A brief intervention is sufficient for many adolescents seeking help from low threshold adolescent psychiatric services
1 Department of Adolescent Psychiatry, Kuopio University Hospital and University of Kuopio, Kuopio, Finland
2 Department of Psychiatry, Paijat-Hame Central Hospital and University of Tampere, Lahti, Finland
3 Department of Health Sciences, University of Oulu, Senior Lecturer, Department of Nursing Science, University of Tampere, Finland
4 Department of Adolescent Psychiatry, Joensuu Central Hospital, Finland
5 Department of Adolescent Psychiatry Helsinki University Hospital and University of Helsinki, Finland
6 Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
BMC Health Services Research 2010, 10:261 doi:10.1186/1472-6963-10-261Published: 6 September 2010
There has been a considerable increase in the need for psychiatric services for adolescents. Primary health care practitioners have a major role in detecting, screening and helping these adolescents. An intervention entitled SCREEN is described in this article. The SCREEN intervention was developed to help practitioners to detect and screen adolescent needs, to care for adolescents at the primary health care level and to facilitate the referral of adolescents to secondary care services in collaboration between primary and secondary health care. Secondly, the article presents the background and clinical characteristics of youths seeking help from the SCREEN services, and compares the background factors and clinical characteristics of those patients referred and not referred to secondary care services.
The SCREEN intervention consisted of 1 to 5 sessions, including assessment by a semi-structured anamnesis interview, the structured Global Assessment Scale, and by a structured priority rating scale, as well as a brief intervention for each adolescent's chosen problem. Parents took part in the assessment in 39% of cases involving girls and 50% involving boys. During 34 months, 2071 adolescents (69% females) entered the intervention and 70% completed it. The mean age was 17.1 years for boys and 17.3 years for girls.
For 69% of adolescents, this was the first contact with psychiatric services. The most common reasons for seeking services were depressive symptoms (31%). Self-harming behaviour had occurred in 25% of girls and 16% of boys. The intervention was sufficient for 37% of those who completed it. Psychosocial functioning improved during the intervention. Factors associated with referral for further treatment were female gender, anxiety as the main complaint, previous psychiatric treatment, self-harming behaviour, a previous need for child welfare services, poor psychosocial functioning and a high score in the priority rating scale.
A brief intervention carried out by a team including professionals from both primary and secondary level services was sufficient for a considerable proportion of adolescents seeking help for their psychiatric problems. Referral practices and counselling in special level services can be standardized. In the future, it will be important to develop and assess psychiatric services for adolescents using randomised controlled trials.