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Quality standards for child and adolescent mental health in primary care
Kapil Sayal1, Myanthi Amarasinghe, Sarah Robotham
1Section of Developmental Psychiatry, University of Nottingham, Nottingham, UK. Kapil.Sayal@nottingham.ac.uk
Insights
Developing quality standards for child and adolescent mental health in primary care is feasible. Parental perspectives are crucial for improving care and influencing help-seeking behaviors in pediatric mental healthcare.
Area of Science:
- Pediatric Mental Health
- Primary Healthcare Research
- Quality Improvement in Healthcare
Background:
- Child and adolescent mental health issues are prevalent in primary care.
- Parents often underreport concerns regarding their child's mental health during consultations.
- Understanding parental views is key to enhancing mental healthcare quality.
Purpose of the Study:
- To develop quality of care measures for child and adolescent mental health in primary care settings.
- To achieve consensus on the importance of these quality standards among stakeholders.
- To incorporate parental perspectives into pediatric mental healthcare standards.
Main Methods:
- An iterative approach was used, including focus groups with parents.
- Preliminary quality standards were refined through expert and parent nominal groups.
- A modified Delphi study with 55 experts and piloting with 52 parents informed the final standards.
Main Results:
- Ten essential Quality Standards for child and adolescent mental health in primary care were identified and agreed upon by all expert panels.
- Key domains included access, confidentiality, practitioner knowledge, communication, continuity of care, and referral processes.
- Parents participating in the pilot study confirmed the importance of all ten quality standards.
Conclusions:
- Developing and implementing Quality Standards for pediatric mental healthcare in primary care is achievable.
- Primary care practitioners must consider parental perspectives to improve care and encourage help-seeking.
- These standards can guide improvements in child and adolescent mental healthcare delivery.
Background:
Child and adolescent mental health problems are common in primary healthcare settings. However, few parents of children with mental health problems express concerns about these problems during consultations. Based on parental views, we aimed to create quality of care measures for child and adolescent mental health in primary care and develop consensus about the importance of these quality standards within primary care.
Methods:
Quality Standards were developed using an iterative approach involving four phases: 1) 34 parents with concerns about their child's emotional health or behaviour were recruited from a range of community settings including primary care practices to participate in focus group discussions, followed by validation groups or interviews. 2) Preliminary Quality Standards were generated that fully represented the parents' experiences and were refined following feedback from an expert parent nominal group. 3) 55 experts, including parents and representatives from voluntary organisations, across five panels participated in a modified two-stage Delphi study to develop consensus on the importance of the Quality Standards. The panels comprised general practitioners, other community-based professionals, child and adolescent psychiatrists, other child and adolescent mental health professionals and public health and policy specialists. 4) The final set of Quality Standards was piloted with 52 parents in primary care.
Results:
In the Delphi process, all five panels agreed that 10 of 31 Quality Standards were important. Although four panels rated 25-27 statements as important, the general practitioner panel rated 12 as important. The final 10 Quality Standards reflected healthcare domains involving access, confidentiality for young people, practitioner knowledge, communication, continuity of care, and referral to other services. Parents in primary care agreed that all 10 statements were important.
Conclusions:
It is feasible to develop a set of Quality Standards to assess mental healthcare provision for children and adolescents seen within primary healthcare services. Primary care practitioners should be aware of parental perspectives about quality of care as these may influence help-seeking behaviours.
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