2434 - Experiences of engaging with mental health services in 16-18 year olds: An interpretative phenomenological analysis
Dr. Alexander Hassett | Canterbury Christ Church University | United Kingdom
Dr. Siobhan Jones | Oxleas NHS Foundation Trust | United Kingdom
Objectives: Despite older adolescence being a risk period for the development of mental health concerns, engagement with mental health services is low amongst 16-18 year olds. As therapeutic attendance is linked to clinical outcome, it is important to understand engagement in this population. There is a paucity of research looking specifically at the older adolescent engagement phenomenon. Previous qualitative research into adolescent experiences has provided some rich and detailed results. The current study aimed to explore older adolescent sense-making of their engagement with mental health service experiences, barriers and facilitators, in order to contribute to a sparse understanding. Research questions were:
• What is the 16 to 18-year-old understanding of their experience of engaging in mental health services?
• What is their understanding of their experience of engagement facilitators and engagement barriers?
Method: Ten 16 to 18 years olds were recruited from two London-based Child and Adolescent Mental Health Services. Each young person was interviewed in order to understand their personal experience of engaging in mental health services, and associated engagement barriers and facilitators. Interviews were transcribed and underwent Interpretative Phenomenological Analysis.
Results: Analysis revealed twelve subthemes subsumed within five superordinate themes: engagement begins at help seeking, strength of inner resolve, evolution of the self, in the clinic room, and, existing within service walls: physical and policy-based boundaries. The interaction between theme is explored.
Conclusions: Conclusions are drawn in relation to previous theory and research. When considering 16-18 year understandings of the engagement phenomena, key elements include: clinician and service developmental appropriateness, negotiation of developmental tasks in relation to engagement, experience of the physical building environment, and awareness of service policy. Suggestions for clinical practice in relation to engagement facilitators and threat are made, and recommendations for future research proposed.
2597 - Transformation in the Dutch health system organisation from the perspective of Youth Team professionals.
Janna Eilander | Curium-LUMC | Netherlands
Laura Nooteboom | Curium-LUMC
Since January 2015, in the Netherlands, all care for children until age 18, including child psychiatry, is the responsibility of local communities. In order to optimise the entrance to care and to offer care close by families, local area teams, also called Youth Teams, have been created in most communities. The main goal of the Youth Teams is to support families in their self-management and provide customised help and support at an earlier stage. Five transformation goals are formulated that the teams need to accomplish.
- Improve prevention and strengthen the responsibility and capacities families and their social network.
- Strengthen the pedagogical climate.
- Offer earlier and customised care to reduce the cost of specialised care.
- Organise integrated care to families.
- Reduce pressure on and increase trust in professionals.
The Academic Workplace ‘Gezin aan Zet’ aims to support the Youth Teams in achieving these transformation goals, through developing a self-evaluation cycle, as an instrument to collect feedback, reflect and improve competencies of the Youth Team professionals. An inventory of effective and non-effective factors of the transformation will be made.
The project is based on action research, a research method that simultaneously aims to gain knowledge, while similarly directly changing or improving situations. Data is collected through qualitative and quantitative research methods, including semi-structured interviews, observations and a questionnaire.
- Knowledge of effective and non-effective factors of the youth teams, in relation to transformation goals to be achieved.
- Implementation of a self-evaluation cycle for the youth teams to increase their self-learning and managing abilities.
- Education modules for (future) professionals based on the findings from the first two results.
The focus of this project correspondents to the main topic of the 17th ESCAP Congress, transition and the organisational aspects of the transition in the child and adolescent mental health care, and will connect to the topic introduced by State of the Art speaker Prof. Dr. R. Vermeiren. The main focus of the presentation of the Academic Workplace ‘Gezin aan Zet’ will be on the meaning of the transformation goals and the new role of the professional in the Netherlands. Effective and non-effective factors of the transformation goals experienced by the Youth Team professionals will be discussed.
2778 - How can we provide better support to children whose parents are hospitalized in a psychiatric ward? /Comment mieux prendre en compte les enfants de patients suivis dans un service de psychiatrie adulte ?
Charlène Tripalo | Centre Hospitalier Universitaire Vaudois (CHUV) | Switzerland
Vanessa Baier | Centre Hospitalier Universitaire Vaudois (CHUV)
Observation: Professionals working in psychiatric wards are often asked to address the worries of patient’s relatives. We can observe that the children of patients are those most particularly exposed to their parents’ suffering, but that they are not yet sufficiently supported by those caring for their parents. Increased health risks to children, exposed to their parents mental health problems, have been clearly demonstrated. Further, parents have very few opportunities to share their concerns about their parenting.
Approach: Since 2015, a pilot has been conducted in the CHUV (University Hospital of Vaud) general psychiatric ward in Lausanne. This pilot concerns the reception and integration of the patients’ relatives, both adults and children. Within this institutional pilot, a survey has been conducted to determine how many children have a parent being followed due to a psychiatric disorder. A multidisciplinary working group was then created to brainstorm about what could be done to support the children better and to help the parents with their parenting.
Objectives: Raise the awareness of the psychiatric professionals for adults about the issues of patients children and take into account the patient’s parental responsibilities, independent of their proposed treatment.
Results: The survey showed that about 30% of patients undergoing a treatment within the CHUV general psychiatric ward are parents. Meaning that more than 300 children are concerned.
The working group identified 4 approaches: 1) Raising of awareness amongst psychiatric professionals about patients parental roles; 2) Creation of a room dedicated to families with young children; 3) Implementation of a group as an exchange point to discuss parenthood for the patients; 4) Reinforcement of inter-professional collaborations with partners providing support for children and parents.
Conclusion: This project involves a significant aspect of public health issue prevention. It is essential to lead the professionals of both child and adult care into a progressive change of their practices. We observed that it’s extremely important that these changes are supported by the hierarchy of the institution and that the whole process of reflection must actively involve, from the beginning, the psychiatric staff in the field. This presentation will outline several examples of interventions that were targeted according to in-patient or out-patient treatments.
3469 - PERCIVAL project: Italian adaptation of Intensive Outreach Teams for the treatment of psychiatric emergencies in adolescence
Dr. Silvia Perinetti | Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico,Milan, ITaly | Italy
Rationale: Because of the increasing number of adolescence “psychiatric emergencies” with a raising number of hospitalizations and finally in costs for mental health “PERCIVAL” project is conceived to guarantee appropriateness of care for acute psychiatric adolescent patients and families, to offer a prompt response through an intensive pathway of care that may act in different setting as an alternative to ordinary hospitalization and to prevent residential care. It is based on modified international paradigm of Intensive Outreach Teams– IOT.
Methods: Target population: adolescents (12-18 yrs) with psychiatric symptoms in the I and II Rosenn and Gail classification. The psychiatric evaluation and the intervention are conducted by a multiprofessional team (child and adolescent neuropsychiatrists, psychologists, social workers, professional educator experts). Treatment goals are differentiated according to the clinical stage (acute and post-acute), focused on adolescent’s and caregiver’s needs and strengths and shared with them.
The intervention includes 4 stages: 1) 2-4weeks: A) assessment: A1) Diagnostic assessment (HoNOSCA, CBCL, DSM-5 Self-Rated L1 C-CSM; PID-5, DERS-A, BIS11); A2) Risk assessment (Suicide Screen, CSSRS, BVC, RTSHIA); A3) global and family functioning (C-GAS, CGI, Score15, SIPA); A4) quality of life (PEDS QL, WHO QoL). The CANS communimetric tool and its related versions (Crisis Assessment Tool-CAT) are used to plan the intervention and evaluate and monitor the treatment outcomes B) crisis plan and crisis intervention; 2) 4-20 weeks: multidisciplinary treatment in outpatient, home and/or community context with different levels of intensity (high 5-7 treatments/week; medium 2-3 treatments/week; low 1-2 treatments/week). It includes DBT-oriented psychotherapeutic individual treatment and/or skills training group, focusing on emotional disregulation associated with suicidal and disrupted behaviors/self-harming; outreach approach reinforces the daily implementation and customization skills in different context of life through professional educators intervention 3) 2-4 weeks: transition to the local healthcare service 4) Follow up at 12 months.
Conclusions: “PERCIVAL” is an innovative project that aims to test the applicability, cost, sustainability and effectiveness of outreach approach in the Italian context and in adolescent population. Moreover, the project is testing the application of a DBT model for psychiatric acute in adolescence.
2451 - Cross-sectoral collaboration in care for adolescent girls with Multiple and Complex Needs
Dr. Helena Van den Steene | University of Antwerp | Belgium
Objectives: This mixed models study of a cross-sectoral care delivery project for adolescent girls with Multiple and Complex Problems (MCP), based on intensive collaboration between child psychiatry and child welfare services, aims to concretise ‘MCP’ in Child and Adolescent Psychiatry through description of population characteristics and care trajectories and to optimise collaborative care provision for youth with MCP by identifying its key elements.
This is a necessity because available care delivery often fails to meet the needs of the growing population of youth with MCP, who suffer far-reaching consequences for their development and wellbeing, challenge care delivery organisation, and yield a high societal cost.
Methods: Quantitative (file analysis, questionnaires) and qualitative (focus groups, interviews) methods are used in this participatory action research for characterisation of the population, description of the care trajectories and evaluation of the cross-sectoral collaboration, from the perspectives of clients (youths and their key relatives) and professionals involved.
Results: Preliminary quantitative results regarding the population illustrate an interplay of vulnerabilities and problems in biological, psychological and socio-contextual domains and highlight the complexity of care trajectories. Professionals stress the importance of intensive collaboration (shared vision, shared responsibility, synergy) between Child and Adolescent Psychiatry and Child Welfare and a patient-centred focus.
Conclusion: The preliminary results provide insight into the characteristics of these adolescent girls with multiple and complex problems and the key practices in the cross-sectoral networks of care delivery set in place by this collaboration project. They illustrate the importance of transitioning from classical care organisation to a patient-centred, intensive collaboration in order to optimise care delivery for adolescent girls with multiple and complex problems.
2742 - HIV-disclosure to HIV-infected adolescents in the transition to adulthood in West and Central Africa: perspectives of caregivers, health care providers and HIV-infected adolescents.
Dr. Valeriane Leroy | Inserm 1027 | France
Background: Adolescents living with HIV (ALH) surviving thanks to antiretroviral therapy must learn to live with this chronic infection. The disclosure of their HIV status is the key for coping with treatments during transition to adulthood. Still, disclosure poses challenges to health care teams and literature suggests relatively late disclosure in sub-Saharan Africa. We report the attitudes and practices of health workers involved in the disclosure process to ALH in a network including West and Central African countries, and confront these to the experiences of youth expert patients.
Methods: We organized a 3-day workshop in Abidjan, Côte d’Ivoire with 40 staff members (doctors, psychologists, counselors) from French speaking African countries. Involved in HIV disclosure in their practice, participants shared their guidelines and practices (moment of disclosure, proceeding, staff involved in the disclosure process). Four adolescents/young adults living with HIV shared their experience with the disclosure process.
Results: overall, 35 participants from eight African countries (Benin, Burkina Faso, Côte d'Ivoire, Cameroon, Mali, Democratic Republic of Congo, Senegal, Togo), representing 17 clinical centers with expertise on pediatric HIV care attended the workshop: 14 physicians, 8 psychologists, 6 counselors, 4 youth, and 3 social workers. Various practices and a relatively late age of disclosure were reported for all centers: 34% of the adolescents aged between 10 and 12 had a full disclosure (N=1296, range: 0%-93%) compared to 76% of the adolescents aged between 13 and 19 years (N=2132, range: 23%-100%). The median age of full disclosure was 13 years ranging from 11 to 15 years. Different practices of disclosure were reported, some of them involving adolescent peers or using group sessions. The four patient-experts attending to the meeting advocated for early disclosure, estimating that the disclosure process should start at the age of 10 years.
Discussion: HIV disclosure to adolescents is challenging for both health care worker and parents, and early disclosure remains infrequent due to multiple obstacles. Still, earlier disclosure processes is expected to smoothen the transition to adulthood and to promote empowerment of adolescents living with HIV. During the meeting, a first step to the elaboration of consensual guidelines for a good practice was realized in order to enhance earlier and better adapted disclosure processes.