Grimwade, Jolyon Roderick (2006) Practices and Perceptions: Referral and Intake to Child and Adolescent Mental Health Services. PhD thesis, Victoria University.

Abstract

This thesis reports research into referral and intake to child and adolescent mental health services intended to illuminate a largely unnoticed but potentially powerful clinical phenomenon in service provision. Referral and intake to child and adolescent mental health services was demonstrated to be a complex process that shapes subsequent clinical interactions. Three questions guided the present research. Why are the practices of referral and intake as they are and how have they been shaped, historically? What are the specific practices involved? What are the effects of these practices upon subsequent case consultations and outcomes? Four enquiries were conducted. An extensive and critical literature review was directed toward the first question and demonstrated the historical roots of child and adolescent mental health services, elucidated the phases of the referral and intake process, clarified the many images of the parent in such services, and postulated the existence of three categories of service applicants, namely committed, containable, and crisis-reactive parent referrers. A retrospective empirical enquiry addressed the second question and a prospective empirical enquiry addressed the second and third questions. A further, integrative and empirical enquiry addressed the practices, role, and clinical thinking of referral and intake workers. The empirical studies demonstrated that, when done well, referral and intake provides momentum toward change in subsequent clinical contact. The referral and intake worker was shown to perform nearly one hundred tasks within a 15 to 25 minute referral call. The committed parent referrer, who was distinguished from other referring parents, was characterized by hopefulness, determination, and often, emotional pain in gaining access or the active presence of another party opposed to the referral, in the xviii retrospective study. The findings have major implications for the conduct of psychotherapy research and for the efficient and personable management of child and adolescent mental health services.

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