Working together to improve the mental health of indigenous children: A systematic review

Objective: This review analyses the available literature that underpins intersectoral service integration processes and tools designed to improve mental healthcare for Indigenous children. Method: 10 databases and 12 grey literature sources were searched for publications in English and published between 1 January 2008 and 31 December 2017 that evaluated or measured primary health care interventions that focussed on the intersectoral integration of services, service partnerships, or action across at least two sectors to improve children's mental health, and that included Indigenous children 4-17 years old in one of the five CANNZUS countries (Canada, Australia, New Zealand, Norway and/or the United States). The five sectors considered were PHC, specialist mental health, education, child protection, and juvenile justice. Study characteristics were extracted and reported aims, strategies, enablers, and outcomes were identified and analysed. Results: Eleven studies were included: five were Australian; four Canadian; one from the USA; and one from New Zealand. Nine key strategies for service integration were: intervention delivery through community workers and external workers, interdisciplinary delivery, staff and organizational capacity building, engaging community, empowering families, individual counselling, adaption of care to Indigenous sociocultural specificities, and strengthening culture and identity. Six enablers of implementation were: involvement of community, access and cost, collaborative multidisciplinary health services, strong relationships, cultural sensitivity, and organizational and staff capacity. Six outcomes were: health and human services collaboration, psychosocial functioning and stress management, health service & organizational empowerment, development and promotion of appropriate health policy and protocols, linkage of health services, and community and family empowerment. Discussion and conclusion: The evidence for intersectoral interventions addressing Indigenous child mental health is in the early stages of development, but suggests potential for improving health outcomes for Indigenous children, their families and communities, as well as the satisfaction and utilization of healthcare and community services. Further research surrounding cost evaluation, impact on the social determinants of health, extent of consumer engagement, and Indigenous voice is needed.