Browne Gina, Gafni Amiram, Roberts Jacqueline, Byrne Carolyn, Majumdar Basanti
System-Linked Research Unit (SLRU), School of Nursing, McMaster University, Hamilton, Ont., Canada.
Soc Sci Med. 2004 Apr;58(7):1367-84. doi: 10.1016/S0277-9536(03)00332-0.
The prevalence of mental health problems, some of which seem to be occurring among younger cohorts, leads researchers and policy-makers to search for practical solutions to reduce the burden of suffering on children and their families, and the costs to society both immediate and long term. Numerous programs are in place to reduce or alleviate problem behaviour or disorders and/or assist positive youth development. Evaluated results are dispersed throughout the literature. To assess findings and determine common elements of effective children's services, a literature search was undertaken for evidence-based evaluations of non-clinical programs for school-age children. Prescriptive comments aim to inform service-providers, policy-makers and families about best practices for effective services such as: early, long-term intervention including reinforcement, follow-up and an ecological focus with family and community sector involvement; consistent adult staffing; and interactive, non-didactic programming adapted to gender, age and cultural needs. Gaps are identified in our understanding of efficiencies that result from effective programs. Policy implications include the need to develop strategies for intersectoral interventions, including: new financing arrangements to encourage (not penalize) interagency cooperation and, to ensure services reach appropriate segments of the population; replication of best practices; and publicizing information about benefits and cost savings. In many jurisdictions legislative changes could create incentives for services to collaborate on service delivery. Joint decision-making would require intersectoral governance, pooling of some funding, and policy changes to retain savings at the local level. Savings could finance expansion of services for additional youth.
心理健康问题的患病率，其中一些问题似乎在较年轻的人群中出现，这促使研究人员和政策制定者寻找切实可行的解决方案，以减轻儿童及其家庭的痛苦负担，以及对社会造成的短期和长期成本。有许多项目旨在减少或缓解问题行为或障碍，和/或促进青少年的积极发展。评估结果分散在整个文献中。为了评估研究结果并确定有效儿童服务的共同要素，我们对针对学龄儿童的非临床项目进行了基于证据的评估的文献检索。规范性评论旨在向服务提供者、政策制定者和家庭通报有效服务的最佳做法，例如：早期、长期干预，包括强化、随访以及以家庭和社区部门参与为重点的生态视角；稳定的成人工作人员配备；以及根据性别、年龄和文化需求进行互动式、非说教式的项目安排。我们发现，在对有效项目所产生的效率的理解方面存在差距。政策影响包括需要制定部门间干预战略，其中包括：新的融资安排，以鼓励（而非惩罚）机构间合作，并确保服务覆盖适当的人群；推广最佳做法；以及宣传有关效益和成本节约的信息。在许多司法管辖区，立法变革可以为服务机构在服务提供方面的合作创造激励措施。共同决策将需要部门间治理、汇集一些资金，以及进行政策变革以在地方层面保留节约资金。节约资金可以为扩大针对更多青少年的服务提供资金。
