Re-Accessing Community Mental Health Services for Children and Adolescents

Pathways into Child and Adolescent Psychiatry

“…The proportion of re-referral to CAMHS found in this research project is slightly higher, but comparable to previous findings from the UK and Canada which found rereferral rates of 30% 82,148 . Studies investigating in-patient CAMHS have found oneyear re-admission rates between 10 and 38% [149][150][151][152] .…”

“…Based on this PhD project it is not possible to determine the intervals between rereferrals. Reid et al investigated time between service contacts with community CAMHS and found a median duration between first and second service contact of 638.8 days (SD 377.6) 154 while another study found a median time to renewed contact of 13 months 148 . For in-patient clinical populations demographic, clinical, family and treatment characteristics have been found to predict re-admission 151 .…”

“…Fontanella found that adolescents discharged to lower levels of care were more likely to be readmitted 151 and Yampolskaya et al found that timing of services was crucial in preventing re-admission 152 . The only existing study examining predictors of re-access to out-patient CAMHS found that younger age at first contact, a medium level of care from CAMHS, and high parental burden, was associated with higher odds of reaccess to CAMHS 148 . These findings indicate that part of the high re-referral rate may be explained by suboptimal service provision either by CAMHS or by services in primary settings following initial CAMHS assessment.…”

“…This was not possible within this PhD project. In contrast to the extensive research on predictors of initial service contact, there is a paucity of research investigating predictors of recurrent use of outpatient CAMHS 148 . The high proportion of re-referrals is probably partly explained by the natural history of child mental health problems 155,200 .…”

“…However, there is a lack of research on the optimal organization of services for children with repeated need for referral to CAMHS 200 . Research on predictors of in-patient CAMHS re-admission 151,152 as well as the few studies conducted on outpatient services 148,200 suggest that factors related to services and the timing of service provision after contact with CAMHS might be associated with rereferral to outpatient CAMHS. If this is true, then optimization of service provision following initial contact with CAMHS could potentially contribute to lowering referral rates to CAMHS.…”