Review: Crisis responses for children and young people – a systematic review of effectiveness, experiences and service organisation (CAMH‐Crisis)

Abstract

BackgroundIn England, one in six children aged 5–19 has a probable diagnosable mental health disorder. This is a major public health problem, with multiple agencies adopting varying approaches to care delivery for children and young people (CYP) in crisis.ObjectivesTo examine the organisation of crisis services across education, health, social care and voluntary sectors; the experiences and perceptions of CYP, families and staff; the effectiveness of current approaches to care and the goals of crisis intervention.MethodsA systematic review of all relevant English language evidence regarding the provision and receipt of crisis support for CYP aged 5–25 (PROSPERO‐CRD42019160134). Seventeen databases were searched from 1995 to 2021 and relevant UK‐only grey literature was identified. Critical appraisal was conducted using appropriate design specific appraisal tools. A narrative approach to synthesis was conducted.ResultsIn total, 138 reports (48 reports covering 42 primary research studies; 36 reports covering 39 descriptive accounts of the organisation services and 54 UK‐only grey literature reports) were included. The evidence suggests that crisis services were organised as follows: triage/assessment‐only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, four themes were identified: (a) barriers and facilitators to seeking and accessing appropriate support; (b) what children and young people want from crisis services; (c) children's, young people's and families' experiences of crisis services; and (d) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of crisis services were identified.DiscussionDespite a lack of high‐quality international studies, findings suggest that support prior to reaching crisis point is important. From this work, various aspects of crisis care have been identified that can be incorporated into existing services across education, health, social care and the voluntary sector.

Differences in treatment trajectory following brief paediatric inpatient admissions for children and young people with eating disorders

“…This might reflect a variety of issues that the service provides intervention for, from symptom severity to family functioning and stress. As this variable appears to have a more sizeable effect on treatment trajectory, targeting interventions provided by the crisis team following a paediatric admission may be particularly useful in reducing the risk of longer‐term inpatient care, which is consistent with evidence from systematic reviews (Carpenter et al., 2013; Edwards et al., 2023). Furthermore, the data suggests that treating comorbid anxiety and depression alongside management of an ED may be another useful approach in reducing the risk of longer‐term inpatient care being required, and there is evidence that doing so can improve response to treatment and outcomes (Hambleton et al., 2022).…”