Factors influencing the outcome of children attending a Child and Adolescent Mental Health Services (CAMHS): a prospecti
Lead Research Organisation:
UNIVERSITY OF EXETER
Department Name: UNLISTED
Abstract
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Technical Summary
Aims and objectives:- This application would focus on the effectiveness of child and adolescent mental health services (CAMHS). It would evaluate a methodology for assessing the effectiveness of attendance at CAMHS by judging clinical outcome measures against normative data from national epidemiological studies. It would also identify factors predicting the outcome of children attending CAMHS and thereby generate an empirically derived prognostic index. In addition it would evaluate the use of a standardised diagnostic assessment as an aid to routine clinical work and compare the rates of public sector service use over 18 months by CAMHS attenders as compared with a community sample of untreated children with similar psychopathology from a national study with a view to planning a more detailed cost-effectiveness study in the longer term.
Design and methodology:- The study will be a prospective observational study of outcome with a randomised clinical trial nested within it. Consecutive attenders at Croydon CAMHS will be compared with untreated children with similar psychopathology and socio-demographic characteristics from national epidemiological studies that used the same instruments in terms of change in psychopathology over time and the number of other public sector services accessed. The results of a standardised diagnostic assessment will be revealed to the assessing clinician in a random half of cases in order to compare clinical and standardized diagnoses and rates of evidence-based intervention.
Scientific and medical opportunities:- It may surprise non-psychiatrists that the need for routine outcome monitoring is challenged by many professionals working within CAMHS. The national service framework for children has stated that services should monitor outcome, but few are in a position to do so. Despite the existence of evidence-based treatments for childhood psychiatric disorders, a small literature provides inconsistent evidence about the effectiveness of routine intervention at CAMHS. CAMHS teams are multidisciplinary, so that staff involved in assessments may have different conceptualizations of the same child‘s difficulties. The tension between maintaining the richness of each discipline‘s contribution while ensuring a minimum standard of assessment is major concern of child mental health professionals.
Design and methodology:- The study will be a prospective observational study of outcome with a randomised clinical trial nested within it. Consecutive attenders at Croydon CAMHS will be compared with untreated children with similar psychopathology and socio-demographic characteristics from national epidemiological studies that used the same instruments in terms of change in psychopathology over time and the number of other public sector services accessed. The results of a standardised diagnostic assessment will be revealed to the assessing clinician in a random half of cases in order to compare clinical and standardized diagnoses and rates of evidence-based intervention.
Scientific and medical opportunities:- It may surprise non-psychiatrists that the need for routine outcome monitoring is challenged by many professionals working within CAMHS. The national service framework for children has stated that services should monitor outcome, but few are in a position to do so. Despite the existence of evidence-based treatments for childhood psychiatric disorders, a small literature provides inconsistent evidence about the effectiveness of routine intervention at CAMHS. CAMHS teams are multidisciplinary, so that staff involved in assessments may have different conceptualizations of the same child‘s difficulties. The tension between maintaining the richness of each discipline‘s contribution while ensuring a minimum standard of assessment is major concern of child mental health professionals.