Hansen Anna Sofie, Kjaersdam Telléus Gry, Mohr-Jensen Christina, Færk Emil, Lauritsen Marlene Briciet
Department of Psychiatry, 53141Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Clin Child Psychol Psychiatry. 2023 Apr;28(2):434-449. doi: 10.1177/13591045221081384. Epub 2022 Mar 25.
High rejection rates for referrals to child and adolescent mental health services (CAMHS) are common. The most cited reasons for rejection are that the child does not have a clinical need for assessment and poor quality of the referrals. However, studies of interventions aimed at improving appropriateness of referrals are sparse. In this randomized feasibility trial, we tested if the Development and Well-Being Assessment (DAWBA) as an adjunct to referral letters could improve accuracy of referral decisions made by CAMHS. The primary outcome of the study was the proportion of "correct" referral decisions. The study included 160 children referred to CAMHS. Almost all (95.6%) participants fulfilled criteria for a mental disorder and 82.1% also reported high impact of symptoms. Compared to the group who did not complete the DAWBA, referral decisions for the DAWBA group showed higher sensitivity (0.63 vs. 0.83), specificity (0.30 vs. 0.42), and negative predictive value (0.14 vs. 0.36) as well as slightly higher positive predictive value (0.81 vs. 0.86). The use of the DAWBA as an adjunct to standard referral letters could lead to more correct referral decisions and reduce the proportion of wrongful rejection referrals to CAMHS.
转介至儿童及青少年心理健康服务机构（CAMHS）时被拒率很高，这很常见。被拒的最常见原因是儿童没有接受评估的临床需求以及转介质量不佳。然而，针对提高转介适宜性的干预措施的研究却很少。在这项随机可行性试验中，我们测试了将发育与幸福评估（DAWBA）作为转介信的辅助工具是否能提高CAMHS做出的转介决定的准确性。该研究的主要结果是“正确”转介决定的比例。该研究纳入了160名被转介至CAMHS的儿童。几乎所有（95.6%）参与者都符合精神障碍标准，82.1%的参与者还报告症状影响严重。与未完成DAWBA的组相比，DAWBA组的转介决定显示出更高的敏感性（0.63对0.83）、特异性（0.30对0.42）和阴性预测值（0.14对0.36），以及略高的阳性预测值（0.81对0.86）。将DAWBA作为标准转介信的辅助工具使用可能会导致更多正确的转介决定，并减少转介至CAMHS时被错误拒绝的比例。
