Experiences and satisfaction with intensive community care services for children and adolescents with severe mental health disorders: a mixed-methods systematic review.
TL;DR
Findings have implications for service design, workforce training, and balancing family involvement with young people's autonomy, as well as for staff perspectives and specific elements of satisfaction.
Abstract
Intensive community care services (ICCS) are community-based alternatives to inpatient care for young people with severe mental health disorders. This systematic review investigated the experiences and satisfaction associated with ICCS. Nine electronic databases were searched from inception to August 2025 for studies on children and adolescents under 18 years receiving mental health care from ICCS. Primary outcomes were experiences and satisfaction from the young people, parents, or clinicians. Quantitative satisfaction data were qualitised before integrating with qualitative data. The synthesis used a meta-aggregative approach to produce statements to inform practice. Nine studies from eight articles were included: two qualitative, three mixed-methods, and four quantitative studies. No studies examining clinician experiences were identified. Positive experiences were generated when ICCS: (a) provide structured emotional and practical support to caregivers; (b) facilitate strong therapeutic relationships across the young person-family-clinician system through frequent, flexible, and community-based contact; (c) offer multidisciplinary expertise and specialist interventions; (d) support sustained improvements beyond treatment by embedding therapeutic work in real-world contexts; (e) actively manage extra-therapeutic factors and family involvement to avoid undermining young people's autonomy or sense of agency. Parents were particularly satisfied with ICCS due to accessibility, responsiveness, intensity of contact, and reduced hospitalisation. ICCS models successfully generate positive experiences in service users. Satisfaction was generally higher than routine care and particularly pronounced amongst parents. Future studies should explore staff perspectives and specific elements of satisfaction. These findings have implications for service design, workforce training, and balancing family involvement with young people's autonomy.