Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.

Needs and resource assessment processes confirmed the magnitude of need, but also suggested the creative re-allocation of local resources. Young people provided invaluable guidance for system design. Creating and sustaining a culture of innovation at each site was challenging, requiring leadership and continuous dialogue.

Timely prevalence data of psychiatric morbidity among adolescents in small areas remains vital for mental health policy planning at the regional and local levels. Furthermore, effective regional policy planning also requires the measurement of psychiatric morbidity using clinically validated instruments. The K6 scale was therefore included on the 2012 administration of the Kentucky Incentives for Prevention Survey as a measure of serious emotional disturbance in the past 30 days. Principal axis and confirmatory factor analyses were performed to determine the unidimensional structure of the K6 in a school-based sample of Kentucky students (n = 108,736). The documented cutoff of 13 on the K6 was then used to screen Kentucky students for serious emotional disturbance, estimate the state prevalence, and define epidemiologic correlates. Overall, the K6 performed well, with factor analyses confirming the 1-factor solution of the K6. Based upon the established cutoff, the prevalence of serious emotional disturbance was 13.9% in Kentucky. Grade, gender, race and ethnicity, and family structure emerged as significant predictors in a multivariable logistic regression model. Substance abuse, antisocial behavior, role impairments, and peer victimization were significantly higher among students with a positive screen. These results indicate the K6 is particularly useful for inclusion in large epidemiologic surveys that have limited space and logistics that demand timely administration.

Effective change initiatives require vision and leadership, competence- and capacity-building, participative planning and engagement, adequate and thoughtfully deployed resources, and a comprehensive change management approach.