Long-term effects of a system of care on children and adolescents

Bickman, Leonard; Noser, Kelly; Summerfelt, Wm. Thomas

doi:10.1007/bf02287490

Cited by 202 publications

(95 citation statements)

References 40 publications

(3 reference statements)

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“…Furthermore, increased coordination of care involving different providers are linked to improved outcomes for youth with both general medical and mental health disorders. 35,[83][84][85][86] However, to increase linkages between PCPs and mental health specialists, changes in many existing health care systems need to occur (eg, mental health specialists to set aside time and be reimbursed for brief telephone consultations to PCPs).…”

Section: Discussionmentioning

confidence: 99%

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management

et al. 2007

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OBJECTIVES. To develop clinical practice guidelines to assist primary care clinicians in the management of adolescent depression. This second part of the guidelines addresses treatment and ongoing management of adolescent depression in the primary care setting.METHODS. Using a combination of evidence-and consensus-based methodologies, guidelines were developed in 5 phases as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) revision and iteration among members of the steering committee.RESULTS. These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized.CONCLUSIONS. These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with depression. that up to 9% of teenagers meet criteria for depression at any one time, with as many as 1 in 5 teens having a history of depression at some point during adolescence. [1][2][3][4][5] In primary care (PC) settings, point prevalence rates are likely higher, with rates up to 28%. 6-10 Taken together, epidemiologic and PCspecific studies have suggested that despite relatively high rates, major depressive disorder (MDD) in youth is underidentified and undertreated in PC settings. 11 Because of barriers to adolescents receiving specialty mental health services, only a small percentage of depressed adolescents are treated by mental health professionals. 12 As a result, PC settings have become the de facto mental health clinics for this population, although most PC clinicians feel inadequately trained, supported, or reimbursed for the management of this disorder. [13][14][15][16][17][18] Although MDD management guidelines have been developed for specialty care settings (eg, see the American Academy of Child and Adolescent Psychiatry [AACAP] practice parameters 19 ) or for related problems such as suicidal ideation or attempts, 2...

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Section: Discussionmentioning

confidence: 99%

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management

et al. 2007

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“…Several large studies conducted in the 1990s suggest that coordination and the development of systems of care alone are not associated with major improvements in mental health outcomes for most children. 44 In some settings, coordination of care may even lead to diffusion of responsibility and inferior results. 45 These studies suggest that what is being coordinated is more important than the coordination itself.…”

Section: Policy For Systems Of Carementioning

confidence: 99%

Trends And Issues In Child And Adolescent Mental Health

Glied¹,

Cuellar²

2003

Health Affairs

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“…Unfortunately, outcome data on the effectiveness of community-based psychotherapeutic care are discouraging (2)(3)(4), and virtually nothing is known about what types of psychotherapeutic care are delivered in usual care (UC) settings, making it difficult to know how to target care improvement (5)(6)(7). National research and policy initiatives call for dissemination and implementation of evidence-based (EB) practices in UC (8).…”

Section: Introductionmentioning

confidence: 99%

“…On average, findings regarding the effectiveness of UC youth psychotherapy reflect minimal impact on children's symptom severity or functional status (2)(3)(4). However, none of these studies included detailed descriptive data about the nature of the UC treatment; therefore, attributions regarding the links between UC treatment processes and outcomes are largely speculative.…”

Section: Introductionmentioning

confidence: 99%

Mental Health Care for Children With Disruptive Behavior Problems: A View Inside Therapists' Offices

Garland¹,

Brookman‐Frazee²,

Hurlburt³

et al. 2010

Psychiatric Services

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Objectives-In the United States, more money is spent on treatment for children's mental health problems than for any other childhood medical condition, yet little is known about usual care (UC) treatment for children. Objectives of this study were to a) characterize UC out-patient psychotherapy for children with disruptive behavior problems, and b) identify consistencies and inconsistencies between UC and common elements of evidence-based practices to inform efforts to implement evidence-based practices in UC.Methods-Participants included 96 psychotherapists and 191 children ages 4-13 presenting for treatment for disruptive behavior to one of six UC clinics. An adapted version of the Therapy Process Observational Coding System for Child Psychotherapy -Strategies scale (TPOCS-S) was used to assess psychotherapy processes in 1215 randomly selected (out of 3241 collected) videotaped treatment sessions for up to 16 months.Results-Most children received a lot of treatment (mean number of sessions=22, plus other auxiliary services), and there was great variability in amount and type of care received. Therapists employed a wide array of treatment strategies directed to children and parents within and across sessions, but all strategies were delivered at low average intensity. Several strategies conceptually consistent with evidence-based practices were observed frequently (e.g., affect education, positive reinforcement); however, others were observed rarely (e.g., assigning/reviewing homework, roleplaying).Conclusion-UC treatment for these youths reflected great breadth but not depth. The results highlight specific discrepancies between evidence-based care and UC, thus identifying potentially potent targets for improving the effectiveness of UC.

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Long-term effects of a system of care on children and adolescents

Cited by 202 publications

References 40 publications

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management

Trends And Issues In Child And Adolescent Mental Health

Mental Health Care for Children With Disruptive Behavior Problems: A View Inside Therapists' Offices

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