Evidence-based brief interventions targeting acute mental health presentations for children and adolescents: systematic review

Background Brief intervention services provide rapid, mobile and flexible short-term delivery of interventions to resolve mental health crises. These interventions may provide an alternative pathway to the emergency department or in-patient psychiatric services for children and young people (CYP), presenting with an acute mental health condition. Aims To synthesise evidence on the effectiveness of brief interventions in improving mental health outcomes for CYP (0–17 years) presenting with an acute mental health condition. Method A systematic literature search was conducted, and the studies’ methodological quality was assessed. Five databases were searched for peer-reviewed articles between January 2000 and September 2022. Results We synthesised 30 articles on the effectiveness of brief interventions in the form of (a) crisis intervention, (b) integrated services, (c) group therapies, (d) individualised therapy, (e) parent–child dyadic therapy, (f) general services, (g) pharmacotherapy, (h) assessment services, (i) safety and risk planning and (j) in-hospital treatment, to improve outcomes for CYP with an acute mental health condition. Among included studies, one study was rated as providing a high level of evidence based on the National Health and Medical Research Council levels of evidence hierarchy scale, which was a crisis intervention showing a reduction in length of stay and return emergency department visits. Other studies, of moderate-quality evidence, described multimodal brief interventions that suggested beneficial effects. Conclusions This review provides evidence to substantiate the benefits of brief interventions, in different settings, to reduce the burden of in-patient hospital and readmission rates to the emergency department.

Mental health conditions refer to a wide range of disorders that affect mood, thinking and behaviour in children and young people (CYP), including acute disorders that require immediate attention and intervention.These conditions can have an adverse effect on a child's emotional, social and environmental development, and can lead to long-term adverse effects on their overall health and well-being.Mental health conditions are experienced by approximately 14% of CYP internationally, 1 which have increased exponentially, particularly in light of the COVID-19 pandemic.According to recent reports, the prevalence of mental health disorders among CYP has increased exponentially, with up to 19% reported for suicidal presentations in Australia. 2Suicide is the leading cause of death among young people, with the global suicide rate of 10.5 per 100 000 individuals. 3,4According to a 2020 report by United Nations International Children's Emergency Fund (UNICEF), mental health issues among CYP are a growing concern globally.Suicide is the second leading cause of death among young people aged 15-19 years. 5The suicide rate has been reported to be 12.0 per 100 000 in the African region, 12.9 per 100 000 in the European region, 13.4 per 100 000 in the South-East Asia region, 11.8 per 100 000 in the USA 6 and 10.4 per 100 000 in Canada. 7The lowest reported suicide rate is 4.3 per 100 000 individuals in the Eastern Mediterranean region. 4 mental health crisis in CYP can arise when they encounter an experience or event that exceeds their and/or their family's capacity to manage their mental health distress, resulting in a significant impairment of their ability to function and requiring urgent medical attention. 8,9Validated screening tools are available to identify CYP who require brief interventions to address acute mental health crises.These measurement tools, rigorously validated through scientific scrutiny and empirical evidence, are designed to adhere to stringent psychometric standards.By applying established criteria, these screening tools systematically evaluate the mental health status of CYP, enabling healthcare professionals to discern the severity and urgency of intervention required.The use of validated screening tools ensures the precision and reliability of the assessment process, facilitating the timely and targeted implementation of brief interventions for CYP experiencing acute mental health crises. 10n situations where risks are higher and the criterion is met, inpatient treatment may be necessary, and many CYP who meet the threshold could benefit from brief interventions. 8,9However, inpatient hospital admissions can place a significant burden on both CYP and their caregivers because of dislocation from family, friends and support networks, with readmission occurrences heightening this situation.Our recent work in Australia has found a substantial increase in CYP presenting to the emergency department 8 and suicide-related ambulance calls 9 during the COVID-19 pandemic, indicating the need to efficiently respond to an acute mental health condition/presentation/crisis and fill service gaps. 11herefore, safe and effective brief interventions have been proposed to improve the efficiency and effectiveness of crisis care in a timely, safe and sensitive manner, accounting for the complex, multifaceted needs of consumers.

Aim of the review
The findings of our systematic review are timely and build upon previous reviews reporting outcomes on brief interventions by Otis et al, 12 Clisu et al 13 and Newton et al. 14 These studies collectively suggest that brief interventions have a beneficial impact on reducing readmission rates to the emergency department, which can reduce the burden on emergency departments and improve outcomes for CYP with mental health concerns.In alignment with these previous studies, which highlight the positive impact of brief interventions on reducing readmission rates to emergency departments and enhancing outcomes, our study hypothesises that strategically tailored brief interventions for mental health crises, incorporating established screening procedures and administered in out-patient settings (excluding emergency departments), possess the potential to significantly reduce reliance on emergency department assessments, re-evaluations or in-patient admissions among CYP aged 0-17 years.This hypothesis serves to guide this review, aligning with our aim to contribute essential insights that advance crisis care strategies in the realm of CYP mental health.

Method
For this review, we followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. 15The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42022323324).Ethical approval was not required as this is a systematic review of published data.

Search strategy and study selection
This systematic literature review utilised five electronic databases (PubMed, PsycINFO via ProQuest, Web of Science via Clarivate, EMBASE and Cochrane Library) to extract studies reporting on the effectiveness of interventions for acute mental health presentations of CYP aged 0-17 years.We also searched cross-references for further articles.Peer-reviewed studies published in the English language were searched over the past 22 years (1 January 2000 to 30 March 2022).We included primary literature evaluating the effectiveness of brief interventions for CYP aged 0-17 years who presented with an acute mental health concern.The full search strategy is included in Supplementary  16 A data collection tool was used to screen each paper for inclusion and exclusion eligibility for the review.

Data extraction and screening
Four reviewers (F.B., B.G., P.H., J.R.J.) performed the initial title and abstract screening with the data collection tool.Two reviewers (F.B., P.H.) independently conducted full-text screening and compared results.At each stage of the selection process, a fifth reviewer (T.W.) was available to resolve or moderate any disagreements on the included articles.Four reviewers (F.B., B.G., P.H., B.O.A.) performed data extraction for the included articles.In parallel, these reviewers extracted data from the full-text reports with Rayyan software, a web-based systematic review application. 16his was used to extract study designs, country, the size of the sample, different characteristics of the study population (including age, ethnicity, gender and diagnoses), type of intervention, characteristics of the control group and the outcomes of interest.

Eligibility criteria
Studies were included if (a) the study reported on the effectiveness of a brief intervention (defined below) targeted at improving mental health outcomes for CYP presenting with an acute mental health condition/presentation/crisis; (b) participants' age ranged from 0 to 17 years, or where the age range was not reported, the mean age of the participant was <18 years; (c) participants presented with an acute mental health condition/presentation/crisis and (d) studies were published in a peer-reviewed journal in English.
Studies were excluded if (a) participant age criteria were not met (participants >18 years of age), (b) participants were not presenting/ attending the intervention for the treatment of an acute mental health condition, (c) the study was a quantitative meta-analysis of published literature and (d) the study was not published in a peer-reviewed journal in English.

Brief intervention services
We defined the term 'acute mental health crisis' as a situation in which CYP experience a sudden and severe deterioration in their mental health.This deterioration is often accompanied by significant distress and impairment in their ability to function.In contrast, we will use the term 'psychiatric emergency' to refer to situations where there is an immediate risk to the safety or well-being of the CYP or others because of their mental health condition.In this review, we defined 'brief interventions' as an intervention that consisted of three or fewer visits to a service or ≤8 weeks of intervention programme duration.The narrative synthesis followed guidance for systematic reviews to assist with evaluating the evidence-based effectiveness of each intervention, such as what interventions (mechanisms) were effective (outcomes) and the type of setting and location (context) where the intervention took place. 17etails describing quality assessment, data extraction and risk of bias can be found in Supplementary Appendices 1 and 2.

Statistical analysis
Previously reported data from various studies were synthesised.Given the narrative synthesis nature of our work, we focused on the qualitative integration of findings rather than employing quantitative statistical methods.Our approach involved an examination of the reported outcomes, utilising frequencies and percentages where appropriate, to convey the distribution of data.This facilitated a nuanced exploration of the collective evidence, aligning with the synthesis objectives of this review.

Results
Our initial search yielded 4892 results, of which 3242 were duplicates, resulting in 1650 articles that were eligible for screening.After title and abstract screening, 436 potentially eligible studies were assessed for eligibility, and 30 studies met the eligibility criteria.Figure 1 illustrates the study selection process, using the PRISMA flow diagram.

Methodological quality of the studies
Table 2 provides a comprehensive overview of each of the included studies, with detailed descriptions of the studies, National Health and Medical Research Council (NHMRC) levels of evidence and risk of bias, interventions examined and the results reported.Among the included studies, there was one study that was rated as high quality or provided a high level of evidence based on the NHMRC levels of evidence hierarchy scale (level of evidence I or II), 40 10 studies were rated as providing moderate evidence (level of evidence III-2: comparative studies with controls such as cohort studies) 8,19,21,27,33,34,37,42,44 and 19 studies were of lower-quality evidence (level of evidence III-3: cohort studies without a comparison group; or level of evidence IV: pre and post studies). 18,22,26,29- 32,35,36,38,39,41,45,47There was considerable variability between study methodologies and 30% (n = 9/30 studies) of studies compared outcomes with a comparison group 19,21,27,28,33,37,42,44    Eapen et al

Effect of interventions on mental health symptoms
We narratively synthesised intervention types into the following categories: crisis intervention, integrated services, group therapies, individualised therapy, parent-child dyadic therapy, general services, pharmacotherapy, assessment services, safety and risk planning, and in-hospital treatment (see Table 2).

Assessment services
Five studies (17%) evaluated assessment services, including motivational interviewing, neuropsychology assessment, telepsychiatry and interdisciplinary assessment, targeting CYP (age range: 3-17 years) with psychosis and behavioural disorders. 19,26,38,39lthough information about mental health disorders for younger children accessing assessment services was not specified, Reliford and Adebanjo's study 29 demonstrated low-level evidence that oncall telepsychiatry consultations in a non-hospitalised intervention programme significantly reduced the total monthly length of stay (LOS) during a 6-month study period (from 285 to 193 h) compared with prior months.Non-hospitalised patients also experienced a significant reduction in monthly LOS, decreasing from 329 h to 193 h during the study period.Additionally, the telepsychiatry intervention reduced the need for face-to-face evaluations by 75%.

Crisis intervention
Crisis intervention was explored in eight studies (27%) focusing on diverse mental health conditions in CYP, such as anxiety, depression and self-harm. 27,31,32,37,38The average duration for a crisis intervention was 4 days.Among the eight studies that reported outcomes associated with a crisis intervention, there was only one study that showed a reduction in the LOS and the frequency of emergency department return visits.One high-quality study 40 reported a 15% decrease in 30-day emergency department return visits among the intervention group.Moreover, a moderate-quality cohort study 27 demonstrated significant reductions in emergency department LOS following the 'Child Guidance' intervention, with a mean decrease of 43.10 min (P < 0.001).Additional findings can be found in Table 2. 30,41 General services General services for CYP mental health included psychiatric evaluations, treatment plan reviews, psychosocial treatments, psychoeducation for families and behavioural health treatments.In the reviewed studies (23%), these services, examined through cohort and pre-post intervention studies, benefited CYP aged 3-17 years with various mental health diagnoses (anxiety, autism spectrum disorder, attention-deficit hyperactivity disorder, conduct disorders, depression, eating disorders, psychotic disorders, self-harm/suicidal ideation) (Table 2).
One study indicated an 8% reduction in emergency department presentations (32.8-24.5%)after receiving intervention services. 28nother study focusing on psychosis intervention found significant improvements in CYP behaviour disorders and psychosis, evidenced by improved Children's Global Assessment Scale (CGAS) scores at assessment and discharge. 38Interventions, lasting from 3 h to <3 months, demonstrated overall benefits, improving outcomes in behaviour disorders and reducing emergency department presentations. 18,20,26,28,39,45,47oup therapy Group therapy, including family therapy, psychotherapy, wellness and substance misuse counselling, demonstrated effectiveness, notably in reducing hospital readmission rates for CYP in family-based interventions.34 Older adolescents in these therapies exhibited diverse mental health symptoms (anxiety, autism spectrum, behavioural disorders, depression, eating disorders, psychosis, self-harm/ suicidal ideation) 23,25,35,42,45 Cognitive-behavioural therapy (CBT) was evaluated in four low-level evidence studies (14%) 24,39,45,46 of CBT programmes for CYP (age range: 8-16 years).24,44,49,51 A group-based CBT programme effectively reduced suicidal ideation at 30 days and 3 months post-intervention for adolescents aged 12-17 years.24 Additionally, CBT interventions for older adolescents (mean age 16 years) resulted in significant improvements in anxiety and mood, without cases of deterioration.46

In-hospital treatment
In five studies (17%) centred on in-hospital interventions for CYP aged 8-21 years, two were pre-and post-studies 26,45 and three were cohort studies, 31,34,38 with risks of bias ranging from moderate to high.Diagnoses included adjustment disorders, anxiety, autism spectrum disorder, behavioural disorders, depression, eating disorders, psychosis and self-harm/suicidal ideation.In-hospital stays, lasting from 1 to 3 months, tailored interventions to mental health conditions.One study reported multimodal in-hospital interventions for CYP showed positive outcomes, with emergency evaluation interviews and brief therapeutic interventions effectively treating CYP within 24 h of their emergency department presentation.Hospital admission rates decreased significantly after the intervention, and no control group was provided for comparison. 31,36dividualised therapy Two studies 27,41 with a moderate risk of bias (7%) investigated individualised therapy for CYP. 20,34In one study, 20 a collaborative practice model intervention was associated with increased access to psychiatric evaluations (adjusted odds ratio 4.16, P < 0.01) and greater engagement in follow-up sessions (adjusted odds ratio 7.54, P < 0.01) for CYP with behaviour, anxiety and mood disorders.The other study found that young people with eating disorders who received weekly individual therapy in a partial hospital programme had significantly lower LOS (29.37 days, s.d.= 18.85 days) compared with the control group (32.96 days, s.d.= 14.59 days), along with lower hospital readmission rates (P < 0.04). 34

Integrated services
Integrated services, comprising various components such as integration with primary care, linkage to specialty and community mental health services, and paediatric behavioural interventions, were explored in eight studies. 19,21,24,38,45,47These services had a duration of <3 months and were accessed by CYP aged 0-17 years with conditions like adjustment disorder, 38 aggression and anxiety, 47 autism spectrum disorder, 25,45,52 behaviour disorders, 38 depression and mood disorders, 38,45 eating disorders, 38,45 psychotic disorders, 38,45 self-harm/suicidal ideation 24,38,45,47 and substance misuse. 47Two Canadian studies provided moderate-level evidence on out-patient aftercare services, showing mixed results in terms of emergency department readmissions. 43,44Another study highlighted the positive impact of a multidisciplinary mobile youth outreach service on consumer engagement and hostility risk in CYP with psychotic disorders. 47rent-child dyadic therapy Parent-child dyadic therapy was the focus of one study with a moderate level of bias and low-quality evidence.22 The study evaluated an infant preschool family mental health initiative for young children (mean age 3 years, range 0-5 years) with anxiety, behavioural disorders, adjustment disorder and affective or reactive disorders.The intervention employed relationship-based dyadic techniques with parents and their children, resulting in high parental satisfaction and significant improvements in the Mental Health Screening Tool and Moderate Risk Assessment scores, as well as higher scores on the Parent-Infant Relationship Global Assessment Scale and Global Assessment of Functioning Scale at post-test.22

Pharmacotherapy
Five studies (16%) evaluated pharmacotherapy efficacy for CYP aged 4-16 years. 18,23,25,39,45Medication, combined with other therapies, showed significant improvements in mental health symptoms, particularly for externalising symptoms (Cohen's d = 0.99) and total problems (Cohen's d = 0.86). 23Older adolescents received pharmacotherapy for a range of mental health conditions, such as attention-deficient hyperactivity disorder, autism and depression. 18,25,39However, some studies lacked specific medication details (type and dose) and effects. 18,45An early psychosis intervention service employing medication management and multimodal therapies, including psychiatric evaluations, psychoeducation (i.e.healthy lifestyle choices, symptom awareness, medication management), individual and family therapy sessions showed improved CGAS scores. 39Additional details associated with the outcomes for each study can be found in Table 1, where a summary of the results from each research study are provided.

Safety and risk assessment planning
Three studies (10%) examined safety and risk assessment planning services, all with a moderate risk of bias.Safety and risk assessments for younger children (age 2-5 years) primarily focused on those with behavioural disorders, 23 whereas for adolescents (age 12-17 years), the services targeted individuals with self-harm/suicidal ideation 24 and behavioural disorders. 30In a study with moderate evidence, safety planning was integrated into a care service for young people with self-harm/suicidal ideation, 19 and outcomes were compared with a control group.Among the participants, 26% received behavioural safety planning as part of the intervention, and the results showed no significant difference in 30-or 90day emergency department return rates compared with the control group. 19

Discussion
The aim of this study was to investigate whether brief interventions, incorporating established screening procedures and delivered in out-patient settings (excluding emergency departments), effectively decreased the reliance on emergency department assessments, reevaluations or in-patient admissions among CYP experiencing mental health crises.This systematic review included studies exploring a wide range of brief interventions in different settings for CYP presenting with a mental health crisis.To translate these findings into practical strategies, several key considerations need to be considered.
In the context of the emergency department, the use of measurement-based care (MBC) for screening purposes can help identify CYP who require brief interventions and improve their treatment outcomes. 52,54MBC can be used by trained health professionals to track treatment progress and outcomes, and has been shown to improve treatment outcomes for CYP with mental health conditions.A study by Parikh et al 55 found that the use of standardised screening tools in the emergency department improved the identification of mental health disorders and increased the provision of appropriate referrals and interventions.Another study by Chun et al 56 found that the use of screening tools in the emergency department improved the identification of mental health conditions among CYP.Further, Bickman et al 57 found that the use of MBC led to significant improvements in mental health outcomes for youths in community mental health clinics, including a reduction in symptoms and improvement in overall functioning.
Integrated services are core strategies to be employed in brief interventions in mental health programmes.Drake et al 58 found that the use of a care coordination model was a key component of successful implementation of evidence-based practices in routine mental health service settings.The authors emphasised the importance of considering regional disparities between urban and rural healthcare systems in the implementation of programmes.A study by Probst et al 59 found that rural areas face unique challenges in implementing integrated service programmes, because of limited resources and access to care.Hoffman et al 60 examined the association between follow-up care visits and return mental health acute care encounters among CYP who had received mental health emergency care, and showed that CYP who received follow-up care visits within 7 and 30 days after an initial mental health emergency visit were less likely to have return mental health acute care encounters.These findings suggest that follow-up care is crucial in reducing the risk of subsequent acute care encounters among CYP with mental health conditions.Further, Lyon and Bruns 61 also found that factors such as a reduction in symptom severity and family engagement were associated with the likelihood of follow-up care after brief interventions for CYP with behavioural health needs.
Crisis interventions also play key role in emergency department LOS.For example, the 'Child Guidance' intervention contributed to significant reductions in emergency department LOS.The Child Guidance intervention is a collaborative model that involves a full-time psychiatric social worker and a full-time child psychiatrist. 24It is specifically designed to provide efficient mental healthcare to children with volatile mood disorders in the emergency department.This innovative approach ensures that CYP with acute mental health needs receive timely and specialised care, resulting in notable reductions in emergency department LOS.The success of the Child Guidance intervention highlights its potential as an effective and efficient strategy for optimising the care and outcomes of CYP in crisis situations. 24he implementation of brief interventions may require additional funding and resources.Therefore, it is important to consider the cost-effectiveness surrounding them when developing and implementing these programmes.For example, a study by Grist et al 62 found that a brief intervention for CYP with anxiety disorders was cost-effective compared with usual care. 62,63creening CYP to determine the appropriate intervention can be challenging.However, validated screening tools are available to identify CYP who require brief interventions.For example, the Pediatric Symptom Checklist is a widely used screening tool to identify CYP with mental health conditions in primary care settings, 64 whereas the 'Home, Education, Activities/peers, Drugs/alcohol, Suicidality, Emotions/behavior, Discharge resources' tool has been shown to be effective in identifying CYP who require emergency department-based interventions. 65Moreover, the Suicide Assessment Five-Step Evaluation and Triage is also a widely used tool for assessing suicide risk in individuals, including CYP who present with suicidal ideation. 66Additionally screening tools, such as the CGAS 67 and the Screen for Child Anxiety Related Emotional Disorders, 68 may also be useful in identifying CYP who require brief interventions. 69,70ddressing the barriers to follow-up care is important for improving treatment outcomes for CYP who receive brief interventions.Recent studies have highlighted the importance of follow-up care for CYP with mental health conditions.For example, a study by Katon et al 71 found that regular follow-up care was associated with improved mental health outcomes for CYP with depression.A study by Zima et al 72 found that many CYP with mental health conditions face barriers in accessing mental health services, such as a lack of available services in their area or difficulty accessing care because of transportation issues.In addition, stigma and shame surrounding mental health issues can also be a barrier to care for some CYP. 73nterventions that address these barriers, such as providing culturally sensitive care and enhancing communication between healthcare providers and families, have been shown to improve followup rates among CYP with mental health conditions. 74ong-term data collection is also an important aspect in evaluating the effectiveness of mental health for CYP, and recent studies have emphasised the significance of conducting follow-up assessments to assess treatment outcomes over extended periods.Weisz et al 75 observed that CBT demonstrated sustained benefits for anxiety and depression in CYP, evident even at a 5-year follow-up assessment.Moreover, a meta-analysis conducted by Bickman et al 57 indicated mental health treatments for CYP generally maintained their effects over time, with potential implications that longer treatment durations could yield more lasting results.Although our systematic review did not explicitly incorporate long-term data supporting the findings, we recognise the importance of considering such data to enhance our understanding of mental health treatment effectiveness.Future research efforts should identify factors contributing to sustained treatment effects and develop interventions promoting enduring mental health outcomes for CYP.

Limitations
Given the escalating number of CYP who present to the emergency department in crisis, it is plausible that brief interventions may enhance mental health outcomes for this population.Consequently, it is imperative to systematically assess the outcomes of brief interventions against a comparison group (including preintervention controls), utilising consistent measurement tools to investigate their effectiveness in lowering emergency department presentations, in-patient admissions, LOS, as well as the psychological impact on CYP and their families.Further research is needed to identify impediments to the effective implementation of these interventions, as well as high-quality studies that can compare different interventions in terms of consumer outcomes and perspectives, with appropriate control groups.Moreover, it is crucial to assess the impact of offering brief interventions on other parts of the mental health treatment services sector, such as private services, primary healthcare and community-based public mental health services.
In conclusion, this systematic review examined the impact of brief interventions, incorporating established screening procedures and delivered in out-patient settings, on the utilisation of emergency department assessments, re-evaluations and in-patient admissions among CYP experiencing mental health crises.Findings provide useful insights to guide and support the development of new and existing brief interventions for consumers with mental health concerns and their families/caregivers.The findings indicate that brief interventions can be successfully delivered in various out-patient settings, such as linking clients to community or out-patient services or in-home care, leading to a reduction in hospital readmission rates and LOS in hospital.This review provided moderate evidence to indicate that incorporating family-based therapies into hospital programmes improves mental health outcomes for CYP in the short term, whereas other lower-quality evidence supports multimodal treatments, including parent-child dyadic therapy and CBT.
However, the feasibility and acceptability of lower-quality evidenced brief interventions for CYP and their families/caregivers requires further research, with a pre-intervention comparison group, in assessing their effectiveness in reducing symptoms and improving mental health function and quality of life across a wide spectrum of mental health symptoms, severity and age groups.As a rationale for improving mental health outcomes for CYP, brief interventions should consider patient safety, care integration and quality of care, as well as rigorous and consistent evaluation of new brief interventions and therapies.Finally, given that these interventions were typically delivered over a short period (often 8 weeks), long-term follow-up is necessary to determine their sustained effectiveness and success.

• 9 and 5 .
In-hospital treatment AAOT is an out-patient community-based service providing intensive community treatment Decrease in mean HoNOSCA scores posttreatment (adolescent assertive outreach team support as well as inpatient care) (22.45 v. 14.40) Improvement in mean CGAS scores posttreatment (46.22 v. 62., specifically in primary care practices that provided paediatric care CYP with major depression or anxiety disorders were less likely to return to primary care paediatricians compared with CYP with ADHD following the intervention (Targeted Child Psychiatric Services programme).Families widely accepted paediatricians' recommendations for referral to child psychiatrists.28.7% CYP returned to their referring paediatricians for follow-up management of their mental disorder following the intervention.Most CYP (n = 52) returned to their referring paediatrician after a single evaluation visit.For ADHD (n = 129), anxiety (n = 43) and major depressive disorder (n = 102), the return rates were 48.8, 27.9%, respectively.(Continued )

48 Female: 26 / 48 INT••
and services provided in the community Clinical and Family Distress Scale scores indicated significant improvements for CYP and caretakers.There was a 33% reduction in time spent in the emergency department, and LOS decreased up to 77% from pre-to postintervention.There was a 6% reduction in visits to the emergency department postintervention Gillig et al 36 2004 USA Evidence: low (level: III-3) Risk of bias: high Cohort INT n = 48 INT 16.5 years (age range: 12-18 years) INT Male: 22/Depression and mood disorder (n = 32/48) • Conduct disorder (n = 8/48) • Psychosis (n = 7/48) • Anxiety (n = 3/48) • Eating disorders (n = 2/48) • Alcohol and drug misuse (1/48) department and in-hospital setting 10% of CYP seen in the emergency department were admitted to hospital after the evaluation was received, no patients were admitted to hospital in the month following the evaluation and 4.2% patients were admitted to hospital 6 Emergency symptoms (not specified) (n = 11/211) • Self-harm/suicidal ideation (n = 186/211) • Anxiety (n = 44/211) • Eating disorders (n = 17/211) psychiatric and mental health services LOS was consistent with the model of care and differed for youth receiving only crisis (4 days) versus crisis plus assessment services (13 days).Youth referred for in-patient transitional care had longer LOS for crisis/assessment services (19 days).Crisis and assessment CYP were more likely than CYP transferred for transitional care to be admitted as an in-patient.The assessment group reported higher levels of emotional and behavioural concerns on the YSR than other groups; significant only for internalising problems, and anxiety/ depression assessment youth had significantly higher scores than crisis youth.All groups had clinically elevated scores on the internalising problems and anxiety/depression scales.Parent/guardian reports of youth's emotional and behavioural functioning on the CBCL were higher for the assessment group compared with other groups.80% of CYP in each group showed reliable improvement in total acuity level.Most of the youth in each group improved on the four CAPI subscales.(Continued ) Brief interventions for mental health in young people Table 1 available at https:// doi.org/10.1192/bjo.2024.25.Search results were de-duplicated in Endnote X9 for Windows (Clarivate Analytics, Berkeley, California, USA; see https://endnote.com/) and again in Rayyan software for Windows for systematic reviews (Rayyan Systems, Cambridge, Massachusetts, USA; see www.rayyan.ai).
Brief intervention was defined as three or fewer visits to a service or ≤8 weeks of intervention programme duration.ATSI, Aboriginal and Torres-Strait Islander.

Table 2
Characteristics of brief intervention studies (N = 30 studies)