Paul Stallard

Posttraumatic Growth in Child Survivors of a Road Traffic Accident

Although the negative consequences of trauma have been well researched and described, posttraumatic growth has only recently come to the attention of researchers. This paper considers whether children (aged 7–18 years) who have been involved in a road traffic accident can experience posttraumatic growth outcomes. From 158 children who took part in an interview, qualitative analysis of interview notes found that 67 (42%) reported some aspect of posttraumatic growth, most notably in terms of their philosophy of life. Of these, 25 (37%) were also assessed as experiencing posttraumatic stress disorder.

The development and evaluation of the pain indicator for communicatively impaired children (PICIC)

&NA; A previous study found that parents of communicatively impaired children with severe cognitive impairments identified six core cues as indicating definite or severe pain in their child (J. Pediatr. Psychol. 27 (2002) 209). The frequency of each cue was assessed by 67 caregivers of communicatively impaired children, twice per day over a 1 week period. On each occasion the caregivers also rated whether they considered their child to be in pain and the severity of any pain. There was a statistically significant relationship between five of the cues and the presence and severity of pain. The single cue of screwed up or distressed looking face was the strongest predictor and on its own correctly classified 87% of pain and non‐pain episodes. The study highlights the potential clinical utility of a short carer completed assessment to assess pain in this vulnerable group of children.

COGNITIVE BEHAVIOUR THERAPY WITH CHILDREN AND YOUNG PEOPLE: A SELECTIVE REVIEW OF KEY ISSUES

The growing interest in the use of cognitive behaviour therapy with children and young people has been encouraged by emerging evidence suggesting that CBT is effective with a wide range of child disorders. Typically, models and techniques developed for work with adults have been extended downwards and applied to children. This review questions the appropriateness of this approach and selectively identifies a number of key issues that need to be addressed. The absence of developmentally appropriate theoretical models to understand the onset and maintenance of maladaptive cognitive processes in children is highlighted. This lack of a coherent theoretical framework has led to a proliferation of diverse interventions falling under the general umbrella of cognitive behaviour therapy with the predominant emphasis being behavioural, rather than cognitive. Developmental factors, the nature, extent and type of cognitive processes in children and the important role of the parent in the onset and treatment of childhood problems have received comparatively little attention. There is a need to understand more about the cognitive processes of children and young people and to develop robust and testable developmentally appropriate theoretical models. In turn this will begin to address the question of which specific cognitive behaviour therapy programmes are effective for which childhood problems.

The availability of cognitive behaviour therapy within specialist child and adolescent mental health services (CAMHS): A national survey

The National Institute for Clinical Excellence has recommended cognitive behaviour therapy (CBT) for a number of common child and adolescent mental health disorders. The aim of this study was to clarify the practice of CBT within specialist child and adolescent mental health services in the United Kingdom. A survey was distributed to specialist child mental health workers through national organizations and professional bodies. Approximately 10% of specialist CAMHS professionals replied (n = 540). One in five reported CBT to be their dominant therapeutic approach, whilst 40% rarely used CBT. Specialist post-qualification training had been undertaken by 21.0% of respondents, with over two-thirds identifying training needs in the core skills of CBT. This survey suggests that the capacity of specialist CAMHS to meet the requirements of NICE in terms of the availability of CBT skills is doubtful. There is a need to develop CBT training and supervision infra-structures.

The Development and Preliminary Evaluation of a Schema Questionnaire for Children (SQC)

This study describes the development and initial evaluation of a cognitive schema questionnaire for children. The Schema Questionnaire for Children (SQC) was designed to capture the 15 early maladaptive schemas proposed by Young (1990). Face validity of the questionnaire items as assessed by a group of CBT experts ( n =16) was good. Concurrent validity was assessed by asking 47 school children aged 11–16 years of age to complete both the (SQC) and a British version of the 75 item Youngs Schema Questionnaire short form (YSC-S). Significant correlations were obtained for 10 of the 15 schemas, with a further two approaching statistical significance. Although some of the correlations were modest, these initial results suggest that the SQC may be a valid quick and developmentally appropriate way of assessing Youngs maladaptive schema in children.

The mental health of young people attending a Youth Offending Team: a descriptive study.

This study documents the health needs of young offenders aged 10-17 attending a community Youth Offending Team (YOT). All young people known to a YOT on a selected date were identified. Health information was collected via semi-structured interviews and standardized questionnaires. Potential mental health problems that required further specialist assessment were identified in 56% of those assessed. Alcohol was consumed more than twice per week by 68%, with 47% having recently smoked cannabis, and, 11% recently using heroin, methadone or crack cocaine. Use of secondary health-care services was common although contact with primary-care services was less frequent with almost half having no contact with a GP in the past year. The process of meeting the physical and mental health needs of young offenders in the community is discussed.

An Opt-In Appointment System and Brief Therapy: Perspectives on a Waiting List Initiative

An opt-in appointment and brief (three session) therapy formed the basis of an initiative designed to tackle a waiting list. The opt-in system, requiring families to confirm in advance attendance at their initial appointment, resulted in a first appointment failure rate of 5%. This compared to 27% using a more traditional appointment system. Almost half of the families were never seen and whether the opt-in system disadvantaged these remains unclear. The majority of families who attended appointments were satisfied with the service they received and both they and clinicians identified fewer problems by the end of contact. The limitations of the assessment methods used are acknowledged although the results suggest that brief therapy can produce short-term change. Further work to identify which problems respond best to brief intervention and whether this change lasts in the longer term is required.

Psychological Debriefing with Children and Young People Following Traumatic Events

Psychological debriefing is routinely provided as part of a crisis-stage intervention for adults involved in traumatic events. Although common with adults, comparatively few studies have reported the use of psychological debriefing with children and adolescents. The historical origins and process of debriefing are described and the studies undertaken with children reviewed. The limited data available do not indicate that debriefing prevents psychological distress, although it may reduce trauma-related symptomatology. There is a need to undertake methodologically sound trials to determine the effectiveness of psychological debriefing with children and adolescents.

Young people’s experience of emergency medical services as road traffic accident victims: a pilot qualitative study

A visit to the Accident and Emergency (A&E) department following an accident is often a young person’s first experience of hospital. A&E is a pressured environment which can be frightening and stressful for young people. This study reports the views of young people who have had contact with emergency medical services following a road traffic accident (RTA). Negative experiences were volunteered more than positive experiences. Concerns were reported around being physically restricted, receiving inadequate information, feeling that they were not understood, experiencing physical discomforts and feeling lonely. This article highlights the need to provide adequately for the younger A&E patient by supplying information, communicating appropriately and offering an environment that is more appropriate for young people.