Care Delivery Strategies for Anxiety, Depression, Obsessive Compulsive Disorder, and Tourette Syndrome to Improve Health Outcomes in Children and Youth.

Abstract

The purpose of this rapid review was to identify effective care delivery strategies for children and youth with anxiety, depression, obsessive compulsive disorder (OCD) and Tourette syndrome (TS) to inform the development of Canadian standards for mental health care provision. The review was developed using the Cochrane organization's minimum standards for Rapid Reviews.The eligible population was children and youth with anxiety disorders, depressive disorder, OCD, or TS. We included comparative studies published since 2010 evaluating the effect on health outcomes of care delivery strategies for diagnosis, assessment and/or treatment of anxiety, depression, OCD, or TS compared to usual care, sham intervention, or no treatment. Thirty-seven studies were included, with sixteen studies pertaining to anxiety, seven to depression, seven to OCD and seven to TS. While a few studies were published on the use of stepped care models in anxiety, depression and OCD, the majority of research studies published in the past 15 years sought to establish if alternative delivery systems for psychological therapies (i.e. by telephone, videoconference, online with minimal therapist involvement) are superior to waitlist or attention controls, or similar in efficacy to face-to-face delivery across these four conditions. Although data are emerging on the cost-effectiveness of online psychological therapies, the evidence summarized here confirms that online approaches are a possible way of ensuring access to these standards of care in rural and remote communities and increasing accessibility.