社区儿科医生与儿童和青少年心理健康服务机构合作的经验：来自英国全国性调查的结果。
Community paediatricians' experience of joint working with child and adolescent mental health services: findings from a British national survey.
机构信息
Division of Psychiatry, Imperial College London, Faculty of Medicine, London, UK
Child and Adolescent Mental Health Service, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK.
出版信息
BMJ Paediatr Open. 2022 Apr;6(1). doi: 10.1136/bmjpo-2021-001381.
OBJECTIVES
Children and young people (CYP) presenting to paediatric or child and adolescent mental health services (CAMHS) often have needs spanning medical and psychiatric diagnoses. However, joint working between paediatrics and CAMHS remains limited. We surveyed community paediatricians in the UK to inform better strategies to improve joint working with CAMHS.
METHODS
We conducted an online survey of community paediatricians through the British Association for Community Child Health (BACCH) on how much joint working they experienced with CAMHS, any hindrances to more collaborative working, and the impact on service users and service provision. This paper is based on thematic analysis of 327 free-text comments by paediatricians.
RESULTS
A total of 245 community paediatricians responded to the survey (22% of BACCH members). However, some responses were made on behalf of teams rather than for individual paediatricians. The following were the key themes identified: a strong support for joint working between community paediatrics and CAMHS; an acknowledgement that current levels of joint working were limited; the main barriers to joint working were splintered commissioning and service structures (eg, where integrated care systems fund different providers to meet overlapping children's health needs); and the most commonly reported negative impact of non-joint working was severely limited access to CAMHS for CYP judged by paediatricians to require mental health support, particularly those with autism spectrum disorder.
CONCLUSION
There is very limited joint working between community paediatrics and CAMHS in the UK, which is associated with many adverse impacts on service users and providers. A prointegration strategy that includes joint commissioning of adequately funded paediatric and CAMHS services that are colocated and within the same health management organisations is crucial to improving joint working between paediatrics and CAMHS.
目的
到儿科或儿童和青少年心理健康服务（CAMHS）就诊的儿童和年轻人（CYP）通常有跨越医学和精神科诊断的需求。然而，儿科和 CAMHS 之间的联合工作仍然有限。我们对英国的社区儿科医生进行了调查，以提供更好的策略来改善与 CAMHS 的联合工作。
方法
我们通过英国社区儿童健康协会（BACCH）对社区儿科医生进行了在线调查，了解他们与 CAMHS 的联合工作经验、更多协作工作的任何障碍，以及对服务使用者和服务提供的影响。本文基于儿科医生 327 条自由文本评论的主题分析。
结果
共有 245 名社区儿科医生对调查做出了回应（BACCH 成员的 22%）。然而，有些回复是代表团队而不是个人儿科医生做出的。确定的主要主题如下：强烈支持社区儿科和 CAMHS 之间的联合工作；承认目前的联合工作水平有限；联合工作的主要障碍是分散的委托和服务结构（例如，综合护理系统为满足儿童健康重叠需求而资助不同的提供者）；以及最常报告的非联合工作的负面影响是，被儿科医生判断需要心理健康支持的 CYP 严重限制了对 CAMHS 的访问，尤其是那些患有自闭症谱系障碍的 CYP。
结论
英国社区儿科和 CAMHS 之间的联合工作非常有限，这对服务使用者和提供者都有许多不利影响。一项促进整合的策略，包括联合委托充足资金的儿科和 CAMHS 服务，这些服务位于同一健康管理组织内，是改善儿科和 CAMHS 之间联合工作的关键。
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