Schutte Valerie, Danseco Evangeline, Lucente Gabrielle, Sundar Purnima
Knowledge Institute on Child and Youth Mental Health and Addictions, 695 Industrial Avenue, Ottawa, ON, K1G 0ZI, Canada.
Int J Ment Health Syst. 2023 Oct 12;17(1):30. doi: 10.1186/s13033-023-00599-2.
While there are mental health treatment programs for children and young people in secure settings (i.e., secure treatment programs) in many countries, there is a lack of transparency and consistency across these that causes confusion for stakeholders and challenges for the design and delivery of high-quality, evidence-based programs. This systematic review addresses two questions: What do mental health treatment programs for children and young people in secure community settings look like across jurisdictions? What is the evidence underlying the various components of these programs?
Twelve databases were searched in November 2021: CINAHL, EMBASE, MEDLINE, PsycINFO, PubMed, Scopus, Science Direct, Academic Search Complete, Psychology and Behavioral Sciences Collection, Google Scholar, OpenDOAR, and GreyLit.org. To be included, publications had to be empirical literature or a report on mental health treatment within a secure setting for people under the age of 25; contain pre-identified keywords; be based on a research or evaluation study conducted since 2000; and be assessed as low risk of bias using an adaptation of the Critical Appraisal Skills Programme qualitative research checklist. The systematic review included 63 publications. Data were collected and analyzed in NVivo qualitative software using a coding framework.
There are secure treatment programs in Australia, Belgium, Canada, New Zealand, the Netherlands, England and Wales, Scotland, and the United States. Although there are inconsistencies across programs in terms of the systems in which they are embedded, client profiles, treatments provided, and lengths of stays, most share commonalities in their governance, definitions, designs, and intended outcomes.
The commonalities across secure treatment programs appear to stem from them being designed around a need for treatment that includes a mental disorder, symptom severity and salience involving significant risk of harm to self and/or others, and a proportionality of the risks and benefits of treatment. Most share a common logic; however, the evidence suggested that this logic may not to lead to sustained outcomes. Policymakers, service providers, and researchers could use the offered recommendations to ensure the provision of high-quality secure treatment programming to children and young people with serious and complex mental health needs.
虽然许多国家都有为处于安全环境中的儿童和青少年设立的心理健康治疗项目（即安全治疗项目），但这些项目缺乏透明度和一致性，给利益相关者带来了困惑，也给高质量、循证项目的设计和实施带来了挑战。本系统评价解决两个问题：不同司法管辖区内针对处于安全社区环境中的儿童和青少年的心理健康治疗项目是什么样的？这些项目各个组成部分的依据是什么？
2021年11月检索了12个数据库：护理学与健康领域数据库（CINAHL）、荷兰医学文摘数据库（EMBASE）、医学索引数据库（MEDLINE）、心理学文摘数据库（PsycINFO）、医学期刊数据库（PubMed）、Scopus数据库、科学Direct数据库、学术搜索完整版数据库、心理学与行为科学文集数据库、谷歌学术、开放获取学术资源目录（OpenDOAR）和灰色文献库（GreyLit.org）。纳入的出版物必须是实证文献或关于25岁以下人群在安全环境中的心理健康治疗的报告；包含预先确定的关键词；基于2000年以来进行的研究或评估研究；并且使用批判性评价技能计划定性研究清单的改编版评估为低偏倚风险。该系统评价纳入了63篇出版物。使用编码框架在NVivo定性软件中收集和分析数据。
澳大利亚、比利时、加拿大、新西兰、荷兰、英格兰和威尔士、苏格兰以及美国都有安全治疗项目。尽管各项目在所嵌入的系统、服务对象特征、提供的治疗以及住院时间方面存在不一致，但大多数在治理、定义、设计和预期结果方面有共同之处。
安全治疗项目的共同之处似乎源于它们围绕一种治疗需求而设计，这种需求包括精神障碍、涉及对自己和/或他人造成重大伤害风险的症状严重程度和突出性，以及治疗风险与益处的相称性。大多数项目有共同的逻辑；然而，证据表明这种逻辑可能不会带来持续的效果。政策制定者、服务提供者和研究人员可以利用所提供的建议，确保为有严重和复杂心理健康需求的儿童和青少年提供高质量的安全治疗项目。
