Scoping review: outpatient psychotherapeutic care for children and adolescents in Germany-status quo and challenges in assessment.

Abstract

Background: In the context of multiple global crises, including the COVID-19 pandemic, climate change, and global conflicts, children and adolescents worldwide are experiencing heightened psychological stress. As the foundation for lifelong mental health is established during childhood and adolescence, early prevention and treatment of mental health problems, such as through psychotherapy, are crucial. In Germany, current outpatient psychotherapeutic care capacities appear inadequate, while systematic evaluations of the care situation are lacking. This study investigates the state of statutory health insurance-funded outpatient psychotherapeutic care for children and adolescents in Germany and evaluates various methodological approaches for its assessment.

Methods: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications from January 2018 to December 2023 were sourced from PubPsych, PubMed, APA PsycInfo, Google Scholar, and ProQuest. Included studies report quantitative primary data on the mental health of community samples of children and adolescents in Germany or their outpatient psychotherapeutic care.

Results: We included 41 publications comprising epidemiological studies, administrative data, and psychotherapist and patient reports. A lack of systematic and standardised research approaches resulted in significant variance in data. Nonetheless, qualitative analysis revealed that approximately one four children and adolescents in Germany is affected by mental health problems, while one in six to seven children and adolescents requires psychotherapeutic treatment. Yet, only up to one in 50 receives guideline-based psychotherapy. Most requests for initial psychotherapeutic consultations are unmet, with waiting times for guideline-based psychotherapy exceeding 6 months for at least half of the patients.

Conclusion: Overall, our findings suggest that outpatient psychotherapeutic care for children and adolescents in Germany is still insufficient. They advocate for a systematic, multimodal, and longitudinal assessment of statutory health insurance-funded outpatient psychotherapeutic care, along with an expansion of treatment capacities to enhance access for children and adolescents in Germany.