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Open Access 01-06-2017 | Original Contribution

Service-level variation, patient-level factors, and treatment outcome in those seen by child mental health services

Authors: Julian Edbrooke-Childs, Amy Macdougall, Daniel Hayes, Jenna Jacob, Miranda Wolpert, Jessica Deighton

Published in: European Child & Adolescent Psychiatry | Issue 6/2017

Abstract

Service comparison is a policy priority but is not without controversy. This paper aims to investigate the amount of service-level variation in outcomes in child mental health, whether it differed when examining outcomes unadjusted vs. adjusted for expected change over time, and which patient-level characteristics were associated with the difference observed between services. Multilevel regressions were used on N = 3256 young people (53% male, mean age 11.33 years) from 13 child mental health services. Outcome was measured using the parent-reported Strengths and Difficulties Questionnaire. The results showed there was 4–5% service-level variation in outcomes. Findings were broadly consistent across unadjusted vs. adjusted outcomes. Young people with autism or infrequent case characteristics (e.g., substance misuse) had greater risk of poor outcomes. Comparison of services with high proportions of young people with autism or infrequent case characteristics requiring specialist input needs particular caution as these young people may be at greater risk of poor outcomes.

There have been recent calls for child mental health services to be structured according to needs-based groupings but they are currently structured according to four Tiers: Tier 1) non-specialist support for common problems of childhood (e.g., sleeping), Tier 2) specialist support provided in primary care settings (e.g., bereavement), Tier 3) specialist multidisciplinary child and adolescent mental health teams based in local clinics dealing with more complex problems (e.g., autism) representing the majority of services in the present research, and Tier 4) specialised day and inpatient units for patients with more severe mental health problems [28].

In the CORC dataset, pseudonymized data are uploaded according to episodes of care. Therefore, it is possible that a young person may have been included under more than one episode of care.

Poor outcome is defined as an increase in mental health difficulties from Time 1 to Time 2.

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Title: Service-level variation, patient-level factors, and treatment outcome in those seen by child mental health services
Authors: Julian Edbrooke-Childs
Amy Macdougall
Daniel Hayes
Jenna Jacob
Miranda Wolpert
Jessica Deighton
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: European Child & Adolescent Psychiatry / Issue 6/2017
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-016-0939-x

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Service-level variation, patient-level factors, and treatment outcome in those seen by child mental health services

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