Interdisciplinary learning from youth psychosocial care trajectories

Several small-scale, exploratory studies have been performed on the
trajectories of children and adolescents in psychosocial care, who use
specialized and very intensive forms of care. These studies show that care for
these children and adolescents is not optimal. Their problems are not always
analyzed with sufficient expertise, available effective interventions are
(partly because of this) not always used on time, or there seems to be no clear
hypothesis or perspective for placement. The researchers also noted the
discontinuity of care in this population.

By evaluating care trajectories of children, adolescents and their families who
receive specialized and very intensive forms of psychosocial care, we aim to
improve future care. The research should lead to a) knowledge about points for
improvement, barriers and facilitating factors for good care, b) practical
recommendations for improving care and c) activating a 'learning movement' to
start the improvement of child and adolescent psychosocial care . The ultimate
goal is to ensure that young people receive the most appropriate and most
effective help earlier, with as few interruptions as possible. This should lead
to a less frequent need of specialized and very intensive forms of care less
often necessary.

In this study, we utilize case reviews to systematically analyze the
psychosocial care trajectories of 75 children/adolescents from the intended
population and their families. The cases will be divided equally between
different types of institutions. Subjects will be recruited in five different
regions in the Netherlands by five research partners. Local 'process
supervisors' inform and recruit children/adolescents and their
parent(s)/caretaker(s) using Informed Consent, and perform case reviews.
We use a mixed methods study design, with the following components per case
review:
1. Interview with child/adolescent;
2. Questionnaire for child/adolescent;
3. Interview with parent(s)/caretaker(s);
4. Questionnaire for parent(s)/caretaker(s);
5. File research;
6. Group meeting of child/adolescent, parent (s)/caregiver(s) and professionals
involved (learning session);
7. Group meeting of professionals involved (reflection session).

During these components, we collect a set of predetermined, quantitative data
and we also systematically collect qualitative data. The different consecutive
components enable the results from one component to support the process in a
subsequent component (action-supportive research). In addition, we use the
data for a systematic analysis of the psychosocial care trajectories. This way
we collect data that leads to points for improvement, barriers and facilitating
factors for good psychosocial care for children and adolescents. Based on the
research findings reports, we organize regional meetings to support the
implementation of these findings.

Participation in the case review requires a time investment of approximately
4-5 hours for children/adolescents and parent(s)/caretaker(s). The time
investment for both consists of:
o Attending an information meeting about the research, individual and face to
face (30 minutes);
o Filling in a questionnaire (30 minutes);
o Participating in an interview, individual and face to face (60-90 minutes);
o Participating in a learning session (120 minutes);
o Participating in regional learning meeting. Children/adolescents and
parent(s)/caretaker(s) will be invited, but participation is optional and not
part of the data collection.

Hence, we make a great appeal to the time, dedication and motivation of
children/adolescents and their parent(s)/caregiver(s). They will receive
explanations about the aim of the study during the information meeting. Its aim
explicitly is to improve the psychosocial care for children and adolescents
based on (among other things) their experiences, not to improve individual care.

Yet, looking back at them can evoke feelings of anger, grief or frustration,
because it concerns families with often a long-term care history. This could
interfere with the current treatment. We realize that there are risks for
participants to participate. We think that the risks of this research are
minimal by taking the following precautions:
o We will discuss opportunities and risks of participation prior to the study
with the intended participants (including professionals);
o We will not include families who are in a crisis situation;
o We will inform, with consent of the people concerned, the confidential
counsellor of the institution where the child/adolescent resides. The
child/adolescent and/or parents can contact the counsellor if situations arise
that can not be handled properly by the practitioners involved.

Occasionally calamities occur in this population. In case of calamities with
children/adolescents or parent(s)/caretaker(s) during the study (such as
suicides or crises of a different nature), participation in the study can of
course be suspended or stopped.

We think that participating in a case review is very similar to the usual
treatment evaluations in psychosocial care of children/adolescents. The
difference is that a case review follows a much more systematic method than a
usual treatment evaluation and therefore requires more time. Also, the case
review is led by an independent process supervisor. Someone outside the
institution and someone who looks at the case from a different perspective. As
a result, it is possible that participation in the case review, by new insights
from clients and/or practitioners, benefits individual care.