Agreement between patients and mental healthcare providers on unmet care needs in child and adolescent psychiatry
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ORIGINAL PAPER
Agreement between patients and mental healthcare providers on unmet care needs in child and adolescent psychiatry Richard Vijverberg1,2,3 · Robert Ferdinand1 · Aartjan Beekman3 · Berno van Meijel2,3,4 Received: 17 March 2020 / Accepted: 23 September 2020 © The Author(s) 2020
Abstract Purpose In mental health care, patients and their care providers may conceptualize the nature of the disorder and appropriate action in profoundly different ways. This may lead to dropout and lack of compliance with the treatments being provided, in particular in young patients with more severe disorders. This study provides detailed information about patient–provider (dis)agreement regarding the care needs of children and adolescents. Methods We used the Camberwell Assessment of Need (CANSAS) to assess the met and unmet needs of 244 patients aged between 6 and 18 years. These needs were assessed from the perspectives of both patients and their care providers. Our primary outcome measure was agreement between the patient and care provider on unmet need. By comparing a general outpatient sample (n = 123) with a youth-ACT sample (n = 121), we were able to assess the influence of severity of psychiatric and psychosocial problems on the extent of agreement on patient’s unmet care needs. Results In general, patients reported unmet care needs less often than care providers did. Patients and care providers had the lowest extents of agreement on unmet needs with regard to “mental health problems” (k = 0.113) and “information regarding diagnosis/treatment” (k = 0.171). Comparison of the two mental healthcare settings highlighted differences for three-quarters of the unmet care needs that were examined. Agreement was lower in the youth-ACT setting. Conclusions Clarification of different views on patients’ unmet needs may help reduce nonattendance of appointments, noncompliance, or dropout. Routine assessment of patients’ and care providers’ perceptions of patients’ unmet care needs may also help provide information on areas of disagreement. Keywords Childhood · Agreement · Care needs · Intensity of care · Outpatient · Assertive Community Treatment
* Richard Vijverberg r.vijverberg@ggz‑delfland.nl Robert Ferdinand r.ferdinand@ggz‑delfland.nl Aartjan Beekman [email protected] Berno van Meijel [email protected] 1
Department of Child and Adolescent Psychiatry, GGZ Delfland Psychiatric Institute, GGZ Delfland, Delft, The Netherlands
2
Inholland University of Applied Sciences, Amsterdam, The Netherlands
3
Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, VU Amsterdam, Amsterdam, The Netherlands
4
Parnassia Psychiatric Institute, The Hague, The Netherlands
Abbreviations ACT Assertive Community Treatment CANSAS Camberwell Assessment of Need Short Appraisal Schedule df Degrees of freedom CP Care provider EMDR Eye-movement desensitization and reprocessing therapy FE Fisher’s exact test GAF score Global Assessment of Functioning score ICF Internat
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