title: Reasons and pathways of first-time consultations at child and adolescent mental health services in Italy: an observational study.
abstract: BACKGROUND
  An increasing number of young people have made contact with the Child and Adolescent Mental Health Services (CAMHS). However, only a small proportion of the population with emotional problems, actually seek specialized care. Research concerning the help-seeking process and pathways to care of a clinical sample could help to develop effective health policies to facilitate access to specialized care.
  
  
  OBJECTIVE
  To analyze the access pattern for CAMHS, reasons of contact and care pathways of a consecutive sample of first-time patients. Our aim was to analyze the association between source of referral, socio-demographic and clinical variables.
  
  
  METHODS
  Standardized assessment instruments and information concerning access patterns and care pathways were collected from 399 patients at first-time contact with CAMHS in a Northern Italian Region.
  
  
  RESULTS
  Most patients were referred to CAMHS by school teachers (36 %) or health professionals (32 %), while only 17 % of the parents sought help by themselves. School issues (50 %) and emotional problems (17 %) were the most frequent reasons for contact. The proportion of first-time contacts with no diagnosis of mental disorder at their first consultation did not differ by source of referral. Parents of children who did not receive a clinical diagnosis of mental disorders described them as "psychosocially impaired" and their condition as "clinically severe" likewise parents of patients who received a psychiatric diagnosis. Patients with externalizing problems were more frequently referred by the parents themselves, while youth with internalizing problems were more often referred through health professionals. Families with non-traditional structures (adoptive, foster care, mono-parental) were more likely to consult CAMHS directly, while immigrant youth were more often referred by teachers.
  
  
  CONCLUSIONS
  Socio-demographic and clinical characteristics can affect pathways to care. To improve early access to care for children and adolescents with ongoing mental disorders, a plan for proper action addressed to teachers and health professionals may well be important. This would improve their ability to recognize emotional and behavioral problems and use proper referral pathways, while informative intervention addressed to non-Italian families should inform them about the functioning and the mission of CAMHS.
authors: IRCCS San Giovanni di Dio Fatebenefratelli di Brescia, via Pilastroni 4, Brescia, 25125 Italy.
authors: Laura
authors: L
authors: Pedrini
authors: Dipartimento di Scienze Biomolecolari, Università degli Studi di Urbino "Carlo Bo", Piazza Rinascimento 6, Urbino (PU), 61029 Italy.
authors: Davide
authors: D
authors: Sisti
authors: Servizio Neuropsichiatria Infanzia e Adolescenza, Spedali Civili di Brescia, P.le Spedali Civili 1, Brescia, 25123 Italy.
authors: Alessandra
authors: A
authors: Tiberti
authors: Centro di Psichiatria di Consulenza e Psicosomatica dell' Azienda Ospedaliero Universitaria di Cagliari, via Ospedale, 09124 Cagliari, Italy ; Dipartimento di Pedagogia Psicologia e Filosofia, Università di Cagliari, Via Mirrionis 1, Cagliari, 09123 Italy.
authors: Antonio
authors: A
authors: Preti
authors: UONPIA, AUSL di Reggio Emilia, Via Amendola 2, Reggio Emilia, 42100 Italy.
authors: Michela
authors: M
authors: Fabiani
authors: UONPIA, AUSL di Modena, Via Alessandrini 2, Sassuolo, 41049 Italy.
authors: Linda
authors: L
authors: Ferraresi
authors: UONPIA, AUSL di Ferrara, via Messidoro 20, Ferrara, 44124 Italy.
authors: Stefano
authors: S
authors: Palazzi
authors: UONPIA, AUSL di Piacenza, Corso Vittorio Emanuele 169, Piacenza, 29100 Italy.
authors: Roberto
authors: R
authors: Parisi
authors: UONPIA, AUSL di Imola, Viale Amendola 8, Imola (BO), 40026 Italy.
authors: Cosimo
authors: C
authors: Ricciutello
authors: Dipartimento di Scienze Biomolecolari, Università degli Studi di Urbino "Carlo Bo", Piazza Rinascimento 6, Urbino (PU), 61029 Italy.
authors: Marco B L
authors: MB
authors: Rocchi
authors: Servizio N.P.E.E., Az. USL di Parma, Via Mazzini 2, Parma, 43100 Italy.
authors: Antonella
authors: A
authors: Squarcia
authors: NPI, Az. USL di Bologna, Via Crisalidi 2, Vado (Monzuno), BO 40036 Italy.
authors: Stefano
authors: S
authors: Trebbi
authors: Servizio N.P.E.E., Az. USL di Rimini, Via Coriano 38, Rimini, 47921 Italy.
authors: Andrea
authors: A
authors: Tullini
authors: IRCCS San Giovanni di Dio Fatebenefratelli di Brescia, via Pilastroni 4, Brescia, 25125 Italy.
authors: Giovanni
authors: G
authors: De Girolamo
keywords: Adolescent; Child; Health services; Help-seeking; Mental health