Mental health planning for children and youth: is it developmentally appropriate?

Objectives: We aim to provide an overview of current issues facing child and adolescent mental health services and the provision of developmentally informed and appropriate care.

Method: We review developmental models of mental disorder and the impact on service design.

Results: Developmental issues can shape service design.

Developing the 'youth model' in mental health services.

Objective: The aim of this paper was to review the basis of the 'youth model' and new 'headspace' service delivery structures, proposed as a solution to the problem of high rates of psychiatric disorder in the youth period of life. Several issues were examined through asking key questions and answering these from the perspective of two academically oriented child and adolescent psychiatrists.

Conclusions: As half of all mental disorders appear during childhood and early adolescence, more research into the origin and emergence of these problems should focus on this early period of life.

Reviewing the learning organisation model in a child and adolescent mental health service.

From 1995 onwards, a child and adolescent mental health service (CAMHS) applied Senge's learning organisation model. This review compared service performance with that of peer services 5 years later and explored whether any differences were associated with the application of this model. The comparison methodology used quantitative analysis of external data from the Department of Human Services, together with qualitative analysis of material including interviews with CAMHS directors and service managers.

Early Onset Dysthymic Disorder in Children and Adolescents: Clinical Implications and Future Directions.

Early onset dysthymic disorder (EODD) is a serious psychiatric disorder that is associated with impaired social and relationship functioning, comorbid psychiatric conditions, a chronic course and increased risk for adult affective disorders. Unlike major depressive disorder (MDD) in childhood, which has been the focus of ongoing research, EODD has been relatively neglected in clinical practice and research. This paper reviews and evaluates EODD research findings and outlines pertinent clinical and research implications.

Using program theory to develop key performance indicators for child and adolescent mental health services.

Key Performance Indicators are used increasingly by health services, but their relevance and utility may be questionable. In this article, Program Theory is used to model the irreducible stages in the system of clinical care in Child and Adolescent Mental Health Services, define the major program operations in each of these stages, and specify the intermediate outcomes of each stage and the final outcomes sought. National and State policy standards are used, with practice experience, to identify key program operations and intermediate outcomes sought.

Children with persistent conduct problems who dropout of treatment.

Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach.

Better mental health services for young people: responsibility, partnerships and projects.

Objective: This paper argues that adolescent psychiatry is best linked with child psychiatry and opposes separate youth mental health programmes for 12-25-year-olds. It reports on the current status of services and considers how adult mental health services (AMHS) can improve services for young adults (18-25-year-olds).

Method: Factors in development, psychopathology, prevention, training and service systems are reviewed to suggest that current child and adolescent mental health service systems (CAMHS) are appropriate for 0-17-year-olds.

Learning organisations: a suitable model for improving mental health services?

Objective: The aim of this paper was to describe an organisational model that has created interest in recent business management literature as supporting learning, adaptation and continuous improvement.

Method: Some key features of the literature on learning organisations are outlined, including the values and processes involved, together with a structural and cultural template that has been applied to a community child and adolescent mental health service. Some blocks to learning and the leadership skills required to develop adaptive services are described.

Building a learning organisation in a child and adolescent mental health service.

In recent business literature, the model of the learning organisation has been proposed as a solution to the problem of continually changing environments and increasing consumer expectations of maximum quality and value for money. The model seems highly appropriate for health services, which are staffed by educated professional staff who must become more adaptive and concerned with improving consumer outcomes. This case study describes how the principles of learning organisations have been applied to the design of a new structure and the creation of a learning culture within a mental health service for children and adolescents.

Continuing the debate on a separate adolescent psychiatry.

Objective: This paper continues the debate, started by George Patton, that a separate adolescent psychiatry is required since many psychotic illnesses begin in late adolescence, and adolescent mental health needs have not been well met by child or adult psychiatry.

Method: Epidemiological studies are used to illustrate that there are many continuities, as well as discontinuities, in the natural history of psychiatric disorders throughout the life cycle. The paper comments on rational service planning, which requires data on the outcomes of different treatment approaches.

Legal rights and responsibilities of adolescents and staff in Victorian Child and Adolescent Mental Health Services.

Objectives: The aim of the paper is to clarify the legal rights of adolescent patients, guardians and staff in Victorian Child and adolescent Mental Health Services (CAMHS). Victorian CAMHS have now been 'gazetted' and can admit patients on an involuntary basis under the amended Mental Health Act 1986 (MHA). The MHA applies equally to young people under the age of 18 years, which has raised some confusion about who has the right to consent to treatment.

Child Behaviour Checklist classification of behaviour disorder.

Objective: The aim of this study was to determine the applicability of the published clinical cut-off scores of the Child Behaviour Checklist (CBCL) for the classification of behaviour disorders.

Methodology: Child Behaviour Checklists were obtained for 1342 subjects newly referred to the six major mental health centres in Melbourne. The normative community sample of 1002 7-, 12- and 15-year-olds was drawn from a school-based asthma prevalence study.

Clinical evaluation of a self-rating scale for depressive disorder in childhood (Depression Self-Rating Scale).

The many conceptual and methodological difficulties involved in evaluating depression rating scales for children are discussed. A clinical validation of the Depression Self-Rating Scale for Children (DSRSC) is described. The instrument is easy to use and has a predictive value comparable with that of a psychiatric global rating of depressed appearance and history of depression obtained at interview.