Abstract
BackgroundMost psychiatric disorders in childhood and adolescence cause impairment in academic performance. Early interventions in school are thought to reduce the burden of disorder and prevent chronicity of disorder, while a delay in reachable help may result in more severe symptoms upon first time presentation, often then causing upon first-time presentation immediate need of inpatient care.MethodsThe study aims at reducing hospitalization rates and increasing social participation and quality of life among children and adolescents by establishing collaborations between schools, mental health care services and youth welfare services. CCSchool offers children and adolescents, aged six to 18 years, who present with psychiatric problems associated to school problems, a standardized screening and diagnostic procedure as well as treatment in school if necessary. Students can participate in CCSchool in three federal states of Germany if they a) show symptoms vindicating a mental health diagnosis, b) present with confirmed school problems and c) have a level of general functioning below 70 on the children global assessment of Functioning (C-GAF). Intervention takes place in three steps: module A (expected n = 901, according to power calculation) with standardized diagnostic procedures; module B (expected n = 428) implies a school-based assessment followed by a first intervention; module C (expected n = 103) offering school-based interventions with either four to six sessions (basic, 80% of patients) or eight to 12 sessions (intensive, 20% of patients).Primary aim is to evaluate the effectiveness of CCSchool, in reducing the need of hospitalization in children with mental health problems. The analyses will be conducted by an independent institute using mainly data collected from patients and their caregivers during study participation. Additionally, claims data from statutory health insurances will be analysed. Relevant confounders will be controlled in all analyses.DiscussionEvaluation may show if CCSchool can prevent hospitalizations, enhance social participation and improve quality of life of children and adolescents with mental health problems by providing early accessible interventions in the school setting.Trial registrationDeutsches Register Klinischer Studien, Trial registration number: DRKS00014838, registered on 6th of June 2018.
Highlights
Most psychiatric disorders in childhood and adolescence cause impairment in academic performance
Evaluation may show if CCSchool can prevent hospitalizations, enhance social participation and improve quality of life of children and adolescents with mental health problems by providing early accessible interventions in the school setting
It has been shown that mental health problems in children and adolescents subsequently contribute to lower achievements in education but bear an increased rate of health risk behaviour such as self-harm or suicidal behaviour [7] – issues that have a huge impact on later quality of life in adulthood
Summary
Most psychiatric disorders in childhood and adolescence cause impairment in academic performance. More than 50% of these children and adolescents remain mentally impaired in adulthood [3,4,5, 6]. Once a severe mental health disease occurs, it tends to become chronic and may need repeated hospitalizations affecting daily life and social integration. It has been shown that mental health problems in children and adolescents subsequently contribute to lower achievements in education but bear an increased rate of health risk behaviour such as self-harm or suicidal behaviour [7] – issues that have a huge impact on later quality of life in adulthood. Early diagnosis and adequate treatment in childhood mental health disorders are crucial for prevention of future persistence of disease. Children and adolescents often experience considerable barriers accessing mental health services (e.g. lack of knowledge of mental health problems among care givers, difficult referral procedures, long distances and lack of transportation, especially in rural areas) [8, 9]
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