Who is the client in psychological services for children and adolescents?
- Adults usually seek therapy themselves and give informed consent
- Children and teens rarely self-refer for therapy
- Services are typically initiated by parents or other adults concerned about behaviour
- So the question remains as to whom the psych services are for - child receiving services or parents support consent
Challenges in Identifying the Client
- Children may not see their behaviour as problematic
- Parents, teachers, and youth often disagree on the issue and goals (what is the problem & if that even is a problem)
- Youth may resists therapy or feel misunderstood
Challenges in Identifying the Client - Parents as Gatekeepers
- Parents control access: referrals, transportation, and payment
- Their engagement affects treatment success
- Example: Parents may disengage if the therapy does not align with their views, leading to missed sessions, cancellations and withdrawing child from therapy
Challenges in Identifying the Client - Legal and Ethical Complexities
- Consent laws vary by age or by capacity to understand treatment
- Psychologists must know the legal context of their practice (education on rules & child protection rules)
- Case Example: Jorge, 14, legally refused treatment despite parental concern
Challenges in Identifying the Client - Consent, Engagement & Confidentiality
- Legal consent does not guarantee willingness to participate
- Confidentiality must be clearly explained at the start
- Therapists balance youth privacy with legal obligations and parental rights
Importance of the Therapeutic Alliance
- Parent-therapist alliance encourages better attendance and commitment
- Youth-therapist alliance encourages better symptom and behaviour improvement
- For best outcomes, both relationships are essential for therapy to be effective
Who Needs Services?
- Adolescent depression is common, with rates similar to adults but it is significantly less studied, due to both parent consent being required for youth studies
- Rates double between 13-14 and 17-18
- Depression is chronic and recurrent, linked to struggles in peer relationships, academic decline, family conflict, and higher suicide risk
Burden of Child and Youth Mental Disorders - Child, his/her friends and siblings
- Most directly affected by mental disorders
- May experience feelings of isolation, low SE, or frustration, especially if they don’t understand what they’re going through
- Friends and siblings may also be affected
Burden of Child and Youth Mental Disorders - Parents, caregivers
- Caring for a child with MH needs can be emotionally and physically taxing
- Parents often experience high levels of stress, guilt & helplessness
Burden of Child and Youth Mental Disorders - School
Must provide accommodations, special education support, & manage behavioural issues
Burden of Child and Youth Mental Disorders - Healthcare
Burdened with demand for pediatric MH services, which are often under-researched
Burden of Child and Youth Mental Disorders - Criminal Justice
- Involvement may increase if MH issues go unaddressed, especially in teens with behavioural disorders
- Conduct disorder is the most serious diagnosis in DSM (harm others, animals, etc.)
Issues of Premature Termination/Drop-out - Key contributing factors
- Parental psychopathology (MH challenges in parents can disrupt engagement in their child’s therapy)
- Parental isolation (lack of support can increase feelings of helplessness, burnouts, difficulty continuing transport, overwhelming parent and may reduce follow-through with treatment plans)
- Family conflict (High stress and instability at home can interfere with consistent attendance and progress (resistance from minimum 1 parent, disagreements between parents can put teen in the middle; distressed parents (-) impact child’s recovery and it can be very difficult to manage child beliefs and parental expectations)
Evidence for Services for Children and Youth
- Thousands of studies conducted globally
- Wide variety of research methods and designs
- Contradictory results make interpretation complex
- EB for youth services lags behind adult services
- Fewer rigorous evaluations for children & adolescents (due to additional barriers from ethical concerns)
Does therapy work
Research suggests it does work, narrowing depending on issue
What therapy works for this problem
Depends on settings, populations, difficulties, contexts, etc.
