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Collaborative care for child and youth mental health problems in a middle-income country: study protocol for a
Vandad Sharifi1, Zahra Shahrivar1, Hadi Zarafshan2
1Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran.
Insights
This study investigates training primary care providers in child mental health. If successful, it supports expanding collaborative care for youth in underserved areas.
Area of Science:
- Global Health
- Child and Adolescent Psychiatry
- Health Services Research
Background:
- Child and youth mental health issues are a significant global burden, particularly in low- and middle-income countries with limited specialized services.
- Collaborative care models can enhance primary care's role in addressing these needs, but child mental health presents unique complexities.
- Existing collaborative care networks for adults offer a foundation for expanding services to youth.
Purpose of the Study:
- To evaluate the effectiveness of training primary care providers in child and youth mental health treatment within an established collaborative care network.
- To determine if enhanced training improves outcomes for children and adolescents receiving care in primary settings.
Main Methods:
- A cluster randomized trial was conducted in Tehran, Iran, utilizing an existing adult collaborative care network.
- General practitioners were randomized to receive either specialized child/youth mental health training or booster training on recognition and referral.
- Children/youth aged 5-15 screened positive on the Strengths and Difficulties Questionnaire were followed for six months.
Main Results:
- The study is designed to compare treatment outcomes between children managed by trained versus control practitioners.
- Data collection focuses on comparing the effectiveness of the two intervention arms.
Conclusions:
- The trial's findings will indicate the feasibility of integrating child and youth mental health care into existing collaborative care frameworks.
- Demonstrating superior outcomes would support the expansion of these models to address the unmet mental health needs of young populations.
Background:
Child and youth mental health problems are leading causes of disability and particular problems in low- and middle-income countries where populations are young and child mental health services are in short supply. Collaborative care models that support primary care providers' efforts to detect and treat child mental health problems offer one way to address this need. However, collaborative care for child mental health can be more complex than collaboration for adults for a number of reasons, including two-generational aspects of care, high degrees of co-morbidity, and variations in presentation across developmental stages.
Methods:
The study takes advantage of an existing collaborative care network in Tehran, Iran, in which general practitioners are supported by community mental health centers to care for adult mental health problems. At present, those practitioners are asked to refer children with mental health problems to the collaborating centers rather than treating them themselves. We are conducting a cluster randomized trial in which practitioners in the network will be randomized to receive training in child/youth mental health treatment or a booster training on recognition and referral. Children/youth aged 5-15 years making visits to the practitioners will be screened using the Strengths and Difficulties Questionnaire; those found positive will be followed for six months to compare outcomes between those treated by trained or control practitioners.
Discussion:
If the trial demonstrates superior outcomes among children treated by trained practitioners, it will support the feasibility of expanding collaborative care networks to include children.
Trial Registration:
ClinicalTrials.gov, NCT03144739 . Registered on 8 May 2017.
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