CCSchool: a multicentre, prospective study on improving continuum of care in children and adolescents with mental health problems associated with school problems in Germany

Abstract

BackgroundMost psychiatric disorders in childhood and adolescence cause impairment in academic performance. Early interventions in school are thought to reduce the burden of disorder and prevent chronicity of disorder, while a delay in reachable help may result in more severe symptoms upon first time presentation, often then causing upon first-time presentation immediate need of inpatient care.MethodsThe study aims at reducing hospitalization rates and increasing social participation and quality of life among children and adolescents by establishing collaborations between schools, mental health care services and youth welfare services. CCSchool offers children and adolescents, aged six to 18 years, who present with psychiatric problems associated to school problems, a standardized screening and diagnostic procedure as well as treatment in school if necessary. Students can participate in CCSchool in three federal states of Germany if they a) show symptoms vindicating a mental health diagnosis, b) present with confirmed school problems and c) have a level of general functioning below 70 on the children global assessment of Functioning (C-GAF). Intervention takes place in three steps: module A (expected n = 901, according to power calculation) with standardized diagnostic procedures; module B (expected n = 428) implies a school-based assessment followed by a first intervention; module C (expected n = 103) offering school-based interventions with either four to six sessions (basic, 80% of patients) or eight to 12 sessions (intensive, 20% of patients).Primary aim is to evaluate the effectiveness of CCSchool, in reducing the need of hospitalization in children with mental health problems. The analyses will be conducted by an independent institute using mainly data collected from patients and their caregivers during study participation. Additionally, claims data from statutory health insurances will be analysed. Relevant confounders will be controlled in all analyses.DiscussionEvaluation may show if CCSchool can prevent hospitalizations, enhance social participation and improve quality of life of children and adolescents with mental health problems by providing early accessible interventions in the school setting.Trial registrationDeutsches Register Klinischer Studien, Trial registration number: DRKS00014838, registered on 6th of June 2018.

How to improve the system of care for adolescents with emotional and behavioural problems from the perspective of care providers: a concept mapping approach

“…Care providers also articulated the necessity of further collaboration with schools via strengthening their competencies and their role in the system of care for children with EBP, as these are the institutions that play an essential role in adolescents’ lives [ 11 ]. Schools may not be only the ideal place for the early detection of a problem, but should also be the place for early professional intervention [ 40 ]. Finally, part of the proposed measures focused on the families themselves and suggested the need for efficient outreach systems that would be able to bring care closer to them.…”

Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study

“…Once a serious mental illness occurs it tends to become chronic, and a patient may need repeated hospitalizations that affect daily life and social integration. Therefore, early diagnosis, proper treatment, and follow-up of mental health disorders are crucial for disease prevention [13].…”

Stationäre Versorgung in der Kinder- und Jugendpsychiatrie – wer hat Platz?

“…Es bedarf deswegen eines Österreichweiten, jährlichen standardisierten Monitoring der besetzen und unbesetzten ärztlichen Planstellen verbunden mit geeigneten Maßnahmen zur Sicherstellung der Versorgung der Bevölkerung, z. B. vermehrten ambulanten Angeboten in der Breite, Etablierung von Hometreatment-Teams [3], niederschwelligen Angeboten an Schulen [2], psychosozialen Diensten, die Hand in Hand arbeiten, aber auch einer ausreichenden Zahl an systemisierten Betten, um nicht nur stationäre Notfallbehandlungen, sondern auch nötige Therapieplätze stationär und teilstationär anbieten zu können. Dabei sind nicht nur (Fach-)Ärzt:innen zur Besetzung der Teams ausschlaggebend, sondern gerade in der KJP spielen Ressourcen der Multiprofessionalität eine große Rolle, so dass unter Supervision und Fallletztverantwortlichkeit einer/eines Fachärzt:in Behandlung auch von anderen Berufsgruppen professionell und für die Kinder, Jugendlichen und Familien hilfreich erfolgen kann.…”