Development of a novel tiered-care mental health model: the Paediatric and Adolescent Wellness Service

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INTRODUCTION: One in three Singaporean adolescents report significant mental health (MH) symptoms, highlighting the urgent need for the development of innovative care models. We describe a paediatrician-led MH service, the Paediatric and Adolescent Wellness Service (PAWS), which was set up in a tertiary pediatric hospital as part of a collaborative tiered-care model to improve access to care for children and adolescents with MH symptoms. METHODS: This study described the development of the PAWS within a tiered-care model. Clinical outcome measures were prospectively collected to evaluate clinical improvement, with scores reported at baseline and post-treatment. Service utilisation data were collected to evaluate improvement in wait time for MH appointments after PAWS was available. RESULTS: In 2023, PAWS started providing MH services for children and adolescents aged 7 to 18 years. From January 2023 to December 2023, the service saw 180 patients. Mean patient-reported function scores improved by 4.4 points (95% confidence interval [CI] 2.9-5.9), from a baseline of 11.3 to post-treatment scores of 6.9, with 75% of patients reporting improvement. Similarly, mean physician-reported function scores improved by 7.0 points (95% CI 5.5-8.4), from baseline of 66.4 to 73.4 post-treatment, with 72% of patients showing improvement. Overall, the wait time for MH appointments improved from 28.7 days in 2022 to 11.3 days in 2023. CONCLUSION: PAWS, a mental health service by paediatricians for children and adolescents with Tier 3 mental health symptom severity, has improved access to care, with patients demonstrating improved clinical outcomes, highlighting the service's potential.

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