outcomes in early adolescence was developed. In order to ensure that all findings were applicable across chronic health conditions, outcomes over this period for children with chronic illness more generally were compared to outcomes for children with asthma diagnoses. Children with chronic health problems presented with a disproportionate rate of psychiatric illness at 10 years, and these chronic health problems continued to be associated with poor mental health outcomes across the early to mid-adolescent period. The outcomes at 10 and 13 years were suggested to be mediated by factors non-specific to any diagnosis, specifically peer victimisation and health-related school absenteeism. Limitations to external validity in the research, and implications for public health and future research are discussed.

Background: Self-compassion which may be shaped by early attachment experiences involves being kind to oneself at times of difficulty and is consistently linked to psychological well-being. Self-compassion may be particularly useful in adolescence during which, difficulties associated with physiological and psychosocial transitions can lead to psychological distress. Aims: The aims of this thesis were twofold. First: to review the literature exploring the relationship between self-compassion and psychological distress in adolescents. Second: a research study to investigate the emerging theory that self-compassion may offer a healthier self-relating construct than self-esteem. The study examined whether self-compassion or self-esteem mediated the relationship between attachment and depression and anxiety in adolescents attending child and adolescent mental health services (CAMHS). Method: A systematic search of articles related to the relationship between self-compassion and psychological distress in adolescents was conducted. The quality of included papers was assessed. In the research study, 53 adolescents (mean age 15.52 years; 75% female) attending CAMHS presenting with symptoms of anxiety and/or depression were asked to complete five self-report questionnaires measuring: self-compassion, self-esteem, quality of life, satisfaction with attachment relationship and current symptoms of depression and anxiety. Results: The systematic review revealed 25 studies for inclusion. Studies reported an inverse relationship between self-compassion and psychological distress in adolescents. Quality ratings illustrated variation in methodological quality of included studies. In the research study self-compassion and self-esteem were both negatively correlated with depression and anxiety. The mediating impact of self-compassion was only apparent in the relationship between attachment availability and depression, but not anxiety. Contrary to the hypothesis, self-esteem mediated the relationship between attachment security and depression and anxiety to a greater extent than self-compassion. Conclusions: Self-compassion may have clinical implications in improving psychological well-being among adolescents. Future studies with different measures of self-compassion; varying study designs and consideration of contextual factors would increase understanding of the relationship between self-compassion and psychological distress in adolescents.

In recent years, there has been an ever increasing emphasis placed on the collection and use of patient reported outcome measures (PROM) in mental health services. This emphasis stems from a culture of evidence based practice, wherein PROM are shown to improve therapeutic outcomes at the clinical level, as well as provide information for the appropriate development of services and commissioning at a national level. This study uses an online survey to explore the use of PROM by mental health staff (n=112) in various Child and Adolescent Mental Health Services across England. Attitudes toward routine outcome monitoring practices and perceived competency around PROM use were also measured. Results found that although significant numbers of staff were using PROM, the amount of data being collected falls short of policy targets. Staff’s attitudes towards the practice are shown to be ambivalent, whereas overall perceived levels of competency were reasonably good. The relationships between attitudes, competence and PROM usage are discussed and a prediction model for PROM usage is developed in light of existing psychological theory. Results showed that training played an important role in the uptake of PROM and implications for the dissemination of training programs are emphasised.

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.

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.

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