Effectiveness of brief intervention and case management for children and adolescents with mental health difficulties

Accepted Manuscript Effectiveness of brief intervention and case management for children and adolescents with mental health difficulties

Giorgia A. Wagner, Helen Mildred, Donna Gee, Emma B. Black, Peter Brann PII: DOI: Reference:

S0190-7409(17)30139-1 doi: 10.1016/j.childyouth.2017.06.046 CYSR 3384

To appear in:

Children and Youth Services Review

Received date: Revised date: Accepted date:

10 February 2017 26 June 2017 26 June 2017

Please cite this article as: Giorgia A. Wagner, Helen Mildred, Donna Gee, Emma B. Black, Peter Brann , Effectiveness of brief intervention and case management for children and adolescents with mental health difficulties, Children and Youth Services Review (2017), doi: 10.1016/j.childyouth.2017.06.046

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ACCEPTED MANUSCRIPT Effectiveness of Brief Intervention and Case Management for Children and Adolescents with Mental Health Difficulties Ms Giorgia A. Wagner, School of Psychology, Faculty of Health and Behavioural Sciences, Deakin University; Child and Youth Mental Health Service, Eastern Health.

University; Child and Youth Mental Health Service, Eastern Health.

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Dr Helen Mildred, School of Psychology, Faculty of Health and Behavioural Sciences, Deakin

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Child and Youth Mental Health Service, Eastern Health.

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Ms Donna Gee, School of Psychology, Faculty of Health and Behavioural Sciences, Deakin University;

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Dr Emma B. Black, Rural Clinical School, School of Medicine, The University of Queensland. Dr Peter Brann, Child and Youth Mental Health Service, Eastern Health; School of Clinical Sciences,

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Monash University

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Word count: 3,988

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Running head: Effectiveness of Brief Intervention

Corresponding Author: Dr Helen Mildred E-mail address: [email protected] Postal address: School of Psychology, Deakin University, 1 Gheringhap Street, Geelong VIC 3220, Australia. Phone: +61 3 9843 1288 Fax: +61 3 9244 6858

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Abstract Objective: To compare the effectiveness of a Brief Intervention (BI) and Treatment As Usual (TAU) in a sample of children and adolescents seeking mental health treatment from a Child

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and Youth Mental Health Service (CYMHS). BI comprised up to six sessions of

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psychological therapy from trainee psychologists, and TAU involves case management

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incorporating assessment and psychological treatment (e.g., individual, parent, family therapy), plus linkage to other services.

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Method: A matched subjects design was used to evaluate the BI (n = 79) and TAU (n = 79) treatment conditions. Participants were matched according to age, gender, and baseline

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symptom scores on the Health of the Nations Outcome Scale for Children and Adolescents (HoNOSCA), which was completed at pre- and post-treatment. The HoNOSCA is a clinician-

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rated measure of symptoms experienced in the previous two weeks.

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Results: BI and TAU both significantly reduced mental health symptoms, with no significant difference between treatments overall, on Externalising or Emotional problems subscales, or

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on the percentage of problematic items for participants. Conclusions: BI was as effective as TAU in reducing mental health symptoms in some

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children and adolescents. BI however is briefer, and could form part of a Stepped Care model for CYMHS. Further research is required to establish the most effective elements of BI in reducing mental health symptoms.

Keywords Child and Youth Mental Health Service; brief intervention; mental health; children and adolescents.

ACCEPTED MANUSCRIPT Effectiveness of Brief Intervention and Case Management for Children and Adolescents with Mental Health Difficulties 1. Introduction Australian children and young people experience high rates of mental illness, compared to the rest of the Australian population. National surveys have found one year

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prevalence of mental disorders to be 13.9% for those aged 4 – 17 years (Lawrence et al., 2015) and 26% for those aged 16 to 24 years (Australian Bureau of Statistics, 2007). Young

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people in Australia aged 16 to 24 years have the highest rates of mental disorder as compared

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to other age groups (Australian Bureau of Statistics, 2007). As a result, mental disorders form the leading disease burden for people aged 0 to 14 years (Begg et al., 2007) and 15 to 24

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years (Mathers, Vos, & Stevenson, 1999). This can place great demand on publicly funded

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specialist Child and Youth Mental Health Services (CYMHS); research however indicates that demand for public mental health services exceeds resources (Doessel, Williams, & Whiteford, 2010).

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In Australia, CYMHS offer multidisciplinary assessment and treatment to children and young people (aged 0 - 25) and their families who have severe mental health issues and psychosocial challenges. For those with less complex issues, there are a range of alternative

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providers including private psychologists and psychiatrists, school welfare systems, and

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general practitioners who provide mental health services. The CYMHS Treatment As Usual (TAU) case management model comprises comprehensive assessment, clinical management and monitoring, psychological therapy, and collaboration with other services (Australian Capital Territory Government Health, 2013). In Australia, CYMHS TAU has an evidence base for significant reduction of psychiatric symptoms in children and young people (Brann & Coleman, 2010; Brann, Walter, & Coombs, 2011), according to the routine outcome measure of the clinician rated Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA; Gowers et al., 1999).

ACCEPTED MANUSCRIPT TAU duration may be a few weeks to many months or a year or more; it can therefore be resource-intensive, whilst there is a constant high demand for public mental health services (Burgess et al., 2004). To help alleviate service demands, several authors have suggested alternative intervention models (e.g.: Campbell, 1999; Hosie, Vogl, Hoddinott, Carden, & Comeau, 2014; Kazdin & Blase, 2011). One model involves offering Single

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Session Therapy (SST) or Brief Intervention (BI) as a first line response (Gee, Mildred,

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Brann, & Taylor, 2015). SST involves providing a single, or at times a small number of

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sessions targeting one or two issues identified by clients, and collaboratively developing strategies and action that will assist the client to overcome or manage those issues. The model

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arose from the finding that not only is the first therapy session the modal number of sessions attended by clients, it is also the session in which most change reportedly occurs (Talmon,

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1990). A number of therapies have been adapted for SST, with cognitive behavioural interventions producing the largest treatment effect sizes for children and young people

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(Schleider & Weisz, 2017).

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Reviews of SST have indicated that it may be helpful for a range of problems with clients with potentially mild to moderate difficulties (see Axelrad, Garland, & Love, 2009;

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Eisenberg & Wahrman, 1994; Hair, Shortall, & Oldford, 2013). The literature however is typically characterised by uncontrolled studies with generally poor methodological rigour

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(Bloom, 2001; Campbell, 2012; Hurn, 2005). Further, there is only one randomised control trial which investigates the impact of SST offered to all clients of a public health Child & Adolescent Mental Health Service (aged 5-15 years) against a wait list control (Perkins, 2006). This study reported large and significant symptom improvements, with most participants (70-74%) describing reductions in problem frequency and severity, which were maintained across time (Perkins & Scarlett, 2008). Continued research with sound

ACCEPTED MANUSCRIPT methodology is warranted to both support the effectiveness of this intervention, and compare it to other modalities. There is no consistent definition of BI in the literature: it can comprise any therapy model applied in the short term, and ranges from SST (e.g., Perkins, 2006) up to 9 intervention sessions (e.g., Van Lieshout, Yang, Haber, & Ferro, 2017). The BI model

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offered within EHCYMHS extends the SST model to be a short term treatment package of up

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to six therapy sessions for clients (aged 0 – 18 years) and their families with severe and

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complex mental health disorders, as well as significant psychosocial difficulties. Clients within this cohort are affected by the range of severe mental health disorders represented in

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the International Classification of Diseases (World Health Organization, 1992) and Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association,

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2013) nosologies. This includes the range of developmental, mood, anxiety, disruptive behaviour, psychotic, eating, personality, and substance use disorders. The therapeutic

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modality of Brief Intervention in this setting is that it is used with severe and complex cases,

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and specifically utilises Cognitive Behavioural techniques (e.g., monitoring, behavioural experiments, psychoeducation, exposure/response prevention) embedded within a solution-

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focussed (De Shazer, 1994), strengths-based approach. The current study seeks to examine the effectiveness of a BI approach for clients up to

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18 years of age within a public child and youth mental health setting, by comparing their outcomes to those of people undertaking TAU. The hypotheses include: (1) TAU and BI will both reduce participant mental health symptoms; and (2), participants receiving BI will have similar levels of symptom reduction to those receiving TAU. 2. Method 2.1 Participants

ACCEPTED MANUSCRIPT Data was collected in the period mid 2012 – January 2014 from Eastern Health CYMHS clients. Data was collected as part of routine clinical care in CYMHS, and extracted from clinical and administrative records. Participants were 158 case matched clients ranging in age from 6 – 18 years (M = 12.67 years); 43% (n = 68) of the sample were male, and 57% (n = 90) were female. These statistics are the same for each condition (BI, TAU), as well as

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overall, as participants were matched by age and gender. Participants presented seeking help

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for a range of difficulties (Table 1).

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During this time period, 101 clients received BI, and for this study 22 BI participants were excluded as 18 were unable to be appropriately matched to TAU clients, and four were

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aged over 18. The remaining 79 BI participants were matched to 79 clients receiving TAU within the same time period (see Results for details). As this study involved routine clinical

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care, condition allocation was not random. People were allocated to TAU or BI (see Procedure), as well as relying on varying appointment availability within the BI Clinic for

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2.2 Procedure

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client throughput.

Eligibility for CYMHS service at the time of data collection time involved residing

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within the service’s catchment area, being aged between 0 – 25 years, and experiencing an acute and/or severe mental disorder. All referrals are triaged by the intake team to determine

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whether these criteria are met. Clients have generally been seen by a number of health and/or mental health practitioners before being eligible for CYMHS. A subsample of referrals are referred to the BI service and the remainder to TAU. 2.3 Treatment Approaches and Procedure BI is offered to consumers who meet CYMHS criteria, however exclusions apply which are not present for TAU. These criteria are if the person: requires urgent assessment (e.g., due to very high risk to self or others); is experiencing psychotic symptoms; has

ACCEPTED MANUSCRIPT anorexia nervosa; or requires specific diagnostic assessment (e.g., Autism Spectrum Disorder). People are offered BI according to varying appointment availability due to modest staffing numbers. The BI Clinic operates part time and is staffed by 3-4 provisional psychologists (clinical psychology postgraduate students), under the supervision of senior Clinical Psychologists and mental health clinicians (approximately 1.5 full time clinicians).

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Participation in the BI service is voluntary and clients receive TAU, if they wish post-BI. Of

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the 79 participants in this study, 22 (28%) went on to TAU after their involvement with BI.

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BI is completed within a maximum of six, 60 to 90 minute sessions, generally within a three month time frame. Each session is approached as though it may be the only one, and

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structured as a single session with a stated goal. At the end of each session, the family and clinician collaboratively decide if further sessions are required. Intervention incorporates

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elements of cognitive behavioural therapy and typically involves a solution-focused approach, including identifying both past family successes, and noting exceptions when the

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presenting problem did not occur. Client and family strengths are also elicited, with the focus

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being on tasks and strategies aimed to increase client and family efficacy. As previously mentioned, TAU includes a range of assessments and interventions

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(including individual, parent and/or family therapy) which generally occur over a longer period of time than BI. Between treatment sessions, other contacts may occur, for example,

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monitoring via phone calls. It can involve multi-disciplinary intervention, for example, by a psychologist, social worker, occupational therapist, family therapist, and psychiatrist. In TAU it may be decided that the client will be treated individually by one clinician and the family may be referred to the family therapy team or another clinician may do work with the parents. Therapeutically BI and TAU may share some of the same techniques (e.g., Cognitive Behavioural Therapy). The goal of TAU for the clients and their supports is to reduce the impact of symptoms on their lives, increase their level of functioning across social and

ACCEPTED MANUSCRIPT emotional domains, and respect the resilience and individualised nature of the recovery process. TAU tends to comprehensively identify and treat a number and range of symptomatology however, whereas in BI the client/family select one or two single issues to work on within a time limit. The ‘dose’ therefore is generally less in BI than TAU, and a solution-focused, rather than symptom based, therapeutic approach is more commonly used.

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BI and TAU are both tailored according to client need- as such, there is no set protocol or

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manualised intervention for either approach.

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Ethics approval was provided by Eastern Health and the Administrative University [University name and Ethics Approval numbers to be inserted post-blinded review].

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2.4 Measures

The HoNOSCA is a routine outcome measure administered across CYMHS in

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Australia (Brann & Coleman, 2010). It consists of 15 items completed by the clinician, who rates the most severe occurrence for each item in the preceding 2 weeks. The HoNOSCA is

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scored on a 0–4 scale, from ‘no problems’ (0) through to ‘severe problems’ (4). A total score

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is obtained by summing the first 13 items. Research indicates that the HoNOSCA has satisfactory reliability and validity (Gowers et al., 1999), moderate to good inter-rater

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reliability and its validity has been demonstrated in a number of studies (Bilenberg, 2003; Brann, Coleman, & Luk, 2001; Garralda, Yates, & Higginson, 2000; Manderson & McCune,

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2003). Further, the HoNOSCA is both sensitive to change and a valid outcome measure for routine use in child and adolescent mental health services (Bilenberg, 2003; Garralda et al., 2000; Gowers et al., 1999). As part of routine outcome measurement for the CYMHS, clinicians complete the HoNOSCA following the first and last appointments, as well as in regular reviews every three months. 2.5 Analytic Strategy

ACCEPTED MANUSCRIPT To assess both intervention effect and the rate of improvement in mental health symptoms, Split Plot Analysis of VAriances (SPANOVA; Time x Group) were conducted. Outcomes included HoNOSCA scores at pre- and post-intervention, by intervention group (BI and TAU). These outcomes were total HoNOSCA scores, as well as separate analyses for the Emotional Problems and Externalising subscales (Tiffin & Rolling, 2012).

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Differences in specific symptomatology between BI and TAU groups were also

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evaluated at pre- and post-intervention. This was done by calculating the percentage of high scores (3, moderate problem; and 4, severe problem) across HoNOSCA items (Hanssen-

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Bauer et al., 2011) at both time points. Pearson’s Chi Squared was used to locate any

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significant differences between problematic item percentages for BI and TAU at pre- and post-intervention.

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3. Results 3.1 Data Preparation

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The 79 BI participants were matched to those receiving TAU within the same time

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period on the basis of age, gender, and HoNOSCA score (±1) at pre-intervention. The comparison group was drawn from all clients aged six to 18 years who completed TAU at

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CYMHS in the same period. SPANOVA assumptions (normality, homogeneity of variance, and homogeneity of intercorrelations) were satisfied in each analysis.

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3.2 Descriptive Statistics Participant presenting problems are outlined in Table 1. As the purpose of BI was to focus on one or two key issues, these negotiated targets could differ from the presenting problem. Key issues that formed the BI focus were as follows: violent outbursts (n = 17; 47.2%); mood swings (n = 11; 13.9%); bullying behaviour (n =11; 13.9%); being bullied (n = 10; 12.7%); depression (n = 10; 12.7); aggression (n = 9; 11.4); school refusal (n = 5; 6.4); anxiety or worry (n = 4; 5.1); or data not locatable (n = 2; 2.5).

ACCEPTED MANUSCRIPT As the two groups (TAU and BI) were matched on age, gender and initial HoNOSCA scores, no significant difference on these variables were expected. Mean HoNOSCA scores for BI and TAU groups at pre- and post-intervention are presented in Table 2. Variations in length of care were observed between the BI and TAU groups, as would be expected according to the different treatment frameworks. In the TAU group, the episode of

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care ranged from 13 to 1200 days (M= 382 days, SD = 295). In comparison, length of

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treatment for BI ranged from 1- 248 days (M = 61 days, SD = 46.4). The majority of BI cases

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(n = 67, 84.8%) completed the intervention within three months.

Amount of contact with the service also varied: the number of TAU contacts ranged

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from 1 - 606 (M = 65.78, SD = 92.26), and comprised face to face sessions or phone calls with the young person or their family, and liaison with other services (such as school or

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primary health). These contacts equated to 0.12 - 394 hours (M = 46.66 hours, SD = 64.53). The BI contacts comprised face to face sessions ranging from 60 – 90 minutes long, up to a

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maximum of six sessions (M = 3.97 sessions, SD = 1.77); contact time therefore ranged from

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1 – 9 hours.

3.3 Statistical analyses

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A SPANOVA determined a significant main effect for time, F (1, 156) = 57.28, p < .001, ηρ² = .27, power = 1.0; see Table 2). No significant main effect was obtained for

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condition, nor was there an interaction between condition and time. Therefore, there were no significant differences in outcome between the BI and TAU participants in overall symptomatology, and both interventions significantly reduced symptomatology. There was a significant reduction in Externalising symptoms from pre- to postintervention, F (1, 155) = 23.04, p < .001, ηρ² = .13, power = 1.0; Table 2). There was no significant difference between BI and TAU. For the Emotional problems subscale, there was

ACCEPTED MANUSCRIPT again a significant reduction as a result of treatment, F (1, 155) = 57.15, p < .001, ηρ² = .27, power = 1.0; Table 2), with no significant difference between treatments. Problematic mental health symptoms (i.e., moderate or severe ratings on HoNOSCA items) are presented in Table 3. On the whole, BI and TAU participants at baseline were not significantly different in terms of problematic symptomatology, excepting family problems-

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this was significantly higher in the TAU group. Following intervention, BI and TAU groups

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largely had equivalent levels of problematic symptoms; the only significant difference was

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that TAU participants had significantly higher levels of overactivity and attention difficulties. As this item was not significantly different between BI and TAU at pre-intervention, a post-

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hoc repeated measures analysis of variance was conducted to determine if BI significantly reduced this symptom more than TAU: it did not.

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4. Discussion

This study aimed to investigate the effectiveness of BI in improving psychopathology

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of children and adolescents attending an Australian publically funded CYMHS. The BI

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intervention was compared with a matched TAU control group in an attempt to overcome the lack of methodological rigour found in past SST or BI studies. Key findings included that

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both treatment significantly reduced psychopathology, and that gains made were not significantly different between the treatment conditions. This was despite TAU typically

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having more contact hours with participants, a longer duration of treatment, and experienced clinicians providing treatment (whereas BI was provided by intern psychologists). Comparison of the mean initial HoNOSCA score for BI and TAU with that obtained from all Australian CYMHS (n = 47,777) revealed that the study sample are between the 49th to 55th percentile (Australian Mental Health and Classification Outcomes Network, 2016). This indicates that the sample are certainly within the level of severity that could be expected to be seen by CYMHS. The most statistically rigorous study examining mental health

ACCEPTED MANUSCRIPT outcomes using SST for children and adolescents attending a CYMHS (Perkins, 2006) actually had a lower baseline HoNOSCA (10.1) than in the current study (BI M = 14.47; TAU M = 15.61), indicating that clients in the current study had higher baseline symptom severity (Gowers et al., 1999). Interestingly, similar effect sizes to those in Perkins’ study were observed: Perkins reported a 39% symptom reduction at one month follow-up (as

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measured by the HoNOSCA), and the BI condition had a 36% symptom reduction. This

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indicates that BI and SST may be beneficial for clinically significant symptoms of varying

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severity, in the absence of immediate risk of harm (also an exclusion criterion in Perkins’ study).

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Prior to, and following intervention, BI and TAU conditions largely had equivalent levels of problematic symptoms (i.e., a moderate or severe rating on items). Post-treatment,

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the only significant difference located was that TAU participants had significantly higher levels of overactivity and attention difficulties than those receiving BI. The percentage of BI

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participants with a problematic rating on this item reduced by over 50% as a result of

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treatment. Despite TAU recipients having a significantly higher rate of overactive or disruptive behaviours post-intervention, this is not a function of TAU performing

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significantly worse than BI on treating this symptom. It is interesting to note however, that the majority of BI therapeutic targets were focused on this type of behaviour: 58.6% of the

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sample receiving intervention for violent outbursts or aggression. It is unknown whether such symptoms were also made a key focus in the TAU group. At first glance, it appears surprising that participants in BI and TAU conditions made equivalent gains, given that BI is of much shorter duration and dose than TAU, and provided by less experienced clinicians. This finding however is consistent with prior research: an evaluation of brief CBT (up to 7 sessions) found equivalent mental health gains made to TAU for adults attending outpatient mental health services (Meuldijk et al., 2016). Regarding

ACCEPTED MANUSCRIPT treatment dose for young people receiving psychological therapy, a large meta-analysis (N = 30,431; k = 447) has indicated that the number of treatment sessions was not related to treatment effect size (Weisz et al., 2017). These outcomes raise questions regarding the ideal length of care within the TAU model, and the use of a potentially long-term, resourceintensive TAU intervention within CYMHS (which experiences high service demands), when

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for some clients, similar symptom reductions may be obtained through BI. Whilst largely the

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same type of presentations were treated in BI and TAU, it is important to note that BI

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excluded clients who were high risk (unlike TAU), as well as certain presentations (such as psychotic symptoms or eating disorders). This factor may help account for the longer

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duration and higher dose of TAU. Further, people accessing BI were typically seen within a few weeks of contacting CYMHS, whereas at the time of the study TAU clients may have

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been on a waitlist prior to intervention- potentially for weeks or months. This may also account for longer TAU input.

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As demand can outweigh resources in the public mental health system, one model

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suggested to have significant possibilities for this difficulty is Stepped Care (Hosie, Vogl, Hoddinott, Carden, & Comeau, 2014). In the public system, Stepped Care involves providing

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less intensive treatment as a first response, and for those who don’t benefit (or who are not expected to benefit), more resource-intensive treatments are made available (Bower &

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Gilbody, 2005). Stepped Care within CYMHS specifically has been conceptualized as offering brief intervention (comprising strengths-based sessions) as a first line treatment to children and young people in a timely manner (Gee, Mildred, Brann, & Taylor, 2015). Research has found that the Stepped Care model within a mental health service resulted in better matching of resources to illness complexity than TAU (Belsher et al., 2016), and significantly greater symptom reduction than TAU (the assessed disorders were major depression and post-traumatic stress disorder; Engel et al., 2016).

ACCEPTED MANUSCRIPT In this study, BI utilised fewer paid resources than TAU (duration, sessions, and clinician experience), was accessed faster than TAU, and produced significant symptom improvement, so that only 28% of BI participants went on to access TAU post-interventionthus reducing the demands on CYMHS. Stepped Care, comprising BI and TAU, could be implemented under the same conditions as in this study, with only some clients being eligible

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for BI. Those with high risk, more complex conditions, or clients not expected to benefit from

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BI, could go straight to TAU. Those who access BI, and continue needing support afterwards,

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could then be offered TAU. This model would also allow BI clients to access an effective service faster.

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4.1 Limitations and Directions for Future Research

Participants were not randomly allocated to conditions, and some presentations were

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not eligible for BI (e.g.: high risk; psychotic disorders; anorexia nervosa). Even those deemed suitable for BI may not have been offered this treatment, due to the small service’s limited

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appointment availability. Therefore, BI and TAU groups are not equivalent samples, despite

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similar presentations being treated in both. Further, it is possible to get a relatively low overall score on the HoNOSCA with high levels of suicidality: matched cases may therefore

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have had different risk levels, or complexity. Whilst cases were matched by initial HoNOSCA score (as well as age and gender),

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the BI group was the reference point. Given that BI had several exclusions, it’s likely that TAU (without exclusions) has a higher level of severity than the 49th- 55th percentile reported in this paper, and there are likely to be unmeasured group differences which could have influenced the results. A final limitation is that the current study only used HoNOSCA data: although a quick and reliable measure, it relies on an overall score from a clinician perspective regarding client symptom difficulty and severity. The use of other measures of outcome and functioning

ACCEPTED MANUSCRIPT would elucidate whether there are additional positive outcomes associated with TAU which are not captured by using only this symptom measure. It also omits the consumer’s perspective; including client-report measures could provide further insights into the helpfulness of each intervention. Exploration into the mechanisms and ‘active’ ingredients of BI is particularly

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warranted, given that significant changes were achieved by trainee psychologists in a brief

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time period, working with families that typically present with complex problem histories and

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significant psychosocial challenge. It may be that the BI focus on a family’s strengths and past successes (rather than their problems) engendered hope and positively influenced the

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therapeutic relationship and therefore client outcomes. Clarifying whether this is accurate would not only be helpful for the literature, but also for practising (and training) clinicians.

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4.2 Conclusions

In conclusion, this study found that BI can lead to significant symptom improvements

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for children and adolescents experiencing mental health problems. The model enables clients

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and their families to be seen in a timely manner, is briefer than TAU, and can produce equivalent levels of overall symptom reduction to TAU when employed with consumers who

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are not at high risk of harm. It is therefore possible that incorporating this intervention into the CYMHS service model as a first line treatment for indicated clients, could help maximise

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service impact and client improvement. Further research is required to determine which elements of BI are most effective in alleviating mental health symptoms.

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ACCEPTED MANUSCRIPT World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health

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Organization.

ACCEPTED MANUSCRIPT Tables Table 1 Participant Presenting Problem by Condition. TAU n(%) BI n(%) 13(16.5)

Other1

10(13)

4(2.4)

Adjustment disorder

9(11.4)

3(1.9)

Acute stress reaction

5(6.3)

Borderline personality disorder

5(6.3)

2(1.3)

Family disruption (separation/divorce)

5(6.3)

4(2.5)

Anorexia nervosa

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1(0.6)

5(6.3)

1(0.6)

4(5.1)

-

4(5.1)

-

Unspecified childhood emotional disorder

4(5.1)

5(3.2)

Austism spectrum disorder

3(3.8)

4(2.5)

3(3.8)

3(1.9)

2(2.5)

2(1.3)

Unspecified negative life event in childhood

2(2.5)

4(2.5)

Oppositional defiant disorder

2(2.5)

12(7.6)

Childhood sexual abuse

2(2.5)

2(1.3)

Conduct disorder

2(2.5)

3(1.9)

-

4(2.5)

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Disturbance of activity and attention

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Anxiety disorder not otherwise specified

Dysthymia

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Suspected mental/behavioural disorder

Attention deficit hyperactivity disorder

1

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Depression

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12(15.2)

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Presenting Problem

This is for presenting problems with n = 1, which are as follows for the TAU group: post-traumatic stress disorder; relationship problems with parents and/or in-laws; ‘other’ mental and behavioural disorder; mixed anxiety and depressive disorder; elective mutism; eating disorder not otherwise specified; unspecified childhood disorder of social functioning; bipolar affective disorder; atypical parenting situation; and dissociative motor disorder. For the BI group: obsessive compulsive disorder; and generalised anxiety disorder.

ACCEPTED MANUSCRIPT -

12(7.6)

Data not locatable

-

2(1.3)

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MA

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SC

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Anxiety

ACCEPTED MANUSCRIPT Table 2 Means and standard deviations of HoNOSCA total and subscales scores for the Brief Intervention and Treatment As Usual Groups at Pre- and Post-Intervention. Pre-Intervention Treatment Condition

Total Score

Externalising

Emotional

Total Score

M(SD)

Subscale M(SD)

Subscale M(SD)

M(SD)

Brief Intervention

14.47 (5.35)

3.83(2.89)

10.69(3.54)

11.28 (6.35)

Treatment As Usual

15.61 (6.36)

4.49(2.99)

11.06(4.40)

D E

T P E

A

C C

T P

Post-Intervention

M

N A

C S U

I R

11.01 (7.68)

Externalising

Emotional

Subscale M(SD)

Subscale M(SD)

3.12(2.81)

8.18(4.50)

3.23(3.23)

7.80(5.35)

ACCEPTED MANUSCRIPT Table 3 Significance Test and Percentages of Participants with Problematic Scoresa on Items at Pre- and Post-Intervention by Treatment Condition. Pre-intervention

Post-intervention

Brief

Treatment As

Pearson’s

Brief

Intervention

Usual

χ²

Intervention

%

%

19.2

29.1

2.09

I R

12.7

.55

14.1

26.7

3.74

6.4

16.5

3.9*

9

17.9

2.70

9.0

3.9

1.66

4. Alcohol/drug misuse

2.6

1.3

5. Scholastic difficulties

11.5

20.0

6. Physical illness/disability

6.4

7. Hallucinations/delusions

2.6

8. Somatic symptoms

6.4

Item

1. Aggressive/disruptive

%

C S U

behaviour 2. Overactivity 3. Self-injury

10. Relationship problems 11. Self-care difficulties 12. Family problems 13. School attendance

%

0

1.3

1.01

2.01

14.1

15.4

.05

.09

3.8

3.8

.00

5.3

.78

2.6

0

2.05

9.3

.45

3.8

0

3.06

73.1

.31

43.6

29.5

3.35

20.5

32.9

3.08

17.9

19.2

.04

2.6

9.5

3.24

5.1

3.8

.16

37.2

57.7

6.58**

32.1

36.7

.38

39.7

29.1

1.97

21.8

12.7

2.3

D E 5.3

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Note. ***p ≤ .001; **p ≤ .01; *p ≤ .05

a

χ²

.31

76.9

C A

T P

Usual

Pearson’s

N A

E C

9. Emotional problems

9

Treatment As

These were scores 3 (moderate problem) and 4 (severe problem) on each item.

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ACCEPTED MANUSCRIPT 26 Effectiveness of Brief Intervention

Highlights

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  

Brief intervention significantly reduced mental health symptoms in children and adolescents Brief intervention was as effective as case management Trainee psychologists can provide effective brief intervention Brief intervention is a useful first response when service demand is high

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