Abstract
There are potent evidence-based psychological treatments for youth with mental health needs, yet they are rarely implemented in clinical practice, especially for youth with mental health disorders in the context of chronic physical illness such as epilepsy. Implementation science, the study of the translation of research into practice, can promote the uptake of existing effective interventions in routine clinical practice and aid the sustainable integration of psychological treatments with routine health care. The aim of this report was to use four implementation science methods to develop a version of an existing effective psychological treatment for mental health disorders [the Modular Approach to Treatment of Children with Anxiety, Depression or Conduct Problems (MATCH-ADTC)] for use within paediatric epilepsy services: (a) literature search; (b) iterative focus groups underpinned by normalisation process theory; (c) Plan–Do–Study–Act methods; and (d) qualitative patient interviews. Findings: Three modifications were deemed necessary to facilitate implementation in children with both mental health disorders and epilepsy. These were (a) a universal brief psychoeducational component addressing the relationship between epilepsy and mental health; (b) supplementary, conditionally activated interventions addressing stigma, parental mental health and the transition to adulthood; and (c) additional training and supervision. The intervention needed relatively little alteration for implementation in paediatric epilepsy services. The modified treatment reflected the scientific literature and the views of clinicians and service users. The multi-method approach used in this report can serve as a model for implementation of evidence-based psychological treatments for children with mental health needs in the context of other chronic illnesses.
Highlights
Epilepsy is one of the most common serious long-term illnesses in young people, with a lifetime prevalence of 1% (Russ et al 2012)
Integration is needed as psychological interventions targeting the enhancement of health-related quality of life, medication adherence and comorbid mental health symptoms have been recommended as part of comprehensive epilepsy care (Michaelis et al 2018)
Four related implementation science methods were used to develop a version of MATCH-ADTC delivered via the telephone for use in children and young people with epilepsy that could be implemented within routine epilepsy
Summary
Epilepsy is one of the most common serious long-term illnesses in young people, with a lifetime prevalence of 1% (Russ et al 2012). An alternative approach is to train existing clinical nurse specialists or neurologists working in epilepsy services with a special interest in mental health to deliver evidence-based psychological interventions This alternative approach has the advantage of the clinician having expertise in both the physical and mental health aspects of epilepsy and truly being able to deliver a patient-centred approach to optimise health outcomes. The modularity offered by MATCHADTC, accompanied by excellent training and patient materials, led us to conduct a preliminary evaluation of MATCHADTC in young people with epilepsy (Bennett et al 2018) This preliminary work indicated that it is feasible to deliver MATCH-ADTC to this population in a self-help format via the telephone (Bennett et al 2018) and highlighted the importance of the intervention being delivered flexibly within epilepsy services using a patient-centred approach. The preliminary work led to important questions about how best to modify and optimise the intervention for children with epilepsy for delivery within epilepsy services by non-mental health specialists
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