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儿童和青少年常见心理健康问题的服务设计:文献综述、服务映射和集体案例研究。

Service design for children and young people with common mental health problems: literature review, service mapping and collective case study.

机构信息

School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK.

Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.

出版信息

Health Soc Care Deliv Res. 2024 May;12(13):1-181. doi: 10.3310/DKRT6293.


DOI:10.3310/DKRT6293
PMID:38767587
Abstract

BACKGROUND: The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm. AIM: To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services. DESIGN: Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services. SETTING: Global (systematic reviews); England and Wales (service map; case study). DATA SOURCES: Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites. METHODS: A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'. RESULTS: A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems. LIMITATIONS: Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn. CONCLUSIONS: There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research. FUTURE WORK: Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility. STUDY REGISTRATION: This study is registered as PROSPERO CRD42018106219. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in ; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

摘要

背景:儿童/青少年的心理健康是国际上日益关注的问题。大量的报告和评论一致描述英国儿童心理健康服务存在碎片化、多变、难以获得和缺乏证据基础等问题。关于经历焦虑、抑郁、注意缺陷多动障碍和自残等“常见”心理健康问题的儿童/青少年服务模式的有效性和实施复杂性知之甚少。

目的:通过确定现有的服务、获取服务的障碍和促进因素,以及此类服务的有效性、成本效益和可接受性,为经历常见心理健康问题的儿童/青少年设计高质量的服务模式。

设计:使用顺序、混合方法设计进行证据综合和原始研究。在进行英格兰和威尔士的相关服务地图绘制和集体案例研究之前,进行了相关的范围界定和综合审查。

设置:全球(系统评价);英格兰和威尔士(服务地图;案例研究)。

数据来源:文献综述:相关文献数据库和灰色文献。服务地图:在线调查和离线桌面研究。案例研究:来自 9 个案例研究地点的 108 名参与者(41 名儿童/青少年、26 名家长、41 名工作人员)。

方法:单次文献检索为两项综述提供了信息。服务地图是通过在线调查和互联网搜索获得的。案例研究地点是从服务地图中抽样的;由于 2019 年冠状病毒病,案例研究数据是远程收集的。“年轻共同研究人员”协助案例研究数据收集。使用“通过叙述进行整合”的“编织”方法对综合审查和案例研究数据进行了综合。

结果:从范围界定综述中得出了服务模型分类法。综合评价发现协作式护理、外展方法、短期干预服务和“可用性、响应性和连续性”框架具有有效性证据。只有协作式护理具有成本效益证据。似乎没有一种服务模式比其他模式更受欢迎。服务地图确定了 154 个英格兰和威尔士服务。从案例研究数据中出现了三个主题:“支持途径”;“服务参与”;和“学习和理解”。综合评价和案例研究数据被综合成一个为经历常见心理健康问题的儿童/青少年提供高质量服务的合作模式。

局限性:定义“服务模式”是一个挑战。一些服务举措太新,尚未纳入文献或服务地图中。2019 年冠状病毒病导致远程/数字服务激增,但在文献中却没有得到充分体现。由于缺乏相关研究,几乎没有得出成本效益的结论。

结论:没有强有力的证据表明任何现有服务模式优于其他模式。相反,我们开发了一种合作的、基于证据的模式,该模式包含了高质量儿童心理健康服务所需的基本组成部分,并为政策、实践和研究提供了实用价值。

未来工作:未来的工作应集中于:我们的模型在设计、提供和审计儿童心理健康服务方面的潜力;服务不参与的原因;儿童心理健康不同方法的成本效益;数字/远程平台在提供服务方面的优势/劣势;了解法定部门如何从非法定部门中了解到关于选择、个性化和灵活性的内容。

注册:本研究在 PROSPERO CRD42018106219 中进行了注册。

资金:这项资助由英国国家健康与保健卓越研究所(NIHR)健康与社会保健交付研究计划(NIHR 奖 REF:17/09/08)资助,并在 ;第 12 卷,第 13 期。有关进一步的奖项信息,请参见 NIHR 资助和奖项网站。

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A collaboratively produced model of service design for children and young people with common mental health problems.

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