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Child and adolesCent Mental health

Research will: • extendintotheoriginsofchildmentaldisorderbystudyinginfants;• implementnewtechnologies,suchasnearifraredspectroscopy,eye-trackingand imagingtechniques;• extendthedatacollectiononCaseRegisterInteractiveSearchtoincludemoresystematic phenotypingandtreatmentasusualoutcomes,aswellaslinkagetopoulationdatabasestoprovide theworld’slargestclinicalchildmentalhealthdatabase;• developastrategyforroutinebiomarkercollectionthatwillaiddeepphenotyping.

Educationandtrainingwillfocuson:• implementationoftheextendedImprovingAccesstoPsychologicalTherapiestoprovidecore trainingatanationallevel;• developmentofdistancelearningstrategythatconsidersthefullrangeoftrainingopportunities andprogrammes.

Clinicaldevelopmentswillinclude:• developing,triallingandevaluatingmoreeffectiveandefficientmodalitiesofassessmentand treatmentineconomicallychallengingtimes;• extendingthecloserelationshipbetweenresearchandclinicalpracticetoincreasethenumberof patientsparticipatinginresearch,embedresearchonserviceuserattitudesandprioritiesinto routineclinicalwork,andextendtheroutinesystematicdata;• developingrelationshipswithinthenewcommissioningarrangementsthatfosterourstrategy includingevidence-basedassessmentsandinterventions,comprehensiveservicesforchildrenand youngpeoplewithmentaldisorders,andregionalcommissioningofspecialistservices.

Weplantomaintainanintegratedapproachtoleadershipthatwilldelivertheseambitions.

ContactsEmilySimonoff,AcademicLead,[email protected] BruceClark,ClinicalLead,[email protected]

Plans and priorities for the next five yearsMeeting the tripartite mission

Education and trainingTheCAGhostsandcontributestoarangeofprofessionaltraininginchildandadolescentpsychiatry,mentalhealthnursing,clinicalpsychology,postgraduatetraineesincognitivebehaviouraltherapy,parenttraining,familytherapy,andchildandadolescentmentalhealth.Newdevelopmentsincludeacontracttoprovidetrainingforthechildpsychiatrysub-specialtyacrosssouthLondon;usingfeedbackfromtraineestoredesignthemedicalstudentteachingprogramme;thedesignandpilotofsimulationtraining;useofresearchtrainingandcapacitybuildingcomponentwithintheNationalInstituteforHealthResearch(NIHR)BiomedicalResearchCentre(BRC);expansionoftheDepartmentforEducation’simplementationprogrammeofevidence-basedinterventionsforchildrenandfamilies;anddeliveringtheDepartmentofHealth’snewChildrenandYoungPersonsIncreasingAccesstoPsychologicalTherapiesinitiative.TheCAGhasalonghistoryofclosetiesbetweenuniversityandhealthservicesprovision,buttheestablishmentofKing’sHealthPartnershasconsolidatedandintensifiedtherelationshiptofacilitatetheseandotherdevelopments.

Clinical outcomes OurCAGhasdevelopedcarepathwaysforassessmentandtreatmentwhicharenowusedastheexemplarofbestpracticenationallybytheDepartmentofHealth.Acentralaspectofthishasbeentheincorporationofkeyoutcomemeasuresthroughoutallassessmentandtreatmentwork,whichhasallowedustocompareourworkwithintheCAGtoensurethedisseminationofbestpractice.TheDepartmentofHealthdatashowclearevidencethatourtreatmentapproachesareasgoodasorbetterthanothersimilarlyfundedservices.Wehavethelargestpopulation-baseddatasetoftreatmentoutcomesmeasures.

TheDepartmentofHealthcommissionedourCAGasaprinciplepartnertodesign,developandpilotthefuturesystemofchildandadolescentmentalhealthservices‘PaymentbyResults’(PbR).Thishasbeendevelopedutilisingourcomprehensivedatasetoffullyphenotypedcases.WecontinuetoshareouruniquedatasetasPbRispilotedacrossnearly60centresintheUK.

ResearchOverarchingstrategy:toidentifythecausesofchildmentaldisorder,developandevaluatenovelinterventionsandimplementevidence-basedassessmentandtreatment.Touseawhole-CAGapproachtoimprovethementalhealthofthecommunityweservethroughbetterdiagnosis,preventioninat-riskgroups,andpersonalisedtreatmentsthatconsidertheprioritiesofserviceusersandtheirfamilies.

Ourresearchencompassestheentiretranslationalpathwayfrombasicsciencestudiesofthecausesofmentaldisordersthroughbiomarkerstudies,earlyphasetrialsandefficacy/effectivenesstrials.AllstaffintheCAGcontributeactivelytoresearchindiverseways,includingobtaining‘consentforcontact’anddirectrecruitmenttoresearchstudies.

Researchincomestreams(over£6millionincurrentgrants)includetheMedicalResearchCouncil,WellcomeTrust,EU,NIHRandDepartmentsofHealthandEducation,aswellasmorethanadozensmallercharities.

Summary

TheChildandAdolescentMentalHealthClinicalAcademicGroup(CAG)aimstooffercomprehensivecareforchildrenandyoungpeopleaged0-18presentingwithmentaldisorders.Evidence-basedassessmentsandinterventionsaredeliveredatcommunity,secondaryandtertiarylevels,providingout-,day-andin-patientservicestomeettheneedsofpatients.WeprovidecommunityservicesforchildrenandyoungpeopleinLambeth,Southwark,LewishamandCroydonandspecialistservicesforLondon,the

regionandnationally.CareiscloselyintegratedwiththeChildHealth CAGandothermentalhealthCAGs,withwhomwehavejointstrategies.Routineoutcomemonitoringisacoreelementofservicedelivery.

CentraltotheCAGprioritiesisachievingthetripartitemission.Clinicalacademicresearchershaveprogrammesthatextendfrombasicscienceidentifyingthecausesofchildmentaldisorderthroughevaluationsofnewdiagnosticandtreatmentmodalities.Manyofthemleadnationally-recognisedspecialistservicesprovidinginnovativecare.Thisevidencebase isthenextendedtolocalservices,nationallyandgloballythrough

multi-professionaleducationandtrainingprogrammesatalllevels.Overthelastfouryears,therehasbeenacultureshiftintheCAGwith re-alignmentofservicestomeetnewresearchandimplementationprioritieswithlocalservicesmodifyingpracticeaccordingtoscientificfindings.Collaborationacrossthemental-physicalinterfacehasextendedandinvolvesallcomponentsofthetripartiteagenda.ExamplesincludejointChildHealth/ChildMentalHealthcommunityclinicsineveryborough,teachingofpsychiatrytraineesbycolleaguesinchildhealth,andsharedresearchprojectsineatingdisorders,neurodevelopmentanddeliberateself-harm.Researchisembeddedateveryleveloftheservicethroughconsentforcontactingandrecruitingpatients.

Academic pre-eminence–WearetheonlyindependentacademicdepartmentofchildandadolescentpsychiatryintheUK;andweincludethegreatestnumberofchildpsychiatryacademicsofanyinstitution.Eightofthelastninejunioracademictraineeshavemovedtopostdoctoralorseniorlecturerposts.Ourintegratedclinicalacademicteamsareinternationalresearchleadersinautism,ADHD,childhooddementia,eatingdisorders,OCDandanxietydisorders.

Mental-physical interface–Thisincludes:pioneeringmentalhealthinterventionsforchildhooddementia;developingpsychologicaltreatmentsforobesity;evaluatingnewapproachestothetreatmentofdeliberateself-harm;determiningtheneurodevelopmentalandmentalhealthconsequencesofobstetriccomplications;andaphysicalhealthstrategyforchildrenandyoungpeoplewitheatingdisorders.

Innovative models of local healthcare–Wearedevelopingandevaluatingsupporteddischargetoreducein-patientstays,andevaluatingmulti-systemictherapyforantisocialadolescents.Wehavedevelopeddialecticalbehaviourtherapyforemergingpersonalitydisordertoreduceadmissions,multi-familygroupsforeatingdisorder,andgroup-basedinterventionsforfosterparents.

Population health–Wehaveidentifiedtheco-occurrenceofothermentaldisordersinautism;demonstratedthehighrateofmentaldisorderinlooked-afterchildren;showedthatmoodproblemsinyoungchildrenpredictpooroutcomeinadolescenceandadultlife;andshowedthatearlytraumaaffectsphysicalandmentalhealthinlaterlife.

Education and training for the healthcare workforce–OurMScinchildandadolescentmentalhealthtakesstudentsfromover50countries.WearetransformingtheMScinFamilyTherapytoaccommodatenewteachingmethods.WehaveaglobalintakeofclinicalstudentsthroughMaudsleyInternationalandweareextendingeducationandtrainingthroughdistancelearning.

Commissioning–Wewononeofthefivenationalcontractsforspecialistautismclinicalandresearchservices.

Achieving our goals Examples of excellence

Innovative model for teaching medical students TheCAGhasdevelopedaninnovativemodelforteachingmedicalstudents.Childpsychiatryisasmallcomponentoftheundergraduatecurriculumbutitisimportantthatundergraduatesappreciatethatknowledgeofthissub-specialitycontributestoarangeofareasinmedicine,bothwithin andbeyondpsychiatry.

Undergraduatesreceiveahalf-dayofteaching-twolecturesandaninteractivetutorialcomprisedofcasevignettes,videomaterialandrole-play. Ahandbooksupportstheteaching.Undergraduatescanundertaketheirspecialstudycomponentinchildpsychiatrywhichisinhighdemand. Theycanalsogainfurtherexpertiseinchildpsychiatrythroughelectiveplacements,thepaediatricsummerschoolandasobserversinchild psychiatryoutpatientclinicsandinpatientservices.Studentfeedbackispositiveandotherareasofpsychiatryarenowconsideringadoptingthemodelthathasbeendevelopedbychildpsychiatry.

Student feedback is positive andotherareasofpsychiatryarenowconsideringadoptingthemodelthathasbeendevelopedbychildpsychiatry.

Regional specialist commissioning of autism servicesOurresearch,undertakenwithcolleaguesfromtheChildHealthCAG,showedthatthemajorityofchildrenwithautismhaveadditionalmentaldisordersincludingADHDandanxietythatfurtherimpairtheirfunctioningandqualityoflife.ThisfindingdrovetheNICEguidancerecommendationthatacomprehensiveautismassessmentshouldincludeamentalhealthevaluation,andcontributedtothecurrentNICEguidance(outforconsultation)wheretreatmentrecommendationsconsiderco-occurringdisordersaswellascoreautismsymptoms.Itfurtherinfluencedthespecificationforautismspecialistcommissioningwithinmentalhealth,andwehavebeenawardedoneofthecontracts.WearenowdevelopingacarepathwaywithcolleaguesfromChildHealthtohelpidentifytheoptimalreferralpathwaybetweenthetwoservicesandtocreateasharedresourceofclinicalandresearchmeasures.