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1
Lawrence, Estelle. "School-based HIV counselling and testing: providing a youth friendly service." University of the Western Cape, 2012. http://hdl.handle.net/11394/2159.
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Philosophiae Doctor - PhDHIV counselling and testing (HCT) is an essential element in the response to the HIV epidemic. Thereare still major gaps in research about the best ways to provide HCT, especially to young people. School-based HCT is a model which has been suggested for providing HCT to young people in a youth friendly manner. This study was aimed at producing recommendations for providing a youth friendly school-based HCT service using the World Health Organisation (WHO) framework for youth friendly health services. It was conducted in six secondary schools in Cape Town, where a mobile HCT service is provided by a nongovernmental organisation (NGO). It was an exploratory descriptive study, using a mixed-methods approach. Twelve focus group discussions (FGDs) were held with learners to explore their needs with regards to school-based HCT. An evaluation (which consisted of observation of the HCT site, service provider interviews and direct observation of the HCT counselling process) was done to determine whether the mobile school-based HCT service was youth friendly. A learner survey was conducted with 529 learners to investigate the factors that influence the uptake of HCT and to explore learners’ behaviours and experiences under test conditions. In the FGDs, learners said that they wanted HCT to be provided in schools on condition that their fears and expressed needs were taken into account. They wanted their concerns regarding privacy and confidentiality addressed; they wanted to be provided with information regarding the benefits and procedure of HCT before testing took place; they wanted service providers to be competent to work with young people, and they wanted to be assured that those who tested positive were followed up and supported. On evaluation of the mobile school-based HCT service, it was evident that the service did not meet all the needs of the learners nor did it have all the characteristics of a youth friendly health service. The model of ‘mass testing’ used by the NGO did not fulfil learners’ expressed need for privacy with regards to HCT. Service providers were friendly and on-judgemental but had not been trained to work with young people (especially marginalised groups e.g. young men who have sex with men). The information needs of learners were not addressed, and learners were not involved in the provision of the HCT service. Learners who tested positive were not assisted in accessing care and support. The learner survey revealed a high uptake of HCT (71% of learners) at schools with learners who do not identify themselves as Black, with female learners and older learners being more likely to have had an HIV test. Factors that influenced uptake of HCT were complex, with learners reporting many different motivators and barriers to testing. Of concern was the low risk perception of learners with regards to HIV infection and the fact that learners who tested HIV positive were not being linked up with treatment and care. Based on the findings of the study, recommendations were made for proving youth friendly school based HCT. A multisectoral approach, with learner and community involvement, was suggested in order to provide a service which is equitable, accessible, acceptable, appropriate and effective.
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Chakare, Rejoice Sesedzai. "Attitudes towards adolescent friendly health service provision among health workers at a primary health care clinic in Windhoek, Namibia." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79966.
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Thesis (MPhil)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Health statistics on adolescents in Namibia indaicate high incidences of teenage unwanted pregnancies, unsafe abortions, baby dumping, maternal ill health, early marriages and STIs including HIV. These are indicators of underutilisation of adolescent friendly health services (AFHS) by adolescents as education on these problems are covered in it. Although Government has made some strides to esure implementation starts, there is a recognisable lack of its adoption by health workers. The aim of this study was to establish the reasons for the slow adoption of AFHS practices by health workers at Katutura Health Centre. A quantitative non-experimental cross-sectional descriprive research approach was used in this study. Evidence using both primary data collected in the field through self-administered semi-structured questionnaires (with both open and closed questions) and secondary data collected in the literature review was employed . A census of the entire population of health workers was prefered over sampling. A total of 56 health workers accepted to participate in the study and the questionnaire, 46 of which returned it within a stipulated three weeks data collection period. Descriptive statistics was utilised together with frequencies, mean and basic collection. Eighty two percent of the sample participated in the study of which 67% respondents were female and 33% were male. The majority of the respondents (78.3%) had tertiary education. The results indicated: AFHS were not known to the majority of health workers; there is slow adoption of AFHS; and the programme introduction could have been done better. Factors significantly associated with adoption of AFHS are knowledge of such services, sex, level of education, job position, work experience and effective implementation of the programme. A probability value of p<0.05 was adopted. The programme is well appreciated despite concerns of lack of training and proper implementation. Key recommendations were on staff recruitment, retention and training of health workers; creation of space for implementing AFHS and marketing the programme. The system is in place, what is left is to tighten some loose ends and programme is up and running.
AFRIKAANSE OPSOMMING: Gesondheid statistieke oor die jeug in Namibië verwys na hoë voorkoms van ongewenste tiener swangerskappe en onveilige aborsies, weg gooi van babas, swak moederlike gesondheid, vroeë huwelike en seksueel oordraagbare siektes, insluitend MIV. Dit is aanwysers van die onderbenutting van jeug vriendelike gesondheidsdienste (AFHS) deur die jeug, as die onderwys op hierdie probleme gedek word. Hoewel die regering 'n paar implementerings begin het, is daar 'n beduidende gebrek van aanneming deur gesondheidswerkers. Die doel van hierdie studie was om die redes vas te stel vir die stadige aanvaarding van AFHS praktyke deur gesondheidswerkers by Katutura Gesondheids Sentrum. 'n Kwantitatiewe, nie-eksperimentele navorsingsbenadering is gebruik in hierdie studie. Bewyse uit beide primêre data wat ingesamel is in die veld deur middel van self-geadministreerde semi-gestruktureerde vraelyste (met beide oop en geslote vrae) en sekondêre data wat ingesamel is in die literatuuroorsig was gebruik. 'n Sensus van die hele bevolking van gesondheidswerkers is verkies in plaas van steekproefneming. 'n Totaal van 56 gesondheidswerkers het aanvaar om deel te neem aan die studie en die vraelys, waarvan 46 teruggedien is binne die vasgestelde tydperk van drie weke se data-invorderingstermyn. Beskrywende statistiek is gebruik saam met frekwensies, gemiddelde en basiese versameling. Tagtig en twee persent van die steekproef het deelgeneem aan die studie, waarvan 67% respondente vroulik en 33% manlik was. Die meerderheid van die respondente (78,3%) het tersiêre opleiding. Die resultate het aangedui: AFHS is nie bekend aan die meeste van gesondheidswerkers nie, en daar is stadige aanneming van AFHS; en die program inleiding kon beter gedoen gewees het. Faktore wat beduidend verband hou met die aanneming van AFHS is kennis van sodanige dienste, geslag, vlak van onderwys, werk posisie, werkervaring en doeltreffende implementering van die program. 'n Waarskynlikheid waarde van p <0,05 is aangeneem. Die program is goed waardeer ten spyte van kommer aan 'n gebrek van opleiding en behoorlike implementering. Belangrikste aanbevelings was op die personeel werwing, behoud en die opleiding van gesondheidswerkers; skepping van ruimte vir die implementering van AFHS en bemarking van die program. Die stelsel is in plek, wat oorbly om gedoen te word, is om 'n paar los punte te versterk en die program is aan die gang.
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Kambikambi, Chilobe Muloba. "Young males’ perceptions and use of reproductive health services in Lusaka, Zambia." Thesis, University of the Western Cape, 2014. http://hdl.handle.net/11394/4011.
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Magister Public Health - MPHThe aim of this study was to describe the health seeking behaviours, knowledge about the available services, as well as experiences, and barriers to access and utilization of the reproductive health services among male adolescents in Lusaka. A descriptive, qualitative study was conducted among male adolescents in a peri-urban setting in Lusaka. Four focus group discussions were conducted with 46 adolescents aged between 13 and 24 years of age, and six key informant interviews. Data was audio-tape recorded and transcribed verbatim. Thematic content analysis was done. Health concerns were related to the social, psychological, societal and puberty needs of participants. Concerns, questions and queries about masturbation were common, especially among the younger adolescents. Most problems related to puberty and body changes rather than sexual and reproductive health matters per se. Knowledge about the available sexual and reproductive health services was generally low, with some young men being completely unaware of the existence of youth friendly services at the local clinic. Contrary to popular opinion, adolescents in this community reported that they did not seek help on sexual matters from friends and did not want to discuss their problems with their peers, due to fears of being marginalized. Perceived gender, cultural and social norms, lack of knowledge about the availability of adolescent reproductive health services, and poor attitudes among the health care providers were some of the identified barriers to seeking health care. Adolescents perceived health providers to be judgmental, not helpful and condescending towards young people. Lack of privacy and confidentiality were also reported as barriers to access and utilization of sexual and reproductive health services
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Govender, Thashlin. "Factors that influence utilization of primary health facilities by adolescents in Tafelsig, Mitchells Plain." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4032.
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Magister Public Health - MPHPromoting positive and healthy decision-making practices and encouraging the utilization of health care facilities amongst adolescents is an important public health priority given that the period of adolescence is characterized by experimentation and risk taking behaviour. In the Tafelsig area of Mitchell‟s Plain, a poor socio-economic community within the Cape Town metropole, adolescents are exposed to a range of social problems (such as alcohol and substance abuse) that can potentially be harmful to their health. Given this context there was some concern raised by the sub-district health management team that adolescents are not making sufficient use of the local health facilities. The purpose of this study was to gain a greater understanding of the factors that contribute to, or hinder, the utilization by adolescents of the public health facilities in the Tafelsig area and in turn provide the Department of Health with information on adolescents‟ preferences concerning access to and use of the local primary-level health services in Mitchells Plain.An exploratory descriptive study was conducted to explore the topic using qualitative research methods. Permission to conduct the research was obtained from the Higher Degrees Committee of the University of the Western Cape and the School Principal. In-depth interviews were conducted with eight Grade 9 and seven Grade 10 male and female learners from the local secondary school - all of whom were randomly selected from a list of learners who indicated their willingness to participate in the study and who had obtained the written consent from their parents or guardian to do so. Interviews with the learners explored the positive and negative experiences, perceptions and opinions they have of using – or contemplating the use of – the local health facilities. The data from these interviews were analyzed using thematic content analysis.The study demonstrated that even when public health services are available, adolescents are often not in a position themselves to choose for themselves: their parents or guardians invariably make the choice for them. At times they are also reluctant to use public health facilities for fear of being judged by health personnel for being sexually active. The idea of waiting for long periods of time to see a health professional, or being observed at the health facility by other members of their community, are also considered to be disincentives.Many of the learners interviewed expressed a need for more information about sexual and reproductive health issues and matters that affect their health. The findings of this study also suggest that there is an urgent need for youth-friendly health services to be made available in the Mitchells Plain community. It is thus recommended that the Department of Health strategically assess whether an existing public health facility can be re-orientated to cater for the specific health needs of adolescents in Mitchells Plain.
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Jimmy-Gama, Dixon. "An assessment of the capacity of faculty-based youth friendly reproductive health services to promote sexual and reproductive health among unmarried adolescents : evidence from rural Malawi." Thesis, Queen Margaret University, 2009. https://eresearch.qmu.ac.uk/handle/20.500.12289/7456.
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Despite the recognition of the influence of cultural norms on adolescent sexual behaviours in most societies (Kaler 2004; Chege 2005), less attention has been paid to the link between social norms and effectiveness of health facilities to promote adolescent sexual and reproductive health (ASRH). This thesis therefore examines the capacity of facilitybased youth-friendly reproductive health services (YFRHS) to promote ASRH in rural Malawian societies where culture strongly influences adolescent sexual behaviours. The study employs a social constructionist epistemology and a social interactionism theory to understand the capacity of YFRHS in ASRH promotion in rural Malawi. Qualitative and quantitative data were collected using a sequential exploratory design. Semi-structured in-depth interviews, participant observations, client exit interviews, survey, focus group discussions and review of health strategic and service utilisation documents/records were conducted. The results were generated by triangulating both qualitative and quantitative data. The findings of the study illuminate how social norms related to social identities influence adolescent sexual behaviours and ASRH promotion. An exploration of the cultural context reveals a major disjuncture between an ideal norm - no premarital sex - and a modelled norm where unmarried adolescents are expected to engage in unsafe sex. It also shows the conflicts between the cultural and scientific models of ASRH promotion. Structural gender asymmetry that emphasises subservience in females and hegemonic masculinity also reduces adolescents’ rights and agency in SRH promotion. The health providers are cultural agents. They manage diverse roles both as ‘moral guardians’ and as ‘health promoters’ in a way that limits their effectiveness as health promoters. The thesis concludes that the way facility-based YFRHS is implemented has limited impact on SRH promotion among unmarried adolescents of rural Malawi. The study recommends that appropriate health promotion interventions based on conscientisationoriented empowerment theories directed at adolescents, community and health workers should be used in ASRH promotion in societies with strong cultural influence on sexual behaviours.
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Geza, Gcobisa. "Evaluation of the effect of adolescent and youth friendly services implementation on HIV testing uptake among youth (aged 15 – 24 years) in health facilities of Amathole district, Eastern Cape." University of Western Cape, 2020. http://hdl.handle.net/11394/7642.
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Master of Public Health - MPHHuman Immunodeficiency Virus (HIV) prevalence and new infections rate among young people in Southern Africa is high despite various programmes implemented to address general population prevention and treatment. The youth has a low HIV testing uptake even though there seems to be high HIV prevalence among this age population group. Youth focused interventions have proven to be a success in encouraging young people to have an HIV test done as part of improved health-seeking behaviours. In South Africa, such an intervention was initially implemented by LoveLife and later adopted in 2006 by the government as Adolescent and Youth Friendly Services (AYFS) for a larger-scale implementation in Primary Health Care facilities as a strategy to improve youth Sexual and Reproductive Health.
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Anderson, Melinda. "Improving Adolescent Friendly Healthcare Services: Implementing Comprehensive Psychosocial Histories Into Practice." Diss., North Dakota State University, 2014. http://hdl.handle.net/10365/24794.
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Anderson, Melinda Kay. "Improving Adolescent Friendly Healthcare Services: Implementing Comprehensive Psychosocial Histories into Practice." Diss., North Dakota State University, 2014. https://hdl.handle.net/10365/27274.
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Adolescence is a unique period of rapid physical and psychosocial growth and development. Adolescents are most often physically healthy, but as a normal part of adolescent development the population commonly experiments with risky behaviors, which may lead to the development of unhealthy habits (National Research Council and Institute of Medicine [NRC/IOM], 2009). Additionally, risky behaviors are connected to the top three causes of potentially preventable adolescent death ? accidents/unintentional injury, homicide, and suicide (Goldenring & Rosen, 2004; NRC/IOM, 2009).
Primary healthcare providers may have not received specialized training in providing healthcare to the adolescent population, or may feel uncomfortable engaging in communication about psychosocial risk factors with adolescents (NRC/IOM, 2009). One critical gap involves the fragmented healthcare services available to adolescents and the missed opportunities for health promotion and disease prevention when adolescents do seek healthcare. Incorporating comprehensive psychosocial adolescent histories into practice may help facilitate positive changes in adolescent healthcare delivery.
In response to the need for improved adolescent friendly healthcare services, an online continuing education module was created in collaboration with the American Association of Nurse Practitioners Continuing Education Center. The psychosocial assessment focused on utilizing the HEEADSSS assessment, as psychosocial risk factors contribute to the leading causes of adolescent morbidity and mortality (Goldenring & Rosen, 2004; NRC/IOM, 2009).
The module was evaluated through pretest, posttest, and evaluation questions. Data were collected for approximately two months, and there were 328 participants. Following completion of the module, over half (52.4%; n = 172) of the participants reported they will modify their practice, and nearly all of the participants (91.8%; n = 301) felt that the level of content was ?just right? for nurse practitioners. Five pretest and posttest questions related to the module?s content demonstrated increased knowledge as a result of the module. Additionally, a majority of the written qualitative responses were in support of or praising the quality of the module. Overall, data indicate a positive impact from the continuing education module about conducting comprehensive psychosocial interviews with adolescent patients.
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Jones, Siobhan. "Adolescent engagement in mental health services." Thesis, Canterbury Christ Church University, 2016. http://create.canterbury.ac.uk/14807/.
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Despite older adolescence being a risk period for the development of mental health concerns, mental health service engagement 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 rich and detailed results. Ten 16-18 years olds, engaged in Child and Adolescent Mental Health Services, were recruited from two London-based services. Each young person was interviewed in order to understand their personal experience of engaging in mental health services. Interviews were transcribed and underwent Interpretative Phenomenological Analysis. Analysis produced 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. Themes are discussed in detail. 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 limitations. Suggestions for clinical practice in relation to engagement facilitators and threat are made, and recommendations for future research proposed.
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Oppong-Odiseng, Amma C. K. "Adolescent health : problems, needs, services and service providers." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339846.
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Introduction There is a paucity of knowledge regarding adolescent's preferences for care. The health related problems they face have implications for individuals and nations. Objectives To determine the health problems and needs of adolescents, their knowledge, use of, and preferences for health related services and service providers. Study design A descriptive study involving a two-stage probability sample. An interview schedule was designed for data collection. Setting Eight randomly selected main-stream high schools in Stoke-on-Trent, England. Subjects One hundred and eleven males and 142 females aged 14 and 15 years between 1 st April and 30th June 1994. Results The adolescents had unmet problems and needs relating to lifestyle and risk-taking behaviour, sexual and reproductive health, and emotional problems, influenced by socio-economic and legislative factors. Services were used primarily for physical problems. Knowledge of the location and opening times of two local contraceptive services for adolescents was poor (10/253,4%). Factors they associated with confidentiality were identified. Preferences for service providers varied with the nature of the problem. The girls were more likely to give advice to peers regarding substance abuse, and issues relating to sexual and reproductive health, and expressed a greater preference for advice from peers on these issues. The services the adolescents wanted to see provided were appropriate to their needs and reflected a holistic concept of health. Conclusions • The Health of the Nation targets will not be met unless these problems and needs are addressed. • Potential intervention points for health promotion are being missed. • Local services must be widely advertised. • Adolescents need specific reassurance from service providers that their care will be confidential. • Positive actions adolescents are prepared to take need reinforcing. • Peer counselling programmes might be expected to have a greater positive impact on girls. • Adolescents' opinions regarding service provision must be taken into account.
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Beckham, Tony A. "Adolescent mental health services the use of psychological consulting /." Theological Research Exchange Network (TREN), 2005. http://www.tren.com.
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Jefferies, Natalie. "Young people moving on from child and adolescent mental health services to adult mental health services." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3715/.
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There is a sound evidence base on the effects of the therapeutic alliance on outcome in psychotherapy for adults. In comparison, there is a smaller amount of literature on the effects of the therapeutic alliance on outcomes for adolescents. Adolescents rarely are seen individually for therapy and instead are often seen by family therapists as part of a system with other members of the family. At present, it is uncertain what the effects of the therapeutic alliance on outcome for adolescents in family therapy are. This paper presents a systematic review that aims to investigate the effects of the therapeutic alliance on outcome in adolescents in family therapy and what factors influence the therapeutic alliance with adolescents in family therapy. A systematic review of electronic databases was carried out using a quality assurance checklist adapted from the American Academy of Neurology Clinical Practice Guidelines (2004). This checklist was used as it assessed aspects of the studies’ theoretical basis, design, measures, analysis and results. Eleven studies met the inclusion criteria and were reviewed. The findings of this review suggest that the therapeutic alliance affects outcome for adolescents in family therapy. The presence of identifiable features of the therapeutic alliance, such as task, goal and bond can strengthen the therapeutic alliance with adolescents. Research into this area is still in its preliminary stages. However, important factors have been identified that affect outcome. Further research is necessary before more substantial claims of the therapeutic alliance on outcome can be made. The limitations of this review are presented, followed by clinical, training and supervision implications and suggestions for future research.
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McAlaney, John, M. Fyfe, and M. Dale. "A specialist adolescent deliberate self harm service." Royal College of Nursing, 2009. http://hdl.handle.net/10454/2820.
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Donnelly, Katherine. "Emotion recognition in parents attending Child and Adolescent Mental Health Services." Thesis, University of Exeter, 2015. http://hdl.handle.net/10871/18151.
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Objectives: This study sought to determine whether a computerised cognitive bias modification programme could be effective within a waiting-room setting for parents accompanying their children to CAMHS appointments. The primary objectives were to determine whether detectable changes to participants' emotion recognition could be observed in this setting, and whether this approach would be acceptable to the population. Secondary measures investigated whether the programme would lead to changes in participants' affect or changes in parents' appraisals of difficulties with children. Methods: A computerised emotion recognition training task was delivered to all participants during four weekly sessions. Participants in the experimental condition (n=17) received feedback aiming to shift their detection of positive facial emotions, while those in the control condition (n=14) received feedback which was not designed to elicit any shift in emotion detection. Results: Positive shifts in emotion recognition were observed in the experimental group, although no changes were observed in secondary measures in either control or experimental groups. Qualitative data indicated that the programme was acceptable and appropriately constructed. Conclusion: This study demonstrates that cognitive bias modification is possible within a waiting-room setting, although the extent to which this can lead to clinically significant improvements in mood or relationships remains uncertain. This work has implications for emotion recognition interventions for clinical populations known to present with negative emotional biases (e.g. anxiety and depression) and represents an important first research step towards developing interventions to improve parent-child relationships.
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Gardner, Lea Anne. "Factors Associated with Hospital Commitment to Provide Child/Adolescent Psychiatric Services." VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/788.
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General acute care hospitals play a particularly important role in the delivery of children's mental health given the extant lack of alternatives to long term hospitals for patients requiring a restrictive treatment environment (Glied and Cuellar, 2003). This cross-sectional study identifies environmental and organizational factors associated with general acute care and children's hospitals in the United States that provide hospital-based child/adolescent psychiatric services and the number of services. Two macro-level theories, Resource Dependence Theory and Institutional Theory were used to identify environmental and organizational factors. A nationwide sample of hospitals was drawn from the 2003 AHA annual survey. Data from the 2002 AHA annual survey, Area Resource File and American College of Graduate Medical Education was used for the independent variables. There were three analyses, correlation, descriptive and logistic regression. Results demonstrate that hospitals in markets with a low percentage of non-white children, higher family median income, high hospital community orientation, and high percentage of not for profit hospitals are more likely to offer child psychiatric services. Organizational factors associated with an increased likelihood to providing child psychiatric services include hospitals identified as Catholic, public or children's and those with a child psychiatric residency program. Three factors were associated with hospitals providing a high number of child psychiatric services and include hospitals in metropolitan statistical areas, system affiliation, and general acute care hospitals. This study demonstrated that 1. large hospitals are more likely to offer child psychiatric services and a high number of services, 2. children's hospitals provide child psychiatric services, but not a high number of them, and 3. hospitals with a high number of service offerings are mainly located in MSA's and more likely to offer outpatient substance abuse services. Significant results were obtained in the analysis of hospital characteristics and the provision of child psychiatric services, but weaker results were observed when analyzing the number of services. Further research is needed to identify factors with stronger associations to the level of service offerings.
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Baldwin, Laurence James. "The discourse of professional identity in child and adolescent mental health services." Thesis, University of Nottingham, 2008. http://eprints.nottingham.ac.uk/10504/.
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Background: Child and adolescent mental health teams have traditionally been constructed using multidisciplinary teams of different professions. Current workforce policy in mental health, however, stresses team function and the skills and competences required to fulfil that function which leads to a questioning of professional identity within those teams. Aims: This study aims therefore to define how professional identity is constructed in the policy discourse and amongst a sample of current practitioners in mental health teams. Methodology: This study uses a linguistic method, Critical Discourse Analysis, to question whether functional approaches based on role theory are appropriate when identity work discourse has overtaken role theory as a way of thinking about professional working. It uses elements of role theory and identity work thinking, informed by postmodernist theorists such as Pierre Bourdieu, to look at the need for the underlying conceptual frameworks that professional training and socialisation bring. Findings: By analysing the current policy discourse, and a sample of practitioner discourse on the subject, the study shows that there is a need for the professional identity of individuals to be better addressed and understood. It examines the importance of the underlying conceptual frameworks that inform the skills and competences and what these frameworks bring to team functioning. The study also questions the way in which policy uses linguistic capital as a change agent to bring about workforce modernisation in child and adolescent mental health teams. Conclusions: The study highlights the need for professional groups to maintain their professional identity by being better able to articulate the contribution they make to team functioning by virtue of their conceptual frameworks. These are shown to inform the way in which individuals use their skills and competences to care for service users and their carers.
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Page, Helen. "Black African mothers experiences of a child and adolescent mental health services." Thesis, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589458.
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Evidence indicates disparities in the help-seeking experiences of Black African families engaging with Child and Adolescent Mental Health Services (CAMHS). UK health policy aims to reduce these inequalities and ensure that services are appropriate in meeting the needs of a multicultural society. Literature exploring the reasons for service use disparities has identified numerous correlates of service engagement, however the experience and operation of these correlates is less well understood. As such, clinicians lack a depth of knowledge that could facilitate their work. Help-seeking research has highlighted that service engagement is a dynamic and social process shaped by cultural context. As such, qualitative research methods have been advocated to explore the individual's understanding of this experience. This study sought to develop a qualitative and in-depth understanding of the experience of Black African mothers attending a CAMHS and explore how cultural values and perceptions contribute to this experience. Six Black African mothers were interviewed regarding their experiences of attending CAMHS. Semi-structured interviews explored how participants understood their experience and how their cultural background may relate to their experience. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes were identified concerning the experiences of 'parenting in a new context', 'the problem' and 'power and acceptability'. Participants' experiences 3 of CAMHS occurred in the context of raising a child in a new cultural context associated with various changes. This context contributed to the experience of defining a problem and understanding the responses taken. The experience challenged participants' existing understanding and introduced alternatives that were acceptable to different degrees across the sample. The findings indicate that culturally shaped beliefs regarding parenting, childhood behaviour and help-seeking are important in understanding the engagement of Black African families. Recommendations are made that aim to consider the world view of the client and service in order to deliver acceptable and appropriate services.
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Fang, Wing-yee, and 方頴怡. "A review of child and adolescent mental health services in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48423142.
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Background and Objectives
The prevalence of child and adolescents mental health problems has been increasing in Hong Kong and is comparable to that of the world. It is estimated that the mental health problems of the future generations would account for 15% to 30% of their disability-adjusted life years (DALYs) and become a healthcare burden on societies in the near future. Therefore, it is necessary to address their mental healthcare needs now. The objective of the project is to review how the mental health services for children and adolescents have been changing in Hong Kong throughout the past few decades and to assess whether the local services have improved. While the service advancement in adult and old age (for example dementia) psychiatry has been significant, the children and adolescent mental health services would be reviewed by using the Donabedian framework. Based on some local and western models, the project will also address what the local healthcare providers can do for the children and adolescents with the capacity of developing multi-disciplinary and community-based integrated care as well as primary care and prevention. Service gap and areas of improvement on addressing the healthcare needs would be identified for the consideration of policymakers.
Methods
This project is a literature review. Archives of the Hong Kong College of Psychiatrists and Paediatricians, PubMed, PsycInfo, World Psychiatry, Lancet, etc have been searched with keywords including “children”, “adolescents”, “mental health services”, “child psychiatry” and “Hong Kong”. Journals from 1991 to 2011 have been retrieved. Publications and official sites of Hospital Authority and government organizations have also been searched.
52 journals, articles and online sources have been searched. 38 papers are identified and 19 are providing relevant materials. Studies with aggregated population level data rather than clinical studies which focus on symptoms and treatment of individuals are much more useful and providing more relevant information to this project.
Results
Secondary and tertiary care, in terms of screening, detection, in-patient and out-patient setting and rehabilitation services have been developed in Hong Kong since the 1980s whilst there are rooms for further development on primary care and prevention. An integrated approach, which emphasizes early identification and treatment by specialists-led multi-disciplinary professionals, has been more prominent. The stigmatization, which would result in reluctance of treatment, should also be addressed by enhancing the public understanding and awareness on the mental healthcare needs of children and teenagers.
Conclusions
It is necessary to work on the improvement of child and adolescent mental health in the primary, secondary and tertiary care in Hong Kong at present. Policymakers shall consider strengthening the support for child and adolescent psychiatry services in addition to the adults’.published_or_final_version
Public Health
Master
Master of Public Health
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Allen, Dawn. "Child and adolescent mental health : the strategic framework and its implementation in Wales." Thesis, University of South Wales, 2010. https://pure.southwales.ac.uk/en/studentthesis/child-and-adolescent-mental-health(5d009658-a303-4cfe-bba6-18ba0f2276a3).html.
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This research comprises three linked projects stemming from the first project which aimed to define “long-term” pupil absence from school and discover the principal reasons for such absence. The second project focussed on the area of Child and Adolescent Mental Health Services (CAMHS), an issue emerging from the first project. The CAMHS 4-Tier Strategic Framework (or “CAMHS Concept”), including links between CAMHS providers were examined and referral pathways investigated and measured against published criteria. The third project explored the new CAMHS Strategic Framework and considered whether implementation problems were to blame for its lack of transformational impact.
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Aslam, Sidra. "Exploring looked after children's experiences of accessing Child and Adolescent Mental Health Services." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3726/.
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Looked-after children (LAC) are particularly vulnerable to poor mental health. Yet there appears to be limited research on their experiences of Child and Adolescent Mental Health Services (CAMHS) despite the concept of participation and being listened to strongly exemplified throughout government policy and guidance. A multiple case study design explores the lived experiences of four looked-after young people who have accessed CAMHS and attended a therapeutic intervention. Semi-structured interviews were conducted with four looked-after young people, using activities that are congruent with personal construct psychology (Kelly, 1995). Thematic analysis highlights that ‘CAMHS as a secure base’ is a facilitator to attending CAMHS. Barriers for the looked-after young people in attending CAMHS related to limited accessibility due to in-care factors and CAMHS factors. LAC’s experiences of attending a therapeutic intervention through CAMHS were positive. The overarching theme of ‘exploring trauma, loss and rejection’ highlights that attending a therapeutic intervention at CAMHS supported the looked-after young people to process and resolve difficult past experiences and reconstruct working models of self and attachment figures. Participants also highlighted ways in which CAMHS could be improved for LAC through a need for transparency. Implications for all professionals working with LAC are discussed.
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Okeorji, Samuel C. Godwin. "Counselors' Perceptions on Adolescent Access and Use of School-based Mental Health Services." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6255.
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The role of school-based mental health counselors (SBMHCs) is essential in addressing the mental health needs of U.S. adolescents. The purpose of this phenomenological study was to examine SBMHCs' perceptions about factors that affect the use of SBMH services by adolescents from a school district in Connecticut. SBMHCs were chosen for this study because they provide direct mental health services to adolescents. Mechanic's general theory of help-seeking provided the framework to interpret research findings using the 10 interrelated constructs. Fifteen SBMHCs participated in face-to-face semistructured interviews. Colaizzi's 6-steps-guide was used to organize, code, and identify common themes. The following themes were identified: (a) there was no uniform process to identify and refer a student for services, which makes it time-consuming for SBMHCs to identify students in need; (b) there was a lack of established trusting relationship between adolescents and SBMHCs; (c) adolescents with persistent truancy at school had issues associated with poverty, housing, and family security that negatively affect access to use SBMH services; (d) financial resources were needed to support schools to hire more qualified professionals, create programs, and assist families of adolescents who may need SBMH services. Barriers to the use of SBMH services were identified as the lack of parental engagement, SBMHCs time constraints, and social stigma. Study findings may raise awareness to mental health access factors and barriers faced by adolescents and SBMH professionals and help improve access to critical SBMHCs and use of mental health services as needed.
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Raza, Abid. "Epidemiology of adolescent asthma : risk and prognosis in a birth cohort over adolescence." Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/376796/.
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Craig, Eva M. "Child and adolescent obesity : prevalence and risk factors in a rural South Africa population." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/5176/.
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The World Health Organization estimates that 22 million children worldwide aged <5 years are overweight and highlights tackling childhood obesity as an urgent priority. Childhood obesity is rising to epidemic proportions in the developing world, reflecting changing physical activity levels and dietary intakes, adding a significant public health burden to countries where undernutrition remains common. Interventions to prevent childhood obesity have had disappointing results, because the science and aetiology of obesity is poorly understood and prevention programmes have not targeted appropriate behaviours nor adequately engaged communities being studied. The origins of obesity appear simple, excess energy intake and/or low energy levels expended on physical activity, leading to chronic energy imbalance. However, the problem is more complex with underlying societal, behavioural and genetic causes of energy imbalance remaining unclear. Obesity is driven by individual, household and community factors: research to date has concentrated on individual factors with almost no significant focus on higher level influences on obesity. Findings from studies in developed countries are unlikely to be applicable to rural African settings where there is an increasing transition from a state of undernutrition to that of overnutrition. Few data exist on the prevalence of child and adolescent obesity from low and middle income countries like South Africa. This thesis aimed to determine the prevalence of overweight and obesity in children and adolescents (aged 7-15 years) within this population and to identify possible risk factors. Participants and Methods The study was cross-sectional and involved collecting primary data in local schools. A total of 1,519 subjects were recruited from three age groups (approximately 500 from each age group 7, 11 and 15 years). Participants were recruited from school grades 1, 5 and 9 corresponding to the ages 7, 11 and 15 years respectively. The study comprised two parts, a main cross-sectional study and a further study including a sub-sample of the participants. In the main cross-sectional study anthropometric measurements (height, weight, mid-upper arm circumference and body fat) were performed on all the participants and a lifestyle questionnaire administered (questions related to water collection, travel to school, TV watching and sport participation). The study took place in a demographic surveillance area and data collected from participants was linked with their household/community data to allow analysis of variables associated with overweight/overfat status. 150 participants were randomly selected from the main study (50 from each age group 7, 11 and 15 years) and invited to take part in a sub-sample study which included objective measurement of physical activity (7 days accelerometry) and dietary assessment (2 x 24 hour multiple pass recall assessments) on each participant. Main Findings Prevalence of overweight and obesity was higher in girls than boys and was highest in the oldest age groups for females. Using the Cole/IOTF BMI for age reference combined overweight and obesity was 23% in grade 9 females compared to only 6% in boys in the same grade (p<0.01). The lifestyle questionnaire revealed high levels of water collection, active commuting and TV watching.
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Stallard, Paul. "Learning from children and their carers : assessing needs, developing services and evaluating satisfaction." Thesis, University of Bath, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340976.
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Prince-Slocum, Brooke Marie. "Adolescent participation in pregnancy prevention interventions." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2615.
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Baughman, Margaret C. "Consumer Participation in Identifying Barriers to Ohio's Adolescent Alcohol and Drug Treatment Services." University of Akron / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=akron1259624734.
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Whitener, Louise M. "Using Hongvivatana's model to evaluate health care access : a field study of adolescent women's access to reproductive health care services in rural Missouri counties /." free to MU campus, to others for purchase, 2000. http://wwwlib.umi.com/cr/mo/fullcit?p9974703.
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Kershnar, Rebecca. "Adolescent Medicine: Attitudes, Training And Experience of Pediatric, Family Medicine and Obstetric-Gynecology Residents." Yale University, 2008. http://ymtdl.med.yale.edu/theses/available/etd-08142007-140035/.
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Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. In many instances, a correlation has been noted between insufficient training and provision of adolescent medicine services in the practicing physician population. The American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetrics and Gynecology and Society for Adolescent Medicine recommend adolescent providers deliver comprehensive health services to teenagers. This study sought to assess and compare Pediatric, Family Medicine and Obstetric-Gynecology resident perceptions of their responsibility, training, experience and comfort with providing comprehensive health care services adolescents. We asked residents to identify the following: (1) adolescent health services they considered part of their scope of practice in their respective field; (2) the level of training they had received with regard to select adolescent health services; (3) the experience they had performing select clinical activities with adolescents; and (4) their comfort with aspects of adolescent care. We further asked two questions to test resident knowledge of an adolescents right to consent to contraception or an abortion without parental notification in the state of their residency. A total of 87 residents (31 Obstetric-Gynecology, 29 Family Medicine and 27 Pediatric) were surveyed. Most residents from all three fields felt the full range of adolescent preventive and clinical services represented in the survey fell under the scope of their practice. Most residents also reported high levels of comfort with examined aspects of adolescent care. In regard to some activities, the positive scope and comfort responses were matched by high reported levels of training and experience, including defining confidentiality; counseling about eating, exercise and obesity; counseling about substance abuse; and discussing STDs, sexual partners and contraception. However, for multiple key adolescent services, considerable discrepancies existed between reported levels of training and experience and the positive responses concerning scope and comfort. In particular the results of study suggested all residents need considerably more training and experience with mental health issues, referring teenagers for substance abuse treatment, and addressing physical and sexual abuse. Overall, there were also significant differences between fields. Family Medicine residents reported the greatest potential for providing comprehensive health care. However, they suffered from the overall deficiencies in training and experience noted above. Obstetric-Gynecology residents reported deficiencies in the provision of several preventive counseling and general health services. Pediatric residents reported multiple deficiencies in the provision of sexual health services. Our results indicate, at this time and in the near future, it is unlikely that adolescents will be able to obtain the full range of recommended preventive and clinical services in a single physician visit unless residencies programs actively incorporate increased training in the full range of adolescent preventive and clinical health services.
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Killett, Anne Marie. "Children and young people's experiences of child and adolescent mental health services : a participatory approach." Thesis, University of East Anglia, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.427116.
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Wallis, Jennifer Mary. "A demographic study of adolescent in-patients at Lentegeur Psychiatric Hospital 1986-1990 : implications for policy and intervention." Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/21808.
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Bibliography: pages 108-115.The aim of the proposed study is to evaluate demographic factors and treatment characteristics contained in the historical records of those treated as in-patients at the Sonstraal Adolescent unit of Lentegeur Hospital, during the period 1986 to 1990. This demographic study details the following aspects of the adolescent in-patients: size, that is, numbers of those admitted to the unit; composition, including age, sex and area. Treatment characteristics such as reasons for admission, diagnosis of psychopathology, referral agent on admission and discharge and length of stay in the unit are considered. The data for the study have been extracted from the clinical records contained at Sonstraal, namely , the 'Clinical Summary on Discharge' form. This form is completed by the therapist of each adolescent attending the unit. The EpiInfo computer programmes have been utilised to create a database and to select the appropriate procedures and statistics which form the basis for data analysis and interpretation. Data interpretation includes an analysis of the emerging trends and details the implications for policy issues, unit staffing and treatment options. Analysis of the trends and comparisons with literature findings have facilitated the generation of hypotheses which could be tested in future studies. This study therefore provides a working document for future prioritising and planning of in-patient, out-patient and community mental health services to adolescents, their families and communities. This involves recommendations for intervention and community involvement. In addition, the study provides a basis for future research into adolescent mental health care.
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Hedden, Lindsay Kathleen. "Health services utilization and provider continuity of care among survivors of childhood cancer : a cohort analysis." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/2490.
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Purpose: A majority of childhood and adolescent cancer survivors face life-long cancer- and treatment-related sequelae. Long-term follow-up is necessary to facilitate timely diagnosis and management of these health conditions. As part of strategic long-term follow-up, provider continuity of care (PCOC) may improve outcomes through appropriate use of surveillance, screening, and coordination of services. The purpose of this thesis was to assess physician services utilization and PCOC among survivors of childhood cancer compared with general population subjects, and to examine factors associated with survivors' use of physician services and PCOC scores.
Methods: Physician services utilization and PCOC were assessed in a population-based cohort of 1322 five-year cancer survivors diagnosed between 1981 and 1995 under age 20 in British Columbia, and a group of 13,220 age- and gender-frequency matched, randomly selected population-based subjects, whose records were linked to individual-level administrative healthcare datasets. Effects of clinical and sociodemographic modifiers on utilization and PCOC were examined using generalized linear modeling. Changes in utilization and PCOC by age were estimated using a longitudinal, repeated measures modeling approach.
Results: Survivors incurred an average of 8.94 medical visits per year: 4.82 to primary care physicians, 2.69 to specialists, and 1.43 to non-physician providers. Survivors had more visits than comparators in all visit categories (p<0.0001 for all). As they age, survivors' use of primary care services increases significantly, while their use of specialist services declines, trends that are not mirrored by the comparison population.
The average PCOC score for survivors was 0.54 ± 0.22, indicating survivors saw the same primary care provider for only 50% of their primary care visits. Mean score did not differ between survivors and comparators; however, in the population sample scores improved with age (p=0.02), while among survivors, scores worsened (p=0.05).
Conclusions: The dramatic age-related increase in primary care visits observed in the survivor group suggests that primary care physicians play a key role in ensuring quality long-term follow-up care. Survivors are at heightened risk for poor PCOC as they age and transition into adult-oriented community care, raising concerns about whether they are receiving the appropriate follow-up care encompassing screening, surveillance and psychosocial support.
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Chopra, Gurpreet Kaur. "Exploring the experiences of transitional care from child and adolescent mental health services to adult mental health services : the perspectives of professionals, parents and young people." Thesis, University of Wolverhampton, 2016. http://hdl.handle.net/2436/621926.
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Transitional care is an important process for professionals to consider, particularly as recent studies have shown how a mental health difficulty in adolescence will persist into adulthood. This indicates that a number of those seen in Child and Adolescent mental health services are likely to make the transition into Adult services. For professionals from both services, barriers can arise when supporting young people across service boundaries and recent studies have stated that the current practice of transitional care in mental health is deemed to be problematic. However at the time of conducting this study, there was a paucity of literature, therefore the aim of the study was to add to the existing knowledge. The study followed a Social Constructivist grounded theory (Charmaz, 2014) approach to explore the experience of stakeholders of the transition process. Semi-structured interviews were conducted with professionals, young people and parents. There were a total of eight interviews which were transcribed and analysed. The findings present the core category as Facing the transition, with three sub- categories: Changing status, Manoeuvring the boundaries and Reflections on the process. The tentative theory explains how facing the transition involves stakeholders adjusting to the changing status of the service user. This category triggers the service transition but also describes how societal perceptions about adulthood influence the expectations placed on young people. Manoeuvring the boundaries describes and explains service transition, identifying a range of barriers and strategies to overcome these. One of the most significant barriers was identified as cultural differences between the two services. The third category describes how stakeholders make sense of their experiences, and how these are managed within the therapeutic relationship.
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Choka, Constance Ndhlovu. "Teenage girls' access to and utilization of adolescent reproductive health services in the Mpika District, Zambia." Thesis, University of the Western Cape, 2011. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_8701_1361366876.
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Teenage pregnancy is one of the major public health problems facing teenage girls in Zambia (Webb, 2000
Warenius, 2008). Teenage girlsâ access to and utilization of adolescent
reproductive health (ARH) services is important for the prevention of teenage pregnancies and sexually transmitted infections (STIs) amongst teenagers.High incidence of teenage pregnancies has been noted in the district despite availability of ARHservices. Teenage pregnancy is a major contributing factor to the high school drop-out rate amongst the girls and is one of the challenges faced by non-governmental organizations (NGOs) that support girl child education, such as the campaign for female
education (CAMFED) as well as for government agencies such as the Ministry of Education. The high incidence of teenage pregnancies could be an indication of poor access to
and utilization of ARH services and therefore an assessment of the accessibility and utilization of the ARH services was done to explore the reasons for this.This research aimed to explore the factors affecting teenage girlsâ access to and utilization of ARH services in the Mpika district, Zambia. The research was a qualitative, descriptive and exploratory study using individual interviews with ten in-school teenage girls, four key informants rendering ARH services and a focus group discussion (FGD) with ten pregnant teenage girls. By exploring these particpantsâ perceptions and experiences, appropriate interventions to improve accessibility to and utilization of ARH services could be designed that would be appropriate for the local context in order for them to be effective. Thematic analysis with categorizing and coding methods was used to analyze the data. The study used the theory of planned behaviour (TPB) which stipulates that an individualâs attitude,subjective norms and perceived behavioural control influence behaviour as a framework to explain the findings of the results of the study. The findings of the study indicated that physical, psychological and social barriers hindered adolescents from accessing and utilizing ARH services. The findings also suggested that high levels of knowledge about RH services do not necessarily translate into accessibility and utilization of ARH services. Accessibility to and utilization of ARH services by adolescents can also be determined by an individualâs attitude, subjective norms, and perceived behavioural control as illustrated by the TPB. Adolescents need to feel comfortable using ARH services. Therefore the three variables of TPB should be taken into consideration when designing comprehensive ARH programmes in order to accommodate the unique reproductive health needs of the adolescents. There is need to encourage participation in and involvement of adolescents in planning and
implementation of ARH programmes. The participants also made recommendations which included strengthening information and education on ARH, strengthening adolescent-friendly services, improving staffing levels and promotion of school health services.
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Kemp, Rachel. "The experiences of staff working in secure forensic child and adolescent mental health services : exploratory interviews." Thesis, University of Leicester, 2009. http://hdl.handle.net/2381/4530.
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Purpose: The needs of young people within forensic mental health settings are starting to become more recognised and services are beginning to reflect this. However there is little research into how staff in forensic child and adolescent mental health settings experience the task of working with this group of young people with complex difficulties. The purpose of this study is to explore how these staff experience their work. This is intended to expand research in this area and identify how the findings can inform clinical practice and future research. Method: A systematic literature search identified some research in relation to the needs of adolescents with mental health and forensic difficulties and literature in relation to working with children. Very little was found in relation to staff experiences working with children in forensic mental health settings but some research relating to adult forensic and mental health settings was found. A qualitative study was carried out in order to bridge this gap in the research. Interpretative Phenomenological Analysis was selected as the method of analysis for the study, which involved interviews with nine participants who were currently working in secure child and adolescent forensic mental health services. Results: Four themes emerged from the first level of analysis: powerful internal experiences, impact of the environment, negotiating complex staff relationships and managing complex client dynamics. A second level of analysis focusing on the researcher's impressions of the research overall identified another theme: difficulty thinking about and articulating experiences. Conclusion: This study is an important first step in identifying some of the issues faced by staff working in a challenging area. It has highlighted clinical implications and where further research might be useful.
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Mitchell, Paul. "Pathways and preferences : adolescent offenders help-seeking behaviour and access to mental health services in custody." Thesis, University of East Anglia, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.502516.
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Adolescent offenders in custody are known to have a high prevalence of mental health problems yet recent reports suggest that these needs often still go unrecognised. This study set out to track help-seeking behaviours, attitudes to mental health issues and access to mental health services by adolescent boys following admission to custody. The sample comprised 115 boys aged 15 to 18 years who had been admitted to a Young Offender Institution. Mental health needs were assessed using standardised tools; attitudes to services and help-seeking intentions were assessed using a questionnaire developed specifically for the study.
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Yeung, Kit-yi, and 楊潔儀. "The current issues facing the child and adolescent mental health care in Hong Kong: challenges of integratingprovision into primary care." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45175196.
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Rush, Michelle Anne. "What are the experiences of young people who, following their discharge from child and adolescent mental health services (CAMHS), do not transfer into adult mental health services (AMHS)?" Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/4136/.
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This thesis is submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology (D.Clin.Psy.) at the School of Psychology, University of Birmingham, UK. It comprises two volumes. Volume I consists of the research component whilst Volume II comprises the written clinical component based on work completed during training. Volume I comprises of a systematic literature review, an empirical research paper and a public domain paper. The systematic literature review considers available literature investigating mental health literacy and help-seeking behaviours in young people. The empirical research paper explores young people’s experiences who upon reaching the upper age limit for Child Adolescent Mental Health Services (CAMHS) are discharged rather than being transferred into Adult Mental Health Services (AMHS). Volume II contains five Clinical Practice Reports (CPR’s). CPR1 presents both cognitive behavioural and systemic formulations of a 16 year old female referred to CAMHS due to symptoms of depression. CPR2 is a service evaluation which aimed to assess service users’ perspectives of the Choice And Partnership Approach (CAPA), a newly implemented way of working within CAMHS. CPR3 presents a case-study of a 67 year old man, referred to mental health services for older people, due to long-standing symptoms of depression. CPR4 documents a single-case experimental design that assessed the effectiveness of a behavioural intervention implemented to reduce symptoms of Obsessive Compulsive Disorder (OCD) in a 13 year old male with a moderate learning disability. An abstract outlining CPR5, a clinical presentation about a 21 year old female referred to a systemic service following developing symptoms of depression related to difficult family relationships is also included.
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De, Monk Ingrid Venessia. "Turning the lens on the adolescent suicide." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1020791.
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In South Africa, suicidal behaviour in the younger generations has become rapidly part of a major public health problem. It is a well-known fact that adolescence is a critical period of progression in a teenager’s development which makes them more susceptible and vulnerable to suicide. Statistics have shown that there has been an increase in suicide among adolescents within the last decade (Schlebusch, 2005). The main aim of this research study is to explore the perceptions of adolescents regarding the factors that contribute to adolescent suicide. This study reviews literature concerning various risks factors for adolescent suicidality. It also described major social and psychological theories of suicide and the extent to which these studies support the importance to adolescent suicide. In the literature review theories of Bronfenbrenner’s Ecological Systems Theory, Durkheim’s sociological theory of suicide, Freud’s psychological perspective and Baumeister’s Escape Theory were discussed. A qualitative research design will be used by using visual participatory methodology techniques namely photo voice and reflective writing. A sample of 12 grade 11 learners, male and female, was purposely selected to participate in the research study. The focus of the study is to investigate the risk factors underlying adolescent suicidal behaviour in schools in the Northern Areas of Port Elizabeth, as well as to explore the stressors experienced by adolescents that could contribute to them having a higher suicide risk. Another focus point will be to look at prevention strategies as an antipode for suicidal behaviour. The main findings that emerged from the data analysis include contributing factors namely: socio-economic factors, personal factors, psychological factors and educational and school-related factors. The main prevention strategy themes emerged from findings derived from the data and include: parental involvement, religion, professional help and support groups and confiding in someone that you trust.
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Hayes-Burrell, Ingrid Monique. "Financing School-Based Health Centers: Sustaining Business Operational Services." ScholarWorks, 2015. http://scholarworks.waldenu.edu/dissertations/1684.
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Walden University
College of Management and Technology
This is to certify that the doctoral study by
Ingrid Hayes-Burrell
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Ify Diala, Committee Chairperson, Doctor of Business Administration Faculty
Dr. Anne Davis, Committee Member, Doctor of Business Administration Faculty
Dr. Yvette Ghormley, University Reviewer, Doctor of Business Administration Faculty
Chief Academic Officer
Eric Riedel, Ph.D.
Walden University
2015
â??
School-based health centers (SBHCs) have faced challenges in securing adequate funding for operations and developing sound business systems for billing and reimbursement. Specifically, administrators often lack strategies to develop and sustain funding levels to support appropriate resources for business operations. The focus of this descriptive study was to explore best practice strategies to develop and sustain funding through the experiences of SBHC administrators. The conceptual framework included Elkington's sustainability theory, which posits that corporate social responsibility, stakeholder involvement, and citizenship improve manager's effect on the business system. Twenty full-time SBHC administrators working in separate locations throughout the state of Maryland participated in semistructured telephone interviews. The van Kaam process was used to cluster descriptive experiences in data analysis that resulted in the development of thematic strategies for implementing best practices relevant to developing and sustaining funding for SBHC business operations. Major themes provided by the participants were interagency communications, creating marketing plans, and disparities in the allocation of funding for programs and professional staff. Findings indicated SBHC administrators continue to face challenges in developing and sustaining adequate funding for operations in the state of Maryland. Suggestions for future research include how administrators can develop marketing plans and explore long-range funding for SBHC services. The findings in this study may contribute to positive social change by demonstrating to officials in the Maryland State Department of Education the significance of SBHCs, and the need to increase mental health services.
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Quinn, Megan, Shimin Zheng, Hadii M. Mamudu, Martin Whiteside, and James L. Anderson. "Adolescent and Young Adult Cancer in Tennessee: An Overview of Findings." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/87.
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Adolescents and Young Adults (AYAs) ages 15-39 years with cancer have received little attention in the health field, resulting in a lack of progress. The purposes of this study were to use the Tennessee Cancer Registry for all new cancer cases from 2004-2008 to determine the main types of cancer that affect AYAs in Tennessee and understand if there were any cancer types that warranted additional investigation. A total of 8,097 cancer cases were diagnosed in AYAs in Tennessee from 2004-2008. The main types were breast, melanomas, thyroid, lymphomas, and testicular, accounting for over 50% (N=4,269) of cancers in the sample. The incidence of melanoma and thyroid cancer was higher in Tennessee compared to the United States, deserving further examination. In Tennessee, females were significantly more likely to be diagnosed with melanomas (AIR 14.01, 95% CI 12.96-15.06) and thyroid cancers (AIR 13.39, CI 12.37-14.42) compared to males (AIR 8.08, CI 7.28-8.88 and AIR 3.50, CI 2.98-4.03. Regression models were used to further analyze melanoma and thyroid cancers, specifically looking at predictors of late stage diagnosis and treatment types, respectively. Individuals with government insurance were eight times (OR 8.41, CI 3.04-23.27) more likely to be diagnosed with late stage melanoma when compared with private or other types of insurance. Individuals diagnosed with regional or distant stage thyroid cancer compared to localized stage were three times (OR 3.01, CI 1.84-4.94) more likely to have a total thyroidectomy. These data suggest the need for additional cancer prevention and control efforts geared towards AYAs.
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Pareja, Béhague Dominique. "The shaping of adolescent psychopathology in the wake of Brazil's new democracy /." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=85032.
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This thesis explores how concepts of "adolescence" and "adolescent psychopathology" have become salient among medical and lay communities in Pelotas, a small town in Rio Grande do Sul, Brazil's southernmost state. The concept of adolescence emerged throughout the 20th century in Western Europe and North America from various specialized fields, including evolutionary medicine, psychiatry, and developmental psychology. Within these sub-fields, adolescence came to refer to a transitional phase in the life span, and specifically, to the psychopathologies and psychological opportunities ensuing from what could potentially become a life-altering transformation. In the past two decades, this concept of adolescence has been adopted by a number of global health agencies, who depict the adolescent phase as an opportunity for addressing the underlying causes of multiple psychopathologies and accordingly, for improving the developmental "health" of nations. Concepts and practices relating to the management of adolescent psychopathology readily took hold in Pelotas in the 1990s, not only because local professional communities have been seeped in a psychoanalytic tradition dating back to the early 20th century, but also because of a recent growing community-based health care movement that prompted the expansion of publicly funded mental health services. This expansion widened definitions of "therapy" to include preventive care and social mobilization, and impacted significantly the identity, social role and political inclinations of practitioners. Due to these changes, psychiatrists and psychologists are showing greater interest in adolescent patients and their various common mental disorders, including "aggressiveness," nervos, anxiety, and learning and school achievement problems. Yet several social and class struggles ensue when practitioners, many of whom seek to maintain their psychodynamic models relatively intact, shift the focus of their work f
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Reynolds, Gillian. "Accessibility and consumer knowledge of services for deaf adolescents." CSUSB ScholarWorks, 2001. https://scholarworks.lib.csusb.edu/etd-project/1977.
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The percentage of deaf and hard of hearing people who need mental health crisis services is similar to the percentage of the general population needing such services. Yet, coordinated mental services for deaf and hard of hearing individuals are virtually nonexistent. People who are deaf and hard of hearing, like everyone else, find themselves, from time to time, in need of mental health services.
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Mngadi, Patricia Thuli. "Adolescent pregnancy and parenthood in Swaziland : quality of care, community support and health care service needs /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7140-725-2/.
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Mokitimi, Stella. "Child and adolescent mental health services in the Western Cape of South Africa: policy evaluation, situational analysis, stakeholder perspectives, and implications for health policy implementation." Doctoral thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33866.
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In spite of the need for child and adolescent mental health (CAMH) services across the globe, very little has been done to develop and strengthen CAMH in low- and middle-income countries (LMIC). South Africa is an example of an LMIC where CAMH services have been very limited as a result of various potential factors, including the legacy of apartheid, stigma associated with mental health, and lack of priority of CAMH. In this thesis, we set out to generate an evidence-base about CAMH services in one South African province to inform service strengthening across the full healthcare system through policy development and implementation. We proposed that a comprehensive understanding of specific services requires a multilevel exploration of ‘hardware' (structural) and ‘software' (social) elements in the health systems that support these services. We started by reviewing the CAMH policy landscape with an analysis of the current state of policy development and implementation at national and provincial levels in all nine provinces of South Africa. Using the Walt and Gilson policy analysis triangle (1994), we examined the content, context, processes and actors involved in mental health or CAMH-specific policies. We then evaluated the hardware and software elements of CAMHS in the Western Cape Province by performing a situational analysis using the WHO-AIMS version 2.2 of 2005 (Brief version) adapted for the South African context and to CAMHS. We proceeded to seek the perspectives of stakeholders within the province – firstly a SWOT analysis with senior stakeholders, and secondly, qualitative analysis of the perspectives of grassroots service providers, and of parents/caregivers and adolescent service users. We collected information from these stakeholder groups through a stakeholder engagement workshop, focus group discussions and semi-structured individual interviews. Using the World Health Organization (WHO) (2007) and Gilson (2012) health systems frameworks, we reviewed both the hardware and the software elements of CAMH services and concluded with a synthesis of findings to provide a set of recommendations for policy development and service strengthening based on the evidence generated. In terms of service delivery, findings showed that child and adolescent mental health services (CAMHS) in the Western Cape were provided at all levels of care (primary, secondary and tertiary) and, at least at inpatient and outpatient level, based on catchment/geographical service areas. However, CAMHS were still limited and were provided under very resource-constrained conditions by inadequately trained service providers. In terms of the health workforce, CAMHS were provided by a range of professionals including child & adolescent psychiatrists, general psychiatrists, medical officers, clinical psychologists, social workers, mental health nurses, occupational therapists, and speech and language therapists. However, multidisciplinary expertise and psychosocial interventions were only available in specialist CAMHS at tertiary level of care. In addition, the specialist services were all based in the City of Cape Town, with no direct access to specialist CAMHS at secondary levels of care or in any of the rural districts of the province. Health information systems were not fit-for-purposes to generate disaggregated data on under-18-yearolds, thus made it extremely difficult to provide a comprehensive view of CAMHS in the province. In terms of access to essential medicines, basic classes of psychiatric medications were available at all levels of care, but not consistently so. An exploration of financing showed that no ring-fenced or disaggregated budgets were available for CAMHS, thus making it impossible to comment on the appropriateness of funding for the mental health needs of children and adolescents. In terms of leadership and governance, a national CAMH policy existed, but no implementation plans had been developed since the publication of the CAMH policy in 2003. Our findings highlighted a lack of dedicated CAMH leadership and governance in the province. We argued that the absence of a clear CAMH leadership structure also explained why provincial plans and strategies had not been developed and implemented over the last two decades. A very consistent finding from our data was a need for a dedicated provincial lead for CAMH. We concluded the thesis with hardware and software recommendations for policy implementation, service development, training and research.
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Onasoga, Olayinka Abolore. "Challenges and barriers to adolescents' post-abortion care services: Implications for reproductive health policy in Nigeria." University of the Western Cape, 2017. http://hdl.handle.net/11394/6503.
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Philosophiae Doctor - PhDThe prevention of abortion related complications and mortality is dependent on the availability, accessibility and usability of emergency post-abortion care (PAC) throughout the health care system. Unfortunately, abortion is not legal in Nigeria and Nigerian women, especially adolescents, are often unable to obtain adequate post-abortion care services due to a variety of reasons. A review of literature shows that adolescent PAC patients receive worse care than older women seeking PAC services. There is widespread recognition of the need to overcome these barriers and make it easier for women to obtain the PAC services they need. Therefore, overall aim of this research study was to provide empirical information on the barriers and challenges to adolescents' PAC and develop a policy document to inform reproductive health services for Nigerian hospitals. To develop this policy document, the study specifically sought to assess knowledge of reproductive-health and related post-abortion care services among health care providers; describe the adolescents' perception of post-abortion care received; determine the service providers' perspectives on adolescents' post-abortion care challenges and barriers; analyze the challenges and barriers faced by adolescents in obtaining post-abortion care services; explore ways in which the knowledge about challenges and barriers to adolescents' post-abortion care can be used to inform policy; develop policy document and make recommendations in key areas to improved PAC services in Nigeria as part of working towards improving reproductive health services.
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Murakami, Jessica L. 1980. "The “Ignored Common Factor”: The Role of Expectancy in the Treatment of Adolescent Depression." Thesis, University of Oregon, 2011. http://hdl.handle.net/1794/12097.
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xvii, 93 p. : ill. (some col.)Since Rosenzweig's "Dodo Bird Verdict" in 1936, the "common" versus "specific" factors debate has continued to polarize the field of psychotherapy. Treatment expectancy is an important but often overlooked common factor. The current study investigated the role of treatment expectancy in the Treatment of Adolescents with Depression Study (TADS). Four-hundred three adolescents ( M age =14.62, SD =1.56) filled out the Treatment Expectancy for Adolescents (TEA) measure prior to treatment randomization to one of four treatments: fluoxetine (FLX), cognitive behavior therapy (CBT), their combination (COMB), and placebo (PBO). Adolescents randomized to CBT or COMB also filled out the CBT Rationale Acceptance and Expectation for Improvement (C-RAEI) form during their second session of CBT. Before finding out their treatment assignments, adolescents endorsed higher treatment expectancies for COMB than CBT and medication only. Family income levels below $75,000 and higher levels of depression severity, hopelessness, and suicidality were associated with lower expectations for improvement with CBT. The presence of a comorbid anxiety disorder diagnosis was associated with lower expectations for medication without CBT. Separate random coefficients and logistic regression models identified treatment expectancy as a predictor of outcome for three primary outcome measures in TADS, irrespective of treatment assignment. Severity of depression moderated this relationship; mild to moderately depressed adolescents appeared to be more sensitive to the effects of treatment expectancy than marked to severely depressed adolescents. The opposite results were found for the self-rated outcome measure in TADS based on the C-RAIE. For marked to severely depressed adolescents assigned to CBT or COMB, acceptance of treatment rationale and expectancy for improvement were associated with treatment response. These results suggest that treatment expectancy is an important common factor of treatment for mild to moderately depressed adolescents prior to treatment initiation, although it may be especially important for initially skeptical, marked to severely depressed adolescents to "buy in" to treatment after treatment initiation. Treatment effects were still found after controlling for the effects of treatment expectancy on outcome. It seems that both the "common" factor of treatment expectancy and the "specific" factor of treatment assignment contributed to outcome in TADS.
Committee in charge: Anne D. Simons, Chair; Gordon Nagayama Hall, Member; Holly Arrow, Member; Jeffrey Todahl, Outside member
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Kitchen, Charlotte Emma Wray. "The feasibility and acceptability of a behavioural activation intervention for young people with depression in Child and Adolescent Mental Health Services." Thesis, Durham University, 2018. http://etheses.dur.ac.uk/12564/.
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Depression in young people is common, resulting in morbidity and mortality. Behavioural Activation (BA) is a cost-effective and efficacious treatment for reducing depressive symptoms in adults. There is little published research relating to BA as a treatment option for young people with depression. Thus, the aim was to explore the feasibility of conducting a trial of BA for depression in Child and Adolescent Mental Health Services (CAMHS). Stage I The initial stage of the study comprised a focused ethnography, conducted over a six-month period. The purpose was to explore the CAMHS study site, with a view to pre-empting (and addressing) any difficulties that may be encountered during a planned trial. Participant observation (158 hours), staff interviews (n= 6) and document collection (n= 17) were used to gather data. Data were coded using thematic analysis and the resulting themes were verified by a second coder. Insights into the individual, practical and organisational boundaries of the service guided implementation of Stage II. Stage II The second stage involved a randomised controlled feasibility trial with an embedded qualitative component. Participants were identified via a case note review or self/clinician referral from three CAMHS over seventeen months. Young people (aged 12 to 17 years) displaying symptoms of depression were offered a structured diagnostic interview to confirm depression status. Additional measures of mood, functioning and self-esteem were recorded. Twenty-two patients were randomised to BA or usual CAMHS care. Existing CAMHS staff were trained to deliver the 8-week manualised BA intervention. Following treatment, participants in the BA arm, their parents and clinicians were offered semi-structured interviews to explore their experiences of receiving or administering BA. Verbatim interview transcripts were coded using thematic analysis. At three months post-baseline, the diagnostic interview and outcome measures were repeated. At six months post-baseline, a telephone interview repeated selected outcomes. Participant recruitment was successful but the trial suggests that the process used could be streamlined. Participants were 82% female, with a mean age of 15.7 (SD, 1.2) years. Qualitative feedback from patients and their caregivers supported the acceptability of BA treatment. Families also identified barriers to participating in the intervention. Most staff found the intervention acceptable, but some raised concerns about the manualised treatment delivery. Retention at three months was 68%, with higher loss to follow-up in the BA (4/11; 36%) vs. usual care (3/11; 27%). Although not powered to demonstrate statistical differences, preliminary quantitative data suggest BA treatment may result in improved outcomes compared to usual care, such as remission from depression. Fewer BA participants met depression criteria at three-month follow-up (3/7; 42.9%) than in usual care (7/8; 87.5%). However, the assessor was not blinded to treatment allocation, fidelity was not assessed and the number of sessions was not controlled for, which increases uncertainty relating to the results. This research contributes valuable information about how a BA trial could be implemented in an adolescent mental health setting, and provides indications about the potential of the approach to treat depression in this context. However, outstanding questions relating to the feasibility of the intervention remain.
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Timmons, Cory. "Sisterhood for Change Project evaluation." online resource, 2008. http://digitalcommons.hsc.unt.edu/theses/8/.
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Jeffries, Fiona Walker. "Development and initial validation of child-and parent-report measures of personal recovery for use in child and adolescent mental health services." Thesis, University of Surrey, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.580574.
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Eye Movement Desensitization and Reprocessing (EMDR) was developed by Shapiro (1989a, 2001) and was designed to facilitate the processing of distressing memories. It has since evolved into a standardised intervention for post-traumatic stress disorder (PTSD) that utilises elements from many different treatment approaches. EMDR has generated considerable debate, perhaps due to a lack of understanding of how it works. One aspect of EMDR procedure that has remained particularly controversial is the use of eye movements. Over the past twenty years there have been a number of studies investigating whether eye movements contribute to outcome in EMDR. Much of the research suffered from methodological flaws and therefore was inconclusive. More recently, researchers have begun to investigate why eye movements may be useful in EMDR by looking into possible psychological and neurophysiological mechanisms. This review provides an overview of research so far, including a description of two prominent theories of how eye movements might contribute to outcome in EMDR: the interhemispheric interaction account and the working memory account. Implications for clinical practice and future research are discussed.
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Adabla, Samuel. "Perceptions, Attitudes and Beliefs of Youth Regarding the Use of Sexual and Reproductive Health (SRH) Services in Ashaiman, Ghana." Bowling Green State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1563531116481538.
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