Care needs of children and adolescents in psychiatry: steps towards personalized mental healthcare

This dissertation had a twofold aim. The first was to generate greater knowledge about outpatients who are referred to more intensive mental healthcare in the form of Youth ACT. The second was to generate knowledge of the care needs of children and adolescents with mental health problems, such that mental healthcare could be better tailored to these needs. The motivation for the thesis was rooted in daily clinical practice, and the rationale for the research project lay in the following: (i) indications that, due to high rates of non-compliance, non-attendance at appointments, or drop-out, many patients referred to child and adolescent psychiatry are undertreated; (ii) the assumption that such non-compliance, non-attendance, or drop-out can be explained, at least in part, by the limited attention paid to the broad range of patients’ met and unmet care needs; and (iii) our identification of knowledge gaps with respect to these patients’ met and unmet care needs – needs that must be addressed if patients are to receive more personalized care, if adherence to treatment is to be optimized, and, ultimately, if better treatment outcomes are to be attained. To gain a comprehensive overview of these care needs, we examined children’s and adolescents’ perceptions of their care needs, and also the perceptions of their mental health professionals. In Chapter 2 of this thesis, we will describe the design and results of a systematic PRISMA review on youth ACT. In this review, the results of the existing studies are summarized with respect to the effects of Youth ACT on severity of psychiatric symptoms, general functioning, and frequency and duration of psychiatric hospital admissions. In Chapter 3, we will describe a cross-sectional study that investigated the patient, family and contextual variables that are associated with treatment intensification from regular outpatient care to Youth ACT. In Chapter 4, we will zoom in on the unmet care needs in children and adolescents with ADHD, in general outpatient clinics compared with those receiving Youth ACT. In Chapter 5, we will examine the extent to which children and adolescents agree or disagree with care providers on the broad range of met and unmet care needs. In Chapter 6, we describe the factors that are associated with concordance on needs for care between patients and mental healthcare providers in child and adolescent psychiatry. Finally, Chapter 7 provides a summary and a general discussion in which the main findings, methodological issues, and the implications for clinical practice and research are discussed.