Pathways to care in children- perspectives from a child guidance clinic in South India.

Autor: George Joseph R; Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India; Christian Medical College Vellore, Department of Psychiatry, Vellore, India; Cumberland Hospital, The New South Wales Department of Health, Sydney, Australia. Electronic address: rachna.george@cmcvellore.ac.in., Kallivayalil RA; Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India., Rajeev A; Pushpagiri Institute of Medical Sciences and Research Centre, Department of Psychiatry, Thiruvalla, Kerala, India; All India Institute of Medical Sciences, Department of Community and Family Medicine, Mangalagiri, India.
Jazyk: angličtina
Zdroj: Asian journal of psychiatry [Asian J Psychiatr] 2020 Dec; Vol. 54, pp. 102310. Date of Electronic Publication: 2020 Jul 18.
DOI: 10.1016/j.ajp.2020.102310
Abstrakt: Purpose: In India the pathways to care in children with mental health problems remain relatively unexplored. Investigating the factors that drive the pathway will help determine interventions and also draft policies for a streamlined Child and adolescent mental health service.
Method: Children who attended the Child Guidance Clinic sampled by WHO Pathways Encounter questionnaire. Statistical tests applied to find key influencers like gatekeepers, intermediate points of care, symptoms initiating referral, duration of untreated illness, time to arrive at appropriate care and primary diagnosis.
Results: The most common diagnostic category was externalizing disorder 51(37.5 %). The gatekeepers identified were 111(81.6 %) Parents/Relatives/Guardians and teachers 25 (18.3 %). Academic concerns identified by teachers took a mean of 72 months (30.271) to arrive at appropriate care versus 50.4 months (23.18) when identified by Parents/Relatives/Guardians group. Significant delays were observed with Neurodevelopmental disorders arriving to care with delays up to 130.2 (70.11) months (p < 0.001) and having 64.2 (33.7) months (p < 0.001) duration of untreated illness. Externalizing disorders took a duration of 94.08 (54.17) months (p < 0.001) to arrive to appropriate care and had 54.2 (36.33) months (p < 0.001) duration of untreated illness. Teachers took longer time in detecting the indicators and this caused duration of untreated illness of 73.44 (36.05) months (p < 0.001) and a delay of 128.08 (71.23) months (p < 0.001) to arrive to appropriate care.
Conclusions: The pathways to care in children are characterized by long duration of untreated illness and undue time to care. Gatekeepers like teachers and intermediary points of care were associated with inadvertent delays along the pathway.
(Copyright © 2020 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: