Annotation: Pathways to care for children with mental health problems
ABSTRACT Although many children with mental health problems are in contact with primary health care services, few receive appropriate help.
Using a pathways to care model, this paper systematically reviews the literature relating to access to services. It separates out the various stages of help-seeking: parental perception of problems, use of primary care services, recognition within primary care, and referral to or use of specialist health services.
Following parental awareness of child symptoms, parental perception of problems is the key initial step in the help-seeking process. Although children with mental health problems or disorders are regular attenders within primary care and most parents acknowledge that it is appropriate to discuss concerns about psychosocial issues in this setting, few children are presented with mental health symptoms even if their parents have such concerns. Subsequently, less than half of children with disorders are recognised in primary care. Amongst recognised children, about half are referred to specialist services. Overall, up to one-third of children with disorders receive services for mental health problems. Factors such as the type and severity of disorder, parental perceptions, child age and gender, and family and social background factors determine which affected children access services.
As there are inequities in patterns of service use, a greater emphasis on developing resources at population and primary care levels is required. Barriers involving parental perceptions and expression of concerns within consultations should be minimised at these levels. This requires both public education approaches and improved training and specialist support for primary care services to enhance their ability to provide for these children.
SourceAvailable from: S.A. Reijneveld[Show abstract] [Hide abstract]
ABSTRACT: TAKECARE is a prospective cohort study designed in The Netherlands to obtain evidence on the care chain for children and adolescents with psychosocial problems, and its long-term outcomes. Little is known about the content of care as offered and on whether the care is adequate. The cohort consists of children and adolescents entering care for psychosocial problems (care sample, n = 1382) and a random sample of the general population (community sample, n = 666). Children were eligible for participation if they were aged 4-18 years (inclusive) and had estimated IQs of 70 and over. The care sample covers the fields of Preventive Child Healthcare (PCH), Child and Adolescent Social Care (CASC) and Child and Adolescent Mental Healthcare (CAMH). Children, parents or guardians and involved practitioners completed five questionnaires (baseline, and at 3, 12, 24 and 36 months thereafter). The main categories of data concern the sociodemographic characteristics of children and their parents or guardians, the characteristics of entry into care and care content, and intermediate and final treatment outcomes. Information about data access can be requested by e-mail: email@example.com. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.International Journal of Epidemiology 12/2014; DOI:10.1093/ije/dyu237 · 9.20 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Parents with a child suffering from psychosocial problems frequently experience barriers to psychosocial care, which may hinder access. Expectations of barriers may have the same effect, but evidence is lacking. The aim of this study is to examine parents’ and adolescents’ expectations of barriers regarding psychosocial care for the child, along with associated child and family characteristics. We obtained data on an age-stratified random sample of school children/pupils aged 4–18 via questionnaires (N = 666; response rate 70.3 %). Expectations of barriers to psychosocial care were measured with the “Barriers to Treatment Participation Scale-Expectancies” questionnaire (BTPS-exp). Results showed that 64 % of the parents of children below age 12, 59 % of the parents of adolescents (age 12–18), and 84 % of the adolescents expected one or more barriers. Parents and adolescents expected barriers most frequently with respect to irrelevance of treatment. Mainly parents with low educational level and their adolescents expected barriers regarding treatment, and quite a few characteristics of parents of adolescents were associated with expecting multiple barriers regarding treatment demands and issues, for example, single parents, parents of lower educational level and of adolescent boys, and parents of adolescents with psychosocial problems. We conclude that adolescents especially, but also their parents and parents of younger children, expect major barriers to psychosocial care, which may greatly hinder appropriate care seeking. This evidence may support professionals and policymakers in their attempts to improve access to psychosocial care.European Child & Adolescent Psychiatry 05/2015; 24. DOI:10.1007/s00787-015-0717-1 · 3.55 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: School-based interventions involving teacher training programmes have been shown to benefit teachers’ ability to identify and manage child mental health problems in developed countries. However, very few studies have been conducted in low-income countries with limited specialist services. The aim of the study was to evaluate the impact of the training programme on teachers’ knowledge and awareness. A total of 114 primary school teachers from five schools in Karachi participated in a two-day (10–12 hours) workshop to provide them with an understanding of common child mental health problems and train them in basic skills. Their pre- and post-training knowledge was evaluated through a rating scale and open-ended questions. Single tailed t-test, involving paired differences, was applied for participants’ scores. Pre-/post-training differences were statistically significant. The training sessions were associated with an improvement in teachers’ knowledge and awareness of various signs and symptoms of common child mental health problems. The greatest improvement was noted in response to strategies of managing difficult behaviours, as 61% of respondents were able to formulate appropriate behavioural management techniques after the training. In low-income developing countries like Pakistan, teachers should be trained in early-intervention programmes for the identification and school-based management of less complex emotional and behavioural problems. Such interventions can maximise the use of sparse mental health resources.Emotional and Behavioural Difficulties 09/2013; 18(3):284-296. DOI:10.1080/13632752.2013.819254