The child and adolescent version of the Health of the Nation Outcome Scales (HoNOSCA) represents the first attempt at a routine outcome measure for Child and Adolescent Mental Health Services in the U.K. Extensive field trials suggested that the scales were both acceptable to clinicians from the various disciplines working in this area and also valid and reliable. A growing number of services are now using the scales in audit and research, supported by the national HoNOSCA base that provides training and co-ordinates further developments.

There are at least 50000 refugee children and adolescents in the UK, mostly living in London. These young people and their families will have been exposed to high levels of violence, disruption of social life and losses, all of which will increase their risk for psychiatric disorders. Up to 40% may have psychiatric disorders, mostly depression, posttraumatic stress disorder and other anxiety related difficulties. Multi-agency support to refugee youngsters and families is important. Some refugee children and adolescents will require help from specialist mental health services that will need to be flexible in view of the refugees' cultural diversity, mobility and the need for the full range of treatments. Special efforts are required to reach this vulnerable group, and links with social services and schools in particular should be considered.

Prompt and accurate diagnosis of Munchausen's syndrome by proxy is essential in order to minimise the risk of iatrogenic and parentally-induced harm to the child. However, inaccurate diagnosis of MSBP may have devastating consequences for the child, family and professionals involved. ‘Psychiatric’ Munchausen's syndrome by proxy, which involves the presentation of signs and symptoms suggestive of a psychiatric disorder in the child, is even more difficult to diagnose and requires an unbiased and full assessment by the appropriate multidisciplinary team.

The education of children with behavioural difficulties is under scrutiny from various quarters. The provision of specialised school environments is being questioned, at the same time as there is pressure to minimise the exclusion of disruptive pupils. This study looked at the rate of psychiatric disorder that was prevalent in a school for emotionally and behaviourally disordered (EBD) pupils, and found, using DSM III-R criteria, that 24% of the sample had depression, 11% had overanxiousness, and 70% had a diagnosis of Attention Deficit Disorder with Hyperactivity (ADHD). Educational attainment assessment showed that 75% had a reading age that was at least 2 years below their chronological age. These results suggest that such settings are dealing with a very disturbed group of youngsters.

Needs assessment is a frequently used term by all agencies involved in the welfare of children and adolescents, and is a key method in health service planning (Stevens & Raftery, 1994). However, there is often a lack of clarity about the meaning of the phrase ‘needs assessment’ (Cohen & Eastman, 1997). In addition, for CAMHS services there are few established research or clinical instruments to assess the needs of individuals. This review sets out first to describe some key concepts and issues and, second, to describe the development of a needs assessment instrument for adolescents with complex and multiple problems, and how such an instrument can be used in clinical and research settings.

This article discusses the main findings of a detailed study of the operation of the appeal process in cases of permanent exclusion in England and Wales carried out by the author with Karen Eden (Research Fellow) in 1997–99. The project, which involved the first comprehensive research into this subject, was funded by the Nuffield Foundation.

David Galloway, Chair of the ACPP, is Professor of Primary Education and Chairman of the Board of Studies in Education in the University of Durham. ‘Primary Education’ in the title of his Chair does not do justice to the extraordinary range of his interests and achievements. At the core there lies a fundamental concern to maximise schools' contribution to children's development by extending our understanding of processes, individuals and personal relationships. His exploration of processes extends from the interface between home and school to children's approach to learning: their motivational style. Those with a mastery orientation ‘are concerned with their own further learning and the opportunities offered by new and challenging tasks’. It is an adaptive response in which such children demonstrate persistence and seek ways to overcome difficulties. That this is David's style became rapidly apparent when discussing his career. Some would call him a self-starter, who has retained his independence of spirit while working within educational and university structures.

The papers I have drawn together reflect some of the dilemmas inherent in the changing role and focus of childcare social work in this post-modern millennium world. Professional social work activity is being increasingly framed and some may argue constrained within a welter of well- intentioned legislative and policy imperatives underpinned by targets and performance indicators. The dawning of the millennium will bring the implementation of two further new procedural guidance documents. First, the new draft Working together to safeguard children and second, the Framework for the assessment of children in need and their families. These guidance documents represent an attempt to help social workers and other professionals become clearer in their task of protecting children, and to improve assessment skills so that appropriate support services can be provided to meet the complex and diverse needs of children and their families. The following articles are reviewed as they highlight how, despite their laudable aims, legislative imperatives and policy initiatives can easily become subverted by the complex, contradictory and ambiguous reality that childcare practitioners often encounter.