van Roosmalen Marc, Gardner-Elahi Catherine, Day Crispin
Community CAMH Early Intervention and Prevention Service, Alma Street, Luton, UK.
Clin Child Psychol Psychiatry. 2013 Jan;18(1):25-43. doi: 10.1177/1359104511431660. Epub 2012 Jan 27.
Over the last 15 years, policy initiatives have aimed at the provision of more comprehensive Child and Adolescent Mental Health care. These presented a series of new challenges in organising and delivering Tier 2 child mental health services, particularly in schools. This exploratory study aimed to examine and clarify the service model underpinning a Tier 2 child mental health service offering school-based mental health work. Using semi-structured interviews, clinician descriptions of operational experiences were gathered. These were analysed using grounded theory methods. Analysis was validated by respondents at two stages. A pathway for casework emerged that included a systemic consultative function, as part of an overall three-function service model, which required: (1) activity as a member of the multi-agency system; (2) activity to improve the system working around a particular child; and (3) activity to universally develop a Tier 1 workforce confident in supporting children at risk of or experiencing mental health problems. The study challenged the perception of such a service serving solely a Tier 2 function, the requisite workforce to deliver the service model, and could give service providers a rationale for negotiating service models that include an explicit focus on improving the children's environments.
在过去15年里，政策倡议旨在提供更全面的儿童和青少年心理健康护理。这些倡议在组织和提供二级儿童心理健康服务方面带来了一系列新挑战，尤其是在学校。这项探索性研究旨在审视和阐明支撑提供校内心理健康工作的二级儿童心理健康服务的服务模式。通过半结构化访谈，收集了临床医生对操作经验的描述。使用扎根理论方法对这些描述进行了分析。分析在两个阶段得到了受访者的验证。形成了一个个案工作路径，其中包括作为整体三功能服务模式一部分的系统咨询功能，这需要：（1）作为多机构系统的一员开展活动；（2）围绕特定儿童改进系统运作的活动；（3）普遍培养有信心支持有心理健康问题风险或正在经历心理健康问题的儿童的一级工作人员的活动。该研究对这种仅服务二级功能的服务观念、提供该服务模式所需的劳动力提出了质疑，并可为服务提供者就明确关注改善儿童环境的服务模式进行谈判提供理论依据。
