چکیده (انگلیسی):

Background:Child and adolescent mental health problems are frequently not identified and properly treated
within general practice. Politicians in the Netherlands are promoting more primary healthcare treatment for mental
health problems. The current study aims to evaluate an integrated primary mental healthcare approach for child
and adolescent emotional and behavioural problems. This integrated approach allows general practitioners (GPs) to
comprehensively explore the request for help, followed by an informed decision to refer, offer short-term treatment
within general practice or postpone a decision by asking for additional consultations with youth mental health
specialists.
Method:The study is a naturalistic evaluation of Dutch general practices with pre-test and post-test comparison
with controls based on data from Electronic Medical Records (EMR). The intervention started in September 2010.
EMR data of all GP contacts with children aged 4 to 18 (including diagnosis, prescriptions, referrals) from practices
involved in the intervention was used from 1 January 2009 to 31 December 2012. Extra codes were added to the
EMR to record aspects of the intervention. Comparable EMR data was used in control practices in 2011.
Results:GPs in the intervention group were able to identify more emotional and behavioural problems after the
integrated service had started. They also identified more problems than GPs in the control practices. They were
already reluctant to prescribe psychopharmacological medication to children before the intervention, and levels of
prescription at intervention GP practices remained low for psychotropic drugs compared to control practices.
Referral rates to mental healthcare remained relatively steady after the introduction of the integrated service, but
referrals switched from specialized to primary mental healthcare.
Conclusion:An integrated mental healthcare approach within general practice may lead to an increase in detected
psychosocial problems among children, and these problems can mainly be treated within the primary care setting