Joanna K. Anderson

Background Children and young people (CYP) with comorbid physical and/or mental health conditions often struggle to receive a timely diagnosis, access specialist mental health care, and more likely to report unmet healthcare needs. Integrated healthcare is an increasingly explored model to support timely access, quality of care and better outcomes for CYP with comorbid conditions. Yet, studies evaluating the effectiveness of integrated care for paediatric populations are scarce. Aim and Methods This systematic review synthesises and evaluates the evidence for effectiveness and cost‐effectiveness of integrated care for CYP in secondary and tertiary healthcare settings. Studies were identified through systematic searches of electronic databases: Medline, Embase, PsychINFO, Child Development and Adolescent Studies, ERIC, ASSIA and British Education Index. Findings A total of 77 papers describing 67 unique studies met inclusion criteria. The findings suggest that integrated care models, particularly system of care and care coordination, improve access and user experience of care. The results on improving clinical outcomes and acute resource utilisation are mixed, largely due to the heterogeneity of studied interventions and outcome measures used. No definitive conclusion can be drawn on cost‐effectiveness since studies focused mainly on costs of service delivery. The majority of studies were rated as weak by the quality appraisal tool used. Conclusions The evidence of on clinical effectiveness of integrated healthcare models for paediatric populations is limited and of moderate quality. Available evidence is tentatively encouraging, particularly in regard to access and user experience of care. Given the lack of specificity by medical groups, however, the precise model of integration should be undertaken on a best‐practice basis taking the specific parameters and contexts of the health and care environment into account. Agreed practical definitions of integrated care and associated key terms, and cost‐effectiveness evaluations are a priority for future research.

Background At least half of all young people who die by suicide have previously self‐harmed and most of those who self‐harm will not seek help from health services for self‐harming behaviours. By default, schools, colleges and universities necessarily play a key role in identifying those who self‐harm and supporting them to access help. Methods We conducted a systematic review (PROSPERO ID: CRD42021243692) of five databases (Medline, PsycINFO, ASSIA, ERIC and BEI) for quantitative studies evaluating interventions to reduce self‐harm among students in schools, colleges and universities. Results We identified six eligible studies that reported interventions. Two interventions used mindfulness‐based approaches and the remaining four interventions focused on in‐classroom education. Three interventions reported a significant reduction in self‐harm, all three used in‐classroom education. Of the six studies, one study was rated methodologically moderate, while the remaining five were weak. Conclusion In summary, the evidence base is limited in size and quality. Most current interventions to address self‐harm in schools focus on training staff in awareness, with a significant gap in direct support for students.