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Evaluation of practice nurses' management of paediatric psychosocial problems in general practice
Lukas B M Koet1, Heike Gerger1,2, Wilma Jansen3,4
1Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands.
Insights
Youth Mental Health Practice Nurses (YMHPNs) successfully managed one in four children with psychosocial issues without referral. However, most children required further specialized care, highlighting ongoing challenges in child mental health access.
Area of Science:
- Pediatrics
- Mental Health Services Research
- Primary Care
Background:
- Global child mental health services face significant pressure.
- Youth Mental Health Practice Nurses (YMHPNs) were implemented in Dutch general practices to enhance care accessibility.
- This study evaluates the effectiveness of care provided by YMHPNs.
Purpose of the Study:
- To assess the role and outcomes of Youth Mental Health Practice Nurses in primary care settings.
- To analyze the types of psychosocial problems managed by YMHPNs and their referral patterns.
- To evaluate the success rate of YMHPNs in managing child mental health concerns without external referrals.
Main Methods:
- A quantitative content analysis of medical records from a population-based cohort of 21,717 children (0-17 years).
- Inclusion of 375 children's records who consulted a YMHPN, detailing problem types, care provided, and referral outcomes.
- Assessment of patient demographics, consultation frequency, and treatment trajectories.
Main Results:
- The study analyzed records of 375 children, with a mean age of 12.9 years, predominantly female (59.2%).
- YMHPNs managed diverse psychosocial problems, with 22.4% of children not requiring referral.
- Over half (52.0%) were referred for additional care, and 13.3% dropped out; treatment was inconclusive or ongoing for 12.3%.
Conclusions:
- YMHPNs effectively managed approximately one in four children with psychosocial problems independently.
- Despite YMHPNs' contributions, the majority of children ultimately required referral for specialized mental health services.
- The findings indicate a continued need for integrated and accessible child mental health support within primary care.
Background:
Child mental health services are under major pressure worldwide. In the Netherlands, Youth Mental Health Practice Nurses (YMHPNs) have been introduced in general practice to improve access to care. In this study, we evaluated care delivered by YMHPNs.
Methods:
We used medical records of a population-based cohort (21 717 children, 0-17 years). Characteristics of children consulting a YMHPN, type of problem, care delivered by YMHPNs and referrals were assessed using quantitative content analysis.
Results:
Records of 375 children (mean age 12.9 years, 59.2% girl) were analysed. These children were often in their adolescence (57.3% was between 13 and 17 years), and more often female than male (59.2% vs 40.8%). YMHPNs had a median of four consultations (IQR 2-7) with the child. YMHPNs managed a variety of psychosocial problems. YMHPNs managed 22.4% of children without need of referral, 52.0% were eventually referred for additional care. 13.3% of children dropped out during the treatment trajectory. In the remaining 12.3% of children, the treatment trajectory was stopped because the child was already attending specialized services, the treatment trajectory was still ongoing or the medical record was inconclusive.
Conclusions:
YMHPNs successfully managed one in four children with psychosocial problems without need for referral. Nevertheless, most children were eventually referred for additional care.
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