Review: management of children with mental health problems by specialist teams in primary care improved some outcomes.

Main results Educational studies involving the primary care team: 8 studies (1 RCT) were included. The RCT compared an introduction to the use of behaviour modification techniques (12 sessions) with a wait list control group in 14 health visitors who worked with 205 families. Groups did not differ for child behaviour. Studies involving treatment by the primary care team: 6 studies (3 RCTs) were included. 1 RCT compared 12 brief preschool interviews (20–30 min) with no interviews over 5 years in a community sample of 246 non-distressed parents (and children). The intervention group showed improvement in some behaviour and relationship outcomes but no difference in school performance. Differences in neurotic symptoms persisted for up to 20–30 years. In 1 RCT of 90 children with night waking problems, no differences were seen at 12 weeks between groups receiving an advice booklet (with and without support from a researcher) and controls. 1 RCT (n=25) showed that adolescents at risk of substance abuse who received an educational intervention by nurses (eg, pamphlets, motivational interview, and setting a contract of personal goals) reported greater reductions in alcohol use at 1 and 3 months than control participants. Management by specialists in primary care: 10 studies (3 RCTs) met the selection criteria. 1 RCT of 191 mothers with postpartum depression showed that treatment groups (counselling, cognitive behavioural therapy, and dynamic therapy) were better than routine primary care for maternal reports of infant relationship problems but not for mother–child interaction, cognitive development, or behavioural problems at 18 months. 1 RCT of 17 frequent attendees showed that the intervention group (group therapy by psychologist and general practitioner) had fewer family consultations than the control group (routine primary care). In 1 RCT of 260 preschool children with emotional and behavioural problems, 4 groups were compared: intensive health visiting, family therapy by social workers, mother and toddlers’ groups run by social workers and health visitors, and no treatment. At 1 year, children in the family therapy group had lower cognitive development than children in the other 3 groups. At 3 years, groups did not differ.