Collaborative care for child and youth mental health problems in a middle-income country: study protocol for a randomized controlled trial training general practitioners

Abstract

Background: Child and youth mental health problems are leading causes of disability and particular problems in low- and middle-income countries where populations are young and child mental health services are in short supply. Collaborative care models that support primary care providers' efforts to detect and treat child mental health problems offer one way to address this need. However, collaborative care for child mental health can be more complex than collaboration for adults for a number of reasons, including two-generational aspects of care, high degrees of co-morbidity, and variations in presentation across developmental stages.

Methods: The study takes advantage of an existing collaborative care network in Tehran, Iran, in which general practitioners are supported by community mental health centers to care for adult mental health problems. At present, those practitioners are asked to refer children with mental health problems to the collaborating centers rather than treating them themselves. We are conducting a cluster randomized trial in which practitioners in the network will be randomized to receive training in child/youth mental health treatment or a booster training on recognition and referral. Children/youth aged 5-15 years making visits to the practitioners will be screened using the Strengths and Difficulties Questionnaire; those found positive will be followed for six months to compare outcomes between those treated by trained or control practitioners.

Discussion: If the trial demonstrates superior outcomes among children treated by trained practitioners, it will support the feasibility of expanding collaborative care networks to include children.

Trial registration: ClinicalTrials.gov, NCT03144739 . Registered on 8 May 2017.

Keywords: Adolescents; Children; Collaborative care; Mental health; Middle-income countries; Primary care.

Fig. 1

Simplified* flow of study procedures. *Figure shows one of three waves of general practitioners (GPs) who are trained and whose patients are recruited, screened, and followed. **Note: in this cluster randomized study, the children/youth are “allocated” by the status of the GP who provides their care. ***See Table 2 for outcome measures and time points for collection