Leo Kroll - Academia.edu (original) (raw)

Papers by Leo Kroll

Clinical Child Psychology and Psychiatry, 2003

... EDDY STREET South Wales, UK HELLE MITTLER Stockport, UK CAROL DUNN Stockport CAMHS, UK ... As... more ... EDDY STREET South Wales, UK HELLE MITTLER Stockport, UK CAROL DUNN Stockport CAMHS, UK ... As a pilot, we devel-oped an alternative model of service delivery that provided a brief (2+1) consultation. We also created a manual as a guide to this process. ...

Journal of Children's Services, 2007

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

To investigate health gain and its predictors during inpatient and associated day patient treatme... more To investigate health gain and its predictors during inpatient and associated day patient treatment. Consecutive admissions to two inpatient units for children and young adolescents in northwest England were studied (N = 55). Ascertainments were made from multiple perspectives, including family, teacher, clinician, and an independent researcher. Measures were taken at referral, admission, discharge, and 6-month follow-up; health gain was inferred from change scores on measures. Recruitment lasted from late 1995 to 1997; follow-up was completed during 1998. Independent variables tested as predictors included assessments of presenting symptoms, therapeutic alliance, and family functioning. Significant health gain during hospitalization was found on most measures and sustained to follow-up. There was no symptom change during the waiting-list control condition. Health gain was predicted independently by child and parental therapeutic alliance with the unit early in hospitalization and by preadmission family functioning. Externalizing problems did well if accompanied by good alliance. Assessment of health gain from multiple perspectives is possible and valuable. Inpatient treatment has significant therapeutic effect. Predictors for health gain lie in process variables of therapeutic alliance and family functioning rather than presenting symptoms. The results are discussed in relation to clinical practice and future research.

Clinical Child Psychology and Psychiatry, 1997

The Therapeutic Alliance in Child Inpatient Treatment: Development and Initial Validation of a Fa... more The Therapeutic Alliance in Child Inpatient Treatment: Development and Initial Validation of a Family Engagement Questionnaire DR LEO KROLL Cherry Tree Hospital, Stockport, UK DR JONATHAN GREEN Booth Hall Children's Hospital, Manchester, UK ABSTRACT This ...

Journal of Child Psychology and Psychiatry, 2007

Background: Inpatient treatment is a complex intervention for the most serious mental health dis... more Background: Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses.Methods: A prospective cohort study, including economic evaluation, conducted in 8 UK units (total n = 150) with one year follow-up after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and teacher-rated symptomatology.Results: We found a significant (p < .001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain (p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning independently predicted better outcome. Mean cost of admission was £24,100; pre-admission and post-discharge support costs were similar.Conclusions: Inpatient treatment is associated with substantive sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives limits any unqualified inference about causal effects, but the rigour of measurement here gives the strongest indication to date of the positive impact of admission for complex mental health problems in young people.

Psychological Medicine, 1999

For adolescents, there is no specific needs assessment instrument that assesses significant probl... more For adolescents, there is no specific needs assessment instrument that assesses significant problems that can benefit from specified interventions. A new instrument (S.NASA) was developed by incorporating and adapting three well established adult needs assessment instruments. The S.NASA covers 21 areas of functioning including social, psychiatric, educational and life skills. Client and carer interviews were conducted by different researchers. A week later the interviews were repeated using a crossover design. Significant (cardinal) problems were generated from the clinical interviews using a pre-defined algorithm. Final need status (three categories) was made by clinicians assessing the cardinal problems against defined interventions. The interventions were generated from discussions with clinicians and a survey of appropriate professionals working with adolescents. RESULTS. Pre-piloting led to the final version being administered to 40 adolescents from secure units, forensic psychiatric and adolescent psychiatric services. There were 25 males and 15 females, mean age 15.5 years. Overall there were moderate to good inter-rater and test-retest reliability coefficients, the test-retest reliability coefficients for the total scores on the needs assessment interviews ranged from 0.73 to 0.85. Consensual and face validity was good, the adolescents and staff finding the instrument useful and helpful. This new needs assessment instrument shows acceptable psychometric properties. It should be of use in research projects assessing the needs and the provision of services for adolescents with complex and chronic problems.

Journal of The American Academy of Child and Adolescent Psychiatry, 1998

To identify predictors of remission from major depression in adolescent patients given cognitive-... more To identify predictors of remission from major depression in adolescent patients given cognitive-behavioral therapy (CBT). The study was based on 50 patients aged between 10 and 17 years who were obtained from two studies of CBT. A wide range of possible predictors was examined. Sixty percent remitted by the end of treatment. In multivariate analyses remission was associated with younger age and less social impairment. Depressed patients who respond to CBT tend to be younger and less severely impaired than those who do not respond.

Journal of Child Psychology and Psychiatry, 2005

Background: The mental health of child offenders who are detained in secure settings is a matter... more Background: The mental health of child offenders who are detained in secure settings is a matter of great public and professional concern but there has been little systematic longitudinal research on the outcomes of these problems once the young person has returned to the community. The aims of the present study were to describe the psychosocial outcomes of boys in secure care and to establish if these outcomes were correlated with criminal outcomes.Method: Prospective cohort study of 97 boys whose average age was 14 years when they were admitted to secure units in the North West of England. The boys were followed up on average 2 years later, when outcome data were obtained on 81/97 (83%) cases. The main outcome measure was a standardised assessment of mental health, social and educational needs obtained by interview with the young person and corroborated in most cases by information from informants. All data were then reviewed by experienced clinicians who made best-estimate ratings of need ‘blind’ to the findings from the first phase of the study.Results: The average number of needs requiring an intervention at follow-up (mean = 3.4, sd = 3.0) was much lower than before admission to secure care (mean = 8.2, sd = 2.5) (mean difference 4.9 needs, 95% CI 4.0 to 5.7). Educational and occupational needs were particularly well dealt with. However, many mental health problems persisted or worsened. For example, 31% had a need for treatment of substance abuse, a significant increase compared with when they were in secure care (percentage difference 21%, 95% CL 9.0% to 32.7%). No mental disorder predicted subsequent offending.Conclusions: Boys who have been in secure care continue to have a high rate of mental health problems. The mental health needs of this group are not, however, static but change over time and with changing circumstances. Services need to be designed to meet these changing needs.

Journal of The American Academy of Child and Adolescent Psychiatry, 1996

To determine whether continuation of cognitive-behavioral therapy (CBT-C) could prevent relapse i... more To determine whether continuation of cognitive-behavioral therapy (CBT-C) could prevent relapse in adolescent psychiatric patients who had remitted from major depressive disorder (MDD). Seventeen patients who continued to have CBT-C for 6 months after remission from MDD were compared with a historical control group of 12 cases who had no further treatment after remission. Only 1 of the 17 cases who continued with CBT-C dropped out. The cumulative relapse risk during CBT-C was significantly lower (0.2) than it had been in the historical control group (0.5). CBT-C warrants further investigation in a randomized, controlled trial.

Journal of Child Psychology and Psychiatry, 1995

Abstract— This study examined the psychometric properties of the Mood and Feelings Questionnaire ... more Abstract— This study examined the psychometric properties of the Mood and Feelings Questionnaire (MFQ) in 104 adolescent outpatients unending a psychiatric clinic. The clinic offers a special assessment and treatment service for young people with depressive disorders. In this sample the self-report version of the MFQ had acceptable reliability and was a satisfactory screen for major depressive disorder diagnosed by a standardised interview with the child. It was also a useful measure of clinical remission.