Child psychiatry in the Finnish health care reform: national criteria for treatment access.
OBJECTIVE
As a part of the Finnish National Health Care Project, to develop and validate nationwide standardised criteria for assessing the need for non-urgent child psychiatric specialised medical care (SMC).


METHODS
The Finnish criteria tool, a cutpoint measure indicating access to SMC, was developed on the basis of the Western Canada Waiting List Criteria Tool. The Finnish criteria were widely discussed at national level and finally confirmed by a national child psychiatric consensus meeting. The testing data included 949 new cases, aged 5-18 years, from SMC, family guidance clinics, primary health care and child protection.


RESULTS
The Finnish Child Psychiatric Criteria Tool covers the entire case-mix of child psychiatric disorders. Danger to self or others and psychotic symptoms have been combined into a threshold item. This alone suffices to indicate access to SMC. Sensitivity of the tool was 82% and specificity 74% with cutoff point 16/75.


CONCLUSIONS
Child psychiatric non-urgent SMC is provided in accordance with national criteria, publicly accessible in the Internet. The criteria development process evoked multisectoral discussion on organising child mental health services and, by determining the need of treatment requiring SMC, defined health policy.
Kaukonen
Pälvi
P
Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland. palvi.kaukonen@pshp.fi
Salmelin
Raili K
RK
Luoma
Ilona
I
Puura
Kaija
K
Rutanen
Mervi
M
Pukuri
Tarja
T
Tamminen
Tuula
T
D000293:Adolescent; D002648:Child; D002665:Child Psychiatry / Q000379:methods*; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D005387:Finland; D018166:Health Care Reform; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D020407:Internet; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*