Grant Claire, Blackburn Ruth, Harding Duncan, Golden Sarah, Toth Katalin, Scott Stephen, Ford Tamsin, Downs Johnny
Department of Child and Adolescent Psychiatry, King's College London, London, UK.
Department of Epidemiology and Public Health, University College London, London, UK.
Child Adolesc Ment Health. 2023 May;28(2):212-220. doi: 10.1111/camh.12519. Epub 2021 Nov 2.
In the United Kingdom, schools play an increasingly important role in supporting young peoples' mental health. While there is a growing evidence base to support the effectiveness of school-based interventions, less is known about how these provisions impact on local Child and Adolescent Mental Health Service (CAMHS) referral rates. There is a concern that an increase in school-based provision might lead to an increase in CAMHS referrals and overwhelm services. We aimed to examine the longitudinal association between Place2Be counselling provision in primary schools on CAMHS referral rates in South London.
This was a retrospective cohort study using linked data from the National Pupil Database (NPD) and CAMHS referrals to the South London and Maudsley's NHS Foundation Trust (SLaM) identified through the Clinical Record Interactive Search (CRIS) tool. The cohort included a total of 285 state-maintained primary schools in four London boroughs for the academic years of 2007-2012. During the study period, 23 of these schools received school-based mental health provision from Place2Be. The primary outcome was the incident rate ratio (IRR) of school-level accepted CAMHS referrals in 2012/13 in schools with, or without, Place2Be provision.
There was no significant association between elevated rates of CAMHS referral and Place2Be provision, even after comprehensive adjustment for school-level and pupil characteristics (IRR 0.91 (0.67-1.23)). School-level characteristics, including higher proportion of white-British pupils (IRR 1.009 (1.002-1.02)), medical staff ratio (IRR 6.49 (2.05-20.6)) and poorer Ofsted school inspection ratings (e.g. IRR 1.58 (1.06-2.34) for 'Requires Improvement' vs. 'Outstanding') were associated with increased CAMHS referral rates.
Place2Be provision did not result in increased specialist mental health referrals; however, other school-level characteristics did. Future research should investigate pupils' Place2Be clinical outcomes, as well the outcomes of individuals referred to CAMHS to better understand which needs are being met by which services.
在英国，学校在支持年轻人心理健康方面发挥着越来越重要的作用。虽然有越来越多的证据支持基于学校的干预措施的有效性，但对于这些措施如何影响当地儿童和青少年心理健康服务（CAMHS）的转诊率，人们了解得较少。有人担心，基于学校的服务增加可能会导致CAMHS转诊增加，使服务不堪重负。我们旨在研究伦敦南部小学的Place2Be咨询服务与CAMHS转诊率之间的纵向关联。
这是一项回顾性队列研究，使用了来自国家学生数据库（NPD）的关联数据以及通过临床记录交互式搜索（CRIS）工具确定的向伦敦南部和莫兹利国民保健服务基金会信托（SLaM）转诊的CAMHS数据。该队列包括2007 - 2012学年伦敦四个行政区的总共285所公立小学。在研究期间，其中23所学校接受了Place2Be提供的校内心理健康服务。主要结果是2012/13学年有或没有Place2Be服务的学校中，学校层面接受的CAMHS转诊的发病率比（IRR）。
即使在对学校层面和学生特征进行全面调整后，CAMHS转诊率升高与Place2Be服务之间也没有显著关联（IRR 0.91（0.67 - 1.23））。学校层面的特征，包括较高比例的英国白人学生（IRR 1.009（1.002 - 1.02））、医务人员比例（IRR 6.49（2.05 - 20.6））以及Ofsted学校检查评级较差（例如，“需要改进”与“优秀”相比，IRR 1.58（1.06 - 2.34））与CAMHS转诊率增加相关。
Place2Be服务并未导致专科心理健康转诊增加；然而，其他学校层面的特征却导致了转诊增加。未来的研究应该调查学生接受Place2Be服务的临床结果，以及转诊至CAMHS的个体的结果，以更好地了解哪些需求由哪些服务满足。
