8 results
28 - Tier 4 options
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- By Tim McDougall, Cheshire & Wirral NHS Foundation Trust, Anne Worrall-Davies, University of Leeds, Lesley Hewson, Bradford District Care Trust, Rosie Beer, Greg Richardson, North Yorkshire & York Primary Care Trust
- 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 259-269
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Summary
‘Two roads diverged in a wood, and I–
I took the one less travelled by,
And that has made all the difference.’
Robert Frost (1874–1963)Introduction
Tier 4 CAMHS aim to meet the needs of children and young people with the most complex, severe or persistent mental health problems. Tier 4 services include in-patient care (see Chapter 29), as well as a range of day care and intensive community home-based and outreach services for specific groups of children and young people.
Day services
Early descriptions of child and adolescent mental health day units emphasised 5-day ‘milieu’ provision with a strong emphasis on education and behaviour management (Brown, 1996), whereas now they frequently provide daily focused activities to which children and families are invited, depending on their needs. Currently, about half of UK day services are linked to in-patient units, and many in-patient units have a day programme (Green & Jacobs, 1998). It is impossible to classify day services owing to the enormous range in milieu and interventions provided (Green & Worrall- Davies, 2008). However, day services broadly offer:
• support and transition to community services following in-patient admission;
• intensive 5 days per week treatment packages for children and their families;
• treatment of disruptive behaviour, using multimodal treatment strategies with a combination of individual, family and psychopharmacological interventions;
• specialist management and programmes of care for younger children with developmental disorders such as autism, speech and language disorders or neuropsychiatric disorders;
• intensive intervention aimed at improving family functioning in situations of family breakdown or child maltreatment.
Provision and organisation
Day units can offer assessment and therapeutic services that are more specialised, complex and intensive than out-patient services, although they are still community-based and less disruptive than in-patient admission. Most also have the benefit of educational input. Close liaison with specialised education and Social Services is central to their work. There is general acceptance of the central importance of maintaining attachments and working with whole systems if the complex needs of children are to be met. Day units can work with children and young people individually and in groups, as well as with their families, while keeping the focus of concern within the community and avoiding the ‘out of sight, out of mind’ dilemma of in-patient services.
29 - In-patient psychiatric care
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- By Angela Sergeant, Leigh House Hospital, Winchester, Greg Richardson, North Yorkshire & York Primary Care Trust, Ian Partridge, Lime Trees CAMHS, York, Tim McDougall, Cheshire & Wirral NHS Foundation Trust, Anne Worrall-Davies, University of Leeds, Lesley Hewson, Bradford District Care Trust
- 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 270-283
-
- Chapter
- Export citation
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Summary
‘“It all comes”, said Pooh crossly, “of not having front doors big enough.”’
A. A. Milne, Winnie the PoohIntroduction
Despite the development of home treatment teams and early intervention psychosis services, the demand for in-patient child and adolescent beds remains. It is rare for young people with mental disorders to require inpatient services, but when they do, beds are few and far between. Reasons for admission include severity of illness, deterioration in psychological functioning despite community treatment, high risk to self or others, or family difficulties making treatment difficult, any of which may lead to the need for 24-hour care (Green & Worrall-Davies, 2008). In-patient care is a specialised field providing treatment for young people with serious psychiatric illness by skilled and experienced staff.
Who and what are in-patient units for?
There is a range of psychiatric, educational, social, criminal and societal indicators for admission to an in-patient service. It is usually impossible to separate the different aspects or contributors to the young person's disorder so that each can be provided by the different agencies responsible for it. Psychological disorders, because of adverse life experiences, are common and pure psychiatric disorders are rare, but they all have educational and social precursors and sequelae. Trying to compartmentalise children into unidisciplinary treatment pigeonholes is problematic as:
• admission to psychiatric in-patient units considerably disrupts education and the young person's functioning in the community
• education authorities have to meet young people's special educational needs but cannot isolate these from other social and mental health factors, which they often do not have the resources to address
• residential policies of Social Services departments tend to address young people's mental health and educational needs only as secondary considerations
• the Home Office and Ministry of Justice, which will provide care in a prison setting, have little investment in childhood preventative work for the large proportion of young people with conduct disorder and complex needs when they become adults.
Work on sharing residential responsibility and input requires considerable inter-departmental and inter-agency working, but each agency will be uncertain who is going to reap the most for investing in them, and the harvest is not guaranteed.
Angiographic Demonstration of Upward Transtentorial Herniation
- Cameron M. McDougall, Andrew Jack, Jean Raymond, Michel W. Bojanowski, Tim E. Darsaut
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 41 / Issue 1 / January 2014
- Published online by Cambridge University Press:
- 23 September 2014, pp. 82-83
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Contributors
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- By Federico Agliardi, Andrea Alpiger, Gianluca Bianchi Fasani, Lars Harald Blikra, Brian D. Bornhold, Edward N. Bromhead, Marko H.K. Bulmer, D. Calvin Campbell, Marie Charrière, Masahiro Chigira, John J. Clague, John Coggan, Giovanni B. Crosta, Tim Davies, Marc-Henri Derron, Mark Diederichs, Erik Eberhardt, Carlo Esposito, Robin Fell, Paolo Frattini, Corey R. Froese, Monica Ghirotti, Valentin Gischig, James S. Griffiths, Stephen R. Hencher, Reginald L. Hermanns, Kris Holm, Seyyedmahdi Hosseyni, Niels Hovius, Christian Huggel, Florian Humair, Oldrich Hungr, D. Jean Hutchinson, Michel Jaboyedoff, Matthias Jakob, Julien Jakubowski, Randall W. Jibson, Katherine S. Kalenchuk, Nikolay Khabarov, Oliver Korup, Luca Lenti, Serge Leroueil, Simon Loew, Oddvar Longva, Patrick MacGregor, Andrew W. Malone, Salvatore Martino, Scott McDougall, Mika McKinnon, Mauri McSaveney, Patrick Meunier, Dennis Moore, Jeffrey R. Moore, David C. Mosher, Michael Obersteiner, Lucio Olivares, Thierry Oppikofer, Luca Pagano, Massimo Pecci, Andrea Pedrazzini, David Petley, Luciano Picarelli, David J.W. Piper, John Psutka, Nicholas J. Roberts, Gabriele Scarascia Mugnozza, David Stapledon, Douglas Stead, Richard E. Thomson, Paolo Tommasi, J. Kenneth Torrance, Nobuyuki Torii, Gianfranco Urciuoli, Gonghui Wang, Christopher F. Waythomas, Malcolm Whitworth, Heike Willenberg, Xiyong Wu
- Edited by John J. Clague, Simon Fraser University, British Columbia, Douglas Stead, Simon Fraser University, British Columbia
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- Book:
- Landslides
- Published online:
- 05 May 2013
- Print publication:
- 23 August 2012, pp vii-x
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Childhood cognitive function and adult psychopathology: associations with psychotic and non-psychotic symptoms in the general population
- Jennifer H. Barnett, Fiona McDougall, Man K. Xu, Tim J. Croudace, Marcus Richards, Peter B. Jones
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- Journal:
- The British Journal of Psychiatry / Volume 201 / Issue 2 / August 2012
- Published online by Cambridge University Press:
- 02 January 2018, pp. 124-130
- Print publication:
- August 2012
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Background
Lower cognitive ability in childhood is associated with increased risk of future schizophrenia, but its relationship with adult psychotic-like experiences and other psychopathology is less understood.
AimsTo investigate whether this childhood risk factor is shared with adult subclinical psychiatric phenotypes including psychotic-like experiences and general psychiatric morbidity.
MethodA population-based sample of participants born in Great Britain during 1 week in March 1946 was contacted up to 20 times between ages 6 weeks and 53 years. Cognition was assessed at ages 8, 11 and 15 years using a composite of age-appropriate verbal and non-verbal cognitive tests. At age 53 years, psychotic-like experiences were self-reported by 2918 participants using four items from the Psychosis Screening Questionnaire and general psychiatric morbidity was assessed using the scaled version of the General Health Questionnaire (GHQ-28).
ResultsPsychotic-like experiences were reported by 22% of participants, and were highly comorbid with other psychopathology. Their presence in adults was significantly associated with poorer childhood cognitive test scores at ages 8 and 15 years, and marginally so at age 11 years. In contrast, high GHQ scores were not associated with poorer childhood cognition after adjustment for the presence of psychotic-like experiences.
ConclusionsPsychotic and non-psychotic psychopathologic symptoms are highly comorbid in the general population. Lower childhood cognitive ability is a risk factor for psychotic-like experiences in mid-life; these phenomena may be one end of a continuum of phenotypic expression driven by variation in early neurodevelopment.
28 - Tier 4 options
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- By Tim McDougall, Lead Nurse, Cheshire & Wirral NHS Foundation Trust, Anne Worrall-Davies, MBChB, MMedSc, MRCPsych, Senior Lecturer in Child and Adolescent Psychiatry, University of Leeds, and Honorary Consultant in Child and Adolescent Psychiatry, NHS Leeds, Lesley Hewson, MBChB, MRCPsych, FRCPsych, Consultant Child and Adolescent Psychiatrist, Bradford District Care Trust, Rosie Beer, Retired Consultant in Child and Adolescent Psychiatry, Leeds, Greg Richardson, MBChB, DCH, DPM, FRCPsych, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust
- 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 259-269
-
- Chapter
- Export citation
-
Summary
‘Two roads diverged in a wood, and I–
I took the one less travelled by,
And that has made all the difference.’
Robert Frost (1874–1963)Introduction
Tier 4 CAMHS aim to meet the needs of children and young people with the most complex, severe or persistent mental health problems. Tier 4 services include in-patient care (see Chapter 29), as well as a range of day care and intensive community home-based and outreach services for specific groups of children and young people.
Day services
Early descriptions of child and adolescent mental health day units emphasised 5-day ‘milieu’ provision with a strong emphasis on education and behaviour management (Brown, 1996), whereas now they frequently provide daily focused activities to which children and families are invited, depending on their needs. Currently, about half of UK day services are linked to in-patient units, and many in-patient units have a day programme (Green & Jacobs, 1998). It is impossible to classify day services owing to the enormous range in milieu and interventions provided (Green & Worrall- Davies, 2008). However, day services broadly offer:
• support and transition to community services following in-patient admission;
• intensive 5 days per week treatment packages for children and their families;
• treatment of disruptive behaviour, using multimodal treatment strategies with a combination of individual, family and psychopharmacological interventions;
• specialist management and programmes of care for younger children with developmental disorders such as autism, speech and language disorders or neuropsychiatric disorders;
• intensive intervention aimed at improving family functioning in situations of family breakdown or child maltreatment.
Provision and organisation
Day units can offer assessment and therapeutic services that are more specialised, complex and intensive than out-patient services, although they are still community-based and less disruptive than in-patient admission. Most also have the benefit of educational input. Close liaison with specialised education and Social Services is central to their work. There is general acceptance of the central importance of maintaining attachments and working with whole systems if the complex needs of children are to be met. Day units can work with children and young people individually and in groups, as well as with their families, while keeping the focus of concern within the community and avoiding the ‘out of sight, out of mind’ dilemma of in-patient services.
29 - In-patient psychiatric care
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- By Angela Sergeant, RMN, RGN, MSc, ENB 603, Consultant Nurse in Child and Adolescent Psychiatry, Leigh House Hospital, Winchester, Hampshire Partnership Trust, Greg Richardson, MBChB, DCH, DPM, FRCPsych, Consultant Child and Adolescent Psychiatrist, Lime Trees CAMHS, North Yorkshire & York Primary Care Trust, Ian Partridge, MA, MSc, CQSW, Social Worker, formerly at Lime Trees CAMHS, York, Tim McDougall, Lead Nurse, Cheshire & Wirral NHS Foundation Trust, Anne Worrall-Davies, MBChB, MMedSc, MRCPsych, Senior Lecturer in Child and Adolescent Psychiatry, University of Leeds, and Honorary Consultant in Child and Adolescent Psychiatry, NHS Leeds, Lesley Hewson, MBChB, MRCPsych, FRCPsych, Consultant Child and Adolescent Psychiatrist, Bradford District Care Trust
- 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 270-283
-
- Chapter
- Export citation
-
Summary
‘“It all comes”, said Pooh crossly, “of not having front doors big enough.”’
A. A. Milne, Winnie the PoohIntroduction
Despite the development of home treatment teams and early intervention psychosis services, the demand for in-patient child and adolescent beds remains. It is rare for young people with mental disorders to require inpatient services, but when they do, beds are few and far between. Reasons for admission include severity of illness, deterioration in psychological functioning despite community treatment, high risk to self or others, or family difficulties making treatment difficult, any of which may lead to the need for 24-hour care (Green & Worrall-Davies, 2008). In-patient care is a specialised field providing treatment for young people with serious psychiatric illness by skilled and experienced staff.
Who and what are in-patient units for?
There is a range of psychiatric, educational, social, criminal and societal indicators for admission to an in-patient service. It is usually impossible to separate the different aspects or contributors to the young person's disorder so that each can be provided by the different agencies responsible for it. Psychological disorders, because of adverse life experiences, are common and pure psychiatric disorders are rare, but they all have educational and social precursors and sequelae. Trying to compartmentalise children into unidisciplinary treatment pigeonholes is problematic as:
• admission to psychiatric in-patient units considerably •• disrupts education and the young person's functioning in the community
• education authorities have to meet young people's special educational needs but cannot isolate these from other social and mental health factors, which they often do not have the resources to address
• residential policies of Social Services departments tend to address young people's mental health and educational needs only as secondary considerations
• the Home Office and Ministry of Justice, which will provide care in a prison setting, have little investment in childhood preventative work for the large proportion of young people with conduct disorder and complex needs when they become adults.
Work on sharing residential responsibility and input requires considerable inter-departmental and inter-agency working, but each agency will be uncertain who is going to reap the most for investing in them, and the harvest is not guaranteed.
Looking Backward, Looking Forward: MLA Members Speak
- April Alliston, Elizabeth Ammons, Jean Arnold, Nina Baym, Sandra L. Beckett, Peter G. Beidler, Roger A. Berger, Sandra Bermann, J.J. Wilson, Troy Boone, Alison Booth, Wayne C. Booth, James Phelan, Marie Borroff, Ihab Hassan, Ulrich Weisstein, Zack Bowen, Jill Campbell, Dan Campion, Jay Caplan, Maurice Charney, Beverly Lyon Clark, Robert A. Colby, Thomas C. Coleman III, Nicole Cooley, Richard Dellamora, Morris Dickstein, Terrell Dixon, Emory Elliott, Caryl Emerson, Ann W. Engar, Lars Engle, Kai Hammermeister, N. N. Feltes, Mary Anne Ferguson, Annie Finch, Shelley Fisher Fishkin, Jerry Aline Flieger, Norman Friedman, Rosemarie Garland-Thomson, Sandra M. Gilbert, Laurie Grobman, George Guida, Liselotte Gumpel, R. K. Gupta, Florence Howe, Cathy L. Jrade, Richard A. Kaye, Calhoun Winton, Murray Krieger, Robert Langbaum, Richard A. Lanham, Marilee Lindemann, Paul Michael Lützeler, Thomas J. Lynn, Juliet Flower MacCannell, Michelle A. Massé, Irving Massey, Georges May, Christian W. Hallstein, Gita May, Lucy McDiarmid, Ellen Messer-Davidow, Koritha Mitchell, Robin Smiles, Kenyatta Albeny, George Monteiro, Joel Myerson, Alan Nadel, Ashton Nichols, Jeffrey Nishimura, Neal Oxenhandler, David Palumbo-Liu, Vincent P. Pecora, David Porter, Nancy Potter, Ronald C. Rosbottom, Elias L. Rivers, Gerhard F. Strasser, J. L. Styan, Marianna De Marco Torgovnick, Gary Totten, David van Leer, Asha Varadharajan, Orrin N. C. Wang, Sharon Willis, Louise E. Wright, Donald A. Yates, Takayuki Yokota-Murakami, Richard E. Zeikowitz, Angelika Bammer, Dale Bauer, Karl Beckson, Betsy A. Bowen, Stacey Donohue, Sheila Emerson, Gwendolyn Audrey Foster, Jay L. Halio, Karl Kroeber, Terence Hawkes, William B. Hunter, Mary Jambus, Willard F. King, Nancy K. Miller, Jody Norton, Ann Pellegrini, S. P. Rosenbaum, Lorie Roth, Robert Scholes, Joanne Shattock, Rosemary T. VanArsdel, Alfred Bendixen, Alarma Kathleen Brown, Michael J. Kiskis, Debra A. Castillo, Rey Chow, John F. Crossen, Robert F. Fleissner, Regenia Gagnier, Nicholas Howe, M. Thomas Inge, Frank Mehring, Hyungji Park, Jahan Ramazani, Kenneth M. Roemer, Deborah D. Rogers, A. LaVonne Brown Ruoff, Regina M. Schwartz, John T. Shawcross, Brenda R. Silver, Andrew von Hendy, Virginia Wright Wexman, Britta Zangen, A. Owen Aldridge, Paula R. Backscheider, Roland Bartel, E. M. Forster, Milton Birnbaum, Jonathan Bishop, Crystal Downing, Frank H. Ellis, Roberto Forns-Broggi, James R. Giles, Mary E. Giles, Susan Blair Green, Madelyn Gutwirth, Constance B. Hieatt, Titi Adepitan, Edgar C. Knowlton, Jr., Emanuel Mussman, Sally Todd Nelson, Robert O. Preyer, David Diego Rodriguez, Guy Stern, James Thorpe, Robert J. Wilson, Rebecca S. Beal, Joyce Simutis, Betsy Bowden, Sara Cooper, Wheeler Winston Dixon, Tarek el Ariss, Richard Jewell, John W. Kronik, Wendy Martin, Stuart Y. McDougal, Hugo Méndez-Ramírez, Ivy Schweitzer, Armand E. Singer, G. Thomas Tanselle, Tom Bishop, Mary Ann Caws, Marcel Gutwirth, Christophe Ippolito, Lawrence D. Kritzman, James Longenbach, Tim McCracken, Wolfe S. Molitor, Diane Quantic, Gregory Rabassa, Ellen M. Tsagaris, Anthony C. Yu, Betty Jean Craige, Wendell V. Harris, J. Hillis Miller, Jesse G. Swan, Helene Zimmer-Loew, Peter Berek, James Chandler, Hanna K. Charney, Philip Cohen, Judith Fetterley, Herbert Lindenberger, Julia Reinhard Lupton, Maximillian E. Novak, Richard Ohmann, Marjorie Perloff, Mark Reynolds, James Sledd, Harriet Turner, Marie Umeh, Flavia Aloya, Regina Barreca, Konrad Bieber, Ellis Hanson, William J. Hyde, Holly A. Laird, David Leverenz, Allen Michie, J. Wesley Miller, Marvin Rosenberg, Daniel R. Schwarz, Elizabeth Welt Trahan, Jean Fagan Yellin
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- Journal:
- PMLA / Publications of the Modern Language Association of America / Volume 115 / Issue 7 / December 2000
- Published online by Cambridge University Press:
- 23 October 2020, pp. 1986-2078
- Print publication:
- December 2000
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