# Editorial: Training & treatment in child mental health services (CAMHS): Novel and collaborative approaches

Alexis Revet, Cheryl Kennedy

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Alexis Revet, Cheryl Kennedy. Editorial: Training & treatment in child mental health services (CAMHS): Novel and collaborative approaches. Frontiers in Psychiatry, 2022, 13, pp.997647. 10.3389/fpsyt.2022.997647. hal-04552876

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OPEN ACCESS

EDITED AND REVIEWED BY
David Cohen,
Sorbonne Universités, France

*CORRESPONDENCE
Alexis Revet
revet.a@chu-toulouse.fr

SPECIALTY SECTION
This article was submitted to Adolescent and Young Adult Psychiatry, a section of the journal Frontiers in Psychiatry

RECEIVED 19 July 2022
ACCEPTED 25 July 2022
PUBLISHED 09 August 2022

CITATION
Revet A and Kennedy CA (2022)
Editorial: Training & treatment in child mental health services (CAMHS): Novel and collaborative approaches.
Front. Psychiatry 13:997647.
doi: 10.3389/fpsyt.2022.997647

COPYRIGHT
© 2022 Revet and Kennedy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

# Editorial: Training & treatment in child mental health services (CAMHS): Novel and collaborative approaches

Alexis Revet ID 1,2* and Cheryl A. Kennedy3,4

KEYWORDS

vulnerable children, mental illness in children, training for CAMHS, effective treatments in CAMHS, interprofessional treatment for CAMHS

## Editorial on the Research Topic

### Training & treatment in child mental health services (CAMHS): Novel and collaborative approaches

Child and Adolescent Psychiatry and mental health services in the twenty-first century are facing major challenges that require multiple competences and a strong trans-disciplinary and interprofessional input. Epidemiological data now clearly show that mental health care for children and adolescents should be a public health priority in most countries of the world (1, 2). Globally, about half of all mental disorders occur before the age of 14 and three quarters before the age of 25 (1, 3). In addition, 25% of disability-adjusted life years for mental and substance use disorders occur in young people (4). Too often neglected or minimized, the psychosocial risk factors that have a negative impact on the development of children and adolescents are multiple, including psycho-traumatic factors (migration, wars, terrorism, natural disasters, pandemics, domestic, and community violence) as well as risks linked to socio-economic precariousness (poverty, lack of education, child labor, sexual discrimination) (5). At the global level, the very low number of child and adolescent psychiatrists is of particular concern, and is even more pronounced in low-income countries. More worryingly, a downward trend in recruitment to child and adolescent psychiatry is observed in many countries (6).

Given the complexity of these issues and the multiplicity of challenges, the objectives of this Research Topic were broad, potentially integrating contributions of scientific knowledge from various fields (technology, epidemiology, genomics, protective factors, psychotherapeutic approaches, biological treatments, and others) in order to better understand the problems of children and adolescents with psychiatric disorders, and to advance treatment modalities and innovative approaches, in a biopsychosocial, multicultural, inter- and intra-professional and multimodal perspective.

<footnote n="1">¹Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France,</footnote>

<footnote n="2">²CERPOP/UMR1295, University of Toulouse, Inserm, UPS, Toulouse, France, ³Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, United States, ⁴Department of Psychiatry, University Hospital, Newark, NJ, United States</footnote>
<figure><img src="image_3.png" /></figure>

Check for updates

OPEN ACCESS

EDITED AND REVIEWED BY
David Cohen,
Sorbonne Universités, France

*CORRESPONDENCE
Alexis Revet
revet.a@chu-toulouse.fr

SPECIALTY SECTION
This article was submitted to Adolescent and Young Adult Psychiatry, a section of the journal Frontiers in Psychiatry

RECEIVED 19 July 2022
ACCEPTED 25 July 2022
PUBLISHED 09 August 2022

CITATION
Revet A and Kennedy CA (2022)
Editorial: Training & treatment in child mental health services (CAMHS): Novel and collaborative approaches.
Front. Psychiatry 13:997647.
doi: 10.3389/fpsyt.2022.997647

COPYRIGHT
© 2022 Revet and Kennedy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

# Editorial: Training & treatment in child mental health services (CAMHS): Novel and collaborative approaches

Alexis Revet ID 1,2* and Cheryl A. Kennedy3,4

KEYWORDS

vulnerable children, mental illness in children, training for CAMHS, effective treatments in CAMHS, interprofessional treatment for CAMHS

## Editorial on the Research Topic

Training & treatment in child mental health services (CAMHS): Novel and collaborative approaches

Child and Adolescent Psychiatry and mental health services in the twenty-first century are facing major challenges that require multiple competences and a strong trans-disciplinary and interprofessional input. Epidemiological data now clearly show that mental health care for children and adolescents should be a public health priority in most countries of the world (1, 2). Globally, about half of all mental disorders occur before the age of 14 and three quarters before the age of 25 (1, 3). In addition, 25% of disability-adjusted life years for mental and substance use disorders occur in young people (4). Too often neglected or minimized, the psychosocial risk factors that have a negative impact on the development of children and adolescents are multiple, including psycho-traumatic factors (migration, wars, terrorism, natural disasters, pandemics, domestic, and community violence) as well as risks linked to socio-economic precariousness (poverty, lack of education, child labor, sexual discrimination) (5). At the global level, the very low number of child and adolescent psychiatrists is of particular concern, and is even more pronounced in low-income countries. More worryingly, a downward trend in recruitment to child and adolescent psychiatry is observed in many countries (6).

Given the complexity of these issues and the multiplicity of challenges, the objectives of this Research Topic were broad, potentially integrating contributions of scientific knowledge from various fields (technology, epidemiology, genomics, protective factors, psychotherapeutic approaches, biological treatments, and others) in order to better understand the problems of children and adolescents with psychiatric disorders, and to advance treatment modalities and innovative approaches, in a biopsychosocial, multicultural, inter- and intra-professional and multimodal perspective.

<footnote n="1">¹Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France,</footnote>

<footnote n="2">²CERPOP/UMR1295, University of Toulouse, Inserm, UPS, Toulouse, France, ³Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, United States, ⁴Department of Psychiatry, University Hospital, Newark, NJ, United States</footnote>
A series of four surveys were conducted to explore the experience of new and collaborative approaches to training and treatment in children's mental health services, summarized below.

You et al. retrospectively studied the effectiveness of acupuncture treatment of tic disorder in children over a 12-week period. This work showed that, compared with the control group, the reduction in the Yale Global Tic Severity Scale (YGTSS) total score after 12 weeks of treatment was greater for the acupuncture group (OR = 2.94, 95% CI: 1.03–8.39, *p* = 0.04), and this association was stronger for subjects who had significant vocal tics (*β* = 0.29, 95% CI: 0.88–2.68, *p* = 0.001). The authors of this work have thus provided preliminary evidence supporting the therapeutic effect of acupuncture for tic disorder in children, which could therefore be an effective and well-supported adjuvant treatment in children with this indication, particularly for vocal tics.

Kilicel et al. focused on the transition in psychiatry, that refers to the period when young people move from child and adolescent mental health services to adult mental health services. This period is marked by a strong discontinuity with a potential impact on the young adult's disorders and subsequent follow-up, in both psychiatric (7) and non-psychiatric disorders (8). The objective of this study was to describe the architecture of public mental health providers in Switzerland and to compare it to EU countries, around this issue of transition in psychiatry. Interestingly, the results of this work have shown that, although Switzerland has some of the highest socio-economic resources available for mental health care services in Europe, Swiss cantons seem to experience comparable difficulties and have similar demands and needs regarding transition issues that other countries have. These results are important in that they show that the level of resources invested in mental health care may not be the most important parameter to ensure a quality transition. Indeed, as the authors point out, it is the specific coordination work between services that seems to be central. The authors highlight the importance of implementing national and regional guidelines to guide this transition, that could be useful and effective without requiring additional staffing.

Reis et al. aimed to demonstrate the effectiveness of a behavioral prevention program on sexual abuse for children with intellectual disabilities. While girls in the intervention group (n = 64) showed improvements in prevention knowledge compared to the control group (n = 39), they did less so in prevention behavior, and field tests with realistic seduction situations showed no improvement. This last point is important because, as the authors emphasize, naturalistic contexts are essential to provide evidence of the effectiveness of preventive interventions for children with intellectual disabilities.

Finally, Lincke et al. studied attitudes toward innovative therapeutic approaches (e-mental health and home treatment) in the German health care system. Less than one in five

participants preferred online treatment approaches, while more than half could imagine being treated at home. Younger subjects were more open to online therapy approaches, while people with a low level of education often preferred traditional treatment. Interestingly, the level of acceptance of online therapy did not increase significantly during the first months of the COVID-19 pandemic. The results of this study therefore highlight the need to inform about and promote these innovative treatments, whose diffusion and level of acceptance still seem moderate.

In sum, this Research Topic provides new evidence on: (i) acupuncture treatment of tic disorder in children; (ii) factors that can ensure a quality transition in psychiatry; (iii) an innovative behavioral prevention program on sexual abuse for children with intellectual disabilities; (iv) attitudes of the general population toward innovative therapeutic approaches.

In conclusion, we believe it is important to encourage local and global networks of cooperation and collaboration and the aim of this Research Topic, coordinated by two clinician-scientists, one American and one French, is to contribute—in a modest way—to the advocacy on the ground of these crucial issues, in order to encourage stakeholders to demand socially justifiable and equitable resources. As we have stated several times before (9, 10), promoting child and adolescent mental health is imperative to reduce the burden of mental health problems in future generations and to enable the successful and satisfying development of vulnerable children and adolescents (11).

## Author contributions

AR and CK are the two topic editors of this Research Topic and take responsibility for the views expressed in this editorial. AR wrote the first version of this editorial. CK extensively reworked the editorial. Both authors contributed to the article and approved the submitted version.

## Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

## Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
A series of four surveys were conducted to explore the experience of new and collaborative approaches to training and treatment in children's mental health services, summarized below.

You et al. retrospectively studied the effectiveness of acupuncture treatment of tic disorder in children over a 12-week period. This work showed that, compared with the control group, the reduction in the Yale Global Tic Severity Scale (YGTSS) total score after 12 weeks of treatment was greater for the acupuncture group (OR = 2.94, 95% CI: 1.03–8.39, *p* = 0.04), and this association was stronger for subjects who had significant vocal tics (*β* = 0.29, 95% CI: 0.88–2.68, *p* = 0.001). The authors of this work have thus provided preliminary evidence supporting the therapeutic effect of acupuncture for tic disorder in children, which could therefore be an effective and well-supported adjuvant treatment in children with this indication, particularly for vocal tics.

Kilicel et al. focused on the transition in psychiatry, that refers to the period when young people move from child and adolescent mental health services to adult mental health services. This period is marked by a strong discontinuity with a potential impact on the young adult's disorders and subsequent follow-up, in both psychiatric (7) and non-psychiatric disorders (8). The objective of this study was to describe the architecture of public mental health providers in Switzerland and to compare it to EU countries, around this issue of transition in psychiatry. Interestingly, the results of this work have shown that, although Switzerland has some of the highest socio-economic resources available for mental health care services in Europe, Swiss cantons seem to experience comparable difficulties and have similar demands and needs regarding transition issues that other countries have. These results are important in that they show that the level of resources invested in mental health care may not be the most important parameter to ensure a quality transition. Indeed, as the authors point out, it is the specific coordination work between services that seems to be central. The authors highlight the importance of implementing national and regional guidelines to guide this transition, that could be useful and effective without requiring additional staffing.

Reis et al. aimed to demonstrate the effectiveness of a behavioral prevention program on sexual abuse for children with intellectual disabilities. While girls in the intervention group (n = 64) showed improvements in prevention knowledge compared to the control group (n = 39), they did less so in prevention behavior, and field tests with realistic seduction situations showed no improvement. This last point is important because, as the authors emphasize, naturalistic contexts are essential to provide evidence of the effectiveness of preventive interventions for children with intellectual disabilities.

Finally, Lincke et al. studied attitudes toward innovative therapeutic approaches (e-mental health and home treatment) in the German health care system. Less than one in five

participants preferred online treatment approaches, while more than half could imagine being treated at home. Younger subjects were more open to online therapy approaches, while people with a low level of education often preferred traditional treatment. Interestingly, the level of acceptance of online therapy did not increase significantly during the first months of the COVID-19 pandemic. The results of this study therefore highlight the need to inform about and promote these innovative treatments, whose diffusion and level of acceptance still seem moderate.

In sum, this Research Topic provides new evidence on: (i) acupuncture treatment of tic disorder in children; (ii) factors that can ensure a quality transition in psychiatry; (iii) an innovative behavioral prevention program on sexual abuse for children with intellectual disabilities; (iv) attitudes of the general population toward innovative therapeutic approaches.

In conclusion, we believe it is important to encourage local and global networks of cooperation and collaboration and the aim of this Research Topic, coordinated by two clinician-scientists, one American and one French, is to contribute—in a modest way—to the advocacy on the ground of these crucial issues, in order to encourage stakeholders to demand socially justifiable and equitable resources. As we have stated several times before (9, 10), promoting child and adolescent mental health is imperative to reduce the burden of mental health problems in future generations and to enable the successful and satisfying development of vulnerable children and adolescents (11).

## Author contributions

AR and CK are the two topic editors of this Research Topic and take responsibility for the views expressed in this editorial. AR wrote the first version of this editorial. CK extensively reworked the editorial. Both authors contributed to the article and approved the submitted version.

## Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

## Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References

1. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. *Curr Opin Psychiatry*. (2007) 20:359–64. doi: 10.1097/YCO.0b013e32816ebc8c

2. Gore FM, Bloem PJN, Patton GC, Ferguson J, Joseph V, Coffey C, et al. Global burden of disease in young people aged 10-24 years: a systematic analysis. *Lancet*. (2011) 377:2093–102. doi: 10.1016/S0140-6736(11)60512-6

3. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. *Arch Gen Psychiatry*. (2005) 62:593–602. doi: 10.1001/archpsyc.62.6.593

4. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. *Lancet*. (2006) 367:1747–57. doi: 10.1016/S0140-6736(06)68770-9

5. Srivastava AA, Reilly SP, Okeorji C, Kennedy CA. Mood disorders of childhood and adolescence in a low-income, urban community: a retrospective chart review. *Ann Clin Psychiatry Off J Am Acad Clin Psychiatr*. (2020) 32:27–32.

6. Revet A, Raynaud J-P, Marcelli D, Falissard B, Catheline N, Benvegnu G. Career choice and attractiveness of child and adolescent psychiatry as a medical specialty: a National French Questionnaire Survey. *Front Psychiatry*. (2021) 12:560141. doi: 10.3389/fpsyt.2021.560141

7. Stocker A, Rosenthal L, Mesquida L, Raynaud J-P, Revet A. Adult and child and adolescent psychiatrists' experiences of transition in anorexia nervosa: a qualitative study. *J Eat Disord*. (2022) 10:92. doi: 10.1186/s40337-022-00610-0

8. Gray W, Dorriz P, Kim H, Partain L, Benekos E, Carpinelli A, et al. Adult provider perspectives on transition and transfer to adult care: a multi-specialty, multi-institutional exploration. *J Pediatr Nurs*. (2021) 59:173–80. doi: 10.1016/j.pedn.2021.0 4.017

9. Deschamps P, Hebebrand J, Jacobs B, Robertson P, Anagnostopoulos DC, Banaschewski T, et al. Training for child and adolescent psychiatry in the twenty-first century. *Eur Child Adolesc Psychiatry*. (2020) 29:3–9. doi: 10.1007/s00787-019-01467-6

10. Revet A, Djelantik AAAMJ, Bui E. Promoting children and adolescents' mental health, and child and adolescent psychiatry: an editorial. *Int J Ment Health*. (2021) 50:192–4. doi: 10.1080/00207411.2021.195 4768

11. Cohen D, Baptista A. Homo Developmentalis: an evolutionary proposal relevant for child and adolescent mental health. *Front Child Adolesc Psychiatry*. (2022) 1. Available online at: https://www.frontiersin.org/articles/10.3389/frcha. 2022.940827 (accessed July 25, 2022).
References

1. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. *Curr Opin Psychiatry*. (2007) 20:359–64. doi: 10.1097/YCO.0b013e32816ebc8c

2. Gore FM, Bloem PJN, Patton GC, Ferguson J, Joseph V, Coffey C, et al. Global burden of disease in young people aged 10-24 years: a systematic analysis. *Lancet*. (2011) 377:2093–102. doi: 10.1016/S0140-6736(11)60512-6

3. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. *Arch Gen Psychiatry*. (2005) 62:593–602. doi: 10.1001/archpsyc.62.6.593

4. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. *Lancet*. (2006) 367:1747–57. doi: 10.1016/S0140-6736(06)68770-9

5. Srivastava AA, Reilly SP, Okeorji C, Kennedy CA. Mood disorders of childhood and adolescence in a low-income, urban community: a retrospective chart review. *Ann Clin Psychiatry Off J Am Acad Clin Psychiatr*. (2020) 32:27–32.

6. Revet A, Raynaud J-P, Marcelli D, Falissard B, Catheline N, Benvegnu G. Career choice and attractiveness of child and adolescent psychiatry as a medical specialty: a National French Questionnaire Survey. *Front Psychiatry*. (2021) 12:560141. doi: 10.3389/fpsyt.2021.560141

7. Stocker A, Rosenthal L, Mesquida L, Raynaud J-P, Revet A. Adult and child and adolescent psychiatrists' experiences of transition in anorexia nervosa: a qualitative study. *J Eat Disord*. (2022) 10:92. doi: 10.1186/s40337-022-00610-0

8. Gray W, Dorriz P, Kim H, Partain L, Benekos E, Carpinelli A, et al. Adult provider perspectives on transition and transfer to adult care: a multi-specialty, multi-institutional exploration. *J Pediatr Nurs*. (2021) 59:173–80. doi: 10.1016/j.pedn.2021.0 4.017

9. Deschamps P, Hebebrand J, Jacobs B, Robertson P, Anagnostopoulos DC, Banaschewski T, et al. Training for child and adolescent psychiatry in the twenty-first century. *Eur Child Adolesc Psychiatry*. (2020) 29:3–9. doi: 10.1007/s00787-019-01467-6

10. Revet A, Djelantik AAAMJ, Bui E. Promoting children and adolescents' mental health, and child and adolescent psychiatry: an editorial. *Int J Ment Health*. (2021) 50:192–4. doi: 10.1080/00207411.2021.195 4768

11. Cohen D, Baptista A. Homo Developmentalis: an evolutionary proposal relevant for child and adolescent mental health. *Front Child Adolesc Psychiatry*. (2022) 1. Available online at: https://www.frontiersin.org/articles/10.3389/frcha. 2022.940827 (accessed July 25, 2022).