These results suggest that routine outcome monitoring is feasible, and suggest the possibility of using jointly agreed idiographic measures alongside particular perspectives on outcome as part of a PROMs approach.

Background: Patient Reported Outcome Measures (PROMs) are increasingly being used in Child and Adolescent Mental Health Services (CAMHS). The aim of this research was to explore change in standardized and idiographic outcome measures in CAMHS using naturalistic, routinely collected data. Method: We explored change in psychosocial difficulties and impact on daily life as evaluated by a broad standardized measure, the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997, J. Child Psychol. Psychiatry, 38, 581) and progress toward goals as evaluated by a personalized idiographic measure, the Goal Based Outcomes tool (GBO) (Law, 2011, Goals and Goal Based Outcomes (GBOs): some useful information. London: CAMHS Press) in a sample of N = 137 CAMHS attenders. Results: Psychosocial difficulties and impact on daily life showed less change over the course of treatment than progress toward goals in this study. Change in psychosocial difficulties and impact on daily life were also less strongly associated with change in clinician-reported functioning and satisfaction with care at time two than change in progress toward goals. Conclusions: Findings of the present research may support previous studies in which service users and clinicians report that idiographic measures are more capable than standardized measures of capturing relevant change for individuals. Key Practitioner Message• For normative comparison and clinical purposes, it is important to know how to interpret change in standardized and idiographic measures in CAMHS.• Past research suggests that standardized measures (e.g. the Strengths and Difficulties Questionnaire or SDQ) may be less clinically useful than idiographic measures (e.g. the Goal Based Outcome tool or GBO), but more amenable for aggregation and therefore comparing groups of patients.• The SDQ showed less change than the GBO in this study in terms of mean score change and reliable change.• Change captured by the SDQ was less strongly associated with change in clinician-reported functioning and satisfaction with care at time two than change captured by the GBO, and only change in the GBO was uniquely associated with change in clinician-reported functioning over treatment.• Findings of this study suggest that change greater than 2.45 points in the GBO represents reliable change.

This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals. The scoping review identified 132 approaches, 103 of which referred to children or young people (younger than 25 years). These approaches included social interaction, engagement with nature, relaxation, distraction, sensory stimulation, physical activity, altering perceptions, engaging in hobbies, self-expression, and exploration. A systematic review of effectiveness studies from the literature identified in the scoping review found only 38 studies on seven types of intervention that met the inclusion criteria. 16 studies were based on cognitive or behavioural principles (15 on digital interventions and one on bibliotherapy), ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on contact with a dog. Most studies focused on adolescents or young adults. Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches. Target population identified in the literature Letting oneself be loved Children and young people Unsupported or unguided computer-based attention bias modification Children and young people Unsupported or unguided computer-based attention bias modification of interpretations Children and young people Unsupported or unguided computer-based problemsolving therapy Children and young people Unsupported or unguided computer-based cognitivebehavioural analysis of system psychotherapy Children and young people Unsupported or unguided computer-based worry exposure Children and young people Unsupported or unguided computer-based audio-photic stimulation Children and young people Unsupported or unguided computer-based systematic desensitisation Children and young people Robots Children and young people Apologising to others Children and young people Avoiding conflict or stressful situations at home Children and young people Thinking about things Children and young people Challenge the negative feelings Children and young people Notice triggers Children and young people Goal-setting Children and young people Small actions to release tension Children and young ...

Implementation of SDM in CAMHS is effortful, and while tools may help support SDM, clinicians need to be allowed to use the tools flexibly to allow them to move from a state of apprehension through a sense of feeling "clunky" to integration in practice.

The results suggest that goals may capture areas not captured by other normed outcome measures. In particular, goals may capture higher order, underlying factors, such as confidence, resilience, coping, and parenting factors that may not be explored by other measures. The differences across perspectives also link to existing literature suggesting a different focus on treatment based on perspectives and highlights the potential importance when jointly agreeing goals of ensuring the voice of the child/young person is heard and included in goal setting.