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Viksveen P, Bjønness SE, Cardenas NE, Game JR, Berg SH, Salamonsen A, Storm M, Aase K. User involvement in adolescents' mental healthcare: a systematic review. Eur Child Adolesc Psychiatry 2022; 31:1765-1788. [PMID: 34089383 PMCID: PMC9666298 DOI: 10.1007/s00787-021-01818-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022]
Abstract
More than one out of ten adolescents suffer from mental illness at any given time. Still, there is limited knowledge about their involvement in mental healthcare. Adolescents have the right to be involved in decisions affecting their healthcare, but limited research focuses on their engagement and decision-making. Therefore, this systematic review aims to explore the existing experiences with, the effectiveness of, and safety issues associated with user involvement for adolescents' mental healthcare at the individual and organizational level. A systematic literature review on user involvement in adolescents' mental healthcare was carried out. A protocol pre-determined the eligibility criteria and search strategies, and established guidelines were used for data extraction, critical appraisal, and reporting of results. Quantitative studies were analysed individually due to heterogeneity of the studies, while qualitative studies were analysed using thematic synthesis. A total of 31 studies were included in the review. The experiences with user involvement were reported in 24 studies with three themes at the individual level: unilateral clinician control versus collaborative relationship, capacity and support for active involvement, the right to be involved; and two themes at the organizational level: involvement outcomes relevant to adolescents' needs, conditions for optimal involvement. The effectiveness of user involvement was reported in seven studies documenting fragmented evidence related to different support structures to facilitate adolescents' involvement. The safety associated with user involvement was not reported in any studies, yet a few examples related to potential risks associated with involvement of adolescents in decision-making and as consultants were mentioned.
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Affiliation(s)
- Petter Viksveen
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Stig Erlend Bjønness
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Nicole Elizabeth Cardenas
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Julia Rose Game
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Siv Hilde Berg
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Anita Salamonsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North (RKBU North), Faculty of Health Sciences, UiT The Arctic University of Norway, Langnes, P.O. Box 6050, Tromsø, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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Verhage V, Reijneveld SA, Wunderink C, Grietens H, Almansa J, Jansen DEMC. Care improves self-reported daily functioning of adolescents with emotional and behavioural problems. Eur Child Adolesc Psychiatry 2022; 31:1685-1693. [PMID: 34052910 PMCID: PMC9666343 DOI: 10.1007/s00787-021-01812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Abstract
Emotional and behavioural problems (EBP) have a negative impact on various life domains of adolescents. Receiving care for EBP may improve the functioning of adolescents with EBP, but evidence on long-term outcomes in real-life settings is lacking. We, therefore, investigated self-reported functioning in different life domains of adolescents with various EBP, and the role of care during a three-year period. We used data from the TAKECARE study, which consist of a care and community cohort. We followed adolescents aged 12 and over (n = 733) during 3 years over five assessment rounds. Using the Strengths and Difficulties Questionnaire, self-reported functioning was measured in four life domains: home life, friendships, classroom learning and leisure activities. We categorized the respondents into four groups: (1) adolescents without emotional and behavioural problems (n = 298); (2) adolescents with emotional problems (n = 192); (3) adolescents with behavioural problems (n = 80); and (4) adolescents with both emotional and behavioural problems (n = 163). The development of functioning over time was analyzed using longitudinal ordinal (probit) regression analyses. Adolescents with both emotional and behavioural problems reported poorer functioning at baseline in all domains and adolescents who received care reported poorer functioning at baseline compared to adolescents who did not receive care. Regarding the change in functioning during the 3 years, adolescents who received care showed improved functioning in all domains. We found improved functioning after care, even if the problems may not have been solved. Psychosocial care can contribute to the functioning of adolescents with EBP, which can have major effects on their future life.
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Affiliation(s)
- Vera Verhage
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Centre of Expertise Healthy Ageing, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Charlotte Wunderink
- Centre of Expertise Healthy Ageing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Lentis Psychiatric Institute Groningen, Groningen, The Netherlands
| | - Hans Grietens
- Faculty of Psychology and Educational Sciences, Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
| | - Josue Almansa
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Danielle E M C Jansen
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Sociology and Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
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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: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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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Schreiner K, Grossoehme DH, Friebert S, Baker JN, Needle J, Lyon ME. "Living life as if I never had cancer": A study of the meaning of living well in adolescents and young adults who have experienced cancer. Pediatr Blood Cancer 2020; 67:e28599. [PMID: 32686240 PMCID: PMC7719590 DOI: 10.1002/pbc.28599] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cancer diagnoses pose challenges to adolescents' and young adults' (AYA) physical, mental, and emotional health, and developmental tasks. In order for AYAs, caregivers, clinicians, and other collaborators to optimize health outcomes (coproduction of health), understanding what living well means for AYAs who have experienced cancer is necessary. The objective was to develop an empirical definition of "living well" for AYAs who have experienced cancer to broadly understand AYA values and priorities. This definition may ultimately guide future conversations between caregivers and AYAs, eliciting thorough, personal definitions of living well from individual AYAs. Such conversations may enhance AYA participation in coproducing their health. PROCEDURE Qualitative analysis using a phenomenological approach of N = 30 structured Respecting Choices interviews conducted with AYAs (14-21 years; mean 84.2 [SD 69] months postcancer diagnosis with 21% on active treatment) from four tertiary pediatric hospitals in the context of a primary study of a pediatric advance care planning intervention trial. RESULTS AYAs who have experienced cancer conceptualized "living well" as maintaining physical, mental, and emotional health, as well as engaging in purposeful, age-appropriate activities with people important to them. Living well had three components: living mindfully, living an identity as a healthy AYA, and spending time with friends and family. CONCLUSIONS Conversations with AYAs who have experienced cancer elicited rich, complex concepts of "living well." Provider initiation of discussions about living well may facilitate personalized goals of care conversations. This study may serve as the basis to design and prototype future clinical interventions to enhance AYA engagement.
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Affiliation(s)
- Katherine Schreiner
- George Washington School of Medicine and Health Sciences,
Washington, District of Columbia
| | - Daniel H. Grossoehme
- Akron Children’s Hospital, Rebecca D. Considine
Research Institute, Akron, Ohio,Akron Children’s Hospital, Haslinger Family
Pediatric Palliative Care Center, Akron, Ohio,Department of Family and Community Medicine, Northeast Ohio
Medical University, Rootstown, Ohio
| | - Sarah Friebert
- Akron Children’s Hospital, Rebecca D. Considine
Research Institute, Akron, Ohio,Akron Children’s Hospital, Haslinger Family
Pediatric Palliative Care Center, Akron, Ohio
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department
of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jennifer Needle
- Division of Pediatric Critical Care Medicine, University of
Minnesota, Minneapolis, Minnesota
| | - Maureen E. Lyon
- George Washington School of Medicine and Health Sciences,
Washington, District of Columbia,Division of Adolescent and Young Adult Medicine,
Children’s National Hospital, Center for Translational
Research/Children’s National Research Institute, Washington, District of
Columbia
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Beukema L, Reijneveld SA, Jager M, Metselaar J, de Winter AF. The role of functional health literacy in long-term treatment outcomes in psychosocial care for adolescents. Eur Child Adolesc Psychiatry 2020; 29:1547-1554. [PMID: 31925546 PMCID: PMC7595965 DOI: 10.1007/s00787-019-01464-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022]
Abstract
Although among adolescents with psychosocial problems low health literacy may increase the risk of poor treatment outcomes, the contributing mechanisms within treatment remain unclear. A better understanding of these mechanisms could contribute to improved treatment processes and outcomes. This study aims to examine the relationship between functional health literacy, treatment processes (treatment adherence, learning processes), and treatment outcome (level of psychosocial problems) in adolescents in psychosocial care. We used data from a prospective cohort study among adolescents aged 12-18 (N = 390), collected in four successive measurements: at entry into care, and 3, 12, and 24 months thereafter. We used a mixed effect model to investigate the association between level of functional health literacy (adequate vs. inadequate) and treatment processes (treatment adherence, learning processes) and treatment outcome (level of psychosocial problems). Between adolescents with adequate and inadequate functional health literacy, we found no differences or change over time in adherence or learning processes. The level of psychosocial problems significantly declined over time (β = - 1.70, 95% CI [- 2.72, - 0.69], p = .001) to a similar degree in both groups, though, in all measurements, the level was consistently higher for adolescents with inadequate health literacy. We conclude that health literacy levels did not affect change in treatment processes nor in outcomes of psychosocial treatment. However, the consistently higher level of psychosocial problems among adolescents with inadequate health literacy suggests an unaddressed need in psychosocial care.
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Affiliation(s)
- L Beukema
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1/FA10, 9713 AV, Groningen, The Netherlands.
| | - S A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1/FA10, 9713 AV, Groningen, The Netherlands
| | - M Jager
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1/FA10, 9713 AV, Groningen, The Netherlands
| | - J Metselaar
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
| | - A F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1/FA10, 9713 AV, Groningen, The Netherlands
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