GESTIÓN EN SALUD PÚBLICA: Strategies to Improve Mental Health Care for Children and Adolescents - Executive Summary

martes, 20 de diciembre de 2016

Strategies to Improve Mental Health Care for Children and Adolescents - Executive Summary | AHRQ Effective Health Care Program

Executive Summary – Dec. 19, 2016

Strategies to Improve Mental Health Care for Children and Adolescents

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Background

Approximately one in five children and adolescents living in the United States has one or more mental, emotional, or behavioral health disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria in any given year.1 These disorders contribute to problems with family, peers, and academic functioning. They may exacerbate coexisting conditions and may reduce quality of life. They also increase the risk of involvement with the criminal justice system and other risk-taking behaviors and suicide.2

Several key publications in the mid- to late 1990s suggested that usual care in children's mental health had, at best, no3 and sometimes harmful effects.4 Since then, mental health interventions that improve children and adolescents with mood disorders, anxiety disorders, disruptive behavior disorders, psychotic disorders, eating disorders, and substance use disorders have been tested to varying degrees of benefit.5,6

Despite advances in the evidence base,5,7 some outcomes for children with mental health problems remain suboptimal because of issues with access to care and the failure of systems and providers to adopt established quality improvement (QI) strategies and interventions with proven effectiveness (e.g., evidence-based practices [EBPs]). Studies using nationally representative data on U.S. adolescents show that only approximately one in five children with mental health problems receives services, and only one-third of treatment episodes are considered minimally adequate (at least four visits with psychotropic medication or at least eight visits without psychotropic medication).8-10 The current health care system continues to provide fragmented care to children and adolescents in numerous uncoordinated systems, rendering inefficient the delivery of needed services.11Moreover, clinicians—particularly primary care practitioners—may lack the time, knowledge, or training to identify and treat or refer patients with mental health problems.12

Given the gap between observed and achievable processes and outcomes, one way to improve the mental health care of children and adolescents is to adopt QI strategies and develop strategies to implement or disseminate interventions with known effectiveness. Such strategies target changes in the organization and delivery of mental health services.13,14 They seek to improve the quality of care and patient outcomes by closing the gap between research evidence and practice.15-17

The ultimate goal of these strategies is to improve patient health and service utilization outcomes for children and adolescents with mental health problems. Intermediate outcomes in this context include changes to health care systems, organizations, and practitioners that provide mental health care. Targeting multiple, interrelated, nested levels such as the macro environment (e.g., state), organization or system (e.g., specialty mental health clinic), program (e.g., selected intervention), practitioners (e.g., clinicians), and patients (e.g., children or adolescents and their families) typically increases the effectiveness and sustainability of a particular strategy.18,19 For instance, changes in intermediate outcomes such as practitioners' attitudes20 or organizational climate21 may influence the successful adoption of and fidelity to EBPs. These practices in turn influence patient health outcomes, such as behavior or quality of life.