Development and implementation determinants of competency frameworks for mental health clinicians and service providers working with youth: a scoping review protocol

Abstract

Introduction

Despite high prevalence, access to mental healthcare for Canadian youth is limited, with less than 20% receiving adequate treatment. Marginalised and at-risk youth face particular challenges, including cultural misunderstandings, long wait times and negative care experiences. A competency framework for mental health clinicians working with youth can be a tool to increase the capacity of the health workforce to deliver culturally responsive care. This scoping review aims to comprehensively summarise the existing literature on competency frameworks for mental health clinicians and youth service providers, assessing how these frameworks align with culturally responsive care and examining their development, evaluation and implementation methods.

Methods and analysis

This review protocol is guided by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines and registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/EY7NF). The search strategy, developed with an Information Specialist, comprises a three-step process: preliminary searches in two databases, expansion of the search across Medline, CINAHL, EMBASE, PsycInfo, CENTRAL and dissertations and theses databases and examination of reference lists and hand-searching for additional sources. The search strategy was reviewed using the Peer Review of Electronic Search Strategies checklist. Eligible English language articles will be selected through title and abstract screening (level 1) and full-text review (level 2). The search dates are 18 July and 21 August 2023, as well as 19 January 2024. Data from eligible articles will be extracted in duplicate and independently using a data extraction form. The data will then be summarised descriptively and qualitatively using content analysis mapped to the four evidence-based conceptual frameworks and presented in a table.

Ethics and dissemination

As the scoping review involves gathering and describing existing literature, it is exempt from ethical approval requirements. The findings of this scoping review will be presented at relevant local and international conferences and published in a peer-reviewed journal. The findings will also be disseminated and shared with professional organisations to enhance healthcare workforce capacity and drive systemic change. Furthermore, the findings will be used to inform doctoral work and future mental health and health education research related to underserved youth.

Strengths and limitations of this study.

• Uses evidence-informed frameworks for data analysis.

• Benefits from comprehensive literature searches conducted by an experienced librarian, covering peer-reviewed journal databases and grey literature.

• Acknowledges the risk of missing relevant competency frameworks from unpublished or grey literature.

• Limiting the review to English literature, potentially introducing language bias and excluding relevant studies published in other languages.

Introduction

The transition from adolescence to adulthood marks a critical period for mental health, with most mental disorders emerging by age 24.¹ Mental health challenges in youth have enduring effects on health, social well-being and economic outcomes as well as impact on academic and work productivity throughout life.² Despite the high prevalence with an estimated one in five youth in Canada experiencing mental health challenges, access to appropriate care remains limited, with less than 20% receiving adequate treatment.^{3 4} This lack of access is especially pronounced among marginalised and at-risk youth populations.⁵ For example, black-Caribbean populations waited an average of 16 months for care, more than two times the 7-month wait experienced by white patients.⁶ Additionally, marginalised youth experience racism and discrimination when navigating the health system as well as face barriers in accessing culturally responsive mental healthcare, leading to prolonged wait times and limited services.6,10 Given these challenges, there is a critical need for intentional and culturally responsive mental health delivery models addressing disparities and ensuring equitable access to care.^{6 10}

A culturally responsive approach to mental healthcare entails healthcare professionals considering the varied beliefs, values and perceptions regarding mental health issues, affirming cultural identity, integrating alternative support methods valued by the community and facilitating access to tailored assistance.¹¹ Such a model could effectively address challenges faced by marginalised youth, including misunderstandings of a patient’s cultural experiences, improper mental health diagnoses, overuse and underuse of medication, negative experiences and feelings of distrust.^{6 12 13} A better understanding of the needs of mental health clinicians working with youth could increase the capacity of the health system to deliver culturally responsive mental healthcare to underserved youth.

One way of identifying such needs is through a competency framework. Competency frameworks describe the knowledge, skills and attitudes clinicians should acquire and demonstrate.¹⁴ Competency frameworks, an essential component of competency-based education and training, set clear expectations for professional practice. Furthermore, measurable competencies facilitate programme planning and implementation by standardising practice and enabling the use of quality indicators for monitoring and evaluation.¹⁴ Therefore, a competency framework could enhance understanding of knowledge and training gaps, pinpoint areas requiring additional skill development for both organisations and individuals and establish an assessment framework to ensure clinicians possess the necessary knowledge, skills and attitudes to deliver culturally responsive care.

To our knowledge, no evidence synthesis systematically collects and describes competency frameworks specifically designed for mental health clinicians and service providers working with youth. This scoping review will determine the extent of the literature on competency frameworks for mental health clinicians and youth service providers, with a particular focus on how the knowledge, skills and attitudes align with culturally responsive care, equity considerations and framework implementation determinants.

Methods and analysis

The scoping review protocol is guided by the Joanna Briggs Institute (JBI) Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines and has been registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/EY7NF).¹⁵ All members of the study team have expertise in knowledge synthesis methodology. The reporting of the finalised scoping review manuscript will follow the PRISMA-ScR and JBI guidelines.^{15 16}

Research questions

• What are the competencies recommended for mental health clinicians and service providers working with youth?

• How do the competencies, including knowledge, skills and attitudes, align with the current recommendations for culturally responsive care?

• What theories, models, frameworks, methods and equity-related factors have guided the development, evaluation and implementation of competency frameworks in mental health and youth services?

• What are the barriers and facilitators to the implementation of competency frameworks?

Inclusion criteria

Participants

Competency frameworks for mental health clinicians and service providers working with youth will be included in this scoping review. The mental health clinicians include specialists and non-specialists providing mental health services (eg, nurses, community health workers, personal support workers, psychiatrists and psychologists). Youth service providers include social workers, teachers, counsellors and peer support workers. Informal caregivers will not be included. The beneficiaries of the service should be youth aged 13–29 years old.^{17 18}

Concept

Competency frameworks outline the knowledge, skills, abilities and behaviours required for individuals to perform effectively in a specific role or profession. Studies that highlight frameworks defining competencies necessary for mental health clinicians and youth service providers are eligible for inclusion.

Context

Studies conducted in various settings, including primary care, home care, clinics, community settings and hospitals, as well as those focusing on the provision of social services for youth, will be included. Empirical studies of all study designs will be included (eg, experimental, quasi-experimental, observational, qualitative, mixed and multiple methods). Grey literature (eg, policy briefs and guidelines from professional colleges) and dissertations are also eligible for inclusion. Systematic reviews, meta-analyses, editorials, commentaries and conference proceedings will be excluded. Reference lists of reviews will be scanned to capture all relevant references manually and through Citation Chaser. Only articles available in English will be included. There will be no restriction in terms of publication date.

Search strategy

The search strategy was developed in collaboration with an Information Specialist and followed the JBI-recommended three-step process. The initial step involved conducting a preliminary search in a minimum of two relevant online databases, namely MEDLINE and CINAHL, selected for this review. By analysing the retrieved papers, text words present in the titles and abstracts and the index terms employed to describe the articles were extracted to develop a search term list. MESH terms and text words are centred on competency frameworks related to youth, health-related professions, youth service providers and mental health.

The second step involved a subsequent search conducted across all relevant databases, including Medline, CINAHL, EMBASE, PsycInfo, CENTRAL, as well as databases containing dissertations and theses, using all the identified keywords and index terms. The search strategy for Embase, Psychinfo and Medline can be found in online supplemental appendix A. Given that competency frameworks may not always be formally published in peer-reviewed journals and could originate from institutions like professional organisations, we conducted supplementary searches in grey literature databases including TRIP Medical Database, Google Scholar, CPG Infobase: Clinical Practice Guidelines, TSpace, Theses Canada (Library and Archives Canada), MacSphere, Government of Canada Publications, CIHR, NICE and National Guideline Clearinghouse. Two reviewers conducted a pilot review in Covidence, screening the titles and abstracts of 200 articles generated during the preliminary search and randomly selected by the Information Specialist. This process aimed to identify potential modifications to the eligibility criteria to optimise the search strategy. If required, the authors of primary sources and reviews may be contacted for further information to clarify their findings.

The search strategy was reviewed by another Information Specialist using the Peer Review of Electronic Search Strategies checklist.¹⁹ The search dates were 18 July and 21 August 2023, as well as 19 January 2024. The searches yielded 8612 studies for title and abstract screening after removing duplications.

The third stage, to be completed after full-text review, will involve examining the reference lists of literature reviews and of the sources that have been selected for inclusion in the review using Citation Chaser. By tracing citations and references, we aim to uncover additional pertinent literature that may have been missed in the initial searches, thereby enriching the comprehensiveness of our review.

Source of evidence selection

Covidence and EndNote will be used to manage the results of the search strategy. Source selection will involve three levels: level 0, level 1 and level 2. Two separate reviewers will independently check and evaluate material at every stage of the screening process (ie, in duplicate and independently). Conflicts will be resolved through discussion by the two reviewers. If consensus cannot be achieved, a third reviewer will resolve the conflict. To increase reliability, pilot testing occurs at level 0 and before completing level 2. Level 0 (pilot testing) will involve title and abstract review between two reviewers in increments of 30 papers. Once the reviewers obtain an agreement of 75% or more in three consecutive increments, the reviewers can continue to screen without meeting after 30 papers, moving to level 1. Level 1 screening involves reviewing the titles and abstracts for inclusion using the screening form. After reviewing 10% of articles selected for full-text review, the reviewers will have a meeting to discuss conflicts and potential issues. Subsequently, they will begin level 2 screening. For level 2, the full text of potentially relevant articles will be collected and screened to determine final inclusion.

Data extraction

The data extraction form (online supplemental appendix B) will be pilot-tested and refined with research team members. Data extraction will occur in duplicate and independently. A third reviewer will resolve disagreements.

Extracted data will include study characteristics (eg, year of publication, study design, country of origin) and participant characteristics. The studies’ aims/purpose, population and sample size, development methods, competencies, competency framework purpose, description and target audience, study outcomes and key findings that relate to the scoping review research questions will be extracted.

Key findings will include framework development methods, implementation determinants and study results. The development methods will largely centre around the competency framework development methods highlighted by Batt and colleagues.²⁰ The development methods will include, but are not limited to, literature review, group techniques, stakeholder deliberation, mapping exercise, consensus methods, survey, focus groups, interviews and practice analysis. If a co-design approach was conducted, data on how end-users were engaged will also be extracted.^{21 22} Knowledge translation activities may include integrated knowledge translation, knowledge creation, dissemination, implementation, sustainability, scalability and evaluation. Equity considerations are centred on the social determinants of health such as income, education, occupation, gender and social class. Additional data items will likely be identified through the completion of the full-text review and discussions with the research team. Assessing quality or risk of bias will not be conducted as it falls outside the scope of a scoping review.

Analysis of the evidence

The data from this scoping review will be summarised descriptively and qualitatively using content analysis.²³ NVivo will be used to code the extracted data into categories. Categories will be derived inductively, from the findings, and deductively based on the evidence-based frameworks detailed below and pre-defined data items such as competency framework development methods and knowledge translation activities (described in data extraction). To address research questions 3 and 4, the implementation determinants will be analysed qualitatively and mapped to Consolidated Framework for Implementation Research (CFIR) 2.0.²⁴ CFIR, a determinant framework, provides in-depth implementation-influencing contextual factors. CFIR is composed of five domains: innovation, inner setting, outer setting, individual and implementation process. To address research question 3, equity-related factors will be mapped qualitatively to the WHO Conceptual Social Determinants of Health Framework.²⁵ To address the alignment of competencies with culturally responsive mental healthcare recommendations, the authors will map the responses to the Treatment Improvement Protocol publication on Improving Cultural Competence and recommendations by Kirmayer et al for culturally responsive services in Canada.^{26 27} These findings will be analysed qualitatively and summarised quantitatively. Table 1 will feature the quantitative data results.

Table 1. Quantitative data results.

Parameters	Results (n studies)
Study characteristics	Total number of sources of evidence Types of study design Number of publications per year
Competency framework characteristics	Number of competency frameworks per profession (eg, mental health clinician, youth service provider, etc) Types of competencies (eg, access, diagnostic, treatment, etc)
Competency framework development methods	N Literature reviewN Group techniquesN Stakeholder deliberationN Mapping exerciseN Consensus methodsN SurveyN Focus groupsN InterviewsN Practice analysisN Other
Co-design approaches	N User-controlled approachesN Consultative approachesN real patient storiesN Other
Implementation determinants	N InnovationN Inner settingN Outer settingN IndividualN Implementation process
Knowledge translation activity	N Integrated knowledge translationN Knowledge creationN DisseminationN ImplementationN SustainabilityN ScalabilityN Evaluation
Equity related factors	N Income and social statusN Employment and working conditionsN Education and literacyN Childhood experiencesN Physical environmentsN Social supports and coping skillsN Healthy behavioursN Access to health servicesN Biology and genetic endowmentN GenderN CultureN Race/racism
Alignment with culturally responsive care	N Self-knowledgeN CommunicationN Emphasis on power sharing and dialogue

Presentation of results

The results will be presented in both tabular and graphical form.

Patient and public involvement

Patients and the public were not involved in the preparation of this scoping review protocol.

Limitations

The omission of non-English literature may potentially introduce bias into the results. Furthermore, there is a risk that the search may overlook relevant literature due to potential limitations of this protocol. Unpublished reports, organisational documents and conference proceedings often contain valuable information on competency frameworks that might not be indexed in academic databases or included in the grey literature databases. This gap could affect the study’s ability to fully capture the breadth and diversity of competency frameworks and their applications, leading to potential biases in the findings. Therefore, additional efforts to locate and include grey literature, such as incorporating dissertations and conducting searches in specialised grey literature databases, were crucial for enhancing the comprehensiveness and reliability of the review.

Ethics and dissemination

As the scoping review involves gathering and synthesising existing literature in the public domain, it is exempt from ethical approval requirements. The protocol is registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/EY7NF). However, the authors will consider the ethical considerations of studies selected for synthesis. The findings of this scoping review will be presented at relevant local and international conferences and published in a peer-reviewed journal. Furthermore, the findings will be used to inform doctoral work and future mental health and health education research related to underserved youth.