Close
High integrity mental health services for children: focusing on the person, not the problem by Miranda Wolpert, Panos Vostanis, Kate Martin, Simon Munk, Rachael Norman, Peter Fonagy and Amy Feltham
High integrity healthcare emphasises that more services do not guarantee more health, that clinical evidence alone should not determine treatment, and that healthcare is best delivered by including non-health professionals. The authors consider these three principles and look at the way forward for provision of mental health services for children.
You can also listen to a related podcast about high integrity healthcare with authors Miranda Wolpert and Amy Feltham, and Clare Rowland, a volunteer from the Pause Centre in Birmingham.
Goal formulation and tracking in child mental health settings: when is it more likely and is it associated with satisfaction with care? by Jenna Jacob, Davide De Francesco, Jessica Deighton, Duncan Law, Miranda Wolpert and Julian Edbrooke-Childs
Q&A with senior author, Julian Edbrooke-Childs
What did this research aim to find out?
Goal formulation has been used in mental health settings in the UK and the US for some time, and is seen as important in evidence-based practice. However, little is known about this approach in children’s therapy.
Specifically, we wanted to find out whether setting goals with patients, and keeping track of the goals, was more likely with certain children and young people – and whether setting goals and keeping track of them meant that patients’ parents were more satisfied with the care their children received.
How did you investigate this?
We looked at 3,757 cases from 32 child mental health services and used the Goal-based Outcomes (GBOs) tool and the Experience of Service Questionnaire (ESQ). The GBO tool measures progress towards goals which have been agreed and set by practitioners, children and parents. The ESQ asks 12 questions about the support received and is completed by parents.
We then used two statistical methods: a multilevel logistic regression to look at the goal setting against children’s characteristics, and a Poisson regression to look at the difference between parents who were completely satisfied with care, and the parents who were not completely satisfied with care.
What did you find?
We found that formulating goals was more likely for pre-schoolers, those with learning difficulties, or those with both hyperactivity disorder and conduct disorder.
With regard to whether parents were more likely to be satisfied with their child’s care if goals were set and tracked, we found that parents of children where this had occurred were more likely to report that they were completely satisfied with the service.
What does this mean?
The findings suggest that goal formulation and tracking might be important in patient satisfaction with care. We would recommend that clinicians consider using goal formulation and track the goals with their patients, as it seems to promote collaboration. We would also highlight the need for better training in goal formulation and setting, in order to make sure that more children and parents can be worked with in this way.
You can read the goal formulation article in full.
Service-level variation, patient-level factors and treatment outcome in those seen by child mental health services by Julian Edbrooke-Childs, Amy Macdougall, Daniel Hayes, Jenna Jacob, Miranda Wolpert and Jessica Deighton, published in January 2017
Q&A with lead author, Julian Edbrooke-Childs
What did this research aim to find out?
The research aimed to find out whether child mental health outcomes varied across different mental health services. Comparing the outcome of treatment across services is a priority in healthcare in order to find out the impact and quality of the service, and because it is important to be able to demonstrate what the service is achieving – to secure future funding, for example.
We also wanted to find out whether there were particular characteristics of patients which were associated with the difference in the services.
How did you investigate this?
We had a sample of 3,256 young people from 13 child mental health services. Their parents had completed a commonly used questionnaire, the Strength and Difficulties Questionnaire. We applied a statistical method, multilevel regression, to the scores on the questionnaire in order to examine service level variation and whether this was explained by the demographics and characteristics of the patients.
What did you find?
We found that there was a slight variation in outcomes (4–5%) and that children with autism – and less common characteristics (termed ‘infrequent cases characteristics’), such as substance misuse, had a greater risk of poor outcomes.
What does this mean?
Although the findings showed variation between services, it is important to treat these cautiously. This is because there appears to be more variation between patients than between the child mental health services. For this reason, we would recommend using methods which account for differences across services, such as funnel plots.
We should also be particularly careful when looking at services with high proportions of young people with autism, or less common characteristics, who require specialist input. It may appear that these services are performing less well than other services, when the differences may be because of the patients’ characteristics.
You can read the service-level variation article in full.