Decision Making in Child Mental Health Assessments: A Pilot Study

Michelle O'Reilly
Khalid Karim


There is evidence that many interactions with children are not especially child-centred and this can lead to minimal engagement with children and, therefore, poorer outcomes. This is particularly important in respect to the Children’s National Service Framework (2003) which placed child centred care at the core of the NHS. It has been argued that it is essential that we have a better understanding of children and families to improve service provision. There is very little evidence relating to the interactions between therapists and families in a Child and Adolescent Mental Health setting. As such there is little empirical evidence to show whether the policies are being implemented at an operational level.

In this pilot programme we intend to video-tape approximately 6 families during their screening appointment. We intend to use this data to explore multiple aspects of the interaction using a conversation analytic framework. This will include exploring doctor-patient communication, child engagement strategies and decision-making. The video-taped data will be subjected to appropriate transcription methods and analysed. In planning this project we engaged service users to facilitate the design and process of the project and will be helped by a leading expert in conversation analysis; Professor Ian Hutchby. 

There are a number of outcomes anticipated:

  • This tests the design and methodology of the project and allows for changes to be made
  • We should obtain some preliminary data as qualitative analysis enables substantial data to be taken from small sample sizes
  • This will reinforce a case for applications for larger scale funding
  • The data should be sufficient for preliminary publications

More specifically there are a number of health services related outcomes:

  • By identifying communicative practices in the triage (screening) sessions we will be able to provide guidance to practicing clinical professions. This guidance has potential to facilitate the decision-making with regards to allocations of resources resulting in more cost-effective decisions being made
  • This decision-making has potential to help reduce waiting lists and facilitate direction to appropriate interventions and treatments
  • Through feedback, clinical professionals should be able to improve their engagement strategies and identify the strengths and weaknesses in their practices


Funding body Heart of England Hub: Mental Health Research Network
Award:  £13,000
Duration: March – October 2011

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