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An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services

Hannigan, Ben ORCID:, Edwards, Deborah ORCID:, Evans, Nicola ORCID:, Gillen, Elizabeth ORCID:, Longo, Mirella ORCID:, Pryjmachuk, Steven and Trainor, Gemma 2015. An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services. Health Services and Delivery Research 3 (22) , pp. 1-228. 10.3310/hsdr03220

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Background Inpatient child and adolescent mental health services are one part of a complex system, and exist to meet the needs of young people with the greatest mental health difficulties. Objectives The research question was ‘What is known about the identification, assessment and management of risk (where “risk” is broadly conceived) in young people (aged 11–18 years) with complex mental health needs entering, using and exiting inpatient child and adolescent mental health services in the UK?’ Data sources The two-phase Evidence for Policy and Practice Information and Co-ordinating Centre approach was used. In phase 1, scoping searches were made using two databases with an end date of March 2013. Phase 2 centred on the search for citations relating to the risks to young people of ‘dislocation’ and ‘contagion’. Searches were made using 17 databases, with time limits from 1995 to September 2013. Websites were searched, a call for evidence circulated and references of included citations reviewed. Review methods Priority risk areas for phase 2 were decided in collaboration with stakeholders including through consultations with young people and the mother of a child who had been in hospital. All types of evidence relating to outcomes, views and experiences, costs and cost-effectiveness, policies, and service and practice responses in the areas of ‘dislocation’ and ‘contagion’ for young people (11–18 years) using inpatient mental health services were considered. A staged approach to screening was used. Data were extracted into tables following guidance from the Centre for Reviews and Dissemination or tables developed for the review. Quality was assessed using appraisal checklists from the Effective Public Health Practice Project or the Critical Skills Appraisal Programme or devised by previous reviewers. No papers were excluded on the grounds of quality, and all materials identified were narratively synthesised. Results In phase 1, 4539 citations were found and 124 included. Most were concerned with clinical risks. In phase 2, 15,662 citations were found and 40 addressing the less obvious risks of ‘dislocation’ and ‘contagion’ were included, supplemented by 20 policy and guidance documents. These were synthesised using these categories: Dislocation: Normal Life; Dislocation: Identity; Dislocation: Friends; Dislocation: Stigma; Dislocation: Education; Dislocation: Families; and Contagion. No studies included an economic analysis or economic evaluation. The importance to stakeholders of these less obvious risks contrasted with the limited quantity and quality of research capable of informing policy, services and practice in these areas. Limitations Included studies were of variable quality. Data derived could not be used to inform an economic modelling of NHS costs or to analyse cost-effectiveness. Other limitations were the search for only English-language materials and the use of umbrella concepts (‘dislocation’ and ‘contagion’). Conclusions The less obvious risks are important, but little evidence exists to support their identification, assessment and management. This has implications for services, and a programme of research is recommended to generate new knowledge. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Academic & Student Support Service
Healthcare Sciences
Additional Information: © Queen’s Printer and Controller of HMSO 2015. This work was produced by Hannigan et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Publisher: NIHR Journals Library
ISSN: 2050-4349
Funders: National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme
Date of First Compliant Deposit: 30 March 2016
Date of Acceptance: 31 October 2014
Last Modified: 15 Dec 2023 07:21

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