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13 - Strategies for working with Tier 1
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- By Greg Richardson, North Yorkshire & York Primary Care Trust, Ashley Wyatt, Ian Partridge, Lime Trees CAMHS, York
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
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- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 112-126
-
- Chapter
- Export citation
-
Summary
‘In the beginning was the word and that word may well have been anxiety.’
Jules MassermanIntroduction
Mental health problems in children are best understood as being affected by and presenting in the children's constitutional functioning and in all areas of their interaction with their environment. Parents, families and teachers have a major role to play in the maintenance of mental health. Professionals such as childminders, teachers, school nurses, educational psychologists, social workers, GPs and health visitors make a substantial contribution to the promotion and maintenance of the mental health of children if they come in contact with them. They also play a role in the early identification of mental health problems, children's vulnerability thereto and in the management of those mental health problems once identified. However, Tier 1 professionals often feel at a loss as to how to manage children's mental health problems and all the emotional baggage that goes with them.
Mental health professionals, who provide a small part of the mental healthcare of children, classify the more serious mental health problems as mental disorders (World Health Organization, 1992). These disorders represent a small proportion of mental health problems produced by constitutional, family, educational, social and environmental factors, illness or developmental delay, all of which may impair future psychological functioning. The epidemiological evidence is that mental disorders affect about 10% of children (Ford et al, 2003), although estimates range from 10 to 20% (Fombonne, 2002). If all those children were referred to CAMHS, the service would be overwhelmed. Child and adolescent mental health services see only about 20% of these children. The alternative of providing support to Tier 1 professionals from primary mental health workers, or other CAMHS professionals ensures:
• children with mental health problems, and their families, are dealt with by those with whom they already have a relationship;
• more children than could be seen by individual mental health professionals have the benefit of mental health expertise;
• increased confidence and expertise among Tier 1 professionals dealing directly with young people and their families (Richardson & Partridge, 2000).
2 - CAMHS in context
-
- By Greg Richardson, North Yorkshire & York Primary Care Trust, Ashley Wyatt
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 9-20
-
- Chapter
- Export citation
-
Summary
‘The farther backward you can look, the farther forward you are likely to see.’
Winston Churchill (1874–1965)Introduction
Over the years, CAMHS have had disparate masters and homes. Local Authority-based child guidance clinics and health service-based in-patient units came together in 1974. At that time, there was recognition that mental health services for children and adolescents should be based in the community rather than in institutions (Department of Health and Social Security, 1975). Now that they are based in health services, the idea and functioning of multidisciplinary services and teams can represent a mystery to doctor-led, referral-based health systems and those responsible for commissioning such services. Child and adolescent mental health services have often been prey to strategic and resource neglect, but idiosyncratic clinical practice has often been of an outstanding nature. With the acceptance of a tiered strategy for CAMHS, there has been increased coordination, an influx of resources and increased scrutiny (Department for Children, Schools and Families & Department of Health, 2008).
Publications in the field of social care (e.g. Children in the Public Care; Department of Health & Social Services Inspectorate, 1991), a precursor of Quality Protects (Department of Health, 1999), education (e.g. Getting in on the Act; Audit Commission, 1992) and health (e.g. With Health in Mind; Kurtz, 1992) were calling attention to children ‘in need’, children with ‘educational and behavioural difficulties’ and children with ‘mental health problems’. They overlapped considerably. Traditionally, health services were interested only if a child had a mental health problem, Social Services were interested only in children in need, and education services were interested only in children with emotional and behavioural difficulties, but children's developmental needs cannot be subdivided into different educational, social and health boxes without a similar dismembering of the child.
It was only in the early 1990s that the need to work across agencies achieved some political recognition as ‘care in the community’ was failing for lack of it. In 1993, as part of the Health of the Nation initiative, Working Together for Better Health (Department of Health, 1993) showed government recognition of health being dependent on ‘healthy alliances’ across agencies. To those using formulations that looked at the constitutional, family and environmental factors affecting children at their developmental stage this was nothing new, but it was quite a shift for medically based illness services.
Rates of diagnostic transition and cognitive change at 18-month follow-up among 1,112 participants in the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing (AIBL)
- Kathryn A. Ellis, Cassandra Szoeke, Ashley I. Bush, David Darby, Petra L. Graham, Nicola T. Lautenschlager, S. Lance Macaulay, Ralph N. Martins, Paul Maruff, Colin L. Masters, Simon J. McBride, Kerryn E. Pike, Stephanie R. Rainey-Smith, Alan Rembach, Joanne Robertson, Christopher C. Rowe, Greg Savage, Victor L. Villemagne, Michael Woodward, William Wilson, Ping Zhang, David Ames, the AIBL Research Group
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- Journal:
- International Psychogeriatrics / Volume 26 / Issue 4 / April 2014
- Published online by Cambridge University Press:
- 20 November 2013, pp. 543-554
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- Article
- Export citation
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Background:
The Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing is a prospective study of 1,112 individuals (211 with Alzheimer's disease (AD), 133 with mild cognitive impairment (MCI), and 768 healthy controls (HCs)). Here we report diagnostic and cognitive findings at the first (18-month) follow-up of the cohort. The first aim was to compute rates of transition from HC to MCI, and MCI to AD. The second aim was to characterize the cognitive profiles of individuals who transitioned to a more severe disease stage compared with those who did not.
Methods:Eighteen months after baseline, participants underwent comprehensive cognitive testing and diagnostic review, provided an 80 ml blood sample, and completed health and lifestyle questionnaires. A subgroup also underwent amyloid PET and MRI neuroimaging.
Results:The diagnostic status of 89.9% of the cohorts was determined (972 were reassessed, 28 had died, and 112 did not return for reassessment). The 18-month cohort comprised 692 HCs, 82 MCI cases, 197 AD patients, and one Parkinson's disease dementia case. The transition rate from HC to MCI was 2.5%, and cognitive decline in HCs who transitioned to MCI was greatest in memory and naming domains compared to HCs who remained stable. The transition rate from MCI to AD was 30.5%.
Conclusion:There was a high retention rate after 18 months. Rates of transition from healthy aging to MCI, and MCI to AD, were consistent with established estimates. Follow-up of this cohort over longer periods will elucidate robust predictors of future cognitive decline.
Contributors
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- By Shamsuddin Akhtar, Greg Albert, Sidney Allison, Muhammad Anwar, Haruo Arita, Amanda Barker, Mary Hanna Bekhit, Jeanna Blitz, Tyson Bolinske, David Burbulys, Asokumar Buvanendran, Gregory Cain, Keith A. Candiotti, Daniel B. Carr, Derek Chalmers, John Charney, Rex Cheng, Roger Chou, Keun Sam Chung, Anna Clebone, Frederick Conlin, Susan Dabu-Bondoc, Tiffany Denepitiya-Balicki, Jeanette Derdemezi, Anahat Kaur Dhillon, Ho Dzung, Juan Jose Egas, Stephen M. Eskaros, Zhuang T. Fang, Claudia R. Fernandez Robles, Victor A. Filadora, Ellen Flanagan, Dan Froicu, Allison Gandey, Nehal Gatha, Boris Gelman, Christopher Gharibo, Muhammad K. Ghori, Brian Ginsberg, Michael E. Goldberg, Jeff Gudin, Thomas Halaszynski, Martin Hale, Dorothea Hall, Craig T. Hartrick, Justin Hata, Lars E. Helgeson, Joe C. Hong, Richard W. Hong, Balazs Horvath, Eric S. Hsu, Gabriel Jacobs, Jonathan S. Jahr, Rongjie Jaing, Inderjeet Singh Julka, Zeev N. Kain, Clinton Kakazu, Kianusch Kiai, Mary Keyes, Michael M. Kim, Peter G. Lacouture, Ryan Lanier, Vivian K. Lee, Mark J. Lema, Oscar A. de Leon-Casasola, Imanuel Lerman, Philip Levin, Steven Levin, JinLei Li, Eric C. Lin, Sharon Lin, David A. Lindley, Ana M. Lobo, Marisa Lomanto, Mirjana Lovrincevic, Brenda C. McClain, Tariq Malik, Jure Marijic, Joseph Marino, Laura Mechtler, Alan Miller, Carly Miller, Amit Mirchandani, Sukanya Mitra, Fleurise Montecillo, James M. Moore, Debra E. Morrison, Philip F. Morway, Carsten Nadjat-Haiem, Hamid Nourmand, Dana Oprea, Sunil J. Panchal, Edward J. Park, Kathleen Ji Park, Kellie Park, Parisa Partownavid, Akta Patel, Bijal Patel, Komal D. Patel, Neesa Patel, Swati Patel, Paul M. Peloso, Danielle Perret, Anthony DePlato, Marjorie Podraza Stiegler, Despina Psillides, Mamatha Punjala, Johan Raeder, Siamak Rahman, Aziz M. Razzuk, Maggy G. Riad, Kristin L. Richards, R. Todd Rinnier, Ian W. Rodger, Joseph Rosa, Abraham Rosenbaum, Alireza Sadoughi, Veena Salgar, Leslie Schechter, Michael Seneca, Yasser F. Shaheen, James H. Shull, Elizabeth Sinatra, Raymond S. Sinatra, Neil Singla, Neil Sinha, Denis V. Snegovskikh, Dmitri Souzdalnitski, Julie Sramcik, Zoreh Steffens, Alexander Timchenko, Vadim Tokhner, Marc C. Torjman, Co T. Truong, Nalini Vadivelu, Ashley Vaughn, Anjali Vira, Eugene R. Viscusi, Dajie Wang, Shu-ming Wang, J. Michael Watkins-Pitchford, Steven J. Weisman, Ira Whitten, Bryan S. Williams, Jeremy M. Wong, Thomas Wong, Christopher Wray, Yaw Wu, Anthony T. Yarussi, Laurie Yonemoto, Bita H. Zadeh, Jill Zafar, Martha Zegarra, Keren Ziv
- Edited by Raymond S. Sinatra, Jonathan S. Jahr, University of California, Los Angeles, School of Medicine, J. Michael Watkins-Pitchford
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- Book:
- The Essence of Analgesia and Analgesics
- Published online:
- 06 December 2010
- Print publication:
- 14 October 2010, pp xi-xviii
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2 - CAMHS in context
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- By Greg Richardson, MBChB, DCH, DPM, FRCPsych, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust, Ashley Wyatt, CAMHS Commissioning Manager, Leeds
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 9-20
-
- Chapter
- Export citation
-
Summary
‘The farther backward you can look, the farther forward you are likely to see.’ Winston Churchill (1874–1965)
Introduction
Over the years, CAMHS have had disparate masters and homes. Local Authority-based child guidance clinics and health service-based in-patient units came together in 1974. At that time, there was recognition that mental health services for children and adolescents should be based in the community rather than in institutions (Department of Health and Social Security, 1975). Now that they are based in health services, the idea and functioning of multidisciplinary services and teams can represent a mystery to doctor-led, referral-based health systems and those responsible for commissioning such services. Child and adolescent mental health services have often been prey to strategic and resource neglect, but idiosyncratic clinical practice has often been of an outstanding nature. With the acceptance of a tiered strategy for CAMHS, there has been increased coordination, an influx of resources and increased scrutiny (Department for Children, Schools and Families & Department of Health, 2008).
Publications in the field of social care (e.g. Children in the Public Care; Department of Health & Social Services Inspectorate, 1991), a precursor of Quality Protects(Department of Health, 1999), education (e.g. Getting in on the Act;Audit Commission, 1992) and health (e.g. With Health in Mind; Kurtz, 1992) were calling attention to children ‘in need’, children with ‘educational and behavioural difficulties’ and children with ‘mental health problems’. They overlapped considerably. Traditionally, health services were interested only if a child had a mental health problem, Social Services were interested only in children in need, and education services were interested only in children with emotional and behavioural difficulties, but children's developmental needs cannot be subdivided into different educational, social and health boxes without a similar dismembering of the child.
It was only in the early 1990s that the need to work across agencies achieved some political recognition as ‘care in the community’ was failing for lack of it. In 1993, as part of the Health of the Nation initiative, Working Together for Better Health(Department of Health, 1993) showed government recognition of health being dependent on ‘healthy alliances’ across agencies.
13 - Strategies for working with Tier 1
-
- By Greg Richardson, MBChB, DCH, DPM, FRCPsych, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust, Ashley Wyatt, CAMHS Commissioning Manager, Leeds, Ian Partridge, MA, MSc, CQSW, Social Worker, formerly at Lime Trees CAMHS, York
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 112-126
-
- Chapter
- Export citation
-
Summary
‘In the beginning was the word and that word may well have been anxiety.’
Jules MassermanIntroduction
Mental health problems in children are best understood as being affected by and presenting in the children's constitutional functioning and in all areas of their interaction with their environment. Parents, families and teachers have a major role to play in the maintenance of mental health. Professionals such as childminders, teachers, school nurses, educational psychologists, social workers, GPs and health visitors make a substantial contribution to the promotion and maintenance of the mental health of children if they come in contact with them. They also play a role in the early identification of mental health problems, children's vulnerability thereto and in the management of those mental health problems once identified. However, Tier 1 professionals often feel at a loss as to how to manage children's mental health problems and all the emotional baggage that goes with them.
Mental health professionals, who provide a small part of the mental healthcare of children, classify the more serious mental health problems as mental disorders (World Health Organization, 1992). These disorders represent a small proportion of mental health problems produced by constitutional, family, educational, social and environmental factors, illness or developmental delay, all of which may impair future psychological functioning.
The epidemiological evidence is that mental disorders affect about 10% of children (Ford et al, 2003), although estimates range from 10 to 20% (Fombonne, 2002). If all those children were referred to CAMHS, the service would be overwhelmed. Child and adolescent mental health services see only about 20% of these children. The alternative of providing support to Tier 1 professionals from primary mental health workers, or other CAMHS professionals ensures:
• children with mental health problems, and their families, are dealt with by those with whom they already have a relationship;
• more children than could be seen by individual mental health professionals have the benefit of mental health expertise;
• increased confidence and expertise among Tier 1 professionals dealing directly with young people and their families (Richardson & Partridge, 2000).
The Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging: methodology and baseline characteristics of 1112 individuals recruited for a longitudinal study of Alzheimer's disease
- Kathryn A Ellis, Ashley I Bush, David Darby, Daniela De Fazio, Jonathan Foster, Peter Hudson, Nicola T. Lautenschlager, Nat Lenzo, Ralph N. Martins, Paul Maruff, Colin Masters, Andrew Milner, Kerryn Pike, Christopher Rowe, Greg Savage, Cassandra Szoeke, Kevin Taddei, Victor Villemagne, Michael Woodward, David Ames, the AIBL Research Group
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- Journal:
- International Psychogeriatrics / Volume 21 / Issue 4 / August 2009
- Published online by Cambridge University Press:
- 01 August 2009, pp. 672-687
-
- Article
- Export citation
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Background: The Australian Imaging, Biomarkers and Lifestyle (AIBL) flagship study of aging aimed to recruit 1000 individuals aged over 60 to assist with prospective research into Alzheimer's disease (AD). This paper describes the recruitment of the cohort and gives information about the study methodology, baseline demography, diagnoses, medical comorbidities, medication use, and cognitive function of the participants.
Methods: Volunteers underwent a screening interview, had comprehensive cognitive testing, gave 80 ml of blood, and completed health and lifestyle questionnaires. One quarter of the sample also underwent amyloid PET brain imaging with Pittsburgh compound B (PiB PET) and MRI brain imaging, and a subgroup of 10% had ActiGraph activity monitoring and body composition scanning.
Results: A total of 1166 volunteers were recruited, 54 of whom were excluded from further study due to comorbid disorders which could affect cognition or because of withdrawal of consent. Participants with AD (211) had neuropsychological profiles which were consistent with AD, and were more impaired than participants with mild cognitive impairment (133) or healthy controls (768), who performed within expected norms for age on neuropsychological testing. PiB PET scans were performed on 287 participants, 100 had DEXA scans and 91 participated in ActiGraph monitoring.
Conclusion: The participants comprising the AIBL cohort represent a group of highly motivated and well-characterized individuals who represent a unique resource for the study of AD. They will be reassessed at 18-month intervals in order to determine the predictive utility of various biomarkers, cognitive parameters and lifestyle factors as indicators of AD, and as predictors of future cognitive decline.
Thin Film Bulk Acoustic Wave Resonators for Continuous Monitoring in the Physical, Chemical and Biological Realms
- Greg Ashley, Jack Luo, Paul Kirby, Timothy Butler, David Cullen
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1222 / 2009
- Published online by Cambridge University Press:
- 31 January 2011, 1222-DD02-18
- Print publication:
- 2009
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- Article
- Export citation
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A transducer that can act as a highly sensitive and reliable universal sensor capable of detecting and continuously monitoring changes in the physical, chemical and biological domains is a potentially useful scientific tool. The Thin Film Bulk Acoustic Wave Resonator (FBAR) is a microwave device that is becoming increasingly recognised as a universal transduction platform with the added advantage of potential integration into CMOS architecture and array-like formats. This work shows preliminary results on FBAR where a continuous monitoring arrangement demonstrated the capability of FBAR to respond to changes in physical parameters such as temperature and light levels, the work goes on further to show the ability of FBAR to respond to changes in humidity in a gas flow and can have sensitivity increased with the addition of hygroscopic polymers on its surface and finally how FBAR can be adapted to act as a biosensor in the form of an immunosensor with sensitivity some orders of magnitude greater than traditional lower frequency bulk acoustic wave platforms.