Characteristics of included studies
| Author and country | Type of mental health service | Study/evaluation design | Target population | Element(s) of quality addressed | Results | Quality assessment |
| Davidson, USA45 | Secondary level services | Pilot randomised controlled trial (RCT) | n=18 providers n=32 children and adolescents (5–16 years, mean=11.5 years) | Appropriate package of services; Provider competency | Strong alliance between adolescents and providers, d=0.11; Assisted in skills-based learning, d=0.47; Adolescent satisfaction with treatment (Child/Adolescent Satisfaction Questionnaire), d=0.53 | Fair |
| Jager,The Netherlands60 | Secondary level services | Longitudinal prospective cohort | n=315 12–18 year olds (mean=15.2 years) | Appropriate package of services; Provider competencies | Smaller reduction of psychosocial problems when adolescents valued communication but didn’t experience it (total difficulties score at T1 an average of 15.6 and at T2 13.9) | Fair |
| Ougrin, UK56 | Tertiary level services | RCT | n=53 in intervention arm (0–17 years; mean=16 years); n=53 in control arm (0–17 years; mean=16 years) | Appropriate package of services | Lower occupied bed days between intervention and control arm (median 34 days, p=0.04); Intervention arm more effective and financially reasonable compared with control arm | Good |
| Dion, Canada58 | Emergency department (ED) services | Cross-sectional surveyed | n=87 medical staff (nurses, residents, and physicians) | Provider competency | ED staff reported greater confidence in managing and referring patients based on years of employment (r=0.35, p<0.01); Physicians (83%) were more confident than nurses (8%) or residents (8%) (p=0.05); The majority of ED staff (67% of nurses, 64% of residents, and 83% of physicians) were satisfied with the programme | Fair |
| Spenser, Canada59 | Tertiary level services | Cohort study | n=27 community paediatricians; n=16 outpatient mental health clinicians | Provider competency | Five mental health clinicians stated that having paediatricians on mental health team was positive; Over 20% of clinical activity for almost 12 paediatricians deals with mental health issues; seven mental health clinicians stated that the educational sessions led to increased knowledge about mental health of children and adolescents | Poor |
| Ayton, UK57 | Secondary level services | Mixed methods including survey with consultants and review of case notes. | n=23 Child an Adolescent Mental Health Service (CAMHS) consultants surveyed; 33 case notes reviewed | Appropriate package of services; Provider competencies | Care Programme Approach (CPA) care plans audited assessed 96.4% of mental health and needs and 71.4% of family needs; other needs (housing: 33.9%, sexual health: 7.1%, and sign of relapse or crisis: 28.6%) minimally assessed in CPA plans | Fair |
| Aupont, USA46 | Primary level services | Prospective cohort with adolescent service users | n=329 (m=12.3 years) | Appropriate package of services | The relative risks of staying in mental healthcare (instead of going back to paediatrics) was 7.5 for those with depression and 5.1 for those with anxiety disorders; The return rates to the referring paediatrician were 27.9% and 5.9% for adolescents with anxiety and major depressive disorders | Fair |
| Simmons, Australia53 | Enhanced primary level services | Prospective cohort study | n=57, 12–25 years old used the decision aid and completed the postdecision assessment; n=48 completed the follow-up assessment (mean=18.5 years) | Mental health literacy; Provider competencies | 97% reported increased confidence in deciding about their own healthcare after using the decision aid (p=0.022); on shared decision making adolescents scored average of 37.4 (range 29–44); indicating high level of perceived involvement in the treatment process | Fair |
| Irvine, Ireland62 | Community, primary, secondary and tertiary level services | Cross-sectional online survey | n=604, 11–21 years old | Mental health literacy, appropriate package of services, provider competencies | 73% of adolescents stated that they had been spoken to in a way that they could understand; 42% and 40% stated that they were given a choice in treatment/support and felt involved in their treatment decisions; general practitioner (GP) and ED services scored poorly across all quality indicators; community services scored the highest | Fair |
| Jager, the Netherlands61 | Secondary level services | Longitudinal, prospective cohort study | n=211, 12–18 years old (mean=15.3 years) | Appropriate package of services; Provider competencies | Adolescents who valued patient centred communication but did not have their communications needs met were less likely to adhere to their treatment (OR: 2.8; 95% CI: 1.1 to 6.8) | Fair |
| Stevens, USA47 | Tertiary level services | RCT | n=179, 11–20 years old (mean=17.2 years) | Appropriate package of services | No significant differences found between treatment and control arms | Good |
| Anderson, Australia54 | Secondary level services | RCT | n=73, 12–18 year olds (mean=13.9 years) | Appropriate package of services | Adolescents in intervention (mean 5.77, SD 1.2) and control (mean 5.58, SD 1.34) reported strong working alliance; Adolescent working alliance was positively associated with compliance at 6 months follow-up (r=0.30, p<0.001) | Poor |
| Kapp, Switzerland63 | Secondary level services | Cross-sectional study | n=663 patients 10+ years of age (mean=14 years) | Appropriate package of services | Patients who had time to formulate and ask questions had better alliance (p<0.001); Easy accessibility to CAMHS by phone had higher alliance scores (p=0.037) | Fair |
| Cairns, Australia55 | Primary level services | Cohort | n=283 clinical charts of 12–25 years old (mean=18 years) | Appropriate package of services; Provider competencies | Emotional management and well-being goals were most frequently recorded; None of the analysed goals met criteria for being specific, measurable, and timed; 57% were specific while 14% were measurable; none had a timeframe; Goal quality was not associated with service retention | Fair |
| Ringle, USA48 | Secondary level services | Medical record audit | n=727 medical records of 8–18 years old (mean=11.4 years) | Provider competencies | 46% of children and adolescents received care that was guideline concordant; Clients with worse functioning (OR=0.985, p<0.001), higher problem severity (OR=1.02, p=0.015), higher risk of harm to others (OR=1.61, p<0.001), more school problems (OR=1.48, p<0.001), and who had a diagnosis of depression (OR=1.37, p<0.05) or a conduct-related disorder (OR=1.37, p<0.05) at intake were more likely to receive less intensive services than those recommended by the guidelines. | Fair |
| Sattler, USA49 | Mix of primary and secondary level | Medical record audit | n=694 medical records 7–17 year olds (mean=12 years) | Appropriate package of services; Provider competencies | Patients received 1.48 evaluations on average for psychiatric symptoms; 45.7% of all facilities used self-report measures and 5.2% used diagnostic interview; 23.2% of psychologists documented the use of diagnostic interviews, compared with 2% and 0% of psychiatrists and primary care physicians (p<0.01); 43% psychologists, 43.3% psychiatrists, and 39.3% of social workers more likely to document specific diagnoses compared with primary care (22.6%) (p<0.01) | Fair |
| Sattler, USA50 | Primary and secondary level services | Medical record audit | n=801, 7–17 years old (mean=12.9 years) | Appropriate package of services; Provider competencies | 5.3% of anxiety disorder specialty clinics used structured diagnostic interviews; 21% of all health facilities used rating scales (28.9% of specialty clinics, 19.6% of general mental health clinics, and 15% primary care); Evaluations in specialised clinics resulted in specific diagnosis (p<0.001); rating scales were associated with specific diagnosis (p=0.04) | Fair |
| Higa-McMillan, USA51 | Secondary level services | Medical record audit | n=2485 3–19 year olds (mean=13.2 years) | Appropriate package of services; Provider competencies | 55%–93% of cases use the following practices derived from the evidence base (PDEB) for adolescents: cognitive, psychoeducational, relaxation, modelling; 99.7% of youth had at least one PDEB over their treatment course | Fair |
| Rukundo, Uganda64 | Primary, secondary and tertiary level | Clinical record review | n=50 providers | Appropriate package of services; Provider competencies | Since training: more children and adolescents had patient-centred assessments; decreased use of medication with more appropriate medication prescribed; increased use of psychological treatments; and non-CAMH professionals had greater diagnosis revisions and management of cases | Fair |
| Bardach, USA52 | ED | Medical record review | n=22, 844 children and adolescents 6–17 years of age (majority 12–17 years) | Appropriate package of services; provider competencies | 62% and 82.3% of patients had follow-up within 7 days and 30 days, respectively; patients discharged from GPs and EDs were less likely to have follow-up compared with those discharged from psychiatric services; Follow-up within seven or 30 days of discharge was associated with an increased risk of a subsequent hospitalisation or ED visit for a mental health illness | Fair |
CAMHS, Child and adolescent mental health services ; CPA, Care programme approach; ED, emergency department; GP, General Practitioner; PDEB, Practices derived from the evidence base; RCT, randomized controlled trial.