Tamsin Ford | University of Exeter (original) (raw)

Papers by Tamsin Ford

Purpose -The Helping Children Achieve study is a randomised controlled trial designed to test the... more Purpose -The Helping Children Achieve study is a randomised controlled trial designed to test the effectiveness of parenting interventions for children at risk of anti-social behaviour. The paper aims to examine the challenges in recruitment to the HCA trial.

Journal of Child Psychology and Psychiatry, 2008

This review focuses on ways in which epidemiological research can inform mental health service de... more This review focuses on ways in which epidemiological research can inform mental health service development and clinical practice. Data from epidemiological studies can provide cross-sectional and secular estimates of the prevalence of psychopathology to support rational service development. Epidemiological surveys have difficulties in finding large enough samples of children with rare disorders, although these disorders are often severely debilitating and require extensive service input. Systematic surveillance provides a rigorous method for studying rare disorders and events. Only a minority of children with impairing psychopathology reach mental health services, although a larger proportion have mental health related contacts with other services. The gap in provision is such that an expansion of mental health services is unlikely to reach all children who could benefit, suggesting that mental health professionals need to develop innovative strategies to increase the number of children seen and the effectiveness of interventions that they receive. Training and supervision of non-mental-health professionals working with children in the identification and management of mental health problems is also extremely important. Most studies suggest that the children with the severest problems are getting to specialist mental health services, and service contact is more likely if important adults can perceive the child’s difficulty or find it to be burdensome. The latter suggests that education of key adults would improve detection if services had the capacity to cope. Studies consistently suggest that the region in which the child lives affects the likelihood of service contact, but studies of other characteristics predicting service contact are so contradictory that studies should only be (cautiously) applied to similar populations to assess which types of children may currently be falling through gaps in service provision. Academics are beginning to explore the use of structured measures developed for epidemiological studies in clinical assessment and outcome monitoring.

Child & Family Social Work, 2008

The British Child Mental Health Survey 1999 collected data from 10 438 children aged 5–15 years, ... more The British Child Mental Health Survey 1999 collected data from 10 438 children aged 5–15 years, selected at random from the child benefit register. At 2 and 3 years, all those with a psychiatric disorder and a random third without were followed up with further detailed interviews about the services contacted if parents reported service contact or if parents expressed concern about their child's mental health at baseline and follow-up, but reported no service use. We compared children in contact with Children's Social Services with children in contact with Child and Adolescent Mental Health Services (CAMHS) or no services. The children in contact with Children's Social Services had a high level of psychopathology and considerable educational difficulties. Despite this, they often had no contact with CAMHS or access to provision for special educational needs. It also became clear that parents were often using Children's Social Services as a first-line service, i.e. a way of trying to access help. The results provide us with an interesting insight into the level of need of those children in contact with Children's Social Services and we hope to stimulate discussion about how liaison between all the services children access can better provide for their needs.

Child and Adolescent Mental Health, 2006

Background: The CAMHS Outcome Research Consortium has 44 members across Great Britain who are co... more Background: The CAMHS Outcome Research Consortium has 44 members across Great Britain who are collaborating to introduce routine outcome monitoring into clinical practice.Methods: Members were surveyed in 2004, in order to establish a baseline against which we could measure progress.Results: Like Johnston and Gowers, we discovered a wide range of measures were being used, while a third of CORC members were sharing information with clinicians and commissioners, and were using it to develop clinical practice or services.Discussion: We discuss the constraints brought up by our members and by Johnston and Gowers, as well as recent work in relation to the development of a national CAMHS dataset.

British Journal of Psychiatry, 2007

British Journal of Psychiatry, 2008

International Review of Psychiatry, 2003

Child and Adolescent Mental Health, 2005

Method: A third of the children from the 1999 British Child and Adolescent Mental Health Survey w... more Method: A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed up over 3 years. Parents provided summary information on service contacts for emotional, behavioural and concentration difficulties, with more detailed information being obtained by telephone interview for selected subgroups. Results: Having a psychiatric disorder predicted substantially increased contact with social services, special educational needs resources, the youth justice system and mental health services (district CAMHS and tier four, but not tier two). Of those children with psychiatric disorders, 58% had been in contact with at least one of these services for help with emotional, behavioural or concentration difficulties, including 23% who had been in contact with mental health services. Conclusions: British children attend a wide variety of services for help with emotional, behavioural and concentration difficulties. The proportion seeing specialist mental health services is higher than that generally reported in the research literature.

Journal of Child Psychology and Psychiatry, 2006

Background: In most countries, the majority of children with attention deficit/hyperactivity dis... more Background: In most countries, the majority of children with attention deficit/hyperactivity disorder (ADHD) are undiagnosed. In the United Kingdom, a major barrier to accessing specialist services is the limited recognition of disorders by general practitioners. However, it is unclear whether there are also barriers at other stages of the help-seeking process. For children with ADHD, this study aims to examine the correlates of the different stages of help-seeking.Method: Children with ADHD (n = 232) were identified from the 1999 British Child and Adolescent Mental Health Survey. Rates and correlates of parental recognition of child mental health problems and contact with services for these problems were examined. Children who had used particular types of services were compared with those who had not.Results: Most (80%) parents of children with ADHD recognise that their child has a problem although few (35%) construe this in terms of hyperactivity. The impact of the symptoms on key adults, rather than child factors, best predicted parental recognition of problems. Most parents had been in contact with education-based professionals but few had consulted primary care for these problems or had sought help from relevant specialist health services. Parental recognition of problems and perceived burden, rather than child factors, were the main correlates of contact with services. Parental views that their child has hyperactivity were associated with greater severity of symptoms.Conclusions: The main barrier to care for ADHD is the limited presentation of these problems to primary care. The majority of parents discuss their concerns with professionals based in education services. There is a need for parental education about ADHD and for health service input to support education professionals in their contact with concerned parents.

Child and Adolescent Mental Health, 2008

Background: Most previous studies of service use in relation to mental health have examined serv... more Background: Most previous studies of service use in relation to mental health have examined services in the USA. We wanted to provide up-to-date findings from a general population sample of British schoolchildren.Method: A total of 2461 children aged 5–15 from the 1999 British Child and Adolescent Mental Health Survey were followed up for 3 years. We examine the relationship between a wide variety of potential predictors gathered in 1999 and the use of services over the following 3 years.Results: Contact with most services was predicted by three factors: the impact of psychopathology; contact with teachers or primary health care; and parents’ and teachers’ perceptions that the child had significant difficulties. Other predictors were specific to each service.Conclusions: Education of parents, teachers and other important adults might increase the proportion of children with impairing psychiatric disorders reaching services.

Clinical Child Psychology and Psychiatry, 2003

... TAMSIN FORD & ROBERT GOODMAN Institute of Psychiatry, De Crespigny Park, ... more ... TAMSIN FORD & ROBERT GOODMAN Institute of Psychiatry, De Crespigny Park, UK ... school performance, socio-economic status, parental psychiatric illness, burden, family structure and geographical factors (Costello & Janiszewski, 1990; Garralda & Bailey, 1988; Verhulst & ...

Social Psychiatry and Psychiatric Epidemiology, 2007

Background The Children Service Interview was designed as a brief measure of service use related ... more Background The Children Service Interview was designed as a brief measure of service use related to mental health problems in Great Britain. Method We validated the Children’s Services Interview against medical records from a sample of 87 children, and assessed test–retest reliability from 25 parents completing two interviews. We examined criterion validity by looking at the service use patterns of children attending clinics for different types of disorders. Results The Children’s Services Interview showed high levels of face validity and moderate or better concordance with medical records as far as contacts were recorded in the case notes. Test–retest reliability was moderate or better apart from contacts with the voluntary sector, teachers, and the number and duration of appointments with some professionals. Conclusion The study suggests the Children’s Services Interview can extract moderately valid and reliable data on service use. Declaration of interest Tamsin Ford was supported by a Wellcome Clinical Training Fellowship in Health Services Research while completing this work.

International Review of Psychiatry, 2003

The frequencies of pervasive developmental disorder (PDD) in Down's syndrome (DS) have been repor... more The frequencies of pervasive developmental disorder (PDD) in Down's syndrome (DS) have been reported from 1% to 11%. However, it is not clear if the frequency of this co-occurrence is higher or lower than in other mental retardations. We study a large sample of DS population, finding a PDD frequency of 15.6%, with 5.58% of autism (eight males and two females) and 10.05% of PDD non autism (nine males and nine females. The meaning of this frequency is discussed.

Journal of The American Academy of Child and Adolescent Psychiatry, 2001

The frequencies of pervasive developmental disorder (PDD) in Down's syndrome (DS) have been repor... more The frequencies of pervasive developmental disorder (PDD) in Down's syndrome (DS) have been reported from 1% to 11%. However, it is not clear if the frequency of this co-occurrence is higher or lower than in other mental retardations. We study a large sample of DS population, finding a PDD frequency of 15.6%, with 5.58% of autism (eight males and two females) and 10.05% of PDD non autism (nine males and nine females. The meaning of this frequency is discussed.

International Review of Psychiatry, 2003

Journal of Child Psychology and Psychiatry, 2007

Background: Many studies have described associations between adult psychiatric disorder among ad... more Background: Many studies have described associations between adult psychiatric disorder among adults and their biographic, socio-demographic and social capital characteristics. Fewer studies have focused on children, and most of these have looked at structural indicators of the neighbourhood. Our objective was to examine one aspect of social capital – perceived neighbourhood trust and safety in relation to childhood psychopathology.Methods: Data on childhood psychopathology and perceived neighbourhood trust and safety were obtained on 3,340 11 to 16-year-olds included in a large survey of the mental health carried out in 426 postal sectors in Great Britain. Data were collected on biographic and socio-demographic characteristics of the child and the family, measures of social capital and neighbourhood prosperity. We entered all these variables into a logistic regression analysis to establish the strength of association between perceived neighbourhood trust and safety separately for emotional and conduct disorders.Results: Children's perception of their neighbourhoods in terms of the trustworthiness or honesty of the people who live there or feeling safe walking alone had a strong association with childhood psychopathology, particularly emotional disorders, rather than the nature of the neighbourhood itself. Children's behaviour, however, such as going to the park or shops alone, did not vary by measures of childhood psychopathology.Conclusions: Regeneration of less prosperous neighbourhoods is likely to increase children's positive perceptions of trust, honesty and safety which in turn can have a positive effect on their mental health.

Journal of Child Psychology and Psychiatry, 2009

Background: Assessments of child psychopathology commonly rely on multiple informants, e.g., par... more Background: Assessments of child psychopathology commonly rely on multiple informants, e.g., parents, teachers and children. Informants often disagree about the presence or absence of symptoms, reflecting reporter bias, situation-specific behaviour, or random variation in measurement. However, few studies have systematically tested how far correlates of child psychopathology differ between informants.Methods: Parents, teachers and children in the 1999 British Child and Adolescent Mental Health Survey (n = 4,525, ages 11–15 years) completed the Strengths and Difficulties Questionnaire. Multiple source regression models tested the extent to which child, family, school and neighbourhood characteristics were differentially associated with the three informants’ reports. The 2004 British Child and Adolescent Mental Health Survey (n = 3,438, ages 11–15 years) was used for replication.Results: Almost all significant correlates of child mental health were differentially related to parent, teacher and child ratings of adjustment. Parental distress, parent-rated family functioning, and child physical health problems were most strongly associated with parent ratings. Child ability and attainment, socio-economic factors, and school and neighbourhood disadvantage were more strongly associated with teacher and parent rated mental health than with children’s own ratings. Gender differences in externalising problems were most pronounced for teacher ratings, and least so for child ratings; the opposite held true for emotional problems. Effect sizes for combined latent scores fell near the upper end of the range of effect sizes estimated for the three individual informants. Results showed good replication across the two samples.Conclusions: The study highlights that there is substantial variation across informants in the links between associated factors and child psychopathology.

British Journal of Psychiatry, 2009

Purpose -The Helping Children Achieve study is a randomised controlled trial designed to test the... more Purpose -The Helping Children Achieve study is a randomised controlled trial designed to test the effectiveness of parenting interventions for children at risk of anti-social behaviour. The paper aims to examine the challenges in recruitment to the HCA trial.

Journal of Child Psychology and Psychiatry, 2008

This review focuses on ways in which epidemiological research can inform mental health service de... more This review focuses on ways in which epidemiological research can inform mental health service development and clinical practice. Data from epidemiological studies can provide cross-sectional and secular estimates of the prevalence of psychopathology to support rational service development. Epidemiological surveys have difficulties in finding large enough samples of children with rare disorders, although these disorders are often severely debilitating and require extensive service input. Systematic surveillance provides a rigorous method for studying rare disorders and events. Only a minority of children with impairing psychopathology reach mental health services, although a larger proportion have mental health related contacts with other services. The gap in provision is such that an expansion of mental health services is unlikely to reach all children who could benefit, suggesting that mental health professionals need to develop innovative strategies to increase the number of children seen and the effectiveness of interventions that they receive. Training and supervision of non-mental-health professionals working with children in the identification and management of mental health problems is also extremely important. Most studies suggest that the children with the severest problems are getting to specialist mental health services, and service contact is more likely if important adults can perceive the child’s difficulty or find it to be burdensome. The latter suggests that education of key adults would improve detection if services had the capacity to cope. Studies consistently suggest that the region in which the child lives affects the likelihood of service contact, but studies of other characteristics predicting service contact are so contradictory that studies should only be (cautiously) applied to similar populations to assess which types of children may currently be falling through gaps in service provision. Academics are beginning to explore the use of structured measures developed for epidemiological studies in clinical assessment and outcome monitoring.

Child & Family Social Work, 2008

The British Child Mental Health Survey 1999 collected data from 10 438 children aged 5–15 years, ... more The British Child Mental Health Survey 1999 collected data from 10 438 children aged 5–15 years, selected at random from the child benefit register. At 2 and 3 years, all those with a psychiatric disorder and a random third without were followed up with further detailed interviews about the services contacted if parents reported service contact or if parents expressed concern about their child's mental health at baseline and follow-up, but reported no service use. We compared children in contact with Children's Social Services with children in contact with Child and Adolescent Mental Health Services (CAMHS) or no services. The children in contact with Children's Social Services had a high level of psychopathology and considerable educational difficulties. Despite this, they often had no contact with CAMHS or access to provision for special educational needs. It also became clear that parents were often using Children's Social Services as a first-line service, i.e. a way of trying to access help. The results provide us with an interesting insight into the level of need of those children in contact with Children's Social Services and we hope to stimulate discussion about how liaison between all the services children access can better provide for their needs.

Child and Adolescent Mental Health, 2006

Background: The CAMHS Outcome Research Consortium has 44 members across Great Britain who are co... more Background: The CAMHS Outcome Research Consortium has 44 members across Great Britain who are collaborating to introduce routine outcome monitoring into clinical practice.Methods: Members were surveyed in 2004, in order to establish a baseline against which we could measure progress.Results: Like Johnston and Gowers, we discovered a wide range of measures were being used, while a third of CORC members were sharing information with clinicians and commissioners, and were using it to develop clinical practice or services.Discussion: We discuss the constraints brought up by our members and by Johnston and Gowers, as well as recent work in relation to the development of a national CAMHS dataset.

British Journal of Psychiatry, 2007

British Journal of Psychiatry, 2008

International Review of Psychiatry, 2003

Child and Adolescent Mental Health, 2005

Method: A third of the children from the 1999 British Child and Adolescent Mental Health Survey w... more Method: A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed up over 3 years. Parents provided summary information on service contacts for emotional, behavioural and concentration difficulties, with more detailed information being obtained by telephone interview for selected subgroups. Results: Having a psychiatric disorder predicted substantially increased contact with social services, special educational needs resources, the youth justice system and mental health services (district CAMHS and tier four, but not tier two). Of those children with psychiatric disorders, 58% had been in contact with at least one of these services for help with emotional, behavioural or concentration difficulties, including 23% who had been in contact with mental health services. Conclusions: British children attend a wide variety of services for help with emotional, behavioural and concentration difficulties. The proportion seeing specialist mental health services is higher than that generally reported in the research literature.

Journal of Child Psychology and Psychiatry, 2006

Background: In most countries, the majority of children with attention deficit/hyperactivity dis... more Background: In most countries, the majority of children with attention deficit/hyperactivity disorder (ADHD) are undiagnosed. In the United Kingdom, a major barrier to accessing specialist services is the limited recognition of disorders by general practitioners. However, it is unclear whether there are also barriers at other stages of the help-seeking process. For children with ADHD, this study aims to examine the correlates of the different stages of help-seeking.Method: Children with ADHD (n = 232) were identified from the 1999 British Child and Adolescent Mental Health Survey. Rates and correlates of parental recognition of child mental health problems and contact with services for these problems were examined. Children who had used particular types of services were compared with those who had not.Results: Most (80%) parents of children with ADHD recognise that their child has a problem although few (35%) construe this in terms of hyperactivity. The impact of the symptoms on key adults, rather than child factors, best predicted parental recognition of problems. Most parents had been in contact with education-based professionals but few had consulted primary care for these problems or had sought help from relevant specialist health services. Parental recognition of problems and perceived burden, rather than child factors, were the main correlates of contact with services. Parental views that their child has hyperactivity were associated with greater severity of symptoms.Conclusions: The main barrier to care for ADHD is the limited presentation of these problems to primary care. The majority of parents discuss their concerns with professionals based in education services. There is a need for parental education about ADHD and for health service input to support education professionals in their contact with concerned parents.

Child and Adolescent Mental Health, 2008

Background: Most previous studies of service use in relation to mental health have examined serv... more Background: Most previous studies of service use in relation to mental health have examined services in the USA. We wanted to provide up-to-date findings from a general population sample of British schoolchildren.Method: A total of 2461 children aged 5–15 from the 1999 British Child and Adolescent Mental Health Survey were followed up for 3 years. We examine the relationship between a wide variety of potential predictors gathered in 1999 and the use of services over the following 3 years.Results: Contact with most services was predicted by three factors: the impact of psychopathology; contact with teachers or primary health care; and parents’ and teachers’ perceptions that the child had significant difficulties. Other predictors were specific to each service.Conclusions: Education of parents, teachers and other important adults might increase the proportion of children with impairing psychiatric disorders reaching services.

Clinical Child Psychology and Psychiatry, 2003

... TAMSIN FORD & ROBERT GOODMAN Institute of Psychiatry, De Crespigny Park, ... more ... TAMSIN FORD & ROBERT GOODMAN Institute of Psychiatry, De Crespigny Park, UK ... school performance, socio-economic status, parental psychiatric illness, burden, family structure and geographical factors (Costello & Janiszewski, 1990; Garralda & Bailey, 1988; Verhulst & ...

Social Psychiatry and Psychiatric Epidemiology, 2007

Background The Children Service Interview was designed as a brief measure of service use related ... more Background The Children Service Interview was designed as a brief measure of service use related to mental health problems in Great Britain. Method We validated the Children’s Services Interview against medical records from a sample of 87 children, and assessed test–retest reliability from 25 parents completing two interviews. We examined criterion validity by looking at the service use patterns of children attending clinics for different types of disorders. Results The Children’s Services Interview showed high levels of face validity and moderate or better concordance with medical records as far as contacts were recorded in the case notes. Test–retest reliability was moderate or better apart from contacts with the voluntary sector, teachers, and the number and duration of appointments with some professionals. Conclusion The study suggests the Children’s Services Interview can extract moderately valid and reliable data on service use. Declaration of interest Tamsin Ford was supported by a Wellcome Clinical Training Fellowship in Health Services Research while completing this work.

International Review of Psychiatry, 2003

The frequencies of pervasive developmental disorder (PDD) in Down's syndrome (DS) have been repor... more The frequencies of pervasive developmental disorder (PDD) in Down's syndrome (DS) have been reported from 1% to 11%. However, it is not clear if the frequency of this co-occurrence is higher or lower than in other mental retardations. We study a large sample of DS population, finding a PDD frequency of 15.6%, with 5.58% of autism (eight males and two females) and 10.05% of PDD non autism (nine males and nine females. The meaning of this frequency is discussed.

Journal of The American Academy of Child and Adolescent Psychiatry, 2001

The frequencies of pervasive developmental disorder (PDD) in Down's syndrome (DS) have been repor... more The frequencies of pervasive developmental disorder (PDD) in Down's syndrome (DS) have been reported from 1% to 11%. However, it is not clear if the frequency of this co-occurrence is higher or lower than in other mental retardations. We study a large sample of DS population, finding a PDD frequency of 15.6%, with 5.58% of autism (eight males and two females) and 10.05% of PDD non autism (nine males and nine females. The meaning of this frequency is discussed.

International Review of Psychiatry, 2003

Journal of Child Psychology and Psychiatry, 2007

Background: Many studies have described associations between adult psychiatric disorder among ad... more Background: Many studies have described associations between adult psychiatric disorder among adults and their biographic, socio-demographic and social capital characteristics. Fewer studies have focused on children, and most of these have looked at structural indicators of the neighbourhood. Our objective was to examine one aspect of social capital – perceived neighbourhood trust and safety in relation to childhood psychopathology.Methods: Data on childhood psychopathology and perceived neighbourhood trust and safety were obtained on 3,340 11 to 16-year-olds included in a large survey of the mental health carried out in 426 postal sectors in Great Britain. Data were collected on biographic and socio-demographic characteristics of the child and the family, measures of social capital and neighbourhood prosperity. We entered all these variables into a logistic regression analysis to establish the strength of association between perceived neighbourhood trust and safety separately for emotional and conduct disorders.Results: Children's perception of their neighbourhoods in terms of the trustworthiness or honesty of the people who live there or feeling safe walking alone had a strong association with childhood psychopathology, particularly emotional disorders, rather than the nature of the neighbourhood itself. Children's behaviour, however, such as going to the park or shops alone, did not vary by measures of childhood psychopathology.Conclusions: Regeneration of less prosperous neighbourhoods is likely to increase children's positive perceptions of trust, honesty and safety which in turn can have a positive effect on their mental health.

Journal of Child Psychology and Psychiatry, 2009

Background: Assessments of child psychopathology commonly rely on multiple informants, e.g., par... more Background: Assessments of child psychopathology commonly rely on multiple informants, e.g., parents, teachers and children. Informants often disagree about the presence or absence of symptoms, reflecting reporter bias, situation-specific behaviour, or random variation in measurement. However, few studies have systematically tested how far correlates of child psychopathology differ between informants.Methods: Parents, teachers and children in the 1999 British Child and Adolescent Mental Health Survey (n = 4,525, ages 11–15 years) completed the Strengths and Difficulties Questionnaire. Multiple source regression models tested the extent to which child, family, school and neighbourhood characteristics were differentially associated with the three informants’ reports. The 2004 British Child and Adolescent Mental Health Survey (n = 3,438, ages 11–15 years) was used for replication.Results: Almost all significant correlates of child mental health were differentially related to parent, teacher and child ratings of adjustment. Parental distress, parent-rated family functioning, and child physical health problems were most strongly associated with parent ratings. Child ability and attainment, socio-economic factors, and school and neighbourhood disadvantage were more strongly associated with teacher and parent rated mental health than with children’s own ratings. Gender differences in externalising problems were most pronounced for teacher ratings, and least so for child ratings; the opposite held true for emotional problems. Effect sizes for combined latent scores fell near the upper end of the range of effect sizes estimated for the three individual informants. Results showed good replication across the two samples.Conclusions: The study highlights that there is substantial variation across informants in the links between associated factors and child psychopathology.

British Journal of Psychiatry, 2009