Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review

Abstract

BackgroundSome outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics.MethodsSources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes.ResultsWe identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions.ConclusionsSeveral strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy.Trial registrationPROSPERO, CRD42015024759.

Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial

“…Additionally, relative to patients treated in the IAU condition, patients treated in the IAU+P4P condition were significantly more likely to receive an empirically supported level of A-CRA treatment exposure (target A-CRA; odds ratio = 5.19), which was positively associated with post-treatment recovery status (odds ratio = 1.91). According to a recent systematic review of quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents [ 21 ], Garner and colleagues [ 19 ] findings provided “The strongest evidence in the review” for their key question (i.e., What is the effectiveness of quality improvement, implementation, and dissemination strategies).…”

Policy Levers to Promote Access to and Utilization of Children’s Mental Health Services: A Systematic Review

“…Although these outcomes are typically considered process measures in efficacy and effectiveness trials, a recent review identified insufficient evidence for the relationship between interventions to increase utilization (“health service contacts”) and developmental outcomes—suggesting that utilization may not be the only factor influencing whether intended effects are achieved (Hurt et al 2018). Rigorous studies linking policy levers with these outcomes (i.e., implementation research), with particular attention to children could further our ability to lift up the interventions that work (Forman-Hoffman et al 2016; Raghavan et al 2008). …”

“…Previous reviews have examined the relationship between policies and health outcomes, although the focus of these efforts has been broader than mental health (Spencer and Komro 2017); examined policies non-systematically (Gassman-Pines and Hill 2013); looked primarily at adult outcomes (Osypuk et al 2014); or focused only on specific settings of care (Forman-Hoffman et al 2016). In the present study, we expand upon the existing evidence through a systematic review of empirical investigations on the use of policy levers to influence access to, and utilization of, mental health services for children and their families.…”

Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): Study protocol for a cluster randomized comparative effectiveness trial

“…These sample sizes are comparable to other implementation science studies. 66 Data cleaning and missing data. All data will be reviewed for valid values/data entry errors, outliers, and extent and pattern of missing data.…”