The following is a summary of “Effect of General Practitioner Training in a Collaborative Child Mental Health Care Program on Children’s Mental Health Outcomes in a Low-Resource Setting,” published in the November 2022 issue of Psychiatry by Sharifi, et al.
Particularly in low- and middle-income nations, where generalists frequently offer mental health treatment, integrated care for children is infrequently investigated. For a study, researchers sought to investigate how adding a child and youth component to an adult collaborative care program might affect treatment results and use.
The randomized cluster study was carried out in Tehran, Iran, as part of an adult collaborative care initiative. Patients aged 5 to 15, their parents, and general practitioners (GPs) were all included. Children and adolescents who attended normal medical appointments and had a Strengths and Difficulties Questionnaire (SDQ) score above the cutoff were tracked for 6 months. The research was carried out between May 2018 and October 2019, and the analysis was done between March 2020 and August 2021. GPs were randomly assigned to receive either a 2.5-day intervention on managing common child mental health issues or a refresher course on recognition and referral (control). Change in SDQ total difficulties score was the primary goal; secondary outcomes included GPs discussing psychosocial concerns and receiving mental health care throughout the follow-up period.
About 389 children with scores over the SDQ criteria were treated by 49 GPs (216 children in the intervention group, and 173 in the control group). 182 (47%) of the patients were female, with a mean (SD) age of 8.9 (2.9) years (range, 5 to 15 years). At six months, the intervention group’s children had higher odds of receiving mental health treatment throughout the study (odds ratio [OR], 3.0; 95% CI, 1.1 to 7.7), parents were more likely to report that intervention GPs had discussed parent (OR, 2.1; 95% Cl, 1.1 to 3.8) and child (OR, 2.0; 95% CI, 0.9 to 4.8) psychosocial issues, and intervention GPs were more likely to report having offered counseling (OR, 1.8; 95% Cl, 1.02 to 3.3). However, the SDQ scores of children visited by intervention GPs did not improve more than those of the control GPs. At the 3- and 6-month follow-up points, there was no significant time-treatment interaction after adjusting for clustering within GP, the variables used for balanced allocation (practice size, practice ownership, and study wave), and the other variables linked to change in SDQ scores over time (linear combination of coefficients for intervention, 0.57 [95% CI, –1.07 to 2.22] and –0.08 [95%CI, –1.76 to 1.56], respectively). Children treated by intervention GPs improved considerably more (–3.6 points; 95% CI, –6.7 to –0.46 points; effect size d = 0.66; 95% CI, 0.30 to 1.01) than those seen by control GPs in a subset of GPs with practices including 50% or more children.
The management of prevalent pediatric mental health issues did not significantly improve child SDQ scores in this randomized cluster trial. For GPs to employ brief training in a way that enhances child outcomes, prior experience dealing with children and their families may be necessary. Child mental health training for GPs in collaborative care can increase children’s access to mental health care.