Barriers and facilitators of implementation of evidence-based interventions in children and young people's mental health care - a systematic review.

BACKGROUND: Effective evidence-based practices (EBP) for children and young people's (CYP) mental health exist, however, there is low uptake in clinical practice and interventions do not always reach those in need. This review aimed to comprehensively identify and synthesise the barriers and facilitators to implementing EBP in CYP mental health care, mapped according to an implementation framework in order to make pragmatic recommendations for practitioners, commissioners and researchers. METHODS: Following the PRISMA guidelines, an electronic search of PsycINFO, MEDLINE, CINAHL and Embase in 2021 yielded 1830 results. In total, 107 abstracts were screened, 57 of which were included for full-text review and 26 were included for data extraction and analysis. RESULTS: We identified a number of organisational and clinician-level barriers which impede the implementation of evidence in 'real world' practice. Barriers included lack of access to funding; poor access to resources; clinician attitudes and flexibility of EBP. Facilitators included targeted funding and access to resources; supportive staff and leadership committed to innovation and skills in the EBP. CONCLUSIONS: Although the process of translating research into practice is challenging and the solutions are not straightforward, we have identified a set of practical recommendations for ways in which implementation practices can improve. Researchers, commissioners, funders and practitioners can work together to improve the implementation of EBP in CYP mental health settings by ensuring funding is available, prioritise implementation beyond the end of trials, upskill staff on integrating EBP into care, ensure EBPs are flexible and are co-produced with service users. REGISTRATION: This review was registered on PROSPERO international prospective register of systematic reviews (CRD42021252995).

The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis.

Background: Healthcare workers (HCWs) are considered at elevated risk of experiencing mental health disorders in working with patients with COVID-19. Objective: To estimate the prevalence of common mental health disorders in HCWs based in hospitals where pandemic-affected patients were treated. Method: Databases were searched for studies published before 30 March 2020. Quantitative synthesis was used to obtain estimates of the prevalence of mental health disorders in four time windows, determined a priori (the acute phase, i.e. during and up to 1.5 months post-pandemic; 1.5-5.9 months; 6-11.9 months; 12 months and later). Results: Nineteen studies met the review criteria. They predominantly addressed the acute phase of the SARS outbreak in Asia. The most studied outcomes were clinically significant post-traumatic stress symptoms (PTSS) and general psychiatric caseness. For clinically significant PTSS in the acute phase, the prevalence estimate was 23.4% (95% CI 16.3, 31.2; N = 4147; I2 = 96.2%); in the 12 months plus window, the estimate was 11.9% (8.4, 15.8; N = 1136; I2 = 74.3%). For general psychiatric caseness, prevalence estimates were acute phase, 34.1% (18.7, 51.4; N = 3971; I2 = 99.1%); 6-12 months, 17.9% (13.1, 23.2; N = 223; I2 = 0.0%); 12 months plus, 29.3% (6.0, 61.0; N = 710; I2 = 97.8%). No differences between doctors and nurses with respective to PTSS and general psychiatric caseness were apparent in the acute phase. Conclusions: Mental health disorders are particularly common in HCWs working with pandemic-afflicted patients immediately following a pandemic, but the course of disorders following this period is poorly understood. There was considerable heterogeneity between studies, likely linked to methodological differences. More extended follow up of HCWs is needed.

Antecedentes: Se considera que los trabajadores de la salud (TS) tienen un riesgo elevado de experimentar trastornos de salud mental al trabajar con pacientes con COVID-19.Objetivo: Estimar la prevalencia de trastornos de salud mental comunes en los TS de los hospitales donde se trataron a pacientes afectados por una pandemia.Método: Se realizaron búsquedas en las bases de datos para estudios publicados antes del 30 de marzo de 2020. Se utilizó una síntesis cuantitativa para obtener estimaciones de la prevalencia de trastornos de salud mental en cuatro ventanas de tiempo, determinadas a priori (la fase aguda, es decir, durante y hasta 1,5 meses después de la pandemia; 1.5-5.9 meses; 6-11.9 meses; y después de 12 meses).Resultados: Diecinueve estudios cumplieron los criterios de esta revisión. Principalmente abordaron la fase aguda del brote de SARS en Asia. Los resultados más estudiados fueron los síntomas de estrés postraumático clínicamente significativos (SEPT) y casuística psiquiátrica general. Para los SEPT clínicamente significativo en la fase aguda, la estimación de prevalencia fue del 23,4% (IC del 95%: 16,3, 31,2; N = 4147; I2 = 96,2%); en los 12 meses adicionales, la estimación fue del 11,9% (8,4, 15,8; N = 1136; I2 = 74,3%). Para los casos de psiquiatría general, las estimaciones de prevalencia fueron: fase aguda, 34.1% (18.7, 51.4; N = 3971; I2 = 99.1%); 6-12 meses, 17.9% (13.1, 23.2; N = 223; I2 = 0.0%); después de 12 meses, 29.3% (6.0, 61.0; N = 710; I2 = 97.8%). No se observaron diferencias entre los médicos y las enfermeras con SEPT y casuística psiquiátrica general en la fase aguda.Conclusiones: Los trastornos de salud mental son particularmente comunes en los TS que trabajan con pacientes afectados inmediatamente después de la pandemia, pero el curso de los trastornos después de este período es poco conocido. Hubo una considerable heterogeneidad entre los estudios, probablemente vinculada a diferencias metodológicas. Se necesita un seguimiento más extenso de los TS.