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Table 1 Inclusion/exclusion criteria for strategies to improve mental health services for children and adolescents

From: Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review

Category Inclusion Exclusion
Population Health care systems, organizations, and practitioners that care for children and adolescents or mixed (child and adult) populations with mental health problems • Health care systems, organizations, and practitioners that care only for adults 18 years of age or older
• Health care systems, organizations, and practitioners that care for children and adolescents with only developmental disorders
Interventions (Strategies) • Quality improvement strategies (e.g., strategies targeting systems and practitioners of mental health care to children and adolescents with the goal of improved quality of care) Interventions targeting only patients, only drug interventions (although strategies to implement or disseminate drug interventions would qualify), and interventions not otherwise described in inclusion criteria
• Implementation strategies (e.g., strategies to integrate evidence-based practice (EBP) interventions that meet National Registry of Evidence-based Programs and Practices (NREPP) inclusion criteria with the goal of changing practice patterns)
• Dissemination strategies (e.g., strategies to enhance the adoption and implementation of evidence-based interventions that meet NREPP inclusion criteria)
Comparator Any control strategy, including usual care or different variants of the same intervention None
Outcomes Intermediate outcomes (at least one intermediate outcome is required for KQs 1, 3) All outcomes not otherwise specified
Patient
 • Access to care
 • Satisfaction
 • Treatment engagement
 • Therapeutic alliance with practitioner
Practitioner
 • Satisfaction with or acceptability of approach
 • Protocol adherence/program model fidelity
 • Competence or skills
System or organization
 • Feasibility
 • Uptake
 • Timeliness
 • Penetration
 • Sustainability
 • Resources (including costs)
Patient health and service utilization outcomes (at least one of these outcomes is required for KQs 1 and 3 unless the strategy uses an intervention that is an EBP)  
Required:
• Change in mental health status, including symptom change, response, remission, relapse, and recurrence
• Coexisting physical health conditions, substance use problems, developmental disorders, other mental health problems
Not Required:
• Mortality
• Socialization skills and behavior
• Functional status
• Quality of life
• Service utilization (e.g., visits, hospitalizations)
Harms of strategy
Patient
 • Lower treatment engagement or more dropouts
 • Negative impact on therapeutic relationship
 • Side effects of EBP incorporated into strategy (e.g., adverse events, suicidality)
Practitioner
 • Burnout or exhaustion
 • Turnover
 • Resistance to the intervention
System or organization
 • Cost
 • Failure to sustain the EBP
 • Resistance to change
Timing of outcome measurement All None
Settings Outpatient settings serving children and adolescents with mental health problems (primary care, specialty care, emergency rooms, community mental health centers, integrated care settings, federally qualified health centers, schools, homes) Inpatient or residential treatment settings, drug treatment programs, jails or prisons
Geographic setting Countries with a very high Human Development Index (HDI) [76] Countries with high, medium, low, or very low HDI
Publication language English All other languages
Study design KQs 1, 3 (benefits) Case series
Case reports
Nonsystematic reviews
Cross-sectional studies
Before and after studies without time-series data
Other designs without a control or comparison group
 • RCTs
 • CCTs
 • Systematic review and meta-analyses
 • Cohort studies
 • Interrupted time series
 • Case-control studies
KQs 2, 3 (harms):
 • RCTs
 • CCTs
 • Systematic review and meta-analyses
 • Cohort studies
 • Interrupted time series
 • Case-control studies
Publication type Any publication reporting primary data Publications not reporting primary data
  1. CCT controlled clinical trial, EBP evidence-based practice, D dissemination HDI Human Development Index, I implementation, KQ key question, NREPP National Registry of Evidence-based Programs and Practices, QI quality improvement, RCT randomized controlled trial