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A B S T R A C TNon-attendance at initial Child and Adolescent Mental Health Services outpatient appointments has been a major problem for staff and (indirectly) for families. The findings presented in this article are, to some extent, in line with previous studies of non-attendance, and to some extent go beyond them. The article organizes findings from previous studies and our own results into four categories: demographic, referral related, system (clinic) related and personal or family related. It focuses on demographic and system-related factors, and reports several significant findings in these areas. Making contact with the family prior to the date of the appointment seems to be a very potent factor in avoiding nonattendance, particularly when the family are asked to confirm whether they will be attending. Demographic factors such as the possession of a car, poverty, single parenthood, and having to care for other dependent relatives are significantly related to attendance rates, either positively or negatively. The quality of the referral letter seemed in some circumstances to be highly related to attendance. Suggestions are made on how to reach out to families that find it hard to attend initial appointments. K E Y W O R D S CAMHS, non-attendance, poverty, pre-clinical contactN O N -AT T E N DA N C E AT initial out-patient appointments in Child and Adolescent Mental Health Service (CAMHS) clinics may incur the waste of several hours time on each occasion for all the professionals involved; and, additionally, for teaching units, the loss of valuable experience for undergraduate doctors and other professionals in training. Frustration levels will be increased where there are long waiting lists, which are harmful to families, and which attract managerial and political concern. Several studies have found an association between the length of time spent on the waiting list and

Hyperactivity is common, but its diagnosis is still controversial, with two contending approaches: ADHD from DSM IV and hyperkinesis from ICD-10. The concept of ADHD predicts higher rates, but its use may lead to overmedication. Hyperkinesis usefully indicates medication, but clinics using it may detect many fewer cases, raising the possibility of underdiagnosis. It has never been shown whether this lower rate results from hyperkinesis' criteria, or to the differing methods used to detect hyperactivity in those centres that prefer it. We report a mirror study, examining rates of all types of hyperkinesis before and after the introduction of a preliminary screen (not originally intended to detect hyperkinesis). Its introduction resulted in an increase of detected hyperkinesis from 2% to 25% of the clinic sample with no change in diagnostic criteria. This was independent of any other change in the sample or clinic staff. We conclude that insensitive assessment may be responsible for low rates of diagnosis of ICD-10 hyperkinesis in secondary care clinics.

Parental illness and maternal health beliefs in the parents of a group of 40 children referred to a paediatric neurology service because of headaches were compared with illness histories and health beliefs in the parents of a matched group of 40 children presenting to the same service with recognized structural pathology, mainly epilepsy. The study focused on the mother's perceptions of her own health (current and past), on life events, social supports and on her beliefs about her own health and the validity of medical reassurance. Significant differences between the two groups were found in relation to: (a) the greater amount of illness experienced by both parents in the index group (i.e. parents of children with headaches), particularly the mothers, both as children and as adults; (b) the greater amount of illness present in the families of the index group in the 3 years prior to being seen by the neurologist; (c) the greater number of index mothers who had experienced the loss of their own mothers caused by death; (d) the greater tendency of the index mothers to express feelings of loneliness; (e) the greater proportion of index mothers who, in response to the Whiteley Attitudes to Health Questionnaire, expressed both (i) concern about serious disease in themselves, and (ii) reluctance to accept medical reassurance; (f) on the other hand, significantly more 'comparison mothers' complained of currently suffering 'many different symptoms'.

allegations, sometimes aggravated by insensitive methods of investigation. Although, for many, the allegation followed a period of difficulties between child and foster carer, the majority of carers were astonished at, and devastated by, the allegations. Sheila Bray is a former foster carer and now manages a private children's home for disturbed childrenBrian Minty is an Honorary Fellow in the Department of Psychiatric Social Work, University of Manchester, and is also a former foster carer

166 boys living in a deprived inner city area in Northern England, and born between 1944 and 1953 were followed up through local and national criminal records to an average age of 30. As adults, just over a quarter (26%) had a conviction for an offence against the person. Having a conviction for ‘violence’ was strongly associated with juvenile delinquency and conduct disorder. It was also found to be associated with certain deficiencies and distorted relationships in the natural home. Although boys who had been in public care for short periods contained a relatively high proportion of subjects later convicted of crimes against the person, the proportion among boys who were virtually brought up in care was much lower. There was also an inverse ratio between the length of time spent in care and the number of violent offences committed in adult life by boys committed to care for offences and being beyond control.

This report is a small, in-depth, descriptive study of allegations of maltreatment made against 22 foster carers, based on semi-structured interviews with the foster carers, 18 family placement officers and all principal family placement officers in six local authorities in the North of England. Less than 10% (in fact, 2/22) of the allegations were eventually substantiated (i.e. found to be true on investigation) and roughly a quarter (six) were found to be untrue. The remainder were either pronounced 'unsubstantiated' (i.e. 'unproven'-eight cases) or were not proceeded with (two) or never reached a conclusion (four). Less than a quarter of the children at the centre of the allegations remained in placement by the end of the investigation. Two-thirds of the foster carers continued to foster. Seven (32%) of the carers had previously had allegations made against them. In three cases there was a second allegation of sexual abuse. In one of these the current outcome was 'founded', and in a second this probably would have been the outcome had the case not been dropped after the foster father's suicide. In certain respects foster carers seem to be judged more severely than birth parents, and they were almost routinely denied aspects of natural 'In certain respects foster carers seem to be judged more severely than birth parents' justice accorded birth parents, such as being clearly informed in writing of the allegation made against them and, subsequently, of the outcome of the investigation. Nor were they permitted to put their side of the story at case conferences and other serious incident meetings. and the suicide of a single foster father who had been the subject of an allegation of sexual abuse. Allegations against foster carers is a subject which touches on a number of areas crucial in child care, i.e. child protection, fairness to foster parents, retention of foster carers and placement stability for children.

This paper describes the evaluation of a small children's home, Daisybank, set up to prepare adolescents, who had been in care for several years, to live in permanent placements. The home seemed largely to fail in this explicit task, but appear to succeed in helping a majority of its residents make substantial progress in coming to terms with their deprived and disrupted lives. It provided them with genuine care and commitment, which they acknowledged and appreciated. We believe that the success of the home needs to be judged by these criteria, since for young people in mid‐ to late adolescence the search for new permanent parental homes probably conflicted with other psychosocial tasks relating to adolescence. On the other hand, Daisybank seemed unable adequately to resolve the problems of a subgroup of adolescent males with serious conduct problems who were responsible for the not infrequent physical abuse of several female staff.