BackgroundPrior to commencing a randomised controlled trial, we conducted a focused ethnography to ensure that the trial was well suited to the proposed setting.MethodsA six-month observation of a Child and Adolescent Mental Health Service site in the North-East of England was undertaken to observe the site procedures, staff culture and patient care pathways. During this period, documentary data were collected and interviews were conducted with key informants to provide insight into staff perceptions of the proposed trial. The data were coded using thematic analysis and the resulting themes were verified by a second coder.ResultsSeventeen documents were collected, 158 h of observation and six formal staff interviews were undertaken. Four themes emerged from the data; non-clinically orientated variation in practice, diagnosis, capacity and staff economy. Non-clinically orientated variation in practice occurred when staff decisions were based upon resource availability rather than on clinical judgement. Diagnosis demonstrated differing staff confidence in making diagnoses and in the treatment of patients who had received a diagnosis. Capacity consisted of the time to attend training and the psychological capacity to consider or incorporate learning into practice. Staff economy was characterised by staff changes and shortages. There was significant interaction between the themes, with staff economy emerging as a central barrier to research. The results directly informed adaptations to the trial protocol.ConclusionsAn ethnographic approach has provided important insights into the individual, practical and organisational boundaries into which a trial would need to be implemented.

Purpose Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors’ knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service. Practical implications Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a “healthy” level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people’s functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value This paper evaluates a young person’s functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England.

An evaluation of a primary care counselling service was conducted. Measures completed by clients were the CORE questionnaire (assessing subjective well-being, symptoms, functioning and risk) and the DIS(BI) (Swartz et al., 1990) identifying cluster B personality disorders. Counsellors' written accounts of the benefits gained in therapy by their clients were also collected. At assessment, it was found that mean scores on the CORE questionnaire suggested the client group was experiencing similar levels of distress as those who attend other psychotherapy services; 50% of clients satisfied the DIS(BI) criterion for cluster B personality disorder. After therapy, there was a significant decrease in scores on all the subscales of the CORE questionnaire. Although those who scored above the criterion on the DIS(BI) indicating a personality disorder had significantly worse scores on the CORE at both pre and post therapy, as a group they nonetheless gained significant benefits from the counselling service. A content analysis method was utilised, based on previous thematic analyses of experiential therapies, to explore the counsellors' perceptions of the benefits of counselling for their clients. Counsellors perceived their clients as having changed in their experience of themselves or of their relationships and to have benefited from a safe, validating and supportive relationship. These benefits therefore relate to person-centred theory in which the counsellors were trained.

Background: Anorexia Nervosa is a severe mental illness most commonly occurring during adolescence. As a parent, caring for a child with Anorexia Nervosa can quickly consume all aspects of family life, leading to frustration, feelings of burden and increased levels of anxiety and depression. Despite the impact of the illness on parents, there is a surprising lack of literature drawing on parents perspectives of recovery, particularly during adolescence.

The aim of this research was to explore the phenomenon of missed appointments in child and adolescent mental health services (CAMHS). It explored how clinicians experience and make sense of non-attendance by assimilating organisational and therapeutic perspectives.

This article discusses some of the issues and challenges of using CHI-ESQ in an NHS trust and ways used to improve its use.

Background In 2017, the Children and Young People’s Improving Access to Psychological Therapies (CYP-IAPT) project was extended to deliver low-intensity Cognitive Behavioural Therapy (CBT), delivered by Children’s Wellbeing Practitioners (CWPs), but to date evaluation is sparse. Aims To evaluate low-intensity interventions delivered by trainee CWPs for the treatment of anxiety and depression in a child and adolescent mental health service (CAMHS). Method The evaluation adopted a quantitative, within-subjects, cross-sectional design. The outcome measures of 98 service users aged 8–17 years were included in the evaluation. Service users were children and young people accessing CAMHS in the North East of England. Outcome measures included the Revised Children’s Anxiety and Depression Scale (RCADS-47) and Goal Based Outcomes (GBOs). Descriptive data relating to the types of interventions used and outcomes following CWP involvement were also explored. Results Analysis of pre and post intervention data highlighted significant reduction in symptomatology across all RCADS subscales and composite total scales, and significant goal progress as measures by GBO’s. Effect sizes ranged from moderate to large ( d = 0.75 – 0.90) across all subscales of the RCADS. Large effect sizes were found for depression, total anxiety and total RCADS scores ( d = 0.86, d = 1.12, d = 1.14), and GBOs ( d = −1.33). Conclusions Findings support the potential value of low intensity CBT interventions delivered by CWPs in reducing anxiety and depression in this population. Recommendations for the development of the CWP role and CWP services are discussed.

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