<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjcapp-2019-009_s_009"><h3>Background:</h3><p>Multiple and complex needs (MCN) in children and youth jeopardize their development and pose significant challenges to the different professionals they meet. However, there is no agreed-upon definition of this vulnerable population.</p></sec><sec id="j_sjcapp-2019-009_s_010"><h3>Objectives:</h3><p>To develop a definition of ‘MCN in children and youth’ that is meaningful for all professionals involved in care delivery for this population.</p></sec><sec id="j_sjcapp-2019-009_s_011"><h3>Method:</h3><p>A cross-sector, multidisciplinary, and geographically spread panel of 47 experts representing mental health, youth care, juvenile justice, and education in Flanders participated in an online Delphi study. Qualitative analysis of answers in the first round yielded four definition possibilities that participants then ranked in the second round. In the last round, participants rated their agreement with the highest ranked definition. An additional survey asked 25 international experts to rate and comment their agreement with the final definition.</p></sec><sec id="j_sjcapp-2019-009_s_012"><h3>Results:</h3><p>The final definition was: Children and adolescents with profound and interacting needs in the context of issues on several life domains (family context, functioning and integration in society) as well as psychiatric problems. The extent of their needs exceeds the capacity (expertise and resources) of existing services and sequential interventions lead to discontinuous care delivery. As such, existing services do not adequately meet the needs of these youths and their families. Cross-sector, integrated and assertive care delivery is necessary for safeguarding the wellbeing, development and societal integration of these young people. Response rates to the three Delphi rounds were 76.6, 89.1, and 91.3%. The definition was widely endorsed among Flemish (93.2% agreement) and international experts (88% agreement).</p></sec><sec id="j_sjcapp-2019-009_s_013"><h3>Conclusion:</h3><p>A definition of MCN in children and youth was constructed using the Delphi method and further evaluated for international relevance in an additional survey. Such an agreed-upon definition can be valuable for optimizing care delivery and conducting research.</p></sec></abstract>

Background:Multiple and complex needs (MCN) in children and youth jeopardize their development and pose significant challenges to the different professionals they meet. However, there is no agreed-upon definition of this vulnerable population.Objectives:To develop a definition of ‘MCN in children and youth’ that is meaningful for all professionals involved in care delivery for this population.Method:A cross-sector, multidisciplinary, and geographically spread panel of 47 experts representing mental health, youth care, juvenile justice, and education in Flanders participated in an online Delphi study. Qualitative analysis of answers in the first round yielded four definition possibilities that participants then ranked in the second round. In the last round, participants rated their agreement with the highest ranked definition. An additional survey asked 25 international experts to rate and comment their agreement with the final definition.Results:The final definition was: Children and adolescents with profound and interacting needs in the context of issues on several life domains (family context, functioning and integration in society) as well as psychiatric problems. The extent of their needs exceeds the capacity (expertise and resources) of existing services and sequential interventions lead to discontinuous care delivery. As such, existing services do not adequately meet the needs of these youths and their families. Cross-sector, integrated and assertive care delivery is necessary for safeguarding the wellbeing, development and societal integration of these young people. Response rates to the three Delphi rounds were 76.6, 89.1, and 91.3%. The definition was widely endorsed among Flemish (93.2% agreement) and international experts (88% agreement).Conclusion:A definition of MCN in children and youth was constructed using the Delphi method and further evaluated for international relevance in an additional survey. Such an agreed-upon definition can be valuable for optimizing care delivery and conducting research.

Towards a definition of multiple and complex needs in children and youth: Delphi study in Flanders and international survey

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Background:Multiple and complex needs (MCN) in children and youth jeopardize their development and pose significant challenges to the different professionals...

		No. of participants	No. of responders round 1	No. of responders round 2	No. of responders round 3
Youth mental health
	Policy	3	2	3	3
	CAP (hospital) psychiatrists	8	3	7	7
	CAP (hospital) psychologists	3	3	3	3
	Mental health center child and adolescent	2	2	2	2
	psychiatrist
	Mental health center psychotherapist	1	1	0	0
Youth care
	Policy	5	4	5	5
	(General) youth care	9	7	8	9
	Youth care for (presumed) Child abuse	3	3	3	3
Welfare
	Welfare centers for families	1	1	1	1
	General Welfare	5	2	1	3
Juvenile justice
	Juvenile judges	2	2	1	2
	Social workers in juvenile justice	2	2	2	2
	Professionals from juvenile justice	2	2	2	1
Institutions
Services for persons with disabilities		2	1	2	2
Education counseling		1	1	1	1
	Total	47	36	41	42

Themes	Subthemes	Examples of codes	Definition aspects where different opinions existed
Issues	Severity, interrelation of problems, domains affected	‘Interrelation of problems,’ ‘family problems,’ ‘psychiatric problems’	Family problems as a separate issue receiving separate emphasis vs family problems not mentioned as a separate entity
Care delivery problems	Fragmented care, incapacity of actual care delivery to cope	‘Negative impact of uncoordinated care,’ ‘services overwhelmed’	Inadequate/failing care delivery plays an important possibly causal role vs inadequate care delivery not mentioned as contributing to complexity
Care delivery needs	Different integrated services, assertive approach	‘Assertive care,’ ‘integrated care provision by different sectors’

Towards a definition of multiple and complex needs in children and youth: Delphi study in Flanders and international survey

Published Online: Nov 08, 2019

Page range: 60 - 67

DOI: https://doi.org/10.21307/sjcapp-2019-009

Keywords
Delphi study, multiple and complex needs, definition, child serving agencies, children and adolescents

© 2019 Helena Van den Steene et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Expert panel of the Delphi study

Analysis of the answers to the first round open question

Towards a definition of multiple and complex needs in children and youth: Delphi study in Flanders and international survey

Published Online: Nov 08, 2019

Page range: 60 - 67

DOI: https://doi.org/10.21307/sjcapp-2019-009

KeywordsDelphi study, multiple and complex needs, definition, child serving agencies, children and adolescents

© 2019 Helena Van den Steene et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Expert panel of the Delphi study

Analysis of the answers to the first round open question

Keywords
Delphi study, multiple and complex needs, definition, child serving agencies, children and adolescents