Perspectives on clinical guidelines for severe behavioural problems in children across Europe: a qualitative study with mental health clinicians.

Clinical guidelines for severe behavioural problems (SBPs) in children have recently been developed in several European countries. However, questions emerged regarding their applicability to practice. Our study aimed to provide a first European insight into guidelines' fitness-for-purpose by exploring mental health clinicians' familiarity with, use and perceived value of guidelines for SBPs in children. Participants included 161 clinicians, primarily psychiatrists, from 24 countries. Clinicians completed a semi-structured qualitative questionnaire on existing SBPs guidelines and development of new guidelines where not available. Clinicians' responses were mapped against academic experts' perceptions on SBPs guidelines highlighted in a previous study (Gatej et al. in Eur Psychiatry 57:1-9, 2019). Under half of the clinicians reported being unaware of guidelines. Of these, 37.6% represented countries where guidelines were available according to experts. The remaining half of clinicians who were aware of guidelines on average reported being moderately familiar with their content, perceiving them as moderately useful and using them some of the time. Additionally, 60.8% clinicians agreed that SBPs guidelines need to be developed, as these would create a shared scientific knowledge base and common practice. Guideline improvements included taking a multifactorial approach, creating specific case recommendations, and dissemination efforts. The modest familiarity with and use of guidelines amongst practitioners may highlight guidelines poor fitness-for-purpose, or, alternatively, an underlying confusion around the meaning and purpose of guidelines. Moving forward, efforts should be directed at disseminating clearer definitions of guidelines, addressing existing challenges, and unifying efforts to further develop and audit application of international guidelines for SBPs.

Awareness and perceptions of clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe: A qualitative survey with academic experts.

BACKGROUND: Severe behavioural problems (SBPs1) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts' perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6-12 across Europe. METHODS: An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries. RESULTS: Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines' benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs. CONCLUSIONS: This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts' consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population.