After being on hold for two years, the Dutch Knowledge Centre for Child and Adolescent Psychiatry was placed under a foundation in April 2009.
Seven child and adolescent psychiatric centres participate in this foundation (De Jutters, Curium, Karakter, Triversum, De Bascule, Yulius and Accare), while two academic child and adolescent psychiatric centres (Rotterdam (ErasmusMC) and Utrecht (UMCU)) provide substantive input.
The information below pertains to the 2002-2006 period.
> Origin of the Knowledge Centre
> Purpose of the Knowledge Centre
> 2002-2006: What was achieved?
> Organisation of the Knowledge Centre
> Substantive goals
> Participating centres
> Work structure
> Subsequent steps
Origin of the Knowledge Centre
Around 2001, the policy of the Ministry of Health, Welfare and Sport (VWS) was aimed at developing and setting up knowledge centres within the field of mental healthcare. Knowledge centres were established on the basis of two documents:
- ‘Mental Healthcare Policy Vision’ (Beleidsvisie Geestelijke Gezondheidszorg) (1999)
- ‘Mental Healthcare Knowledge Centres Policy Vision’ (Beleidsvisie kenniscentra GGZ) (2001)
The Health Council, the advisory body of the minister of Health, Welfare and Sport, published a report on children with ADHD which contained the recommendation to establish a knowledge centre for this focus area. However, in the above policy visions submitted to the Lower House of Dutch Parliament, the minister had indicated the intent of working towards a broad knowledge centre for Child and Adolescent Psychiatry.
At the end of 2001, Accare submitted a request for the designation of the Dutch Knowledge Centre for Child and Adolescent Psychiatry, based in Groningen (dated 4 September 2001), to the Ministry of Health, Welfare and Sport. This application focused on a number of concrete goals, which were to be realised by means of establishing a specific national collaborative structure.
In January 2002, Accare was appointed by the Ministry of Health, Welfare and Sport as secretary of the Dutch Knowledge Centre for Child and Adolescent Psychiatry for a period lasting from 2002 until 2007. Over the past five years, the goals and collaborative structure outlined in the application have formed the basis for the activities of the Knowledge Centre.
Purpose of the Knowledge Centre
With the establishment of the Dutch Knowledge Centre for Child and Adolescent Psychiatry, a nation-wide network has been created in the form of a partnership between all academic institutes and a number of affiliated regional institutes of general child and adolescent psychiatry. The point of departure was the presence of high-quality knowledge at various locations in theNetherlands. This knowledge could be used to develop and/or implement protocols that are broadly applicable in the diagnosis and treatment of children and adolescents with psychiatric conditions.
Through the collaborative structure with the academic centres, top expertise could be devoted to projects aimed at specific forms of behaviour in children, including ADHD, PDD, ODD and CD, OCD, anxiety disorders, depression and Tourette Syndrome.
By also including the general institutes for adolescent mental healthcare in this structure, it was possible to not only utilise the expertise of these institutes but to also guarantee that high-quality knowledge could be translated into a practical and broadly applicable form in protocols.
Parent participation was also an essential feature. Cooperation with parent/patient associations allowed knowledge gained from experience to be implemented at both the strategic and practical level in the working groups.
Primary goals
All goals of the Dutch Knowledge Centre for Child and Adolescent Psychiatry have been achieved. From its inception, the Knowledge Centre had specified a number of goals which had served as the basis for its approval and funding. The operational activities were designed to achieve these goals in a direct fashion. The basic structures which seemed conditional to the success of the operation – i.e. the network structure directed from Groningen, the advisory council, the participation of the academic departments cooperating with general departments, the participation of the parent associations, the central and local working group structure – all contributed to the set goals being achieved (the website) within the agreed period.
Administrative organisation, participation of academic centres and general child and adolescent psychiatric institutes and working structure
The advisory council meets annually and has provided useful commentary on the state of affairs each year. The academic centres have all participated. The collaboration between two or three centres on one issue and/or theme has been a partial success. The collaboration with the general child and adolescent psychiatric institutes has gotten off the ground in some cases. Parent participation has been highly successful in some places, while it has been less or even non-existent in others.
The structure of the three central working groups and the local working groups has worked superbly. The chairmen of the three central working groups laid the foundation for the success of the Knowledge Centre. The participants in the central working groups served as the link to the activities of their own local working groups.
Specific targets
Target 1: protocol-based diagnostics
The protocol-based diagnostics (e.g. standardised questionnaires, interview, observation tools) have been assessed and evaluated, and proposals have been made with respect to both the initial diagnostics upon registration and the further specialised diagnostics specific subproblems (e.g. ADHD, OCD). All of this has been substantiated by evaluating the various tools based on their measuring claims and further scientific substantiation.
All of this has been posted on the site: www.kenniscentrum-kjp.nl/en/
Target 2: medication according to protocol
The overview of the literature on the effects of the various types of psychopharmaceuticals has been updated. The same has been done with the use of the various types of psychopharmaceuticals for the various types of behaviours. This has also been posted on the website.
Target 3: psychological treatment protocols
All current protocols used within child and adolescent psychiatry and mental healthcare in the Netherlands that were relevant to the Dutch Knowledge Centre for Child and Adolescent Psychiatry have been tracked down by making inquires of all participating institutions. These protocols have been evaluated based on criteria explicitly specified in advance. These protocols have also been summarised. Information about these protocols and their evaluation was posted on the website in November 2006.
Target 4: Internet site for the Dutch Knowledge Centre for Child and Adolescent Psychiatry
The website was first developed in order to make all information available. The site has recently been revised to make it more user-friendly and more in line with the centre’s goals. All the material is now available on the site.
Conclusion
The primary goals of the Dutch Knowledge Centre for Child and Adolescent Psychiatry – i.e. compiling all current protocols pertaining to diagnostics, dealing with psychopharmaceuticals and psychological treatment – were achieved at the end of 2006. We see this as a great success.
Since these products are based on the activities of the central and local working groups (in other words, countless clinicians across the entire country), the presumption is that this has laid a solid foundation for implementation opportunities.
The working groups’ activities have served as an impetus for collaborating on multicentre research into the efficacy of healthcare protocols in theNetherlands. There is a great shortage in this respect.
Organisation of the Knowledge Centre
The Dutch Knowledge Centre for Child and Adolescent Psychiatry has been set up as a partnership between the various academic centres for child and adolescent psychiatry and regional partner institutes for general child and adolescent psychiatric care and parent/patient associations.
From 2002 to 2006, the Knowledge Centre was placed under Accare, Stichting Universitaire en Algemene Kinder- en Jeugdpsychiatrie Noord-Nederland. In this structure, Accare’s board of management bore ultimate responsibility for all of the Knowledge Centre’s activities and its financial state of affairs.
At the time, the Knowledge Centre was headed by Dr. R.B. Minderaa, professor of child and adolescent psychiatry and member of Accare’s board of management. Over the first few years (until mid-2005), he was supported in this capacity by a coordinator, Dr. J.H. de Ruiter.
On behalf of the Dutch Knowledge Centre for Child and Adolescent Psychiatry, an advisory/steering committee has been put together from the participating academic departments, three general institutes from the National Committee on Child and Adolescent Psychiatry (Landelijk Beraad Kinder- en Jeugdpsychiatrie), the child and adolescent psychiatry section of the Dutch Psychiatry Association (NVvP), the Netherlands organisation for health research and development (ZonMW), the Ministry of Health, Welfare and Sport (VWS) and the parent/patient associations.
The participating parent/patient associations were Balans, the Dutch Association for Autism (NVA), the Gilles de la Tourette Foundation and the ADF Foundation for anxiety, OCD and phobia.
This advisory/steering committee met once a year and acted as a sounding board group for the activities to be carried out.
The participation of the various academic child and adolescent psychiatric departments in the Knowledge Centre was given form by means of written partnership agreements which provided for the consultation structure, the concrete products that had to be delivered and the financial contributions and accountability agreements. These partnership agreements were also made with the parent/patient associations.
The Ministry of Health, Welfare and Sport appointed the Trimbos Institute as the national knowledge institute for mental healthcare, drug rehabilitation and behavioural health. The Knowledge Centre participated in the national network of knowledge centres organised by the Trimbos Institute.
The Dutch Knowledge Centre for Child and Adolescent Psychiatry focuses on the protocol elements in care and/or those care aspects that have been written out in concrete terms, are accordingly transferable and, if implemented, can be scientifically researched with respect to their effects.
Target 1: protocol-based diagnostics
An assessment has been made of all documented diagnostic procedures carried out according to protocol used within academic and general child and adolescent psychiatry in the Netherlands. Based on an evaluation of their scientific substantiation and clinical relevance, a proposal has been arrived at for a basic protocol and a large number of specific protocols that can be broadly implemented in the care provided by child and adolescent psychiatry and mental healthcare.
A distinction is thus made between a basic protocol, whose elements are standardly applied to all children registered, and specific protocols, which focus on specific psychiatric behaviour, after it has been established that this is probably what a patient has. The central working group (see further) conducted the assessment with respect to the basic protocol.
The protocol elements in the specific diagnostic procedures (e.g. ADHD, OCD) have been compiled by the specialised local working groups (see further).
Target 2: medication according to protocol
The second target involved researching international literature to assess the scientific substantiation of the use of psychopharmaceuticals for children with psychological disorders. The central working group reviewed the literature on the various types of psychopharmaceuticals, while the local working groups reviewed the literature on the various types of disorders. The central working group also focused on the protocol-based reporting methods for prescribing psychopharmaceuticals to children and adolescents.
Target 3: psychological treatment protocols
The third target involved assessing and systematically evaluating psychological treatment protocols which are promising for broad implementation in the country. Among other things, the evaluation focused on the theoretical substantiation, practicality and any effect studies that have been conducted.
Target 4: Internet site for the Dutch Knowledge Centre for Child and Adolescent Psychiatry
All information acquired by means of the three above activities is posted on the website (www.kenniscentrum-kjp.nl/en/).
The following academic centres participated in the 2002-2006 period, together with a large number of affiliated general centres for child and adolescent psychiatry and mental healthcare and parents from the relevant parent/patient association:
- Curium, Leiden
Anxiety disorders
Depression - Sophia children’s hospital, Rotterdam
Anxiety disorders
Depression - Bascule/UvA and AMC
Children and adolescent forensic psychiatry
OCD
Tourette syndrome
ODD and CD - UMCU, Utrecht
Autism
Children and adolescent forensic psychiatry
ADHD - Karakter, Nijmegen
ADHD
Autism - Accare, Groningen
Autism
ADHD
OCD
Tourette syndrome
Local working groups
Local working groups were created at all academic centres, focusing on the relevant themes (e.g. ADHD or anxiety disorders) as these pertained to the protocol-based diagnostics, dealing with medication according to protocol and the psychological treatment protocols.
Central working groups
These local working groups were under the direction of the following three central working groups:
the Diagnostics central working group
the Medication central working group
the Psychological Treatment Protocols central working group
Each of these three central working groups was headed by a chairman, each recruited from different parts of the country. The central working groups had a member from all the local working groups and were responsible for the overall direction of the entire operation.
The products of the Dutch Knowledge Centre for Child and Adolescent Psychiatry were broadly presented and discussed during a national conference held on 30 November 2006.
Plans were presented for maintaining the Knowledge Centre in the future.
The interesting thing about the Knowledge Centre is that it actually consists of activities generated by the care sector itself. In other words, the Knowledge Centre is child and adolescent psychiatry and mental healthcare.
On 30 November, plans were presented regarding the question of how the centre could be sustained, expanded and strengthened. Measures include:
- broadly implementing the protocols developed at the Knowledge Centre within mental healthcare
- improving cooperation with the parent/patient associations
- expanding in the direction of children/adolescents with a mental handicap or addictive behaviour and ADHD in adults. In addition, directing activities towards general practitioners, paediatricians, Youth Care Agencies and education.
