Authors' objectives: Mental health care for children and young people is a rising concern, with one in six children aged 5-19 years in England having a probable diagnosable mental disorder. Care for children and young people in crisis is known to be delivered by multiple agencies using a range of approaches. The review objectives of this study were to critically appraise, synthesise and present the best-available international evidence related to crisis services for children and young people aged 5–25 years, specifically looking at the organisation of crisis services across education, health, social care and the third sector, and the experiences and perceptions of young people, families and staff, to determine the effectiveness of current models and the goals of crisis intervention. The mental health of children and young people (CYP) is a rising concern, with one in six children aged 5–19 years in England having a probable diagnosable mental disorder. A recent National Assembly inquiry found a 100% increase in demand for CYP mental health services in Wales between 2010 and 2014. With resources stretched, and CYP often waiting lengthy periods to be seen, increasing numbers of CYP are seeking help at a point of crisis. During periods of crisis, it is vital that care is timely, effective and based on evidence. Crisis care for CYP has become a national and international policy priority, with substantial funding allocated to the development of crisis services. The needs of young people in crisis can be met through clinical services, such as local child and adolescent mental health (CAMH) teams, crisis teams, and accident and emergency departments, or through school counselling, youth services and internet-based counselling. In the UK, the landscape of crisis care delivery has shifted substantially in recent years. Notably, investments have been made in community crisis teams that aim to provide care close to home and avoid the need for hospital admission. Different forms of crisis support from health, education, social care and the third sector are available for CYP, with considerable regional variability in the way such care is delivered. However, little is known about how these different services are organised or experienced, whether or not they are effective, or how they are integrated within their local system contexts. The review objectives of this study were to critically appraise, synthesise and present the best-available international evidence relating to crisis services for CYP aged 5–25 years. Specifically, we look at: the organisation of crisis services across education, health, social care and the third sector the experiences and perceptions of CYP, families and staff to determine the effectiveness of current models to determine the goals of crisis intervention.

Authors' methods: All relevant English-language international evidence specifically relating to the provision and receipt of crisis support for children and young people aged 5–25 years, from January 1995 to January 2021, was sought. Comprehensive searches were conducted across 17 databases and supplementary searching was undertaken to identify grey literature. Two team members appraised all the retrieved research reports (except grey literature) using critical appraisal checklists. A separate analysis was conducted for each objective. Confidence in research findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation and the Confidence in the Evidence from Reviews of Qualitative research approaches. The protocol was crafted following the guidance published by the Centre for Reviews and Dissemination at the University of York (York, UK). The protocol was then registered with the International Prospective Register of Systematic Reviews. All relevant English-language international evidence specifically relating to the provision and receipt of crisis support for CYP aged 5–25 years, from January 1995 to January 2021, was sought. All records that related to the effectiveness, organisation and goals of services that respond to CYP in crisis, and to the experiences of people using and working in these services, were considered. At the first Stakeholder Advisory Group (SAG) meeting, help was obtained in developing a search strategy, ensuring that appropriate search terms were being used and assisting in the locating of otherwise unidentified sources of evidence, particularly grey literature. Types of evidence sought included quantitative and qualitative research, and grey literature. Following the development and testing of a search strategy, comprehensive searches were conducted across 17 databases: MEDLINE ALL, PsycINFO®, EmCare, Allied and Complimentary Medicine Database, Health Management Information Consortium, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, ProQuest Dissertations & Thesis database Open, Scopus, Web of Science (WoS), OpenGrey, Cochrane Central Register of Controlled Trials, Electronic Theses Online Service and Criminal Justice Abstracts. Supplementary searching was undertaken to identify grey literature and additional research material. This included the use of online searches, and the targeted searching of organisational websites and journal tables of content. Reference lists of included studies were scanned and forward citation tracking was performed using WoS. The title and abstract of each record were reviewed by two members of the team to establish if a paper was relevant, with a third member arbitrating if there was no consensus. The full texts of each record were accessed when a decision about relevance could not be made on the abstract alone. All records deemed relevant on initial screening were then subject to a further review by two members of the team, again using a third team member for arbitration. A specifically designed form was used to guide this process. Two team members appraised all the research reports that had been identified through screening, using critical appraisal checklists. When there were disagreements about quality, a third team member arbitrated. None of the grey literature was appraised for quality. Demographic data from the appraised records were extracted into tables and checked by a second team member. All appraised research material and relevant extracts from the grey literature were managed using the NVivo 12 software (QSR International, Warrington, UK) from which it was thematically analysed. A separate analysis was conducted for each objective. For objective 1, the types of crisis services/responses were categorised and summarised after consultation with the SAG. Next, thematic summaries that explored organisation of crisis services were conducted. To meet objective 2, a thematic synthesis was conducted to explore the experiences and perceptions of young people, their families and staff with regard to mental health crisis services. The confidence in the synthesised findings from the qualitative research to address this objective was assessed by two reviewers using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. The third objective was to determine the effectiveness of current models of mental health crisis services. Owing to the heterogeneity of the included intervention studies, meta-analyses could not be performed and, therefore, thematic summaries were conducted. The confidence in the certainty of the synthesised findings from the quantitative evidence was assessed by two reviewers using the Grading of Recommendations Assessment, Development and Evaluation approach. The final objective was to determine the goals of crisis intervention, and this was achieved using thematic summaries. The literature that informed this evidence synthesis was largely drawn from the USA. Any models or approaches of crisis care operating in the USA may not be directly applicable to the UK because of differences in the way that health care is commissioned and delivered in the USA compared with the UK. In addition, a wide range of crisis provision was reported across many different settings, which made comparison of these models difficult. Therefore, it was not possible to determine their relative efficacy, meaning that only general conclusions can be drawn.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR128359

Year Published: 2023

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/BPPT3407

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: United Kingdom

DOI: 10.3310/BPPT3407

Organisation Name: NIHR Health and Social Care Delivery Program

Contact Name: Rhiannon Miller

Contact Email: rhiannon.m@prepress-projects.co.uk