Development of methods for WHO Quality Standards for Child and Youth Mental Health Services to improve quality of care and patient safety in the WHO European Region

Jennifer Hall^1*Katie H Atmore²Rimma Belikova³Chris Boyd Skinner¹Lisa Corrigan⁴Anastasia Giannaki¹Ana Isabel F Guerreiro⁵Penny Kalpaxi¹Colette Kelly⁶Konstantinos Kotsis⁷Dennis Ougrin^8,9Catalina Popoviciu¹⁰Anne Marie Råberg Christensen¹¹Dion Ras¹²Cassie Redlich¹³Tatiana Taylor Salisbury¹⁴Raffaella Sibilio¹Ana Maria Tijerino¹³Ledia Lazeri¹³Joao Breda¹

• ¹World Health Organization Office on Quality of Care and Patient Safety (Greece), World Health Organization (Greece), Athens, Greece
• ²University College London Institute for Global Health, London, United Kingdom
• ³Methodological Centre, Children's Clinical University Hospital Latvia, Riga, Latvia
• ⁴Department of Health, Ireland, Dublin, Ireland
• ⁵Independent expert, Strasbourg, France
• ⁶University of Galway Health Promotion Research Centre, Galway, Ireland
• ⁷Community CAMHS, Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
• ⁸Youth Resilience Unit, WHO Collaborating Centre for Mental Health Services Development, Centre for Psychiatry and Mental Health, Queen Mary University of London Wolfson Institute of Population Health, London, United Kingdom
• ⁹East London NHS Foundation Trust, London, United Kingdom
• ¹⁰Let's CEE- A Youth Mental Health Initiative for the Central and Eastern European Region., Bucharest, Romania
• ¹¹Independent, Copenhagen, Denmark
• ¹²International Association for Youth Mental Health, Meerssen, Limburg, Netherlands
• ¹³World Health Organization Regional Office for Europe, Copenhagen, Denmark
• ¹⁴Health Service and Population Research Department,, King's College London Institute of Psychiatry Psychology & Neuroscience, London, United Kingdom

Background Child and youth mental health care is of varying quality across the WHO European Region, with many settings being low-resourced. To improve and standardize quality of care, WHO Regional Office for Europe is developing quality standards for child and youth mental health services. This research aims to develop evidence informed methods to develop these quality standards. Methods Desk reviews of grey literature aimed to understand what approaches have been used or recommended to develop quality standards for child and youth mental health /health for use across a range of different countries, and consultation was sought from an expert steering group. A thematic approach was used to synthesize relevant themes. The methods were developed based on the results of these steps. Results Desk reviews identified variation in approaches used and recommended to develop quality standards, with limited available guidance applicable across different resource settings. Nine key themes from stakeholder consultations were highlighted. Based on these results, a seven-step methodology was created to develop the quality standards for child and youth mental health which prioritizes using an evidence-based approach and inputs from a wide range of stakeholders. Discussion The methods taken to develop quality standards need to be rigorous to ensure that standards accurately define high-quality care for a service. There is a need to develop a unified approach to developing quality standards. It is hoped that this paper will provide inspiration for others developing quality standards for child and youth mental health services and spark research in this area.