5至25岁儿童和年轻人的心理健康危机护理:CAMH危机证据综合

N. Evans, D. Edwards, Judith Carrier, Mair Elliott, Elizabeth Gillen, B. Hannigan, Rhiannon Lane, Liz Williams
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引用次数: 0

摘要

儿童和年轻人的心理健康保健日益受到关注,在英格兰,每六个5-19岁的儿童中就有一个可能被诊断患有精神障碍。众所周知,对处于危机中的儿童和青年的照顾是由多个机构采用一系列方法提供的。本研究的审查目标是批判性地评价、综合和提出与面向5-25岁儿童和年轻人的危机服务有关的现有最佳国际证据,具体考察教育、卫生、社会关怀和第三部门的危机服务组织情况,以及年轻人、家庭和工作人员的经验和看法,以确定当前模式的有效性和危机干预目标。寻求了1995年1月至2021年1月期间与向5-25岁儿童和青年提供和接受危机支助有关的所有相关英文国际证据。在17个数据库中进行了综合检索,并进行了补充检索以确定灰色文献。两名团队成员使用关键评估清单评估所有检索到的研究报告(灰色文献除外)。对每个目标都进行了单独的分析。对研究结果的信心通过建议分级评估、发展和评估以及对定性研究方法综述证据的信心进行评估。138份报告被用来为这一证据综合提供信息,包括39份危机服务组织的描述性报告(36份报告),42份研究报告(48份报告)和54份灰色文献文件。危机服务的组织分类如下:仅分类/评估、数字媒介支持方法、干预方法和模型。在观察危机护理的经验时,确定了以下四个主题:(1)寻求和获得适当支持的障碍和促进因素;(2)儿童和青少年希望从危机服务中得到什么;(3)儿童、青少年和家庭的危机服务经历;(4)提供服务。在确定有效性时,调查结果按服务类型进行总结,并从单一的异质性研究中得出。危机服务的目标应该是(1)将儿童和青少年留在他们的家庭环境中,作为入院的另一种选择;(2)评估需求和计划;(3)提高儿童和青少年和/或其家庭对社区治疗的参与;(4)必要时为儿童和青少年和/或其家庭提供额外的精神卫生服务;(5)提供同伴支持;(6)在近期内稳定和管理当前的危机;(7)培训和/或监督员工。本综述的主要局限性是大部分文献来自美国。由于美国和英国在委托和提供服务方面的差异,在美国运作的危机护理方法可能并不直接适用于英国。由于本证据综合中只有三项研究在英国完成,因此有一个明确的案例存在于委托新的高质量研究中,以产生有关在英国运作的危机护理方法的有效性和可接受性的知识。规划了未来在这方面的实证研究。本研究注册号为PROSPERO CRD42019160134。该项目由国家卫生和保健研究所(NIHR)卫生和社会保健提供研究方案资助,将全文发表在《卫生和社会保健提供研究》上;第11卷第3期请参阅NIHR期刊图书馆网站了解更多项目信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mental health crisis care for children and young people aged 5 to 25 years: the CAMH-Crisis evidence synthesis
Mental health care for children and young people is a rising concern, with one in six children aged 5–19 years in England having a probable diagnosable mental disorder. Care for children and young people in crisis is known to be delivered by multiple agencies using a range of approaches. The review objectives of this study were to critically appraise, synthesise and present the best-available international evidence related to crisis services for children and young people aged 5–25 years, specifically looking at the organisation of crisis services across education, health, social care and the third sector, and the experiences and perceptions of young people, families and staff, to determine the effectiveness of current models and the goals of crisis intervention. All relevant English-language international evidence specifically relating to the provision and receipt of crisis support for children and young people aged 5–25 years, from January 1995 to January 2021, was sought. Comprehensive searches were conducted across 17 databases and supplementary searching was undertaken to identify grey literature. Two team members appraised all the retrieved research reports (except grey literature) using critical appraisal checklists. A separate analysis was conducted for each objective. Confidence in research findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation and the Confidence in the Evidence from Reviews of Qualitative research approaches. One hundred and thirty-eight reports were used to inform this evidence synthesis, including 39 descriptive accounts of the organisation of crisis services (across 36 reports), 42 research studies (across 48 reports) and 54 grey literature documents. The organisation of crisis services has been categorised as follows: triage/assessment only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, the following four themes were identified: (1) barriers to and facilitators of seeking and accessing appropriate support; (2) what children and young people want from crisis services; (3) children’s, young people’s and families’ experiences of crisis services; and (4) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of a crisis service should be to (1) keep children and young people in their home environment as an alternative to admission; (2) assess need and plan; (3) improve children’s and young people’s and/or their families’ engagement with community treatment; (4) link children and young people and/or their families to additional mental health services, as necessary; (5) provide peer support; (6) stabilise and manage the present crisis over the immediate period; and (7) train and/or supervise staff. The key limitation of this review was that much of the literature was drawn from the USA. Owing to the differences between USA and UK in terms of commissioning and delivering services, approaches to crisis care operating in the USA may not be directly applicable to the UK. As only three research studies included in this evidence synthesis had been completed in the UK, a clear case exists for the commissioning of new high-quality studies to generate knowledge about the efficacy and acceptability of crisis care approaches operating in the UK. Future empirical research in this area is planned. This study is registered as PROSPERO CRD42019160134. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information.
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