Abstract
Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.
Highlights
Mental health problems are one of the most pressing public health concerns of our time
As part of a national effort to increase the use of evidence-based methods in Child and Adolescents Mental Health Services (CAMHS) in Sweden, national guidelines for the treatment of depression and anxiety disorders (DA guidelines) were presented in 2010 [10]
The informants saw no connection between the guideline recommendations and their own current clinical practice
Summary
Mental health problems are one of the most pressing public health concerns of our time. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. A well-established strategy to support clinicians to translate best research evidence into practice is the production and implementation of Clinical Practice Guidelines (CPGs) [9] As part of a national effort to increase the use of evidence-based methods in Child and Adolescents Mental Health Services (CAMHS) in Sweden, national guidelines for the treatment of depression and anxiety disorders (DA guidelines) were presented in 2010 [10]. The DA guidelines were developed through a standardized procedure described in a previous publication [11] and concluded with recommendations, based on research, for the treatment of depression and anxiety disorders among children, adolescents and adults. National guidelines have been described as a ‘soft governance strategy’ [12]
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