Development of a Mental Health Service System for Guardians of Children and Adolescents with Mental Health and Developmental Problems

Abstract

Introduction The mental health service system for guardians of children and adolescents with mental health and developmental problems remains unclear. Screening is not adequately covered, leading to limited access to services for guardians with mental health issues and a lack of links between service units. 

Objectives To develop and test the efficiency and effectiveness of a mental health service system (MHSS) for guardians of children and adolescents with mental health and developmental problems, using a brief psychosocial intervention program based on the Satir model (BPST). 

Design Research and Development 

Methodology The study was conducted in five stages between January 2020 and December 2022: Stage 1 - Needs assessment and analysis; Stage 2 - Designing the mental health service system for guardians; Stage 3 - Creating the MHSS model; Stage 4 - Testing the efficiency of MHSS in terms of benefits and service quality among 65 guardians, selected by purposive sampling, who received services under the MHSS between June and August 2021; Stage 5 - Testing the effectiveness of BPST among 54 guardians who participated in the MHSS, randomly assigned to either experimental or control groups. The experimental group (n = 27) received the BPST program three times, while the control group (n = 27) received brief counseling using problem-solving principles (BCPS) three times. Outcomes were measured by evaluating guardians' mental health (stress, anxiety, and depression), children's emotional, social, and behavioral problems, family relationships, and satisfaction with services received. Data were analyzed using descriptive statistics, Independent t-test, Mann-Whitney U test, and Friedman test. 

Results The MHSS consisted of 1) an initial screening by nurses, 2) evaluation, diagnosis, and treatment provided by psychiatrists, and 3) reassessment of guardians’mental health status and provision of psycho-social therapy by nurses. The service system's efficiency was demonstrated through guardians' reduced stress and anxiety, mental support, multidisciplinary collaboration, and the application of service providers' knowledge and expertise. In terms of quality, 68% of guardians received services as expected. The effectiveness of BPST showed lower anxiety ( 2 = 8.909, p = .012), stress ( 2 = 22.092, p < .001), depression ( 2 = 28.871, p < .001), children's emotional, social, and behavioral problems ( 2 = 19.809, p < .001), and improved family relationship ( 2 = 10.533, p = .005) in the experimental group across three time-points. While the control group showed an increase in anxiety ( 2 = 9.100, p = .011) and children's emotional, social, and behavioral problems ( 2 = 9.771, p = .008) after completing the program. These symptoms decreased at the 1-month follow-up, and there was an improvement in family relationships ( 2 = 37.829, p < .001). However, no significant difference was observed in stress and depression. On the other hand, the experimental group experienced greater satisfaction with the services (M = 2.67, SD = 0.25, Mean rank = 13.36) compared to the control group (M = 2.35, SD = 0.07, Mean rank = 3.00) (Z = -2.017, p = .043) after the program completion. 

Recommendations The MHSS has been developed to effectively and efficiently support guardians of children and adolescents with mental health and developmental problems. Psychiatric and mental health nurses can implement the BPST to alleviate mental health problems among guardians and improve emotional, social, and behavioral problems in children, as well as enhance family relationships.