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Systematic identification and stratification of help-seeking school-aged youth with mental health problems: a novel approach to stage-based stepped-care |
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| Authors: | Wolf Rasmus Trap Puggaard Louise Berg Pedersen Mette Maria Agner Pagsberg Anne Katrine Silverman Wendy K. Correll Christoph U. Plessen Kerstin Jessica Neumer Simon-Peter Gyrd-Hansen Dorte Thastum Mikael Bilenberg Niels Thomsen Per Hove Jeppesen Pia |
| Affiliation: | 1.Child and Adolescent Mental Health Centre, Mental Health Services – Capital Region of Denmark, Copenhagen, Denmark ;2.Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ;3.Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark ;4.Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland ;5.Department for Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Copenhagen, Denmark ;6.University of Southern Denmark, Odense, Denmark ;7.Research Center At Department for Child- and Adolescent Psychiatry, Aarhus University Hospital, Skejby, Denmark ;8.Institute of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark ;9.Centre for the Psychological Treatment of Children and Adolescents, Department of Psychology and Behavioural Sciences, Aarhus BSS, Aarhus University, Aarhus, Denmark ;10.Centre for Child and Adolescent Mental Health, Oslo, Norway ;11.Centre for Child and Youth Mental Health and Child Welfare, The Arctic University of Norway, North Norway (RKBU North), Tromsø, Norway ;12.Anxiety and Mood Disorders Program, Yale Child Study Center, School of Medicine, Yale University, New Haven, CT, USA ;13.Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Hempstead, NY, USA ;14.Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA ;15.Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA ;16.Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany ; |
| Abstract: | We investigated whether a novel visitation model for school-aged youth with mental health problems based on a stage-based stepped-care approach facilitated a systematic identification and stratification process without problems with equity in access. The visitation model was developed within the context of evaluating a new transdiagnostic early treatment for youth with anxiety, depressive symptoms, and/or behavioural problems. The model aimed to identify youth with mental health problems requiring an intervention, and to stratify the youth into three groups with increasing severity of problems. This was accomplished using a two-phase stratification process involving a web-based assessment and a semi-structured psychopathological interview of the youth and parents. To assess problems with inequity in access, individual-level socioeconomic data were obtained from national registers with data on both the youth participating in the visitation and the background population. Altogether, 573 youth and their parents took part in the visitation process. Seventy-five (13%) youth had mental health problems below the intervention threshold, 396 (69%) were deemed eligible for the early treatment, and 52 (9%) had symptoms of severe mental health problems. Fifty (9%) youth were excluded for other reasons. Eighty percent of the 396 youth eligible for early treatment fulfilled criteria of a mental disorder. The severity of mental health problems highlights the urgent need for a systematic approach. Potential problems in reaching youth of less resourceful parents, and older youth were identified. These findings can help ensure that actions are taken to avoid equity problems in future mental health care implementations. |
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