CCSchool: a multicentre, prospective study on improving continuum of care in children and adolescents with mental health problems associated with school problems in Germany

How to improve the system of care for adolescents with emotional and behavioural problems from the perspective of care providers: a concept mapping approach

BACKGROUND

Emotional and behavioural problems (EBP) are the most common mental health issues during adolescence, and their incidence has increased in recent years. The system of care for adolescents with EBP is known to have several problems, making the provision of care less than optimal, and attention needs to be given to potential improvements. We, therefore, aimed to examine what needs to be done to improve the system of care for adolescents with EBP and to assess the urgency and feasibility of the proposed measures from the perspective of care providers.

METHODS

We used Concept mapping, a participatory mixed-method research, based on qualitative data collection and quantitative data analysis. A total of 33 stakeholders from 17 institutions participated in our study, including psychologists, pedagogues for children with special needs, teachers, educational counsellors, social workers and child psychiatrists.

RESULTS

Respondents identified 43 ideas for improving of the system of care for adolescents with EBP grouped into 5 clusters related to increasing the competencies of care providers, changes at schools and school systems, support for existing services, transparency of the care system in institutions and public administration, and the adjustment of legislative conditions. The most urgent and feasible proposals were related to the support of awareness-raising activities on the topic of EBP, the creation of effective screening tools for the identification of EBP in adolescents, strengthening the role of parents in the process of care, comprehensive work with the family, creation of multidisciplinary support teams and intersectoral cooperation.

CONCLUSIONS

Measures which are more accessible and responsive to the pitfalls of the care system, together with those strengthening the role of families and schools, have greater potential for improvements which are in favour of adolescents with EBP. Care providers should be invited more often and much more involved in the discussion and the co-creation of measures to improve the system of care for adolescents with EBP.

[Inpatient care in child and adolescent psychiatry-Who gets treatment?]

BACKGROUND AND RESEARCH QUESTION

This article presents and analyses the landscape for inpatient child and adolescent psychiatric care in Austria and examines current data from June 2022.

METHOD

In June 2022, the authors surveyed the current status of child and adolescent psychiatric primary care in Austria. Both systemised beds and day hospital beds as well as the number of specialists and assistant doctors were taken into account.

RESULTS

A bed index of 0.05 beds/1000 inhabitants (as of 6/2022) was calculated, which is below the guideline for beds needed and does not correspond with the need depicted for sufficient provision of care ("Österreichischer Strukturplan Gesundheit"). Moreover, in June 2022, 40 beds had to be closed due to staff shortages and 26.5 training positions were vacant across Austria.

DISCUSSION AND CONCLUSIONS

Even though the training ratio was raised to 1:2 as of 07.02.2022 within the framework of the "Mangelfachverordnung" for a limited period of time until 31.05.2027, it is hardly possible to guarantee sufficient mental health care according to the increased demand for child and adolescent psychiatry, especially in times of the pandemic. Measures need to be urgently taken to improve child and adolescent psychiatric treatment options. In order to ensure adequate care for the increasing number of mentally ill children and adolescents (a) the number of beds must be increased, (b) structural deficits have to improve, and (c) innovative treatment options in the sense of inpatient-equivalent treatment (home treatment) has to be considered.

Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study

BACKGROUND

Mental health disorders are a problem that affects patients, their families, and the professionals who treat them. Hospital admissions play an important role in caring for people with these diseases due to their effect on quality of life and the high associated costs. In Spain, at the Healthcare Complex of Zamora, a new disease management model is being implemented, consisting of not admitting patients with mental diseases to the hospital. Instead, they are supervised in sheltered apartments or centers for patients with these types of disorders.

OBJECTIVE

The main goal of this research is to evaluate the evolution of hospital days of stay of patients with mental disorders in different hospitals in a region of Spain, to analyze the impact of the new hospital management model.

METHODS

For the development of this study, a database of patients with mental disorders was used, taking into account the acute inpatient psychiatry unit of 11 hospitals in a region of Spain. SPSS Statistics for Windows, version 23.0 (IBM Corp), was used to calculate statistical values related to hospital days of stay of patients. The data included are from the periods of 2005-2011 and 2012-2015.

RESULTS

After analyzing the results, regarding the days of stay in the different health care complexes for the period between 2005 and 2015, we observed that since 2012 at the Healthcare Complex of Zamora, the total number of days of stay were reduced by 64.69%. This trend is due to the implementation of a new hospital management model in this health complex.

CONCLUSIONS

With the application of a new hospital management model at the Healthcare Complex of Zamora, the number of days of stay of patients with mental diseases as well as the associated hospital costs were considerably reduced.

Erfahrungen der Stakeholder mit den Modellvorhaben nach § 64b SGB V in der Kinder- und Jugendpsychiatrie und -psychotherapie – eine qualitative Studie

Zusammenfassung. Hintergrund und Fragestellung: Seit 2013 sind in Deutschland die Möglichkeiten für eine integrative Behandlungsform gemäß § 64b SGB (Sozialgesetzbuch) V erweitert worden. Diese sogenannte psychiatrische Modellversorgung (MV) ist in den letzten Jahren sowohl an einzelnen Kliniken der Erwachsenen- als auch der Kinder- und Jugendpsychiatrie und -psychotherapie (KJPP) eingeführt worden. Ziel der MV ist es, eine ambulante, individualisierte und kontinuierliche Behandlung anzubieten. In der vorliegenden Arbeit werden die Erfahrungen der Stakeholder mit dieser innovativen Behandlungsform untersucht. Methodik: An zwei kinder- und jugendpsychiatrischen Kliniken der MV wurden Fokusgruppen durchgeführt, an denen Mitarbeitende, Patientinnen und Patienten sowie Eltern (N = 36) teilnahmen. Es folgte eine qualitativ-inhaltsanalytische Auswertung. Ergebnisse: Aus Sicht aller Akteurinnen und Akteure bildet die ambulante Akut Behandlung (AAB) einen zentralen Modellbestandteil, die eine Behandlung von Patientinnen und Patienten mit akuten Beschwerden im Vorfeld, als Ersatz oder im Nachgang einer (teil)stationären Behandlung ermöglicht. Die Flexibilisierung der Behandlung und eine größere Behandlungs- und Behandlerkontinuität wurden als weitere Vorteile der MV genannt. Schließlich gelingt der Einbezug von Sorgeberechtigten im Rahmen der MV leichter, was für diese Akteursgruppe auch einige Herausforderungen mit sich bringt. Schlussfolgerungen: Die Einführung psychiatrischer MV in der KJPP hat komplexe Auswirkungen auf die Behandlungsabläufe und das Erleben aller beteiligten Akteurinnen und Akteure und wird von diesen als bedürfnisorientierte Ausweitung therapeutischer Unterstützungsmöglichkeiten erlebt.

Schnittstellenkoordination von systemübergreifenden Hilfen für Kinder und Jugendliche mit psychischen Beeinträchtigungen

Zusammenfassung. Schnittstellen zwischen psychosozialen Hilfesystemen stellen Sollbruchstellen einer gelingenden systemübergreifenden Behandlung psychisch erkrankter Kinder/Jugendlicher dar. Daten zu Schnittstellenmanagement in Deutschland liegen bisher nicht vor. Ziel der Studie ASpeKT war es, zu vier Zeitpunkten (T1 Aufnahme, T2 Entlassung, T3 6 Mo und T4 12 Mo nach Entlassung) den Ist-Stand von installierten Hilfen bei psychisch erkrankten Kindern und Jugendlichen ( n=191) zu erheben, Patientenzufriedenheit zu evaluieren sowie dies an zwei, strukturell unterschiedlichen Standorten (Klinik A/Klinik B) zu vergleichen. Zu T2 erhielten 13 % der Patienten keine Hilfen. 43,6 % (A) bzw. 70,4 % (B) erhielten Psychotherapie (PT), 67,3 % (A) bzw. 80,3 % (B) Jugendhilfemaßnahmen (JH), 37,6 % (A) bzw. 16.9 % (B) schulische Unterstützung. Gute Schnittstellenkoordination ist prognostisch essentiell, um den meist noch komplexen Hilfebedarf psychisch erkrankter Kinder/Jugendlicher nach stationärer Behandlung abzubilden.