Abstract
Background11.5 % of girls and 17.8 % of boys are affected by a mental health problem (MHP). The most prevalent problem areas are behavioural problems (girls/boys in %: 11.9/17.9), emotional problems (9.7/8.6) and hyperactivity problems (4.8/10.8). Primary care paediatricians are the first in line to be contacted. Nevertheless, even for less severely affected patients, referral rates to specialised care are constantly high. Therefore, a major statutory health insurance fund introduced a Health Coaching (HC) programme, including a training concept for paediatricians, standardised guidelines for actions and additional payments to strengthen primary care consultation for MHP and to decrease referrals to specialised care. The aim of this study was to examine how the HC is perceived and implemented in daily practice to indicate potential strengths and challenges.MethodsDuring a one-year period starting in November 2017, a series of guideline-based interviews were conducted by phone with HC-developers, HC-qualified paediatricians, parents and patients (≥14 years) treated according to the HC programme. Paediatricians were selected from a Bavarian practice network with a total of 577 HC qualified paediatricians. Parents of patients with the four most common MHP diagnoses were approached by their health insurance: [World Health Organization, 2013] developmental disorder of speech and language [Wille N, et al., 2008] head/abdominal pain (somatoform) [Holling H, et al., 2003-2006 and 2009-2012] conduct disorder [Plass-Christl A, et al., 2018] non-organic enuresis. 23 paediatricians, 314 parents and 10 adolescents consented to be interviewed. Potential participants were selected based on purposeful sampling, according to principles of maximum variance. All interviews were recorded and transcribed verbatim. Two researchers analysed the transcripts independently of each other. Structuring content analysis derived from Mayring was used for analysis.Results11 paediatricians, 3 co-developers, 22 parents and 4 adolescents were included. Families were generally satisfied with paediatric care received in the programme’s context. The HC supported paediatricians’ essential role as consultants and improved their diagnostic skills. Lack of time, financial restrictions and patients’ challenging family structures were reported as major barriers to success.ConclusionThe HC programme is perceived as a facilitator for more patient-centred care. However, structural barriers remain. Starting points for improvement are further options to strengthen families’ resources and expanded interdisciplinary networking.
Highlights
Mental health problems (MHP) of children and adolescents can considerably affect individual health and quality of life as well as performance at school and later professional development [1, 2]
The Health Coaching (HC) programme is perceived as a facilitator for more patient-centred care
Among MHP, developmental disorders (17%), followed by conduct disorders (11%) are the most frequent conditions encountered in paediatric care [10]
Summary
Mental health problems (MHP) of children and adolescents can considerably affect individual health and quality of life as well as performance at school and later professional development [1, 2]. Besides the risk of chronicity, there is the risk of developing comorbidities [3, 4] These conditions can be of economic burden for families and healthcare systems [5,6,7]. MHP are of high public health relevance in all countries of the world [1, 8]. The prevalence of MHP in Germany is high: According to the German Child and Youth Health Survey (KiGGS), around 17 % of children and adolescents aged 3-17 years are affected [9]. It has been reported that appropriate medical care is available to only 30 % of children and adolescents with MHP in Germany [13] and other industrialised countries [14, 15]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
