Intensive community care services for children and young people in psychiatric crisis: an expert opinion.

BACKGROUND: Children and young people's (CYP) mental health is worsening, and an increasing number are seeking psychiatric and mental health care. Whilst many CYPs with low-to-medium levels of psychiatric distress can be treated in outpatient services, CYPs in crisis often require inpatient hospital treatment. Although necessary in many cases, inpatient care can be distressing for CYPs and their families. Amongst other things, inpatient stays often isolate CYPs from their support networks and disrupt their education. In response to such limitations, and in order to effectively support CYPs with complex mental health needs, intensive community-based treatment models, which are known in this paper as intensive community care services (ICCS), have been developed. Although ICCS have been developed in a number of settings, there is, at present, little to no consensus of what ICCS entails. METHODS: A group of child and adolescent mental health clinicians, researchers and academics convened in London in January 2023. They met to discuss and agree upon the minimum requirements of ICCS. The discussion was semi-structured and used the Dartmouth Assertive Community Treatment Fidelity Scale as a framework. Following the meeting, the agreed features of ICCS, as described in this paper, were written up. RESULTS: ICCS was defined as a service which provides treatment primarily outside of hospital in community settings such as the school or home. Alongside this, ICCS should provide at least some out-of-hours support, and a minimum of 90% of CYPs should be supported at least twice per week. The maximum caseload should be approximately 5 clients per full time equivalent (FTE), and the minimum number of staff for an ICCS team should be 4 FTE. The group also confirmed the importance of supporting CYPs engagement with their communities and the need to remain flexible in treatment provision. Finally, the importance of robust evaluation utilising tools including the Children's Global Assessment Scale were agreed. CONCLUSIONS: This paper presents the agreed minimum requirements of intensive community-based psychiatric care. Using the parameters laid out herein, clinicians, academics, and related colleagues working in ICCS should seek to further develop the evidence base for this treatment model.

How are parenting practices associated with bullying in adolescents? A cross-sectional study.

BACKGROUND: Parenting styles have been previously associated with bullying, but some parenting practices have not received strong attention in the literature. We aimed to assess how parenting practices are associated with cyberbullying and traditional bullying involvement in adolescents. METHOD: A cross-sectional survey of 2,218 secondary-school students in London (UK) was conducted. The Olweus Bully/Victim Questionnaire and the Alabama Parenting Questionnaire (APQ-child form) were used. RESULTS: Positive parenting significantly protected against cyberbullying involvement but not against traditional bullying. Inconsistent discipline was associated with being a cyberbully but not being a traditional one. Lower levels of monitoring were associated with being a cyberbully, a cyberbully-victim, a traditional bully, or a traditional bully-victim. CONCLUSIONS: Parenting practices seem to be more relevant in cyberbullying than traditional bullying. Effective parenting practices such as positive parenting deserve attention as a potentially modifiable factor to protect against cyberbullying involvement. Ineffective parenting practices such as inconsistent discipline are relevant in cyberaggression, whereas poor monitoring is associated with both cyberbullying and traditional bullying. Clinical and research implications are discussed.

Cyberbullying and post-traumatic stress symptoms in UK adolescents.

OBJECTIVE: Cyberbullying involvement carries mental health risks for adolescents, although post-traumatic stress (PTS) symptoms have not received strong attention in the UK. This study aimed to assess the overlap between cyber and traditional (ie, face-to-face) bullying, and the relationship to PTS symptoms in UK adolescents. DESIGN: A cross-sectional survey. SETTING: Four secondary schools in London,UK. PARTICIPANTS: 2218 secondary school students (11-19 years). MAIN OUTCOME MEASURES: The Olweus Bully/Victim Questionnaire and the Children Revised Impact of Events Scale. RESULTS: There was a significant overlap between traditional bullying and cyberbullying. However, cyberperpetrators were less frequently involved in concurrent traditional bullying. Of 2218 pupils, 46% reported a history of any kind of bullying (34% were involved in traditional bullying and 25% in cyberbullying), 17% as victims, 12% as perpetrators, and 4% as both victims and perpetrators. A significant proportion of those who were cybervictims (n=280; 35%), cyberbullies (n=178; 29.2%) or cyberbully-victims (n=77; 28.6%) presented clinically significant PTS symptoms. Cybervictims (both cyber-only and cyberbully-victims) suffered more intrusion (p=0.003; p<0.001) and avoidance (p=0.005; p<0.001) than cyberbullies. However, cyberbullies still suffered more PTS symptoms than the non-involved (intrusion: z=-3.67, p=0.001; avoidance: z=-3.57, p=0.002). Post-traumatic stress symptoms were significantly predicted (R2=13.6) by cyber and traditional victimisation. CONCLUSIONS: Cyberbullying, as victim only or as a victim-perpetrator, seems to be associated with multiple types of PTS symptoms. Cyber and traditional victimisation significantly predicted intrusion and avoidance. Paediatricians, general practitioners and mental health professionals need to be aware of possible PTS symptoms in young people involved in cyberbullying. Screening and early cost-effective treatments could be implemented.