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Quinlan-Davidson M, Roberts KJ, Devakumar D, Sawyer SM, Cortez R, Kiss L. Evaluating quality in adolescent mental health services: a systematic review. BMJ Open 2021; 11:e044929. [PMID: 33972340 PMCID: PMC8112446 DOI: 10.1136/bmjopen-2020-044929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To evaluate the quality of adolescent mental health service provision globally, according to the WHO Global Standards of adolescent mental health literacy, appropriate package of services and provider competencies. DESIGN AND DATA SOURCES Systematic review of 5 databases, and screening of eligible articles, from 1 January 2008 to 31 December 2020. STUDY ELIGIBILITY CRITERIA We focused on quantitative and mixed-method studies that evaluated adolescent mental health literacy, appropriate package of services and provider competencies in mental health services, and that targeted depression, anxiety and post-traumatic stress disorder among adolescents (10-19 years). This included adolescents exposed to interventions or strategies within mental health services. STUDY APPRAISAL AND SYNTHESIS METHODS Study quality was assessed using the National Institutes for Health Study Quality Assessment Tools. Data were extracted and grouped based on WHO quality Standards. RESULTS Of the 20 104 studies identified, 20 articles were included. The majority of studies came from high-income countries, with one from a low-income country. Most of the studies did not conceptualise quality. Results found that an online decision aid was evaluated to increase adolescent mental health literacy. Studies that targeted an appropriate package of services evaluated the quality of engagement between the therapist and adolescent, patient-centred communication, mental health service use, linkages to mental health services, health facility culture and intensive community treatment. Provider competencies focused on studies that evaluated confidence in managing and referring adolescents, collaboration between health facility levels, evidence-based practices and technology use. CONCLUSIONS AND IMPLICATIONS There is limited evidence on quality measures in adolescent mental health services (as conforms to the WHO Global Standards), pointing to a global evidence gap for adolescent mental health services. There are several challenges to overcome, including a need to develop consensus on quality and methods to measure quality in mental health settings. PROSPERO REGISTRATION NUMBER CRD42020161318.
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Affiliation(s)
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital; Murdoch Children's Research Institute; and Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Rafael Cortez
- Health, Nutrition and Population, The World Bank, Washington, District of Columbia, USA
| | - Ligia Kiss
- Institute for Global Health, University College London, London, UK
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Shanmugavadivel D, Liu JF, Murphy L, Wilne S, Walker D. Accelerating diagnosis for childhood brain tumours: an analysis of the HeadSmart UK population data. Arch Dis Child 2020; 105:355-362. [PMID: 31653616 DOI: 10.1136/archdischild-2018-315962] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 07/23/2019] [Accepted: 09/20/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND HeadSmart, a public and professional awareness campaign, was launched to enhance awareness of brain tumour symptomatology identified in the Royal College of Paediatrics and Child Health, National Institute for Health and Care Excellence-accredited guideline. Quality improvement data showed a reduction in diagnostic interval nationally. To reach the government target of 4 weeks, we need to identify subgroups with ongoing delays. METHODS Incident cases of brain tumours (0-18) diagnosed between January 2011 and May 2013 across 18 UK centres were included. Anonymised data including demographics, diagnosis and date of symptom onset/presentation were collected. Key outcome measures, total diagnostic interval (TDI), patient interval (PI) and system interval (SI) were calculated. Subanalysis by age, tumour grade and location was also performed. RESULTS Young children (0-5 years) accounted for 38% of cases, with a peak age at diagnosis of 2 years. Central tumours experienced longest intervals with a median TDI of 10.5 weeks, PI of 3.2 weeks and SI of 2.9 weeks. Craniopharyngioma, low-grade glioma and optic pathway gliomas had the longest TDIs with a median of 15.1, 11.9 and 10.4 weeks, respectively. The greatest proportion of delay was in the SI. The 12-18 age group had a median TDI of 12.1 weeks, compared with 8 weeks for the 5-11 age group and 6 weeks for the 0-5 age group (p<0.001). CONCLUSIONS Clear patterns of intervals for different age groups and anatomical locations have been demonstrated. Tailoring education and awareness strategies to ensure earlier diagnosis for central tumours and young people is crucial to minimise brain injury, subsequent disability and late effects of treatment for 70% of survivors.
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Affiliation(s)
| | - Jo-Fen Liu
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Laura Murphy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Sophie Wilne
- Paediatric Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David Walker
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
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Hawke LD, Mehra K, Settipani C, Relihan J, Darnay K, Chaim G, Henderson J. What makes mental health and substance use services youth friendly? A scoping review of literature. BMC Health Serv Res 2019; 19:257. [PMID: 31029109 PMCID: PMC6486969 DOI: 10.1186/s12913-019-4066-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 04/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are increasing calls to make mental health and substance use services youth friendly, with hopes of improving service uptake, engagement and satisfaction. However, youth-friendliness in this area has not been clearly defined and there is a lack of information about the characteristics that make such services youth friendly. The purpose of this scoping review was to examine the literature available on youth-friendly mental health and substance use services in order to identify the characteristics, outline the expected impacts, and establish a definition. METHODS A scoping review of seven databases and grey literature sources was conducted. Twenty-eight documents were retained as relevant to the research questions. Relevant data from these documents was extracted, analyzed and presented to stakeholders, including youth, caregivers and service providers to validate and refine the results. RESULTS Youth-friendly mental health and substance use services include integrated, inclusive, confidential and safe organization and policy characteristics; bright, comfortable, environment with informational materials; welcoming and genuine service providers with appropriate communication and counselling skills; an accessible location; minimal wait times; and individualized and innovative approaches. All areas in which youth friendliness should be implemented in a mental health and substance use service organization had a core value of youth voice. CONCLUSION Improving the youth friendliness of mental health and substance use services includes incorporating youth voice in organization, policy, environment, service providers, and treatment services, and has implications for treatment uptake, engagement and satisfaction. Further research is required to determine the impact of youth friendliness in such services.
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Affiliation(s)
- Lisa D. Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
- University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
| | - Kamna Mehra
- University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
| | - Cara Settipani
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Jaqueline Relihan
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Karleigh Darnay
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Gloria Chaim
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
- University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
- University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
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Sattoe JNT, Peeters MAC, Hilberink SR, Ista E, van Staa A. Evaluating outpatient transition clinics: a mixed-methods study protocol. BMJ Open 2016; 6:e011926. [PMID: 27566639 PMCID: PMC5013382 DOI: 10.1136/bmjopen-2016-011926] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/13/2016] [Accepted: 07/26/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION To support young people in their transition to adulthood and transfer to adult care, a number of interventions have been developed. One particularly important intervention is the transition clinic (TC), where paediatric and adult providers collaborate. TCs are often advocated as best practices in transition care for young people with chronic conditions, but little is known about TC models and effects. The proposed study aims to gain insight into the added value of a TC compared with usual care (without a TC). METHODS AND ANALYSIS We propose a mixed-methods study with a retrospective controlled design consisting of semistructured interviews among healthcare professionals, observations of consultations with young people, chart reviews of young people transferred 2-4 years prior to data collection and questionnaires among the young people included in the chart reviews. Qualitative data will be analysed through thematic analysis and results will provide insights into structures and daily routines of TCs, and experienced barriers and facilitators in transitional care. Quantitatively, within-group differences on clinical outcomes and healthcare use will be studied over the four measurement moments. Subsequently, comparisons will be made between intervention and control groups on all outcomes at all measurement moments. Primary outcomes are 'no-show after transfer' (process outcome) and 'experiences and satisfaction with the transfer' (patient-reported outcome). Secondary outcomes consider clinical outcomes, healthcare usage, self-management outcomes and perceived quality of care. ETHICS The Medical Ethical Committee of the Erasmus Medical Centre approved the study protocol (MEC-2014-246). DISSEMINATION Study results will be disseminated through peer-reviewed journals and conferences. The study started in September 2014 and will continue until December 2016. The same study design will be used in a national study in 20 diabetes settings (2016-2018).
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Affiliation(s)
- Jane N T Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Mariëlle A C Peeters
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sander R Hilberink
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Erwin Ista
- Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Robinson N, Lorenc A. 'No one wants to be the face of Herpes London': a qualitative study of the challenges of engaging patients and the public in sexual and reproductive health and HIV/AIDS services. Health Expect 2015; 18:221-32. [PMID: 23194419 PMCID: PMC5060775 DOI: 10.1111/hex.12024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore barriers, challenges and best practice within patient and public engagement (PPE) in sexual and reproductive health and HIV (SRHH) services in London. METHODS Consultation exercise using qualitative interviews with 27 stakeholders including commissioners, managers, voluntary/community organizations (VCOs) clinicians and patients, analysed using Framework Analysis and Atlas.ti software. RESULTS Participants recognized PPE's importance, echoing recent political and NHS drives, and highlighted the need for meaningful, empowering PPE, including user-designed methods, peer research and participatory approaches. Although challenging in SRHH and requiring training and support, PPE may help tackle stigma, and promote self-management and patient-centred-care, including peer education and role modelling. Expertise may come from experienced VCOs. Themes in priority order were: organizational commitment (including lack of dedicated staff, time and money); motivating patients; changing NHS philosophy; informing patients/public; using public awareness/education campaigns; overcoming stigma; working with VCOs. 'Reaching out' to engage underrepresented groups in this sensitive area was emphasized through community outreach, incentivization and linking with existing organizations. Making engagement easy and addressing issues of public value were also important. Stigma was less hindering than anticipated, except for ethnic minorities. PPE was seen to improve patient satisfaction, increase service uptake and reduce inequalities, key priorities in SRHH, and identify innovative service delivery ideas. CONCLUSIONS PPE is crucial in creating a patient-led NHS and responsible society. If organizations, including the NHS, commit to implementing meaningful PPE which actively targets those at risk of poor SRHH, services can be truly patient-led and patients and communities empowered to tackle the stigma of SRHH.
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Affiliation(s)
- Nicola Robinson
- Faculty of Health and Social CareLondon South Bank UniversityLondonUK
| | - Ava Lorenc
- Faculty of Health and Social CareLondon South Bank UniversityLondonUK
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Shanmugavadivel D, Sands R, Wood D. Common Presenting Problems for Young People Attending the Emergency Department. ACTA ACUST UNITED AC 2014; 2014:1-5. [DOI: 10.1155/2014/536080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective. To determine the common presenting problems for young people attending the emergency department. Design. A retrospective review of electronic patient records of all young people between the ages of 13 and 17 who attended a UK University Hospital ED between 07/02/2007 and 06/02/2008 (n=10455). Results. All emergency department attendances for young people over a one-year period were studied in order to determine the common presenting problems. There were a total of 10455 attendances by 8303 young people. The presenting problem in 7505 (71.8%) was classified as injury. Of the remainder the commonest presenting problems reported for young people were abdominal pain (480, 16.3%), self-harm (314, 10.6%), fits, faints and funny turns (308, 10.4%), breathing difficulty (213, 7.2%), and intoxication (178, 6.0%). Ten presenting problems accounted for 72% of noninjury related attendances. Conclusions. Clinical guidelines and pathways developed for young people attending the emergency department should target the commonest presenting problems. In our cohort ten presenting problems account for almost three-quarters of all noninjury attendances for young people. The presenting problems are different to those described in younger children in previous studies. These results will inform the development of clinical pathways in order to improve emergency care.
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Abstract
The outcome of transition from paediatric to adult care is often judged by what happens after transfer. Young people at the point of transfer are reported to have low levels of knowledge and independence. These observations could be interpreted in one of two ways: either that the transition process before transfer is inadequate or that the transition process needs to continue into young adulthood and therefore adult care. The second interpretation is further supported by brain development continuing into the third decade. There is also growing evidence for the effectiveness of young adult clinics in the process of transition. To optimise transition, adult physicians need not only to work with paediatricians to achieve continuity during transfer, but also to look critically at their service as to how it can be changed to meet the needs of young people. In addition, they need to develop knowledge, skills and attitudes to communicate effectively and address a young person's developmental and health needs.
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Affiliation(s)
- Jane Roberts
- University of Sunderland, Faculty of Applied Science, Sunderland, UK.
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Affiliation(s)
- Janet E McDonagh
- University of Birmingham & Birmingham Children's Hospital NHS Foundation Trust
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Abstract
In 2011, the Department of Health (England) will publish revised You're Welcome criteria. This is the first comprehensive attempt to define good quality health services for young people (11-19 years) and provide a self-assessment tool applicable to all adolescent health services. It builds on a growing understanding of the distinctiveness and importance of adolescent health, and the demands placed on adolescent health services. This article reviews changing understandings of the nature of adolescence, including physical, psychological and social transition, evolving patterns of morbidity and mortality, adolescence as part of a life-course approach to health and health behaviours, and the specific needs of young people when using health services. We describe key features of the You're Welcome criteria and discuss the views of young people and professionals involved in revising them, as well as relevant published literature. Lastly, we discuss how the perspective of social paediatrics may be useful in guiding professionals towards a more holistic approach to adolescent care in the future.
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Affiliation(s)
- Dougal S Hargreaves
- Institute Child Health, General & Adolescent Paediatrics, London, United Kingdom.
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Cooke J, Alexander K, Charani E, Hand K, Hills T, Howard P, Jamieson C, Lawson W, Richardson J, Wade P. Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals. J Antimicrob Chemother 2010; 65:2669-73. [DOI: 10.1093/jac/dkq367] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Disorder of sex development (DSD) presents a unique challenge, both diagnostically and in terms of acute and longer-term management. These are relatively rare conditions usually requiring a multidisciplinary approach from the outset and the involvement of a tertiary centre for assessment and management recommendations. This article describes the structure of the multidisciplinary team (MDT) at our centre, with contributions from key members of the team regarding their individual roles. The focus is on the newborn referred for assessment of ambiguous genitalia, rather than on individuals who present in the adolescent period or at other times, although the same MDT involvement is likely to be required. The approach to the initial assessment and management is discussed and the subsequent diagnosis and follow-up presented, with emphasis on the importance of careful transition and long-term support.
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Affiliation(s)
- Caroline E. Brain
- Department of Endocrinology, Great Ormond Street Hospital NHS Trust, London WC1N 3JN, UK
| | - Sarah M. Creighton
- Department of Women's Health, University College Hospital, London NW1 2PG, UK
| | - Imran Mushtaq
- Department of Urology, Great Ormond Street Hospital NHS Trust, London WC1N 3JN, UK
| | - Polly A. Carmichael
- Department of Psychology, Great Ormond Street Hospital NHS Trust, London WC1N 3JN, UK
| | - Angela Barnicoat
- Department of Clinical Genetics, Great Ormond Street Hospital NHS Trust, London WC1N 3JN, UK
| | - John W. Honour
- Clinical Biochemistry, University College London Hospital, 60 Whitfield Street, London W1T 4EU, UK
| | - Victor Larcher
- Department of Adolescent Medicine, Great Ormond Street Hospital NHS Trust, London WC1N 3JN, UK
| | - John C. Achermann
- Developmental Endocrinology Research Group, Clinical & Molecular Genetics Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
- Corresponding author. Tel.: +44 20 7905 2887; Fax: +44 20 7404 6191.
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