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        Measurement of environmental complexity by CAMHS
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        Measurement of environmental complexity by CAMHS
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Thompson et al 1 considered the use of the Paddington Complexity Scale 2 to quantify the case complexity of their child and adolescent mental health service (CAMHS) attenders, but discarded it largely because their study was based on CAMHS records which did not record systematically information on diagnoses or other items relevant to multi-axial formulations, such as physical health and cognitive/developmental status of children and young people seen.

I would like to clarify that - to allow for the fact that CAMHS vary in the extent to which diagnostic and other detailed comprehensive information is obtained on cases seen by different professionals - the Paddington Complexity Scale has, in addition to a summative total score, two complexity subscores and scales: clinical (in itself subdivided into psychiatric, incorporating diagnosis, severity/duration, comorbidity items, and physical/development, scoring information on physical health and intellectual disability) and environmental (with items on family status and attitudes to the use of the service, type of school and multi-agency involvement). These subscales, in particular adaptations of the environmental subscale which is made up of items that will be known to most CAMHS workers, can and have been used on a stand-alone basis, as a measure of psychosocial case complexity. 3

1 Thompson, AE, Nadkarni, A, Nazir, SA, Sorour, W, Owen, V, Buggineni, SK. Professional life in child and adolescent mental health services may be getting more complicated, but cases are not. Psychiatrist 2013; 37: 326–30.
2 Yates, P, Garralda, ME, Higginson, I. Paddington Complexity Scale and Health of the Nation Outcome Scales for Children and Adolescents. Br J Psychiatry 1999; 174: 417–23.
3 Audit Commission. Children in Mind: Child and Adolescent Mental Health Services (National Report). Audit Commission, 1999 (http://archive.audit-commission.gov.uk/auditcommission/subwebs/publications/studies/studyPDF/1350.pdf).