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The association between ethnicity and care pathway for children with emotional problems in routinely collected child and adolescent mental health services data

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Abstract

Adults from black and minority ethnic (BAME) backgrounds are less likely to access mental health services through voluntary care pathways and are more likely to access through compulsory ones. The aim of the present research was to explore the association between ethnicity and care pathway through child and adolescent mental health services (CAMHS), in terms of reason for referral and case closure, in children presenting with emotional problems. A sample of N = 11,592 children from 26 CAMHS was taken from a national routinely collected dataset (56 % female; 7 % aged 0–5 years, 40 % 6–12 years, 53 % 13–18 years, and <1 % 19–25 years). Multinomial logistic regressions showed that BAME children were consistently more likely to be referred to CAMHS through education, social, and other services than primary care, compared to White British children (odds ratio (OR) = 1.52–9.96, p < .001) and they were less likely to end treatment due to child and family non-attendance (OR = 0.59–0.79, p < .05). Similar to adults, children from BAME groups may be more likely to access CAMHS through compulsory than voluntary care pathways.

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References

  1. Arai L, Stapley S, Roberts H (2014) “Did not attends” in children 0-10: a scoping review. Child: care. Health Dev 40:797–805. doi:10.1111/cch.12111

    Article  CAS  Google Scholar 

  2. Baruch G, Vrouva I, Fearon P (2009) A follow-up study of characteristics of young people that dropout and continue psychotherapy: service implications for a clinic in the community. Child Adolesc Ment Health 14:69–75. doi:10.1111/j.1475-3588.2008.00492.x

    Article  Google Scholar 

  3. Bhui K, Bhugra D (2002) Mental illness in Black and Asian ethnic minorities: pathways to care and outcomes. Adv Psychiatr Treat 8:26–33

    Article  Google Scholar 

  4. Bhui K, Stansfeld S, Hull S, Priebe S, Mole F, Feder G (2003) Ethnic variations in pathways to and use of specialist mental health services in the UK: systematic review. Br J Psychiatry 182:105–116

    Article  PubMed  Google Scholar 

  5. Bradby H, Varyani M, Oglethorpe R, Raine W, White I, Helen M (2007) British Asian families and the use of child and adolescent mental health services: a qualitative study of a hard to reach group. Soc Sci Med 65:2413–2424. doi:10.1016/j.socscimed.2007.07.025

    Article  PubMed  Google Scholar 

  6. Campbell J, Ramsay J, Green J, Care P (2001) Age, gender, socioeconomic, and ethnic differences in patients’ assessments of primary health care. Qual Health Care 10:90–95. doi:10.1136/qhc.10.2.90

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Daryani R, Hindley P, Evans C, Fahy P, Turk J (2001) Ethnicity and use of a child service. Child Psychol Psychiatry 6:127–132

    Google Scholar 

  8. Dura-Vila G, Hodes M (2012) Ethnic factors in mental health service utilisation among people with intellectual disability in high-income countries: systematic review. J Intellect Disabil Res 56:827–842. doi:10.1111/j.1365-2788.2011.01466.x

    Article  CAS  PubMed  Google Scholar 

  9. Durham University Mapping Unit. (2009/10). Children’s Service Mapping: caseload overview (2009/10) Strategic Health Authority. http://www.childrensmapping.org.uk/tables/profile-43/. Accessed 30 April 2015

  10. Field AP (2013) Discovering statistics using IBM SPSS statistics, 4th edn. Sage Publications, London

    Google Scholar 

  11. Fleming I, Bradley J, Wolpert M (2014) Learning from a learning collaboration: the CORC approach to combining research, evaluation and practice in child mental health. Adm Policy Ment Health Ment Health Serv Res. doi:10.1007/s10488-014-0592-y

    Google Scholar 

  12. Ford T, Hamilton H, Meltzer H, Goodman R (2007) Child mental health is everybody’s business: the prevalence of contact with public sector services by type of disorder among british school children in a three-year period. Child Adolesc Ment Health 12(1):13–20

    Article  Google Scholar 

  13. Gilbody SM, House AO, Sheldon TA (2002) Outcomes research in mental health. Br J Psychiatry 181:8–17

    Article  PubMed  Google Scholar 

  14. Goldberg D, Huxley P (1980) Mental illness in the community: the pathway to psychiatric care. Tavistock Publications, London

    Google Scholar 

  15. Goodman A, Patel V, Leon D (2008) Child mental health difficulties amongst ethnic groups in Britain: a systematic review. BMC Public Health 8:258. doi:10.1186/1471-2458-8-258

    Article  PubMed  PubMed Central  Google Scholar 

  16. Goodman R, Richards H (1995) Child and adolescent psychiatric presentations of second-generation Afro-Caribbeans in Britain. Br J Psychiatry 167(3):362–369

    Article  CAS  PubMed  Google Scholar 

  17. Green H, McGinnity A, Meltzer H, Ford T, Goodman R (2005) Mental health of children and young people in Great Britain, 2004. Palgrave Macmillan, Basingstoke

    Book  Google Scholar 

  18. Harrison G, Holton A, Neilson D et al (1989) Sever mental disorder in Afro-Caribbean patients: some social, demographic and service factors. Physiol Med 19:683–696

    CAS  Google Scholar 

  19. Hinrichs S, Owens M, Dunn V, Goodyer I (2012) General practitioner experience and perception of child and adolescent mental health services (CAMHS) care pathways: a multimethod research study. BMJ Open 2:e001573. doi:10.1136/bmjopen-2012-001573

    Article  PubMed  PubMed Central  Google Scholar 

  20. Institue of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century. Natl Acad Press, Washington, DC

    Google Scholar 

  21. Ivert AK, Svensson R, Adler H, Levander S, Rydelius PA, Torstensson Levander M (2011) Pathways to child and adolescent psychiatric clinics: a multilevel study of the significance of ethnicity and neighbourhood social characteristics on source of referral. Child Adolesc Psychiatry Mental Health 5:6. doi:10.1186/1753-2000-5-6

    Article  Google Scholar 

  22. Kleinman A (1980) Patients and their healers in the context of culture. University of California Press, Berkeley

    Google Scholar 

  23. McKenzie K, van Os J, Fahy T et al (1995) Psychosis with good prognosis in Afro-Caribbean people now living in the United Kingdom. BMJ 311:1325–1328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Michelson D, Day C (2014) Improving attendance at child and adolescent mental health services for families from socially disadvantaged communities: evaluation of a pre-intake engagement intervention in the UK. Adm Policy Ment Health Ment Health Serv Res 41:252–261. doi:10.1007/s10488-012-0462-4

    Article  Google Scholar 

  25. Miller L, Southam-Gerow M, Allin R Jr (2009) Who stays in treatment? Child and family predictors of youth client retention in a public mental health agency. Child Youth Care Forum 37:153–170

    Article  Google Scholar 

  26. Minty B, Anderson C (2004) Non-attendance at initial out-patient appointments at a hospital-based child psychiatric clinic. Clin Child Psychol Psychiatry 9:403–418. doi:10.1177/1359104504043923

    Article  Google Scholar 

  27. Moffat J, Sass B, McKenzie K, Bhui K (2009) Improving pathways into mental health care for black and ethnic minority groups: a systematic review of the grey literature. Int Rev Psychiatry 21:439–449. doi:10.1080/09540260802204105

    Article  PubMed  Google Scholar 

  28. Morgan C, Mallett R, Hutchinson G, Bagalkote H, Morgan K, Fearon P et al (2005) Pathways to care and ethnicity. 2: source of referral and help-seeking. Report from the AESOP study. Br J Psychiatry 186:290–296. doi:10.1192/bjp.186.4.290

    Article  CAS  PubMed  Google Scholar 

  29. Muthén LK, Muthén BO (1998–2013) Mplus user’s guide, 7th edn. Muthén & Muthén, Los Angeles, CA

  30. NHS (1995) Together we stand: thematic review of the commissioning, role and management of Child and Adolescent Mental Health Services. NHS Health Advisory Service, London

    Google Scholar 

  31. NHS (2015). Governance Arrangements for Research Ethics Committees (GAfREC). http://www.hra.nhs.uk/resources/research-legislation-and-governance/governance-arrangements-for-research-ethics-committees/. Accessed 13 Mar 2015

  32. NHS England (2014) Understanding the new NHS—a guide for everyone working and training within the NHS. BMJ, London

    Google Scholar 

  33. Richter J, Sagatun Å, Heyerdahl S, Oppedal B, Røysamb E (2011) The Strengths and difficulties questionnaire (SDQ)—self-report. An analysis of its structure in a multiethnic urban adolescent sample. J Child Psychol Psychiatry 52(9):1002–1011. doi:10.1111/j.1469-7610.2011.02372.x

    Article  PubMed  Google Scholar 

  34. Roberts N, Cawthrope D (1995) Immigrant child & adolescent psychiatric referrals: a five-year retrospective study of Asian and Caucasian families. Can J Psychiatry 40:252–256

    CAS  PubMed  Google Scholar 

  35. Royal College of Psychiatrists (2013) CR182: building and sustaining specialist CAMHS to improve outcomes for children and young people. http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/cr/cr182.aspx. Accessed 4 Sept 2015

  36. Skokauskas N, Dunne M, Gallogly A, Clark C (2010) Ethnic minority populations and child psychiatry services: an Irish study. Child Youth Serv Rev 32:1242–1245. doi:10.1016/j.childyouth.2010.04.014

    Article  Google Scholar 

  37. Vostanis P, Svirydzenka N, Dugard P, Singh S, Dogra N (2013) Mental health service use by adolescents of Indian and White origin. Arch Dis Child 98:764–767. doi:10.1136/archdischild-2013-303772

    Article  PubMed  Google Scholar 

  38. Zwaanswijk M, Van der Ende J, Verhaak PF, Bensing J, Verhulst FC (2005) Help-seeking for child psychopathology: pathways to informal and professional services in The Netherlands. J Am Acad Child Adolesc Psychiatry 44:12. doi:10.1097/01.chi.0000181038.98712.c6

    Google Scholar 

Download references

Acknowledgments

The Policy Research Unit in the Health of Children, Young People and Families is funded by the Department of Health Policy Research Programme. This is an independent report commissioned and funded by the Department of Health. The views expressed are not necessarily those of the Department. The authors would like to thank members of CPRU: Terence Stephenson, Catherine Law, Amanda Edwards, Ruth Gilbert, Steve Morris, Helen Roberts, Cathy Street, and Russell Viner. The authors would also like to thank all members of CORC, its committee at the time of writing—(including M.W.): Ashley Wyatt, Duncan Law, Alison Towndrow, Tamsin Ford, Evette Girgis, Julie Elliott, Ann York, Mick Atkinson, and Alan Ovenden—and the CORC central team at the time of writing (including M.W. and I.F): Jenna Jacob, Elisa Napoleone, Victoria Zamperoni, Christa Daboiko, Slavi Savic, and Jeni Page. The authors would like to thank Lisa Arai for her useful comments on an earlier draft.

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Authors and Affiliations

  1. Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK

    Julian Edbrooke-Childs, Jessica Deighton & Miranda Wolpert

  2. Child Outcomes Research Consortium, Anna Freud Centre, London, UK

    Robbie Newman, Isobel Fleming & Miranda Wolpert

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  1. Julian Edbrooke-Childs
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Correspondence to Miranda Wolpert.

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Edbrooke-Childs, J., Newman, R., Fleming, I. et al. The association between ethnicity and care pathway for children with emotional problems in routinely collected child and adolescent mental health services data. Eur Child Adolesc Psychiatry 25, 539–546 (2016). https://doi.org/10.1007/s00787-015-0767-4

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