Special-needs student’s psychiatric treatment chain:

Abstract

Objectives. The problems of children and adolescents have increased innumber and severity during the last years. The purpose of the study was toexplore the need for, and the utilisation and functionality of, the specializedpsychiatric health care services available to children and adolescentsof comprehensive and senior secondary school age. The main object ofthe study was to describe a special-needs pupil’s psychiatric pathway ofcare, and to evaluate its functionality and the need for multi-professionalco-operation from the perspective of the networked experts and clients.Study design. Qualitative study employing data and methodological triangulation, questionnaires, multiple constituency evaluations and content analysis.Methods. Data were collected from 112 (82 %) comprehensive schools and senior secondary schools, with a total of 18,532 students, in Oulu Province, Finland, during the period 1998 – 2002. Thirty-seven (97 %) special schools had a total of 1276 students. The data for the first and second sub-studies were collected with a questionnaire. The data for the third sub-study were obtained from documents concerning the need for, and the use and functionality of services provided and evaluated by the key groups of actors. The data sets were evaluated using the multiple constituency methods in co-operative evaluation sessions, which were video-taped. The data for the fourth sub-study consisted of tape-recorded interviews of the study subjects. The phenomenon under study was approached from a number of evaluative perspectives, and data and methodological triangulation was used. Multiple constituency evaluation and content analysis were used as research methods.Results. As evaluated by comprehensive school and senior secondary school teachers, both the incidence and the severity of students’ conduct and emotional disorders have increased over the past few years. Special school students with conduct disorders and mental health problems were referred for examinations and treatment into the treatment chain of child and adolescent psychiatry similarly to other school-aged children and adolescents. Special schools had a constant need for child and adolescent psychiatric services, but there were no direct connections with specialized health care. At all schools, efforts were made by teachers and parents to help students with the assistance of school health care and social work professionals. Whenever students failed to get the requisite help from specialized health care, their problems remained the family’s responsibility. The parents in these situations felt that they had been left alone, without understanding what it was all about and without knowing where to go for help. Nevertheless, the data also included many positive experiences of fluent co-operation and easy availability of help for the student. The findings showed that there is a lot of expertise and a sincere desire to work for the benefit of children and adolescents. The lack of coordination of the entire treatment chain did, however, wear down the self-esteem of the students in need of help, as well as the meagre resources of their parents and the help-providing key actors. All stages of research highlighted the evident need for closer co-operation between the key groups of the network responsible for the treatment chain and the need for social work and health care liaison persons, who could be contacted quickly. It was also suggested that the key groups participating in the treatment chain should be provided joint training and mentoring. The outreach outpatient clinic coordinated by the Clinic of Child Psychiatry was considered extremely important, because it provided specialized expertise locally at the municipal level.Conclusions. The major problems in the functionality of the psychiatric treatment chain were the availability of services and the flow of information. The pupils’ coping was impaired by their crumbling self-esteem and the slow provision of help. In spite of the legislation, the rehabilitation of special-need pupils and the collaboration between schools and mental health authorities are not optimal.