2Westcotes House, Westcotes Drive, Leicester LE3 0QU, UK Aims: To determine whether non-urgent referrals can be adequately assessed in a triage clinic, to determine the service outcome of these referrals, and whether triage was acceptable to families, referrers and CAMHS clinicians. Method: Families, CAMHS clinicians and GPs were surveyed to ascertain the acceptability of triage. Non-attendance and outcome of triage were recorded. Results: Ninety-two cases were included and the DNA rate fell by one-third. Conclusions: Overall, clinicians and families reported high rates of satisfaction with triage (93.7% and 95.2%) and multidisciplinary working improved.

This paper presents a rationale for the education of CAMHS staff and service development as a partnership between the UK and developing countries. The local context and background of child and adolescent mental health services in India are described, and the rationale for the teaching principles is outlined. The planning and delivery of the teaching, following these principles, is illustrated through a case study of work in India. The discussion focuses on what worked well, problems and difficulties faced, how these were managed, and how visitors can influence change whilst respecting the local perspective. Suggestions are made for improving future programmes so as to maximise the outcomes of such links.

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We are supportive of the desire to ensure that CAMHS staff provide appropriate care that is tailor made for each child and family they encounter, and would argue that this is a benchmark for quality. It is important to qualify that this is not just a case of giving the consumer what they want, but rather helping families think about the issues they present with, and then arriving collaboratively at a management plan that is coherent to all parties. However, we would be more cautious about what can be achieved through individual strategies such as cultural competence or diversity training, that are not linked to other strategies. There is a need to reflect on what we are doing rather than responding in a knee jerk fashion. We also need to consider the evidence we use to frame our interventions. Sometimes there is no evidence available and action is needed. In these situations we need to be transparent about our approaches and be prepared to change them in light of emerging evidence. Delivering appropriate services to diverse populations is so much more than having a checklist and sending the workforce to be superficially trained. Before we embark on training, we should ask what we anticipate the training to achieve. This has to be set within an educational rather than political -framework, if educational objectives are to be met. It is also inexcusable to fund or support any kind of intervention without building in evaluation processes. Finally, we need to find out what kind of training improves the patient experience and health care outcomes. Unless we take all these factors into account, paying attention to diverse populations may end up being nothing more than a passing fad.