Systematic identification and stratification of help-seeking school-aged youth with mental health problems: a novel approach to stage-based stepped-care

Rasmus Trap Wolf, Louise Berg Puggaard, Mette Maria Agner Pedersen, Anne Katrine Pagsberg, Wendy K Silverman, Christoph U Correll, Kerstin Jessica Plessen, Simon-Peter Neumer, Dorte Gyrd-Hansen, Mikael Thastum, Niels Bilenberg, Per Hove Thomsen, Pia Jeppesen, Rasmus Trap Wolf, Louise Berg Puggaard, Mette Maria Agner Pedersen, Anne Katrine Pagsberg, Wendy K Silverman, Christoph U Correll, Kerstin Jessica Plessen, Simon-Peter Neumer, Dorte Gyrd-Hansen, Mikael Thastum, Niels Bilenberg, Per Hove Thomsen, Pia Jeppesen

Abstract

We investigated whether a novel visitation model for school-aged youth with mental health problems based on a stage-based stepped-care approach facilitated a systematic identification and stratification process without problems with equity in access. The visitation model was developed within the context of evaluating a new transdiagnostic early treatment for youth with anxiety, depressive symptoms, and/or behavioural problems. The model aimed to identify youth with mental health problems requiring an intervention, and to stratify the youth into three groups with increasing severity of problems. This was accomplished using a two-phase stratification process involving a web-based assessment and a semi-structured psychopathological interview of the youth and parents. To assess problems with inequity in access, individual-level socioeconomic data were obtained from national registers with data on both the youth participating in the visitation and the background population. Altogether, 573 youth and their parents took part in the visitation process. Seventy-five (13%) youth had mental health problems below the intervention threshold, 396 (69%) were deemed eligible for the early treatment, and 52 (9%) had symptoms of severe mental health problems. Fifty (9%) youth were excluded for other reasons. Eighty percent of the 396 youth eligible for early treatment fulfilled criteria of a mental disorder. The severity of mental health problems highlights the urgent need for a systematic approach. Potential problems in reaching youth of less resourceful parents, and older youth were identified. These findings can help ensure that actions are taken to avoid equity problems in future mental health care implementations.

Keywords: Children and adolescents; Mental health problems; Mental health services; Stage-based stepped-care; Visitation; Youth.

Conflict of interest statement

RTW, LBP, MMAP, AKP, WKS, KJP, SPN, DGH, MT, NB, PHT and PJ declare that they have no conflict of interest. CUC has been a consultant and/or advisor to or has received honoraria from: Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He has provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a stock option holder of LB Pharma.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of visitation process. PPR Educational and psychological counselling. SDQ The Strength and Difficulties Questionnaire, MFQ The Mood and Feelings Questionnaire, SCAS Spence Children’s Anxiety Scale, MMM Mind My Mind

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