Purpose This paper aims to report a non-randomized control study undertaken to investigate preval... more Purpose This paper aims to report a non-randomized control study undertaken to investigate prevalence and correlates of conduct disorder among male secondary education students in South-West Nigeria and to assess the impact of a problem-solving skills and attributional retraining (PSSAR) intervention with this population. Design/methodology/approach In total, 787 male students from two schools were screened for conduct disorder. All participants who met criteria for the disorder were allocated to either treatment (n = 55) or control (n = 47) groups. Outcome measures comprised the strengths and difficulties questionnaire (SDQ; teacher and student versions) and the teacher rating of students’ aggressive behaviors. Findings Of the sample, 13% were found to present with difficulties that met criteria for conduct disorder. The presence of these difficulties correlated with several demographic variables, including parental conflict and alcohol use. A statistically significant reduction in mean scores was observed for the treatment group in the student rating of the SDQ emotional subscale and total difficulties scores. Teacher ratings were less consistent in that conduct problems, prosocial behavior and total difficulties increased following the intervention, whereas peer problems and aggressive behavior were reported by teachers to reduce. No statistically significant change was found in the outcome measures for the control group. Practical implications In resource-constrained settings, school-based interventions are an important means through which treatment gaps in child and adolescent mental health can be addressed. Originality/value In resource-constrained settings, school-based interventions are an important means through which treatment gaps in child and adolescent mental health can be addressed. This study’s findings offer some preliminary support for the PSSAR intervention for conduct disorder in this context and indicate areas for further research.
Background: Unaccompanied refugee minors present with disproportionately high prevalence of emoti... more Background: Unaccompanied refugee minors present with disproportionately high prevalence of emotional and psychological morbidities. However, their utilization of mental health services has been shown to be significantly poorer than the indigenous population of the country they seek asylum in. Despite this, there is limited research exploring their perspectives on the barriers they face. Aims: This research aims to understand unaccompanied refugee minors' and their carers' perceptions of the barriers to utilize mental health services and to explore issues perceived to be related to poor engagement with services. Methods: Semi-structured interviews with fifteen unaccompanied refugee minors and their carers were conducted. This was to elicit their views, perceptions and beliefs based on their experience of receiving treatment from a specialist mental health service in the UK. Results: Thematic analysis was used and the findings were categorised into two broad themes; the participants' perceptions of the intervention and perceptions of the professionals. Salient aspects of these are discussed. Conclusions: The findings have potential to stimulate further research into gaining a better understanding of the barriers these young people face in accessing help, and may contribute to developing services that are more efficient in engaging this vulnerable group and meeting their specific needs.
Is autism a disability? Fundamentally, this question also raises additional questions, including:... more Is autism a disability? Fundamentally, this question also raises additional questions, including: What is a disability? Who makes the definition valid? What function does such a label serve within society? The answers are perhaps dependent upon varied points of view and affiliations with particular theoretical frameworks. Indeed, there has been inconsistency regarding the terminology that has been utilised, with this terminology continuing to evolve. In the latest incarnation of autism in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), autism has been defined as Autism Spectrum Disorder (ASD) (American Psychiatric Association, 2013), while other terms are still used within the International Classification of Diseases (ICD). Controversially, the diagnostic label of ‘Asperger’s Syndrome’ has been removed from DSM-5.
Central to a contemporary understanding of childhood is the developmental and clinicalmedical con... more Central to a contemporary understanding of childhood is the developmental and clinicalmedical construct of the 'normal' child. When judged to fall outside of culturally, socially and historically situated parameters of 'normality', children become labelled as 'deviant from the norm'; for instance, in mental health contexts where this may provide the basis for psychiatric diagnosis. However, judgements of a child's 'normality' are further complicated by the range of individuals who may have a stake in that construction, including parents/carers, professionals and the child themselves. Using discursive psychology, we analysed 28 video-recorded UK child mental health assessments, to examine ways that parents presented concerns about their children's development. They did this by drawing on notions of 'ab/normal', in ways that functioned to legitimise their need for services and built a rhetorical case to demonstrate clinical need; often by contrasting the child with other 'typical' children and/or contrasting the same child's behaviour in different settings or contexts. We concluded that given the growing crisis in child mental health, initial assessments play a crucial clinical role in determining diagnosis and labelling, and therefore a critical discussion of these concepts and processes is essential.
Research on children and social interaction, Dec 18, 2017
Questions form the basis of mental health assessments and yet there is limited empirical evidence... more Questions form the basis of mental health assessments and yet there is limited empirical evidence about the linguistic structure of question formats in these clinical environments. While many types of questions are used, the focus of this research was on why-prefaced questions with children. Interaction analysis was employed to interrogate the data, paying specific attention to the interactional organisation of how 'why-prefaced' questions were asked and responded to. Analysis demonstrated that when three core components were present in the question, then it was usual for a reason/explanation to be provided in response, and when one or more component was missing, it rarely elicited a reason or explanation in response. The three components were the sequential position of the question, how the question was indexically tied to the child's prior statement, and the epistemic domain of the question. Implications for therapeutic communication and training were discussed.
Background The international growth of e-cigarette use has been accompanied by a corresponding co... more Background The international growth of e-cigarette use has been accompanied by a corresponding concern that e-cigarettes will act as a 'gateway' to smoking and the use of other drugs. Taking these concerns as our point of departure, we explore the relationships between vaping and smoking among a cohort of young people. Methods Qualitative longitudinal methods with a diverse sample of 36 14-18-year olds from the UK city of Leicester. A total of 66 depth interviews conducted across two phases separated by 6-12 months. The interviews were recorded, transcribed verbatim and thematically analysed. Findings We highlight a complex 'tangle' of connections between substances/risk behaviours recounted to us by our adolescent study participants, including multiple and multilinear relationships between vaping and smoking. These findings problematise some of the core axioms of the notion of gateways as an explanatory model of causality and sequential connection between smoking and vaping. They also throw into question gateway logics more fundamentally. While many of our study participants themselves consciously invoked ideas of 'gateway effects', the accounts they produced repeatedly disrupted the logics of connection (between e-cigarettes and smoking; one set of behaviours and another) presupposed in gateway theory and our own early lines of questioning. Accordingly, we explore how cultural understandings of gateway effects are invoked by users in accounting for their vaping and smoking behaviours, noting the potential influence of these ideas upon the very processes they are understood to apprehend. Conclusion Our findings suggest there is a case to be made to reinforce the distinctiveness of tobacco and e-cigarettes in the life-worlds of young people to avoid naturalising a 'gateway' logic of connection that might ultimately inform the associative logic of young users themselves, and potentially the development of their usage careers.
Integral to the diagnosis of autism spectrum disorder is the initial assessment through which the... more Integral to the diagnosis of autism spectrum disorder is the initial assessment through which the existence of a ‘problem’ is first ascertained. Despite this, there remains limited research on this early part of the diagnostic pathway. In this article, we utilised conversation analysis to examine relevant issues in relation to the practitioner–family interactions that take place within this initial assessment context. Our findings illustrated that parents typically first raised the possibility of the presence of an autism spectrum disorder diagnosis through ‘building a case’, which professionals were then able to ratify or negate. Furthermore, we found that the assessments unfolded sequentially and clinical decisions were typically reached through a distinctive pattern of interaction. These findings have important implications for clinical practice, including for the study of autism spectrum disorder assessments and diagnosis.
BackgroundThe mental health assessment is a fundamental aspect of clinical practice and central t... more BackgroundThe mental health assessment is a fundamental aspect of clinical practice and central to this is the use of questions.AimsTo investigate the frequency and type of questions utilised within a child mental health assessment.MethodThe data consisted of 28 naturally occurring assessments from a UK child and adolescent mental health service. Data were analysed using quantitative and qualitative content analysis to determine frequencies and question type.ResultsResults indicated a total of 9086 questions in 41 h across the 28 clinical encounters. This equated to a mean of 3.7 questions per minute. Four types of questions were identified; yes–no interrogatives, wh-prefaced questions, declarative questions and tag questions.ConclusionsThe current format of questioning may impede the opportunity for families to fully express their particular concerns and this has implications for service delivery and training.
The opposing positions of the social model of disability and the biomedical framework of impairme... more The opposing positions of the social model of disability and the biomedical framework of impairment have created tensions regarding what constitutes ‘normality’. In this article, we drew upon focus group data of parents, professionals, and people with autism, to explore how the dilemmatic tensions of normality and abnormality and of disability and ability were managed. Our findings illustrate how the boundaries of normality in relation to autism are blurred, as well as how the autistic identity is fluid. The members of the focus group invoked their epistemic rights to assert their positions and delicately considered the limitations of the rhetoric of cure. Our findings have implications for professionals working with families of children with autism, specifically as they aim to maintain a balance between providing sufficient support and not being intrusive, and we show how a medical sociology can facilitate an understanding of autism as a social category.
Recent initiatives have emphasized the ongoing need to include children in healthcare research, w... more Recent initiatives have emphasized the ongoing need to include children in healthcare research, which is relevant to the development of both paediatric and mental healthcare services. Our aim was to contribute children and their parents' perceptions and experiences of Child and Adolescent Mental Health Services (CAMHS), with the objective of providing guidance for those wishing to improve inclusivity and empowerment. We performed a thematic analysis of interview data taken from 11 children (9 boys, 2 girls, aged 8-12) and their parents (12 mothers, 2 fathers), who had recently been referred to CAMHS for mental health and educational problems. Three core themes emerged from the data. Fear of the unknown refers to emotional apprehension due to uncertainty of what happens in CAMHS. However children also provided useful reassurances for future service users. Therapeutic engagement refers to the importance of being listened to and building up good relationships with professionals. Fi...
Background: A comprehensive assessment is essential to contemporary practice in child and adolesc... more Background: A comprehensive assessment is essential to contemporary practice in child and adolescent mental health. In addition to determining diagnosis and management, it is seen as important for clinical engagement and forming a therapeutic relationship. However, there has been little research on the processes which occur during this interaction, particularly in first assessments. Method: Twenty-eight naturally occurring child mental health initial assessments were video recorded and subjected to the basic principles of the conversation analytic method. Results: Several processes were identified in a typical child and adolescent mental health assessment. These included introductions, reasons for attendance, problem presentation, decision-making and session closure. Conclusions: Initial assessments provide a platform for all future engagement with services and an understanding of the processes occurring within this setting is important for the eventual outcomes, particularly in respect to new ways of working such as the Choice and Partnership Approach (CAPA).
International Journal of Social Research Methodology, 2012
There is considerable debate around the application of ethical principles and the notion of risk ... more There is considerable debate around the application of ethical principles and the notion of risk in qualitative research, and as such it is becoming increasingly important that we have empirical evidence to draw upon to contribute to these arguments. In this article, we use discourse analysis to look at what Child and Adolescent Mental Health Service users think about the role of anonymity in research. We consider the viewpoints of children and their parents to look at how necessary this ethic is and whether there is a possibility that a choice could or should be offered to those participating. Our findings demonstrate variability in perspectives and differences between parent and child views. Our findings highlight that a single approach to qualitative research ethics does not fit all people, and we consider the wider implications of offering choices in research contexts.
The objective of the present study was to establish the psychosocial characteristics and perspect... more The objective of the present study was to establish the psychosocial characteristics and perspectives of 49 consecutive homeless families who received input from a new designated family support worker (FSW) post at a large statutory hostel for homeless parents and children. The FSW provided: assessment of social, educational and health needs; support and parent training; and liaison with and referral to specialist services. Measures included quantitative questionnaires (i.e. the Hospital Anxiety and Depression Scale, the Parenting Daily Hassles Scale, the Eyberg Child Behaviour Inventory, and the Health of the Nation Outcome Scales for Children and Adolescents), and a qualitative (semistructured) interview on service experiences and satisfaction. The psychosocial measures indicated high rates of parenting difficulties, mental health and related needs among children and their parents. Parenting difficulties were associated with child behaviour problems. Parents expressed satisfaction with the service whilst they were residents at the hostel, but they were often not clear about the objectives of agencies and interventions. Family support interventions have a key role in service provision for homeless and other vulnerable families by providing direct parenting interventions and ensuring that specialist agencies are appropriately involved. Family support worker involvement needs to continue when families are re-housed in the community.
Self-harm in young people is a common presentation to mental health services. There is little lit... more Self-harm in young people is a common presentation to mental health services. There is little literature, however, on how professionals view their role and the role of others within the assessment of these young people, and the relative accountability. This study explored Child and Adolescent Mental Health Services (CAMHS) professionals’ views of these roles utilising a qualitative framework. The interviews of 18 CAMHS professionals from different disciplines were analysed using a thematic approach. Findings showed participants to be clear regarding the remit of their own role and the purpose of the assessment process, but were less confident in the abilities of those outside their service. They commented on the ongoing problems of stigma in this area and the difficulties with multi-agency working. Findings suggested possible ways to ameliorate these problems; however, the current economic climate may not be conducive to this.
Journal of Psychiatric and Mental Health Nursing, 2016
In community psychiatric nursing, asking questions about risk is a fundamental part of the mental... more In community psychiatric nursing, asking questions about risk is a fundamental part of the mental health assessment. This paper examines actual assessments in a Child and Adolescent Mental Health (CAMH) community setting, with a focus on the ways that questions about self-harm and suicidal ideation were composed. The research highlights the issue that in many cases self-harm and suicide questions were not routinely asked. Of those that were a particular way of asking was found to be successful. The relevance to psychiatric nursing practice is to demonstrate how to introduce conversations about self-harm and suicide with children and young people.
Integral to the diagnosis of autism spectrum disorder (ASD) is the initial assessment through whi... more Integral to the diagnosis of autism spectrum disorder (ASD) is the initial assessment through which the existence of a ‘problem’ is first ascertained. Despite this, there remains limited research on this early part of the diagnostic pathway. In this paper, we utilised conversation analysis to examine relevant issues in relation to the practitioner-family interactions that take place within this initial assessment context. Our findings illustrated that parents typically first raised the possibility of the presence of an ASD diagnosis through ‘building a case’, which professionals were then able to ratify or negate. Further, we found that the assessments unfolded sequentially and clinical decisions were typically reached through a distinctive pattern of interaction. These findings have important implications for clinical practice, including for the study of ASD assessments and diagnosis.
Questions form the basis of mental health assessments and yet there is limited empirical evidence... more Questions form the basis of mental health assessments and yet there is limited empirical evidence about the linguistic structure of question formats in these clinical environments. While many types of questions are used, the focus of this research was on why-prefaced questions asked to children. Interaction analysis was employed to interrogate the data, paying specific attention to the interactional organisation of how ‘why-prefaced’ questions were asked and responded to. Analysis demonstrated that when three core components were present in the question, then it was usual for a reason/ explanation to be provided in response, and when one or more components were missing, it rarely elicited a reason or explanation in response. The three components were; the sequential position of the question, how the question was indexically tied to the child’s prior statement, and the epistemic domain of the question. Implications for therapeutic communication and training were discussed.
The Palgrave Handbook of Child Mental Health, 2015
Is autism a disability? Fundamentally, this question also raises additional questions, including:... more Is autism a disability? Fundamentally, this question also raises additional questions, including: What is a disability? Who makes the definition valid? What function does such a label serve within society? The answers are perhaps dependent upon varied points of view and affiliations with particular theoretical frameworks. Indeed, there has been inconsistency regarding the terminology that has been utilised, with this terminology continuing to evolve. In the latest incarnation of autism in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), autism has been defined as Autism Spectrum Disorder (ASD) (American Psychiatric Association, 2013), while other terms are still used within the International Classification of Diseases (ICD). Controversially, the diagnostic label of ‘Asperger’s Syndrome’ has been removed from DSM-5.
Purpose This paper aims to report a non-randomized control study undertaken to investigate preval... more Purpose This paper aims to report a non-randomized control study undertaken to investigate prevalence and correlates of conduct disorder among male secondary education students in South-West Nigeria and to assess the impact of a problem-solving skills and attributional retraining (PSSAR) intervention with this population. Design/methodology/approach In total, 787 male students from two schools were screened for conduct disorder. All participants who met criteria for the disorder were allocated to either treatment (n = 55) or control (n = 47) groups. Outcome measures comprised the strengths and difficulties questionnaire (SDQ; teacher and student versions) and the teacher rating of students’ aggressive behaviors. Findings Of the sample, 13% were found to present with difficulties that met criteria for conduct disorder. The presence of these difficulties correlated with several demographic variables, including parental conflict and alcohol use. A statistically significant reduction in mean scores was observed for the treatment group in the student rating of the SDQ emotional subscale and total difficulties scores. Teacher ratings were less consistent in that conduct problems, prosocial behavior and total difficulties increased following the intervention, whereas peer problems and aggressive behavior were reported by teachers to reduce. No statistically significant change was found in the outcome measures for the control group. Practical implications In resource-constrained settings, school-based interventions are an important means through which treatment gaps in child and adolescent mental health can be addressed. Originality/value In resource-constrained settings, school-based interventions are an important means through which treatment gaps in child and adolescent mental health can be addressed. This study’s findings offer some preliminary support for the PSSAR intervention for conduct disorder in this context and indicate areas for further research.
Background: Unaccompanied refugee minors present with disproportionately high prevalence of emoti... more Background: Unaccompanied refugee minors present with disproportionately high prevalence of emotional and psychological morbidities. However, their utilization of mental health services has been shown to be significantly poorer than the indigenous population of the country they seek asylum in. Despite this, there is limited research exploring their perspectives on the barriers they face. Aims: This research aims to understand unaccompanied refugee minors' and their carers' perceptions of the barriers to utilize mental health services and to explore issues perceived to be related to poor engagement with services. Methods: Semi-structured interviews with fifteen unaccompanied refugee minors and their carers were conducted. This was to elicit their views, perceptions and beliefs based on their experience of receiving treatment from a specialist mental health service in the UK. Results: Thematic analysis was used and the findings were categorised into two broad themes; the participants' perceptions of the intervention and perceptions of the professionals. Salient aspects of these are discussed. Conclusions: The findings have potential to stimulate further research into gaining a better understanding of the barriers these young people face in accessing help, and may contribute to developing services that are more efficient in engaging this vulnerable group and meeting their specific needs.
Is autism a disability? Fundamentally, this question also raises additional questions, including:... more Is autism a disability? Fundamentally, this question also raises additional questions, including: What is a disability? Who makes the definition valid? What function does such a label serve within society? The answers are perhaps dependent upon varied points of view and affiliations with particular theoretical frameworks. Indeed, there has been inconsistency regarding the terminology that has been utilised, with this terminology continuing to evolve. In the latest incarnation of autism in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), autism has been defined as Autism Spectrum Disorder (ASD) (American Psychiatric Association, 2013), while other terms are still used within the International Classification of Diseases (ICD). Controversially, the diagnostic label of ‘Asperger’s Syndrome’ has been removed from DSM-5.
Central to a contemporary understanding of childhood is the developmental and clinicalmedical con... more Central to a contemporary understanding of childhood is the developmental and clinicalmedical construct of the 'normal' child. When judged to fall outside of culturally, socially and historically situated parameters of 'normality', children become labelled as 'deviant from the norm'; for instance, in mental health contexts where this may provide the basis for psychiatric diagnosis. However, judgements of a child's 'normality' are further complicated by the range of individuals who may have a stake in that construction, including parents/carers, professionals and the child themselves. Using discursive psychology, we analysed 28 video-recorded UK child mental health assessments, to examine ways that parents presented concerns about their children's development. They did this by drawing on notions of 'ab/normal', in ways that functioned to legitimise their need for services and built a rhetorical case to demonstrate clinical need; often by contrasting the child with other 'typical' children and/or contrasting the same child's behaviour in different settings or contexts. We concluded that given the growing crisis in child mental health, initial assessments play a crucial clinical role in determining diagnosis and labelling, and therefore a critical discussion of these concepts and processes is essential.
Research on children and social interaction, Dec 18, 2017
Questions form the basis of mental health assessments and yet there is limited empirical evidence... more Questions form the basis of mental health assessments and yet there is limited empirical evidence about the linguistic structure of question formats in these clinical environments. While many types of questions are used, the focus of this research was on why-prefaced questions with children. Interaction analysis was employed to interrogate the data, paying specific attention to the interactional organisation of how 'why-prefaced' questions were asked and responded to. Analysis demonstrated that when three core components were present in the question, then it was usual for a reason/explanation to be provided in response, and when one or more component was missing, it rarely elicited a reason or explanation in response. The three components were the sequential position of the question, how the question was indexically tied to the child's prior statement, and the epistemic domain of the question. Implications for therapeutic communication and training were discussed.
Background The international growth of e-cigarette use has been accompanied by a corresponding co... more Background The international growth of e-cigarette use has been accompanied by a corresponding concern that e-cigarettes will act as a 'gateway' to smoking and the use of other drugs. Taking these concerns as our point of departure, we explore the relationships between vaping and smoking among a cohort of young people. Methods Qualitative longitudinal methods with a diverse sample of 36 14-18-year olds from the UK city of Leicester. A total of 66 depth interviews conducted across two phases separated by 6-12 months. The interviews were recorded, transcribed verbatim and thematically analysed. Findings We highlight a complex 'tangle' of connections between substances/risk behaviours recounted to us by our adolescent study participants, including multiple and multilinear relationships between vaping and smoking. These findings problematise some of the core axioms of the notion of gateways as an explanatory model of causality and sequential connection between smoking and vaping. They also throw into question gateway logics more fundamentally. While many of our study participants themselves consciously invoked ideas of 'gateway effects', the accounts they produced repeatedly disrupted the logics of connection (between e-cigarettes and smoking; one set of behaviours and another) presupposed in gateway theory and our own early lines of questioning. Accordingly, we explore how cultural understandings of gateway effects are invoked by users in accounting for their vaping and smoking behaviours, noting the potential influence of these ideas upon the very processes they are understood to apprehend. Conclusion Our findings suggest there is a case to be made to reinforce the distinctiveness of tobacco and e-cigarettes in the life-worlds of young people to avoid naturalising a 'gateway' logic of connection that might ultimately inform the associative logic of young users themselves, and potentially the development of their usage careers.
Integral to the diagnosis of autism spectrum disorder is the initial assessment through which the... more Integral to the diagnosis of autism spectrum disorder is the initial assessment through which the existence of a ‘problem’ is first ascertained. Despite this, there remains limited research on this early part of the diagnostic pathway. In this article, we utilised conversation analysis to examine relevant issues in relation to the practitioner–family interactions that take place within this initial assessment context. Our findings illustrated that parents typically first raised the possibility of the presence of an autism spectrum disorder diagnosis through ‘building a case’, which professionals were then able to ratify or negate. Furthermore, we found that the assessments unfolded sequentially and clinical decisions were typically reached through a distinctive pattern of interaction. These findings have important implications for clinical practice, including for the study of autism spectrum disorder assessments and diagnosis.
BackgroundThe mental health assessment is a fundamental aspect of clinical practice and central t... more BackgroundThe mental health assessment is a fundamental aspect of clinical practice and central to this is the use of questions.AimsTo investigate the frequency and type of questions utilised within a child mental health assessment.MethodThe data consisted of 28 naturally occurring assessments from a UK child and adolescent mental health service. Data were analysed using quantitative and qualitative content analysis to determine frequencies and question type.ResultsResults indicated a total of 9086 questions in 41 h across the 28 clinical encounters. This equated to a mean of 3.7 questions per minute. Four types of questions were identified; yes–no interrogatives, wh-prefaced questions, declarative questions and tag questions.ConclusionsThe current format of questioning may impede the opportunity for families to fully express their particular concerns and this has implications for service delivery and training.
The opposing positions of the social model of disability and the biomedical framework of impairme... more The opposing positions of the social model of disability and the biomedical framework of impairment have created tensions regarding what constitutes ‘normality’. In this article, we drew upon focus group data of parents, professionals, and people with autism, to explore how the dilemmatic tensions of normality and abnormality and of disability and ability were managed. Our findings illustrate how the boundaries of normality in relation to autism are blurred, as well as how the autistic identity is fluid. The members of the focus group invoked their epistemic rights to assert their positions and delicately considered the limitations of the rhetoric of cure. Our findings have implications for professionals working with families of children with autism, specifically as they aim to maintain a balance between providing sufficient support and not being intrusive, and we show how a medical sociology can facilitate an understanding of autism as a social category.
Recent initiatives have emphasized the ongoing need to include children in healthcare research, w... more Recent initiatives have emphasized the ongoing need to include children in healthcare research, which is relevant to the development of both paediatric and mental healthcare services. Our aim was to contribute children and their parents' perceptions and experiences of Child and Adolescent Mental Health Services (CAMHS), with the objective of providing guidance for those wishing to improve inclusivity and empowerment. We performed a thematic analysis of interview data taken from 11 children (9 boys, 2 girls, aged 8-12) and their parents (12 mothers, 2 fathers), who had recently been referred to CAMHS for mental health and educational problems. Three core themes emerged from the data. Fear of the unknown refers to emotional apprehension due to uncertainty of what happens in CAMHS. However children also provided useful reassurances for future service users. Therapeutic engagement refers to the importance of being listened to and building up good relationships with professionals. Fi...
Background: A comprehensive assessment is essential to contemporary practice in child and adolesc... more Background: A comprehensive assessment is essential to contemporary practice in child and adolescent mental health. In addition to determining diagnosis and management, it is seen as important for clinical engagement and forming a therapeutic relationship. However, there has been little research on the processes which occur during this interaction, particularly in first assessments. Method: Twenty-eight naturally occurring child mental health initial assessments were video recorded and subjected to the basic principles of the conversation analytic method. Results: Several processes were identified in a typical child and adolescent mental health assessment. These included introductions, reasons for attendance, problem presentation, decision-making and session closure. Conclusions: Initial assessments provide a platform for all future engagement with services and an understanding of the processes occurring within this setting is important for the eventual outcomes, particularly in respect to new ways of working such as the Choice and Partnership Approach (CAPA).
International Journal of Social Research Methodology, 2012
There is considerable debate around the application of ethical principles and the notion of risk ... more There is considerable debate around the application of ethical principles and the notion of risk in qualitative research, and as such it is becoming increasingly important that we have empirical evidence to draw upon to contribute to these arguments. In this article, we use discourse analysis to look at what Child and Adolescent Mental Health Service users think about the role of anonymity in research. We consider the viewpoints of children and their parents to look at how necessary this ethic is and whether there is a possibility that a choice could or should be offered to those participating. Our findings demonstrate variability in perspectives and differences between parent and child views. Our findings highlight that a single approach to qualitative research ethics does not fit all people, and we consider the wider implications of offering choices in research contexts.
The objective of the present study was to establish the psychosocial characteristics and perspect... more The objective of the present study was to establish the psychosocial characteristics and perspectives of 49 consecutive homeless families who received input from a new designated family support worker (FSW) post at a large statutory hostel for homeless parents and children. The FSW provided: assessment of social, educational and health needs; support and parent training; and liaison with and referral to specialist services. Measures included quantitative questionnaires (i.e. the Hospital Anxiety and Depression Scale, the Parenting Daily Hassles Scale, the Eyberg Child Behaviour Inventory, and the Health of the Nation Outcome Scales for Children and Adolescents), and a qualitative (semistructured) interview on service experiences and satisfaction. The psychosocial measures indicated high rates of parenting difficulties, mental health and related needs among children and their parents. Parenting difficulties were associated with child behaviour problems. Parents expressed satisfaction with the service whilst they were residents at the hostel, but they were often not clear about the objectives of agencies and interventions. Family support interventions have a key role in service provision for homeless and other vulnerable families by providing direct parenting interventions and ensuring that specialist agencies are appropriately involved. Family support worker involvement needs to continue when families are re-housed in the community.
Self-harm in young people is a common presentation to mental health services. There is little lit... more Self-harm in young people is a common presentation to mental health services. There is little literature, however, on how professionals view their role and the role of others within the assessment of these young people, and the relative accountability. This study explored Child and Adolescent Mental Health Services (CAMHS) professionals’ views of these roles utilising a qualitative framework. The interviews of 18 CAMHS professionals from different disciplines were analysed using a thematic approach. Findings showed participants to be clear regarding the remit of their own role and the purpose of the assessment process, but were less confident in the abilities of those outside their service. They commented on the ongoing problems of stigma in this area and the difficulties with multi-agency working. Findings suggested possible ways to ameliorate these problems; however, the current economic climate may not be conducive to this.
Journal of Psychiatric and Mental Health Nursing, 2016
In community psychiatric nursing, asking questions about risk is a fundamental part of the mental... more In community psychiatric nursing, asking questions about risk is a fundamental part of the mental health assessment. This paper examines actual assessments in a Child and Adolescent Mental Health (CAMH) community setting, with a focus on the ways that questions about self-harm and suicidal ideation were composed. The research highlights the issue that in many cases self-harm and suicide questions were not routinely asked. Of those that were a particular way of asking was found to be successful. The relevance to psychiatric nursing practice is to demonstrate how to introduce conversations about self-harm and suicide with children and young people.
Integral to the diagnosis of autism spectrum disorder (ASD) is the initial assessment through whi... more Integral to the diagnosis of autism spectrum disorder (ASD) is the initial assessment through which the existence of a ‘problem’ is first ascertained. Despite this, there remains limited research on this early part of the diagnostic pathway. In this paper, we utilised conversation analysis to examine relevant issues in relation to the practitioner-family interactions that take place within this initial assessment context. Our findings illustrated that parents typically first raised the possibility of the presence of an ASD diagnosis through ‘building a case’, which professionals were then able to ratify or negate. Further, we found that the assessments unfolded sequentially and clinical decisions were typically reached through a distinctive pattern of interaction. These findings have important implications for clinical practice, including for the study of ASD assessments and diagnosis.
Questions form the basis of mental health assessments and yet there is limited empirical evidence... more Questions form the basis of mental health assessments and yet there is limited empirical evidence about the linguistic structure of question formats in these clinical environments. While many types of questions are used, the focus of this research was on why-prefaced questions asked to children. Interaction analysis was employed to interrogate the data, paying specific attention to the interactional organisation of how ‘why-prefaced’ questions were asked and responded to. Analysis demonstrated that when three core components were present in the question, then it was usual for a reason/ explanation to be provided in response, and when one or more components were missing, it rarely elicited a reason or explanation in response. The three components were; the sequential position of the question, how the question was indexically tied to the child’s prior statement, and the epistemic domain of the question. Implications for therapeutic communication and training were discussed.
The Palgrave Handbook of Child Mental Health, 2015
Is autism a disability? Fundamentally, this question also raises additional questions, including:... more Is autism a disability? Fundamentally, this question also raises additional questions, including: What is a disability? Who makes the definition valid? What function does such a label serve within society? The answers are perhaps dependent upon varied points of view and affiliations with particular theoretical frameworks. Indeed, there has been inconsistency regarding the terminology that has been utilised, with this terminology continuing to evolve. In the latest incarnation of autism in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), autism has been defined as Autism Spectrum Disorder (ASD) (American Psychiatric Association, 2013), while other terms are still used within the International Classification of Diseases (ICD). Controversially, the diagnostic label of ‘Asperger’s Syndrome’ has been removed from DSM-5.
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Papers by Khalid Karim