Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Abstract

BackgroundThe mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health.ObjectivesTo identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision.DesignTwo inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study.SettingGlobal (systematic reviews); England and Wales (mapping exercise and case study).Participants (case study)Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites.Main outcome measures (meta-analysis)A measure of CYP’s mental health symptomatology.Data sources (literature reviews)MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC).Review methodsTitles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review.ResultsSixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support.ConclusionsMental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes.Future workFuture work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness.Study registrationPROSPERO number (for the effectiveness review) CRD42012001981.FundingThe NIHR Health Services and Delivery Research programme.

Self-care of young people with long-term physical and mental health conditions

“…This will be based on two studies that we have conducted that involved systematic reviews and empirical research (Kendal et al 2016;Kirk and Milnes, 2015;Kirk et al 2010;, 2013Pryjmachuk et al 2014). In this paper we summarise and synthesise the findings from these studies.…”

“…self regulation theory, social learning theory)  Aims  Target (children/young people only, parents only, children/young people and parents; family including siblings; professionals)  Location (home/community, hospital, school, combination of locations)  Leadership/facilitation (lay or professional)  Mode of delivery (e.g. face-to-face, virtual, individual child/family, group-based)  Focus (condition-specific or generic) Our reviews found that there is evidence that self-care interventions can improve a range of outcomes (Kirk et al 2010(Kirk et al , 2013Pryjmachuk et al 2014). They can improve children's health in relation to areas such as lung function, glycaemic control and mental health symptoms (e.g.…”

“…A body of research has examined what influences self-care/self-management and identified self-care/self-management activities and their underpinning behaviours (Figures 1 and 2). In mental health research and practice the terms 'self-care' and 'self-management' have been used less frequently although 'recovery' (Gillard et al 2010;Brooks, Davidson) and 'self-help' (Pryjmachuk et al 2014) can be seen as analogous approaches. Recovery similarly emphasises positive health and wellbeing, social networks, empowerment, partnership working and encourages a focus on strengths, positive coping and resilience (Gillard et al 2010;Leamy et al 2011;.…”

“…Details on the individual self-care interventions evaluated in the reviews are presented in Kirk et al (2010Kirk et al ( , 2013 and Pryjmachuk et al (2014). Interventions varied in relation to their:  Theoretical basis (e.g.…”

“…Our two systematic reviews evaluated self-care support interventions for children and young people with long-term physical and mental health conditions (Kirk et al 2010(Kirk et al , 2013Pryjmachuk et al 2014). They looked at the available international evidence from quantitative and qualitative studies with the aim of identifying what was effective in improving outcomes and their acceptability to children/young people, parents and health care professionals.…”