Abstract
BackgroundChild 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.MethodsThe 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.DiscussionIf 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 registrationClinicalTrials.gov, NCT03144739. Registered on 8 May 2017.
Highlights
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
In a study in the United States, we found that training community-based primary care providers in “common factors” skills impacts children’s outcomes [16, 17]
The specific goal of this study is to conduct a hybrid effectiveness-implementation trial with Tehran University Collaborative Care Program (TUCCP) general practitioners (GPs) focusing on the following questions: 1. Whether care delivered by primary care providers results in improved child and parent mental health outcomes?
Summary
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. To date, most adult and child models for integration of mental health with primary care have targeted a narrow range of conditions at diagnostic levels and relied on additional co-located personnel. While this has demonstrated the feasibility of integration on a limited scale, it stops short of providing a readily disseminated model for broadly addressing child mental health problems, which are often subthreshold, highly co-morbid, and can involve simultaneous treatment of parents [9].
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