Objective

The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of community systems of care as they pertain to the delivery of behavioral health care to children and adolescents

Method

A search of the literature on this topic from 2002 was initially conducted in 2016 and repeated in 2019 and 2021, yielding 1,604 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 1,684 total citations, of which 1,184 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 156 based on relevance to the topic.

Results

The systems of care approach, arising in the 1980s, expanded child and adolescent behavioral health care from the core services of psychotherapy, medication management, inpatient psychiatric services, and residential treatment to include home- and community-based treatment and support services; promotion, prevention, and early intervention programs; and specialized services for very young children and youth and young adults of transition age. These services and supports are delivered by a large multidisciplinary workforce and are governed by key principles, including a biopsychosocial case conceptualization; family-driven, youth-guided, strengths-based, and trauma-informed care. Services in the least restrictive setting; continuity of care across transitions; a public health framework for service delivery; promotion of wellness and resilience; and elimination of health disparities. Challenges to systems of care implementation include funding availability, workforce shortages, deficiencies in cross-systems collaboration, and variability in insurance coverage. Although controlled studies have failed to provide convincing evidence of favorable outcomes from the whole systems of care approach, uncontrolled research has demonstrated increased access to care, positive clinical and functional outcomes, improved family functioning, and reductions in costs, particularly when research is focused on specific behavioral health problems, specific interventions such as Wraparound care, or highly specified groups of youth.

Conclusion

Health professionals who are educated in the systems of care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.

中文翻译：

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临床更新：社区护理系统中的儿童和青少年行为保健

客观的

本临床更新的目的是审查社区护理系统的原则、结构、过程和结果，因为它们与向儿童和青少年提供行为保健有关

方法

最初于 2016 年对 2002 年关于该主题的文献进行了检索，并于 2019 年和 2021 年重复进行，产生了 1,604 条英文引文。这些引用由主题专家建议的参考文献补充，并通过网络搜索确定，使总引用量增加到 1,684 次，其中 1,184 次没有重复。经过更新作者在标题/摘要和全文级别的顺序审查后，根据与主题的相关性将引文筛选到 156。

结果

1980 年代出现的护理系统方法将儿童和青少年行为保健从心理治疗、药物管理、住院精神病服务和住院治疗的核心服务扩展到包括家庭和社区治疗和支持服务；促进、预防和早期干预计划；为年幼儿童和青少年以及过渡年龄的年轻人提供专门服务。这些服务和支持由庞大的多学科团队提供，并受关键原则约束，包括生物心理社会案例概念化；家庭驱动、青年引导、基于优势和创伤知情的护理。在限制最少的环境中提供服务；过渡期间护理的连续性；提供服务的公共卫生框架；促进健康和复原力；消除健康差异。护理实施系统面临的挑战包括资金可用性、劳动力短缺、跨系统协作的缺陷以及保险范围的可变性。尽管对照研究未能提供令人信服的证据证明整个护理系统方法的有利结果，但非对照研究表明获得护理的机会增加、临床和功能结果积极、家庭功能改善以及成本降低，特别是当研究侧重于特定的行为健康问题、特定的干预措施（例如环绕式护理）或高度特定的青年群体。和保险范围的可变性。尽管对照研究未能提供令人信服的证据证明整个护理系统方法的有利结果，但非对照研究表明获得护理的机会增加、临床和功能结果积极、家庭功能改善以及成本降低，特别是当研究侧重于特定的行为健康问题、特定的干预措施（例如环绕式护理）或高度特定的青年群体。和保险范围的可变性。尽管对照研究未能提供令人信服的证据证明整个护理系统方法的有利结果，但非对照研究表明获得护理的机会增加、临床和功能结果积极、家庭功能改善以及成本降低，特别是当研究侧重于特定的行为健康问题、特定的干预措施（例如环绕式护理）或高度特定的青年群体。

结论

接受过护理系统教育的卫生专业人员可以改善有行为健康需求的儿童和青少年的行为健康护理的可及性和质量。