Ambulatory mental healthcare for children and youth in child welfare services: a scoping review
Mapping review
|Published
The purpose of this systematic scoping review was to map the existing research on ambulant mental health care for children and young people in child welfare services.
Key message
The purpose of this systematic scoping review was to map the existing research on ambulant mental health care for children and young people in child welfare services. Ambulant mental health care is understood here as psychological health care or treatment that takes place in children and young people's own environment.
We conducted a scoping review. This is a type of systematic review that maps and describes the existing research in a specific topic area. We mapped studies where ambulant mental health care was provided to children and adolescents (0-18 years) receiving interventions from child welfare services. We included studies from Norway, Sweden, Denmark, Finland and the Netherlands, published between 2015-2023.
Two studies met the inclusion criteria. Both were from Norway and published within the last two years. One study dealt with The Scaffolders (Stillasbyggerne), an interdisciplinary team building bridging health care and child welfare services. The other examined the extent of use and experiences with ambulant mental health care in child welfare service institutions in Norway. Only one of the studies included the personal experiences of four young people. The most important findings are:
- There is very limited research on ambulant mental health care provided specifically to children and young people with interventions delivered through child welfare services.
- Children and young people’s participation in existing research on ambulant mental health care is limited.
There is a need for a significant research effort on ambulant mental health care for children and young people in child welfare services. When initiating future interventions, thorough evaluation needs to be included in the planning.
Summary
Introduction
A large proportion of children and young people in child welfare services need mental health care. A 2015 study investigating the scope of mental disorders among young people in child welfare institutions found that 76 percent of the participants met the criteria for at least one psychiatric diagnosis. The Norwegian Board of Health Supervision has also encouraged the use of utilizing more interdisciplinary approaches in mental health care for children in institutions. This indicates that there are unmet needs for mental health care for this group of children and young people. In their summary and recommendations from their work on health care for children in child welfare services, the Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) and the Norwegian Directorate of Health (Hdir) recommend several measures to ensure necessary health care, including ambulant services.
We understand 'Interventions in child welfare services' as all types of child welfare cases where a decision has been made to implement interventions, i.e., children in foster homes, children living in institutions and children and families with interventions in the home. We define 'Ambulant mental health care' as treatment taking place in the patient's own environment, which may be at home, at school or at the institution where the child lives.
Objective
Norwegian authorities are working strategically to develop and strengthen the provision of mental health care for children in child welfare services, including strengthening the provision of ambulant mental health care (see Prop. 73 L 2016-3027). To facilitate informed decisions about future research on mental health interventions for children and young people delivered through child welfare services, the authorities need an overview of the existing empirical research on the use and benefits of ambulant mental health care for children and young people delivered through the child welfare services. An overview of children and young people’s experiences with such services is also demanded.
The purpose of this scoping review was to answer the following research question: What research exists that examines the use of ambulant mental health care for children delivered through the child welfare services, and what does the research say?
Method
We conducted a systematic scoping review aiming to map and describe existing research in a specific field. We conducted the scoping review using systematic and transparent methods. The use of these methods allows others to verify and reproduce our methods, results, and conclusions.
We searched for studies on children and adolescents aged 0-18 years, with interventions delivered through the child welfare services. The intervention was ambulant mental health care, understood as mental health care or psychological treatment that takes place in the child/young person's own environment, e.g., in a child welfare institution, foster home, or home of their parents. We searched for quantitative and qualitative empirical studies published between 2015-2023. We included studies from Norway, Sweden, Denmark, Finland, and the Netherlands, written in Norwegian, English, Swedish or Danish.
We conducted an extensive search for relevant literature in September 2023. We searched both electronic literature databases and grey literature sources, such as relevant organisations' websites and institutional archives in Norway, Sweden, and Denmark. After reviewing the identified references from the databases and grey literature, we supplemented the search with a search in OpenAlex through EPPI Reviewer. In addition, we contacted several Norwegian and international experts and asked for relevant research on the topic.
Two researchers independently assessed the identified references against the inclusion criteria. They first assessed all records based on the title and abstract, and then full texts. We used the machine learning function priority screening in EPPI-Reviewer. One project member extracted data from the included studies, and another controlled the data extraction.
Results
We identified and assessed 3223 references at title and abstract level. We assessed 34 full-text publications. Two studies from Norway met the inclusion criteria. They were published in 2021 and 2023 and based on surveys, interviews, and document analyses. In total, there are 135 respondents in the two studies, of which only four are young people with experience of ambulant mental health care.
One of the studies concerns scaffolders (Stillasbyggerne). This is a service at the child and adolescent psychiatric outpatient clinic (BUP) at Akershus University Hospital, which aims to promote cooperation between child welfare services and mental health services. The programme includes an ambulant service. The study describes core elements of Stillasbyggerne's work. It uses interviews and a survey to investigate how young people, caseworkers and partners experienced the program, and identifies strengths and weaknesses of the program. The study authors report that the four young people perceived Stillasbyggerne as accessible and patient, and as a trustworthy support system. The survey reported that from the employees' perspective, Stillasbyggerne improved collaboration across the services. They also contributed expertise, flexibility, and capacity that the child welfare services did not have, and helped to ensure that the young people received a customised service. The authors perceived it as a challenge that Stillasbyggerne were lacking a clear definition of their role and a clear mandate.
The second study examines the extent of and experiences with ambulant mental health care in child welfare institutions in Norway. The researchers conducted a qualitative interview study with 32 managers and health professionals across the country. They found that several of the staff at the child welfare institution believed there was a need for more ambulant mental health measures, as they perceive that more people need treatment than those who are offered it. Challenges mentioned were that the programme was limited to specific mental health problems or that the programme was limited geographically. Several employees experienced a lack of mutual understanding between child welfare and mental health services regarding needs, in addition to the perception that BUP was deprioritising ambulant activities due to limited resources. The authors highlighted that an advantage of the ambulant programmes was the therapist’s attendance at the institution, which created a sense of security and a relationship with the young person.
Discussion and conclusion
Our scoping review shows that there is very limited empirical research investigating the use of ambulant mental health care for children and young people delivered through the child welfare services in the Nordic countries and the Netherlands. This applies to all types of ambulant mental health interventions. The findings reported by the authors in the two included studies indicate that the experiences with ambulant mental health care are mainly positive, but the service is perceived as limited.
There is a need for a significant research effort in this field, and it is important that any measures implemented in the future are evaluated and disseminated to strengthen the research and knowledge in this area. There are a number of areas where research is lacking and where more research is needed. We found few studies including adolescents as recipients of ambulant mental health services. We found no studies examining the effect of ambulant mental health care for children and adolescents in child welfare services, no studies that examined the extent of the provision of ambulant mental health care for children and adolescents in child welfare services, and no studies that included children or younger adolescents as participants in their studies.
