Due to the paucity of high-quality data and considerable inconsistency in results from different studies, there is currently insufficient evidence to reach any firm conclusions regarding the role of client feedback in psychological therapies for children and adolescents with mental health problems, and further research on this important topic is needed.Future studies should avoid risks of performance, detection and attrition biases, as seen in the studies included in this review. Studies from countries other than the USA are needed, as well as studies including children younger than 10 years.
Introduction: Over the last decades, many Western countries have seen an increase in mental health difficulties in the adolescent population. Among Norwegian adolescents, internalizing symptoms are most prevalent, and 10%-38% of adolescents seek out primary health care services for mental health problems. This study examined whether an idiographic measure designed for adolescents called Assert, which uses variables individually selected by the adolescents, could improve user involvement, locus of control, mental health, and quality of life. Methods: This study conducted a randomized controlled effectiveness trial using Assert in primary healthcare. A community sample of 150 Norwegian adolescents aged 12-23 years (M= 16.2; SD = 2.2) were randomized to the Assert or control group. Of the participants 27 (18%) were male. The adolescents and 52 counsellors from primary healthcare services responded to online questionnaires. Of the counselors, 92.8% were female and trained in the use of systematic idiographic assessment. Results: Adolescents who used Assert scored significantly lower on external LoC, attributing less of their mental health improvement to chance, fate, or luck. However, the intervention showed no effect on the symptoms of mental health, QoL, or user involvement. Conclusions: Using Assert in primary healthcare may enhance adolescents' sense of being able to influence their life circumstances and mental health by allowing them more control of their treatment. However, this approach might not be successful in reducing symptoms."What Matters to You?": A Randomized Controlled Effectiveness Trial, Using Systematic Idiographic Assessment as an Intervention to Increase Adolescents' Perceived Control of their Mental Health.Of all mental illnesses diagnosed in adults, 75% has its onset in adolescence (Ruiz & Primm, 2010). In the last few decades, many Western countries have seen a trend of increasing mental health difficulties in adolescents (Kim & Hagquist, 2018) and a higher prevalence of emotional disorders, especially among young women (Collishaw, 2015). These trends also manifest in Norway, where about 6% of boys and 19.7% of girls experience significant self-reported mental health problems; these figures have increased by about 4% since 2011 (Bakken, 2017). According to a Norwegian national survey, 15.2% of high school-age adolescents were troubled by symptoms of depression (Bakken, 2019). Among high school students, 34%-38% visited a school health nurse in 2017, and 10%-20% visited a low threshold adolescent health clinic (
Purpose: This article aims to explore counsellor experiences using an idiographic assessment procedure implemented in adolescent mental health services. The procedure, Assert, is based on asking the adolescents the question "What matters to you?" to define important topics to address in treatment. Methods: Focus groups and interviews were conducted with counsellors who used Assert (N = 27), and the data were analysed with thematic analysis. Results: Five themes were identified: (a) "What Matters to You?" (b) "Professional Responsibility," (c) "Empowering the Adolescent," (d) "Practical Utility of Assert in Treatment," and (e) "The Implementation of Assert." Each theme had a number of associated sub-themes. Conclusions: Assert was perceived by the counsellors as enhancing collaboration and conveying to the adolescents that the counsellors took their concerns seriously. It also provided structure by giving the sessions a concrete focus. However, some counsellors found it difficult to surrender control to the adolescents, and finding a balance between helping and directing the adolescents to define topics could be challenging at times. Assert was generally considered a useful and simple way to assess adolescents' concerns, and it was accepted by the counsellors as a positive contribution to their existing methods.
Background Adolescents’ self-defined concerns about their mental health are understudied. Yet gaining insight into the individual concerns of this group could be helpful in providing better services to the adolescent population. In this study, an idiographic procedure called Assert was used to increase our knowledge of which concerns are reported by adolescents as the most salient, in a primary mental health care situation. Method 231 unique concerns were reported by 70 adolescents in a primary mental health context in Norway. These concerns were analysed qualitatively by a group of experts, to define categories. The distribution of these categories, and differences in gender and age, were analysed quantitatively. The alleviation experienced on the subjective concerns over the course of counselling was measured. Two linear multilevel models were analysed, to examine whether alleviation on self-defined concerns, as measured with Assert, differed-based on the main category of the concern or the number of times Assert was used. Results Three main categories of concerns emerged, related to (1) Self, (2) Relationships and (3) Life domains; as well as nine sub-categories: (1a) Autonomy, (1b) Mental health, (1c) Somatic health, (2a) Improving of relationships, (2b) Feeling safe from people around them, (2c) Taking responsibility for others, (3a) School, (3b) Work and (3c) Spare time. Girls reported fewer Life domain concerns than boys. Younger adolescents (12–16) more frequently reported no Self concerns, and older adolescents (17–23) more frequently reported no Relationship concerns. The adolescents felt less bothered by their subjective concerns after counselling, and there were some differences in alleviation depending on the category of concern. Conclusions The adolescents defined their own concerns at the start of counselling and were less troubled by these concerns after counselling. The content of the concerns might suggest that these adolescents experienced a need to improve across several arenas: personal, relational and academic. Research to extend the current study, to understand individual adolescent concerns, should include contextual and social factors and personal characteristics—and explore how counselling interventions can best help alleviate these personal concerns.
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