儿童/青少年的心理健康在国际上日益受到关注。许多报告和评论一致地将英国儿童的心理健康服务描述为支离破碎,变量,无法进入并且缺乏证据基础。对其有效性知之甚少,以及与之相关的实施复杂性,为经历焦虑等“常见心理健康问题”的儿童/年轻人提供服务模式,抑郁症,注意缺陷多动障碍和自我伤害。
■通过确定可用的服务,为遇到常见心理健康问题的儿童/年轻人开发高质量的服务设计模型,访问的障碍和推动者,和有效性,此类服务的成本效益和可接受性。
■与主要研究的证据综合,使用顺序,混合方法设计。相互关联的范围界定和综合审查与英格兰和威尔士的相关服务地图一起进行,其次是英语和威尔士服务的集体案例研究。
■全球(系统评论);英格兰和威尔士(服务地图;案例研究)。
■文献综述:相关书目数据库和灰色文献。服务地图:线上调查和线下案头研究。案例研究:108名参与者(41名儿童/年轻人,26父母41名员工)跨越9个案例研究地点。
■单个文献检索为两篇评论提供了信息。服务地图是从在线调查和互联网搜索中获得的。案例研究站点是从服务地图中采样的;由于2019年冠状病毒病,案例研究数据是远程收集的。“年轻的共同研究人员”协助收集案例研究数据。使用“通过叙事整合”的“编织”方法综合综合综合综述和案例研究数据。
■从范围审查中得出了服务模型类型。综合审查发现了协作护理的有效性证据,外展方法,简短的干预服务和可用性,响应性和连续性框架。只有协作护理才有成本效益的证据。没有一种服务模式似乎比其他模式更容易接受。服务地图确定了154个英语和威尔士服务。案例研究数据中出现了三个主题:“支持途径”;“服务参与”;和“学习和理解”。综合审查和案例研究数据被合成为共同制作的模型,该模型为遇到常见心理健康问题的儿童/年轻人提供高质量的服务。
■定义“服务模型”是一个挑战。有些服务计划太新了,无法过滤到文献或服务地图中。2019年冠状病毒病带来了远程/数字服务的激增,这些服务在文献中的代表性不足。缺乏相关研究意味着几乎无法得出成本效益结论。
■没有强有力的证据表明任何现有的服务模型都比其他模型更好。相反,我们开发了一种联合生产的,以证据为基础的模型,包含了高质量儿童心理健康服务所必需的基本组成部分,并具有政策效用,实践和研究。
■未来的工作应集中在:我们模型在辅助设计方面的潜力,提供和审核儿童心理健康服务;不参与服务的原因;不同方法在儿童心理健康方面的成本效益;数字/远程平台在提供服务方面的优势/劣势;了解法定部门如何以及如何从非法定部门学习选择,个性化和灵活性。
■本研究注册为PROSPEROCRD42018106219。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:17/09/08)资助,并在健康与社会护理提供研究;12号13.有关更多奖项信息,请参阅NIHR资助和奖励网站。
在这项研究中,我们探索了为患有抑郁症等“常见”心理健康问题的儿童和年轻人提供的服务,焦虑和自我伤害。我们的目标是找出存在哪些服务,儿童/青少年和家庭如何了解和获得这些服务,这些服务实际上是做什么的,他们是否有帮助,是否提供物有所值。我们查看了国际文献(报告和研究论文),以确定提供支持的不同方法,并找出某些方法是否比其他方法更好,以及儿童/年轻人和家庭是否比其他方法更喜欢某些方法。文献提供的关于服务的金钱价值的信息很少。我们还进行了一项调查,并使用互联网确定了英格兰和威尔士的154个相关服务。为了更详细地探索服务,并直接从使用它们的人那里听到,我们计划访问154个服务中的9个,以采访儿童/年轻人,父母和工作人员。不幸的是,2019年冠状病毒病阻止了我们直接访问这九项服务,所以我们进行了电话和视频采访。我们仍然设法与之交谈,听到的经验,超过100人(包括儿童/年轻人和父母)。我们将文献中的信息与访谈中的信息相结合,以创建基于证据的“模型”,说明服务应该是什么样子。该模型考虑了一些基本的事情,例如儿童/年轻人可以多快访问服务,有什么信息,保密的重要性以及工作人员是否使服务符合儿童/年轻人的需求和兴趣。它还考虑了该服务是否帮助儿童/年轻人学习管理其心理健康的技能,以及服务人员是否可以很好地合作。我们希望我们的模型将帮助现有和新的服务改善他们为儿童/年轻人和家庭提供的服务。
UNASSIGNED: The mental health of children/young people is a growing concern internationally. Numerous
reports and reviews have consistently described United Kingdom children\'s mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing \'common\' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm.
UNASSIGNED: To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services.
UNASSIGNED: Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across
England and Wales, followed by a collective case study of English and Welsh services.
UNASSIGNED: Global (systematic reviews);
England and Wales (service map;
case study).
UNASSIGNED: Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites.
UNASSIGNED: A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. \'Young co-researchers\' assisted with case study data collection. The integrative review and case study data were synthesised using the \'weaving\' approach of \'integration through narrative\'.
UNASSIGNED: A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the \'availability, responsiveness and continuity\' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: \'pathways to support\'; \'service engagement\'; and \'learning and understanding\'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems.
UNASSIGNED: Defining \'service model\' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn.
UNASSIGNED: There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children\'s mental health services and which has utility for policy, practice and research.
UNASSIGNED: Future work should focus on: the potential of our model to assist in designing, delivering and auditing children\'s mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children\'s mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility.
UNASSIGNED: This study is registered as PROSPERO CRD42018106219.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.
In this research study, we explored services for children and young people with ‘common’ mental health problems like depression, anxiety and self-harm. We aimed to find out what services exist, how children/young people and families find out about and access these services, what the services actually do, whether they are helpful and whether they offer value for money. We looked at the international literature (
reports and research papers) to identify different approaches to providing support, and to find out whether certain approaches worked better than others and whether children/young people and families preferred some approaches over others. The literature provided very little information about the value for money of services. We also carried out a survey and used the internet to identify 154 relevant services in
England and Wales. To explore services in more detail, and hear directly from those using them, we planned to visit 9 of the 154 services to interview children/young people, parents and staff. Unfortunately, coronavirus disease 2019 stopped us directly visiting the nine services and so we conducted phone and video interviews instead. We still managed to speak to, and hear the experiences of, more than 100 people (including children/young people and parents). We combined information from the literature with information from the interviews to create an evidence-based ‘model’ of what services should look like. This model considers some basic things like how quickly children/young people could access a service, what information was available, the importance of confidentiality and whether staff make the service fit with the child/young person’s needs and interests. It also considers whether the service helps children/young people learn skills to manage their mental health and whether staff at a service work well together. We hope our model will help existing and new services improve what they offer to children/young people and families.