School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
Manchester Mental Health NHS Foundation Trust, Manchester, UK.
BMC Health Serv Res. 2024 Jan 24;24(1):133. doi: 10.1186/s12913-024-10562-7.
BACKGROUND: Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access. METHODS: Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase. RESULTS: The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture. CONCLUSIONS: A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose - often inflexible and untested - specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences.
背景:对于儿童和青少年(CYP)经历“常见”心理健康问题(如焦虑、抑郁、行为困难和自残)的服务提供模式的有效性及其实施复杂性知之甚少。本文概述了如何通过确定现有服务、其有效性、成本效益和可接受性以及获得服务的障碍和促进因素,为这一人群组设计高质量服务模式。
方法:采用顺序、混合方法设计,结合国际文献的范围和综合审查以及主要研究(英格兰和威尔士的集体案例研究)。这两个要素的数据在随后的模型构建阶段进行了协作综合。
结果:范围审查产生了服务模型分类法。综合审查仅发现了四个模型的有效性证据:协作式护理(唯一具有成本效益证据的服务模型)、外展方法、简短干预服务和称为“可用性、响应性和连续性”的组织框架。没有一种服务模式似乎比其他模式更受欢迎。确定了三个案例研究主题:支持途径;服务参与;以及学习和理解。模型构建阶段确定了快速获得服务、学习自我保健技能、个性化支持、清晰信息、富有同情心和能力的员工以及后续护理计划是高质量服务的核心特征。这些特征由四个组织素质支撑:尊重保密性的价值观;参与和投入;协作关系;以及学习文化。
结论:多年来,在 CYP 心理健康方面,一直存在一个一致的服务设计和提供的组织证据基础,但这似乎对英格兰和威尔士的服务提供没有产生太大影响。与其强加(通常是不灵活和未经测试的)特定的地方或国家模式或框架,为 CYP 设计和提供心理健康服务的委托方、设计方和提供方应(重新)关注高质量服务所需的已知基本要素。这些基本要素已整合到一个针对 CYP 常见心理健康问题的协作产生的服务设计通用模型中。虽然这个通用模型主要侧重于英国的服务提供,但它足够广泛,可供国际受众使用。
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