OBJECTIVES: We sought to examine potential barriers to the use of evidence-based guidelines for youth depression in a tertiary specialist mental health service, as part of an initiative to implement evidence based practice within the service. METHODS: This was a qualitative study adopting a social constructionist perspective using focus groups. The focus groups, conducted with all clinicians (medical and allied health), were audiotaped, transcribed and thematic analysis was undertaken. Clinicians were asked about the barriers to implementing four key recommendations from the National Institute for Health and Clinical Excellence (NICE) guidelines. RESULTS: Barriers existed at (i) the individual clinician level; (ii) the clinical level in terms of the presentation of young people; and (iii) the service level. The key individual clinician level barrier was a stated belief that the guidelines were not relevant to the young people presenting to the service, with little evidence to guide practice. Related, the main barrier with regard to the clinical presentation was the severity and complexity of this presentation, often making the delivery of interventions like cognitive behavioural therapy (CBT) difficult. At the service level, a lack of integration with primary and secondary level care meant sequencing interventions according to guideline recommendations was difficult. CONCLUSIONS: There is a clear imperative to develop the evidence base to ensure that effective treatments for young people aged up to 25 years with severe and complex disorders that include comorbid conditions, suicide risk and psychosocial difficulties are investigated and disseminated. Furthermore, this work has highlighted the need for greater investment in models of care that ensure integration between existing primary and secondary care and enhanced specialist early intervention mental health services for young people.
OBJECTIVES: We sought to examine potential barriers to the use of evidence-based guidelines for youth depression in a tertiary specialist mental health service, as part of an initiative to implement evidence based practice within the service. METHODS: This was a qualitative study adopting a social constructionist perspective using focus groups. The focus groups, conducted with all clinicians (medical and allied health), were audiotaped, transcribed and thematic analysis was undertaken. Clinicians were asked about the barriers to implementing four key recommendations from the National Institute for Health and Clinical Excellence (NICE) guidelines. RESULTS: Barriers existed at (i) the individual clinician level; (ii) the clinical level in terms of the presentation of young people; and (iii) the service level. The key individual clinician level barrier was a stated belief that the guidelines were not relevant to the young people presenting to the service, with little evidence to guide practice. Related, the main barrier with regard to the clinical presentation was the severity and complexity of this presentation, often making the delivery of interventions like cognitive behavioural therapy (CBT) difficult. At the service level, a lack of integration with primary and secondary level care meant sequencing interventions according to guideline recommendations was difficult. CONCLUSIONS: There is a clear imperative to develop the evidence base to ensure that effective treatments for young people aged up to 25 years with severe and complex disorders that include comorbid conditions, suicide risk and psychosocial difficulties are investigated and disseminated. Furthermore, this work has highlighted the need for greater investment in models of care that ensure integration between existing primary and secondary care and enhanced specialist early intervention mental health services for young people.
Authors: R C Kessler; H M van Loo; K J Wardenaar; R M Bossarte; L A Brenner; D D Ebert; P de Jonge; A A Nierenberg; A J Rosellini; N A Sampson; R A Schoevers; M A Wilcox; A M Zaslavsky Journal: Epidemiol Psychiatr Sci Date: 2016-01-26 Impact factor: 6.892
Authors: Sarah E Hetrick; Andrew Thompson; Kally Yuen; Sue Finch; Alexandra G Parker Journal: BMC Health Serv Res Date: 2012-06-27 Impact factor: 2.655
Authors: R C Kessler; H M van Loo; K J Wardenaar; R M Bossarte; L A Brenner; T Cai; D D Ebert; I Hwang; J Li; P de Jonge; A A Nierenberg; M V Petukhova; A J Rosellini; N A Sampson; R A Schoevers; M A Wilcox; A M Zaslavsky Journal: Mol Psychiatry Date: 2016-01-05 Impact factor: 15.992
Authors: Joanna L Henderson; Amy Cheung; Kristin Cleverley; Gloria Chaim; Myla E Moretti; Claire de Oliveira; Lisa D Hawke; Andrew R Willan; David O'Brien; Olivia Heffernan; Tyson Herzog; Lynn Courey; Heather McDonald; Enid Grant; Peter Szatmari Journal: BMJ Open Date: 2017-02-06 Impact factor: 2.692
Authors: Sarah Elisabeth Hetrick; Jo Robinson; Eloise Burge; Ryan Blandon; Bianca Mobilio; Simon M Rice; Magenta B Simmons; Mario Alvarez-Jimenez; Simon Goodrich; Christopher G Davey Journal: JMIR Ment Health Date: 2018-01-23
Authors: Lesley Cousins; Kirstie J Whitaker; Barry Widmer; Nick Midgley; Sarah Byford; Bernadka Dubicka; Raphael Kelvin; Shirley Reynolds; Christopher Roberts; Fiona Holland; Barbara Barrett; Robert Senior; Paul Wilkinson; Mary Target; Peter Fonagy; Ian M Goodyer Journal: Eur Child Adolesc Psychiatry Date: 2016-04-28 Impact factor: 4.785