🔍💡 The WHO publishes the first clinical audit tool to concretely improve the quality of mental health services for children and adolescents. A 5-phase methodology, including practical cases, usable even with limited resources. A lever for action to transform findings into real improvements on the ground. #YouthMentalHealth #QualityOfCare #ChildPsychiatry #ClinicalAudit #HealthPractices #WHO
📌 📌 This tool directly addresses the needs of professionals in child psychiatry, prevention, and the medico-social sector faced with evaluating the quality of services. It provides a structured audit methodology, immediately applicable, that allows for the identification of gaps between current practices and quality standards without requiring advanced research expertise. Particularly useful for service managers, quality teams, and clinicians wishing to improve accessibility, safety, and relevance of mental health care for young people aged 0 to 25.
Source: 📒
✍️ Clinical audit tool to strengthen quality of child and youth mental health services - World Health Organization (WHO) - Regional Office for Europe - May 2026
📜🔗LINK to the source
Number of pages: 60
1. ANALYTICAL SUMMARY
Context and issues: a response to the quality crisis in youth mental health
In the face of the ongoing deterioration of the mental health of children and adolescents in the WHO European Region, this document proposes a structured clinical audit tool to systematically assess and improve the quality of services. Developed as part of the WHO European Programme on the quality of mental health care for children and adolescents, this tool is based on the WHO Quality Standards 2025, which define high-quality care across eight themes: user participation and empowerment, respect for rights and safety, family and community engagement, smooth transitions between services, timely support, developmentally appropriate and evidence-based care, competent staff, and a culture of continuous improvement (p. 10, 18). The document emphasises a non-punitive approach to auditing, positioned as a tool for collective learning rather than sanction, which is essential for fostering team engagement and transparency (p. 2, 4).
Operational contributions: a ready-to-use methodology for continuous improvement
The tool outlines a complete audit cycle in 5 progressive phases with 13 actionable steps: defining the justification, criteria, and audit team; developing the audit plan; conducting the audit; producing results and recommendations; maintaining a continuous cycle of improvement (p. 5-6, 14). Each phase is accompanied by reflective questions, concrete actions, and a fictional case study (Brightview clinic) illustrating practical application to improve the early care of young people presenting with psychosis (p. 12, 20, 23-24, 32-33, 38-39). The document offers two essential appendices: 47 reflective questions to measure compliance with the 8 WHO quality standards (Appendix 1, p. 41-47) and a ready-to-use audit report template (Appendix 2, p. 48-50). The tool values co-construction with users, young people, and families at all stages, and incorporates strict ethical considerations for the collection of sensitive data (p. 19, 27, 30).
2. KEY POINTS OF THE DOCUMENT
1. Non-punitive learning-focused approach: The effectiveness of the audit depends on an environment that promotes openness and learning rather than punishment. The document emphasises the need to integrate audits into existing quality improvement structures and not as parallel processes perceived as disciplinary (p. 2). This constructive approach aims to build trust, encourage honest clinical reflection, and ensure that findings genuinely inform changes in practice (p. 2).
2. Structured methodology in 5 reproducible phases: The audit cycle unfolds in sequential phases - Phase 1: definition of the justification, criteria, and team (p. 7-12); Phase 2: development of the audit plan with identification of stakeholders, planning for data collection and analysis (p. 13-24); Phase 3: conducting the audit with data collection and analysis (p. 25-28); Phase 4: production of results and recommendations co-constructed with stakeholders (p. 29-34); Phase 5: continuous improvement cycle with SMART action plan, monitoring of implementation, and re-evaluation (p. 35-39). Each phase includes summary tables, reflective questions, and concrete examples (p. 8-39).
3. Systematic integration of users and lived experience: Children, young people, and families must actively participate from the definition of the audit scope to the co-creation of recommendations (p. 11, 15, 30). The document recommends adapting feedback formats (individual meetings, anonymous surveys, peer support) to ensure meaningful and non-tokenistic participation (p. 30, 32). Qualitative data from interviews, focus groups, and service experience questionnaires are positioned as essential complements to quantitative data (p. 17-18, 26).
4. Flexibility and adaptability to contexts with limited resources: The tool explicitly recognises the challenges of staff capacity, cultural resistance to auditing, and limited digital infrastructure (p. 31, Box 4). Pragmatic solutions are proposed: assigning dedicated audit roles, integrating into existing workflows, using paper systems, prioritising high-impact audit areas (p. 31). The document emphasises that no advanced expertise is required and that the provided models support services of all experience levels (p. 2).
5. Anchoring in WHO quality standards 2025 and evidence: The audit is structured around the 8 WHO quality standards published in March 2025, developed in collaboration with children, young people, caregivers, and professionals across the Europe region (p. 10, 18). These standards cover: participation and empowerment, rights and safety, family and community engagement, transitions between services, timely support, developmentally appropriate and evidence-based care, competent and supported staff, a culture of continuous improvement, and data collection (p. 10, Box 2). Annex 1 provides detailed reflective questions for each standard, facilitating concrete evaluation (p. 41-47).
3. ACTION POINTS FOR LOCAL ACTORS
1. Form a multidisciplinary audit team including users and families: Identify an audit coordinator who will ensure the coordination of tasks, communication, and problem resolution (p. 11). Form a team with service managers, quality leads, clinicians, peers, users, and young people to ensure a diversity of perspectives and clinical expertise, quality, and data analysis (p. 11). Clearly define the roles and responsibilities of each member to ensure coverage of all aspects of the audit and facilitate effective decision-making and communication (p. 11).
2. Use the audit report template and reflective questions (Annexes 1 and 2): Refer to Annex 1 (p. 41-47) which provides 47 structured reflective questions around the 8 WHO quality themes to concretely measure service performance. Adapt the audit report template from Annex 2 (p. 48-50) including sections for overview, objectives, scope, data sources, findings, analysis, and prioritised recommendations. These ready-to-use tools significantly reduce preparation time and standardise the approach.
3. Prioritise audit areas according to urgency and potential impact: In a context of limited resources, focus the audit on specific high-impact aspects (e.g. waiting times, early intervention processes, medication safety) rather than evaluating all areas simultaneously (p. 8, 21). Use risk stratification to categorise findings and prioritise critical issues (medication errors, sentinel events) before minor discrepancies (documentation completeness) (p. 20). Define SMART objectives (Specific, Measurable, Achievable, Realistic, Time-bound) for each improvement action (p. 8, 36).
4. Combine quantitative and qualitative data for a comprehensive view: Collect quantitative data (waiting times, therapeutic adherence rates, use of standardised assessment tools) through clinical record reviews and existing databases (p. 16-17). Systematically complement with qualitative data (interviews with clinicians, young people and families, focus groups, direct observations) to understand lived experiences, identify communication barriers and cultural factors (p. 17-18, 20). The triangulation of both types of data reveals the underlying reasons for performance gaps (p. 20).
5. Establish a continuous monitoring cycle with simple indicators: After implementing the action plan, define quality indicators that are easy to collect and calculate regularly (e.g. average time between referral and first assessment, rate of use of standardised tools, user satisfaction) (p. 36-37, 39). Plan regular follow-up points (every 6 months) to assess progress and adjust the plan if necessary (p. 39). Involve leaders by regularly presenting the data to maintain engagement and secure necessary resources (p. 36).
4. ADDITIONAL REFERENCES
🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of MENTAL HEALTH ➡️🔗https://pratiquesensante.odoo.com/4-2-sante-mentale-et-psychique
1. WHO quality standards for mental health services for children and young people (March 2025): Reference document defining the 8 quality themes to which this audit tool refers, developed in consultation with children, young people and professionals from the WHO European Region. Available: https://iris.who.int/handle/10665/380778
2. European Framework for Action on Mental Health 2021-2025 (WHO Europe, 2021): European action framework setting regional priorities for mental health including the development of quality services for children and adolescents, within which this audit tool is situated. Accessible:https://iris.who.intANDhttps://www.who.int/europe/publications/i/item/9789289057813
3. Multiannual Programme "Mental Health and Psychiatry" 2025-2030 (High Authority of Health, France, November 2024): French strategic document documenting the challenges of child and adolescent psychiatry and proposing directions for improving the quality of services, complementary to WHO standards. Available:https://www.has-sante.fr/upload/docs/application/pdf/2025-02/programme_pluriannuel__sante_mentale_et_psychiatrie__2025-2030.pdf
5. FREQUENTLY ASKED QUESTIONS (FAQ)
1. Who can use this audit tool and what expertise is required?
The tool is designed for a wide range of professionals involved in the delivery and improvement of mental health services for children and young people: clinical service managers, quality improvement teams, mental health clinicians, patient safety officers (p. 2). It can also be used by external auditors, members of health inspectorates, regulatory bodies, and accreditation agencies (p. 2). A basic understanding of clinical service delivery, quality improvement principles, and data interpretation is required, but no advanced expertise is necessary (p. 2). The tool is flexible and accessible, with integrated guidance and templates to support services of all levels of experience and resources (p. 2).
2. How long does it take to conduct a full audit?
The duration varies according to the scope of the audit, the size of the service, and the available resources. The example of the Brightview clinic illustrates an audit conducted over 3 weeks with a review of clinical records of 15 young people over 12 months, focus groups with users and families, surveys with partners, and mapping of patient pathways (p. 24, 26-27). An audit focused on a specific aspect (e.g. waiting times) may be quicker than a comprehensive evaluation of service quality (p. 8). Planning includes regular team meetings to assess progress and adjust if necessary (p. 26).
3. How can we ensure that the audit is not perceived as punitive by the teams?
The effectiveness of the audit is closely linked to the environmental context in which it is conducted (p. 2). It is essential that audits are understood as tools for continuous learning and service improvement, rather than as mechanisms for blame or punishment (p. 2). Clear communication about the purpose of the audit, inclusive engagement of stakeholders, and ethical data practices help to build trust (p. 2). Services should integrate audits into existing quality improvement structures rather than create parallel processes that may be perceived as burdensome or disciplinary (p. 2). Involving teams from the definition of the scope and criteria promotes ownership (p. 14).
4. What data should be collected and how can confidentiality be maintained?
Data can be primary (surveys, interviews with stakeholders, direct observations) or secondary (archived records, electronic medical records, clinical notes databases, quality indicators) (p. 16). Quantitative data (waiting times, pre/post-treatment outcome measures) and qualitative data (interviews, focus groups) should be combined for a comprehensive understanding (p. 17-18). Any collection must adhere to local, regional, or national ethical policies: informed consent from participants or guardians, privacy protection through data anonymisation, strict confidentiality with limited access to authorised personnel, minimisation of harm to vulnerable populations, clarity on the purpose and use of the data (p. 19).
5. How can young people and families be concretely involved in the audit?
Users can help define the scope of the audit to ensure it is meaningful and reflects the perspectives of lived experience, and discuss findings to shape the outcomes (p. 11). In the Brightview example, the team proposed several participation options: individual meetings to provide feedback, anonymous feedback via an online survey, participation in a wider meeting with other stakeholders, and for young people and families, the option of an individual meeting with peer support (p. 32). Information should be communicated in an easily understandable manner, age-appropriate and developmentally suitable, avoiding jargon, with the use of visual aids or social stories if necessary (p. 44).
6. What should be done if the audit results reveal immediate risks to patient safety?
The action plan must categorise the recommendations by level of priority and risk (p. 21). The critical questions posed include: what specific actions can be taken to implement the findings? What is the criticality of each recommendation? Are there actions that need to be implemented immediately due to substantial risks to patient safety, and within what timeframe? (p. 21, Table 7). Risk stratification allows for prioritising critical issues (medication errors, sentinel events) over minor discrepancies (p. 20). Local child protection and reporting protocols must be followed in the event of an identified risk (p. 42).
7. How often should audits be repeated for an effective improvement cycle?
Continuous improvement requires re-evaluation audits to measure progress and update the action plan (p. 37). In the Brightview example, the team decided to monitor the data continuously and meet every 6 months to assess progress and see if changes are necessary (p. 39). The intensity of the audits will be adjusted based on the results: if no change is observed on a key indicator, additional interviews with users and families may be necessary to understand the reasons (p. 39). Medication safety audits should be conducted regularly, for example annually (p. 42).
6. REWRITING IN EASY READ
What is this guide?
This guide helps to improve mental health services for children and young people.
It explains how to conduct an audit.
An audit is checking if the care is of good quality.
Who is this guide for?
This guide is for people who work in mental health services.
For example: service managers, nurses, psychologists.
These people want to provide the best possible care.
Why conduct an audit?
An audit serves three purposes:
To see what is working well in the service.
To find what can be improved.
To decide what actions to take to improve.
The audit is not meant to punish teams.
It is meant to learn together and make progress.
How to conduct an audit? The 5 steps
Step 1: Prepare the audit
Decide what you want to check.
For example: the waiting time for an appointment.
Choose the people who will conduct the audit.
You need professionals as well as young people who use the service.
Step 2: Make a plan
Decide how you will collect the information.
You can read the patients' records.
You can ask questions to the young people and their families.
Protect people's privacy.
Do not give names.
Step 3: Collect the information
The team collects the information outlined in the plan.
For example: how long young people wait for an appointment.
The team meets regularly to see if everything is going well.
Step 4: Review the results
The team reviews the collected information.
She looks for what works well and what doesn't.
The team discusses with young people and families.
Together, they decide what to improve.
Step 5: Improve and check
The team makes a plan to improve the service.
For example: reduce waiting times.
The team regularly checks if the changes are working.
If necessary, they change the plan.
Key points to remember
The audit should be conducted in a spirit of learning.
It is not to criticise the professionals.
It is to improve care together.
Young people and families must participate.
They are the ones who use the service.
They know what needs to be improved.
You can conduct an audit even with limited resources.
Focus on an important issue.
For example: waiting times.
Use the tools from the guide.
There are lists of questions to help you.
There are report templates to fill out.
After the audit, action must be taken.
Make a plan with specific actions.
Regularly check if it is working.
7. CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES
Literacy: The document proposes tools adapted to different levels of understanding by recommending jargon-free communication, the use of visual aids and social stories for children and families, and various formats for information delivery (verbal, written, pictorial) to ensure accessibility of information (p. 30, 44).
Empowerment: Beneficiaries are involved in all stages, from defining the scope of the audit to co-creating recommendations, with feedback mechanisms (suggestion boxes, satisfaction surveys, discussion groups, complaint mechanisms) and advisory groups composed of representatives with lived experience (p. 11, 30, 32, 41).
Participation: Co-construction mechanisms include: inclusion of users and young people in the audit team (p. 11), co-creation of care plans with children, young people, and families based on their wishes and goals (p. 41), multi-professional meetings with those involved on a daily basis (teachers, social workers) when accepted by the family (p. 43), and active participation in therapeutic decisions (p. 42).
Community health: The collective dimension is integrated through the systematic engagement of community partners (schools, social services, NGOs) in the audit process, the development of effective working relationships with local organisations to meet holistic needs, and the holding of multi-professional meetings to coordinate care (p. 15, 23, 43).
Ethics: Biases are addressed by the requirement to collect and analyse data on children and families using the service and comparing it to local demographic statistics to identify and correct access inequities, and by the availability of qualified interpreters for users from diverse cultural and linguistic backgrounds without resorting to family members (p. 42).
Human rights: The approach respects the principles of equity and inclusion by promoting dignity, respect, protection from abuse and harm, monitoring equitable access without discrimination based on gender, ethnicity, religion, ability, culture, or sexuality, and using language that avoids stigma (p. 42).
Intersectorality: Recommended partnerships include mental health establishments, schools, social services, primary health services, youth support NGOs, and other community partners, with the collection of their perspectives through surveys and participation in outcome discussions (p. 15, 23, 43).
Partnership: Formalised collaboration models are proposed: regular multi-professional meetings with all stakeholders in the life of the child/young person, provision of information and training to those involved on a daily basis regarding mental health support, and coordination with mental health care providers at all stages of treatment (p. 43).
Combating discrimination: The document explicitly mentions the need for mechanisms to monitor and provide equitable access without discrimination based on gender, ethnicity, religion, ability, culture, or sexuality, and recommends avoiding any language that may reinforce stigma (p. 42). Non-judgment is central to the non-punitive approach of the audit, and diversity is taken into account through the cultural and linguistic adaptation of tools and services (p. 2, 42).
8. EVALUATION OF RESOURCE RELIABILITY
Scientific relevance
The tool demonstrates high scientific reliability. It is published by the World Health Organization, Regional Office for Europe, with technical leadership from Natasha Azzopardi Muscat, Joao Breda, and Ledia Lazri, and contributions from over 30 international experts from 10 countries (Greece, North Macedonia, Latvia, Australia, Netherlands, Germany, Denmark, Republic of Moldova) representing academic institutions, hospitals, and social psychiatry organisations (p. iii). The audit methodology is based on scientific evidence regarding the effectiveness of audit and feedback in improving professional practices, with references to the work of Foy et al. (2020) and Ivers et al. (2020) published in BMJ and Cochrane Database (p. 40). The tool is closely linked to the WHO Quality Standards 2025 for mental health services for children and young people, developed in consultation with children, young people, caregivers, and providers across the European Region. The data is current (publication May 2026) and reflects contemporary public health priorities in response to the deterioration of young people's mental health.
Operational relevance
The direct usability in the field is excellent. The document provides ready-to-use tools: a complete audit report template with structured tables (Appendix 2, p. 48-50), 47 reflective questions organised by quality standard (Appendix 1, p. 41-47), and action tables and reflective questions for each of the 13 steps of the process (p. 8-39). The detailed example of the Brightview clinic concretely illustrates each phase with realistic decisions and adjustments along the way, facilitating ownership by the teams (p. 12, 20, 23-24, 26-27, 32-33, 38-39). The document explicitly acknowledges resource constraints and proposes pragmatic solutions: prioritisation of audit areas, paper systems in the absence of digital, audit roles integrated into existing workflows (p. 31, Box 4). The flexibility of the tool allows for its adaptation to different contexts (services of varying sizes, different resource levels, specific national regulatory frameworks) while maintaining a coherent structure (p. 2, 4).