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

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