Child and adolescent mental health care models

Research area: Prevention and screening

Project team: Reinhard Jeindl, Viktoria Hofer

Duration: April 2022 – November 2022
Language: English with German summary

Background: Mental illnesses are among the most common in children and adolescents, with prevalences ranging between nine and 22 percent [1]. Depressive disorders, anxiety disorders and self-harm are the most common psychiatric diagnoses with a high burden of disease [2]. In the context of the COVID-19 pandemic, the mental health of children and adolescents was particularly affected [3, 4]. The current geopolitical situation raises further concerns regarding the increased demand for adequate care [5].

The increasing demand for care in this patient population, combined with the infrastructural and staff limitations in child and adolescent psychiatric care, leads to considerations for an adaptation of care models. In addition, the importance of preventing mental illness in children and adolescents is becoming increasingly apparent. For this, other sectors (e.g. school system for the promotion of mental health literacy) can complement the health care sector in an integrated care model [6]. Furthermore, advances in digitalisation and telemedical/ telepsychiatric care should be considered [7].

To further improve the child and adolescents’ mental well-being and support the planning of services, it is necessary to identify and monitor relevant child and adolescent mental health (care) indicators [8].

Project objectives and research questions: We aim to provide an overview of international child and adolescent mental health care strategies and models (e.g., identifying elements of care, coordination, professional groups involved, comprehensive mental health strategy). Mental health care may include prevention, treatment and other types of support. Additionally, we will describe indicators for monitoring child and adolescent mental health (care). The project should support decision-making in developing Austrian child and adolescent mental health care structures further.

A detailed planning/ implementation of the care models in Austria, or an effectiveness analysis of individual care components, is not within this project's scope.

1. RQ1: How is prevention and care of mental illness in children and adolescents currently organised in Austria?

2. RQ2: What are the recommendations in strategies and models for child and adolescent mental health in selected countries and cross-national documents?

3. RQ3: Which indicators/ parameters can be used to plan and monitor the quality of child and adolescent mental health and psychiatric care?

4. RQ: How aligned are current mental health care structures in Austria to the recommendations of international care and prevention models and indicators?

Methods: We use the following methods to answer the research questions:

1. RQ1: Hand search and supplementary expert consultation.

2. RQ2: Targeted hand search for strategies and models addressing child and adolescent mental health care and prevention (e.g. in PubMed, Google Scholar, TRIP Database, WHO, OECD, websites of ministries of health and public health institutions), supplementary expert consultation, data extraction with an iterative adaptation of preliminary categories, tabular presentation, qualitative content analysis of the model categories and narrative synthesis.

3. RQ3: Hand search, data extraction of quantitative indicators and relevant qualitative information, narrative synthesis, categorisation (into structure indicators, process indicators, outcome indicators and other indicators), semi-structured expert consultations (for supplementary information on indicators and possible prioritisation approaches).

4. RQ4: Description of the similarities and differences between the Austrian mental health care situation and the international strategies/ models, classification of indicators according to Austrian data availability, tabular presentation and visualisation.

Inclusion criteria for relevant mental health care models (FF2):

Publication type	National and cross-national child and adolescent mental health care strategies/ models Exclusion: regional care models (if national ones exist), indication-specific care models
Preliminary categories	Age Target group Professions and workforce qualification and development Components (Screening, etc) Coordination Responsibilities Implementation process additional characteristics: Digitalisation/ Telepsychiatry COVID-19 transcultural care Quality criteria: Evidence base Transparency These categories of the data extraction will be further complemented and adapted in an iterative process
Publication period	No restriction
Settings	Country selection based on various relevant criteria (Global North, countries with public health tradition, type of healthcare system) Exclusion: South America, Africa, Asia
Language	German, English

Inclusion criteria for relevant indicators for planning and monitoring (FF3):

Publication type	No restriction (focus on reviews and evaluation studies)
Preliminary indicators	Possible indicators (with focus on child and adolescence mental health): Structure: Health promotion and prevention (e.g. availablity of programs) Key figures on psychiatric/ psychotherapeutic care infrastructure (e.g. number of inpatient beds / 1,000 children and adolescents) Process: Supply and utilisation rates Quality of care Needs, unmet needs and barriers in mental health care Outcome: Health-related quality of life Self-harm and suicidality rates Social participation Burden of disease / psychopathology (incidence, prevalence, comorbidities) other indicators: Costs (including share of expenditure for child and adolescent mental health of total spending) Sociodemographic variables with an impact on public mental health Mental health risks Mental health resources and resilience Mental health literacy Rationale: possible indicators based on a scoping review [8]. These indicators will be further complemented and adapted as part of the data extraction.
Publication period	No restriction
Language	German, English

Schedule and milestones:

Time period	Task
April – June	Scoping, preparation of the project protocol, hand search, selection and acquisition of literature
July - August	Document analysis, data extraction, expert consultations, writing/drafting the report
September	Writing the report
October - November	Internal and external review, layout, finalisation

References:

[1] Wolf S. and Grössmann N. Home-Treatment in der Kinder- und Jugendpsychiatrie: Eine Analyse zur Wirksamkeit und möglichen Implementierung in Österreich. AIHTA Projektbericht Nr.: 129. HTA Austria - Austrian Institute for Health Technology Assessment GmbH: 2020. Available from: https://eprints.aihta.at/1275/.

[2] Vos T., Lim S. S., Abbafati C., Abbas K. M., Abbasi M., Abbasifard M., et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1204-1222. DOI: 10.1016/S0140-6736(20)30925-9.

[3] OECD. Supporting young people's mental health through the COVID-19 crisis. 2021.

[4] Santomauro D. F., Mantilla Herrera A. M., Shadid J., Zheng P., Ashbaugh C., Pigott D. M., et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet. 2021;398(10312):1700-1712. DOI: 10.1016/S0140-6736(21)02143-7.

[5] Matiashova L., Tsagkaris C., Essar M. Y., Danilchenko V. and Isayeva G. Children growing up in conflict zones in Ukraine and beyond need urgent mental health support. The Lancet. 2022;399(10336):1689-1690. DOI: 10.1016/S0140-6736(22)00579-7.

[6] Belgian Health Care Knowledge Center (KCE). Organisation of child and adolescent mental health care: study of the literature and an international overview. 2011 [cited 26.04.2022]. Available from: https://kce.fgov.be/en/publication/report/organisation-of-child-and-adolescent-mental-health-care-study-of-the-literature-a.

[7] Wang K., Varma D. S. and Prosperi M. A systematic review of the effectiveness of mobile apps for monitoring and management of mental health symptoms or disorders. J Psychiatr Res. 2018;107:73-78. Epub 2018/10/23. DOI: 10.1016/j.jpsychires.2018.10.006.

[8] Peitz D., Kersjes C., Thom J., Hoelling H. and Mauz E. Indicators for Public Mental Health: A Scoping Review. Frontiers in Public Health. 2021;9.