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Mushquash AR, Neufeld T, Malik I, Toombs E, Olthuis JV, Schmidt F, Dunning C, Stasiuk K, Bobinski T, Ohinmaa A, Newton A, Stewart SH. Increasing access to mental health supports for 12-17-year-old Indigenous youth with the JoyPop mobile mental health app: study protocol for a randomized controlled trial. Trials 2024; 25:234. [PMID: 38575945 PMCID: PMC10993577 DOI: 10.1186/s13063-024-08076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Indigenous youth in Northwestern Ontario who need mental health supports experience longer waits than non-Indigenous youth within the region and when compared to youth in urban areas. Limited access and extended waits can exacerbate symptoms, prolong distress, and increase risk for adverse outcomes. Innovative approaches are urgently needed to provide support for Indigenous youth in Northwestern Ontario. Using a randomized controlled trial design, the primary objective of this study is to determine the effectiveness of the JoyPop app compared to usual practice (UP; monitoring) in improving emotion regulation among Indigenous youth (12-17 years) who are awaiting mental health services. The secondary objectives are to (1) assess change in mental health difficulties and treatment readiness between youth in each condition to better understand the app's broader impact as a waitlist tool and (2) conduct an economic analysis to determine whether receiving the app while waiting for mental health services reduces other health service use and associated costs. METHODS A pragmatic, parallel arm randomized controlled superiority trial will be used. Participants will be randomly allocated in a 1:1 ratio to the control (UP) or intervention (UP + JoyPop) condition. Stratified block randomization will be used to randomly assign participants to each condition. All participants will be monitored through existing waitlist practices, which involve regular phone calls to check in and assess functioning. Participants in the intervention condition will receive access to the JoyPop app for 4 weeks and will be asked to use it at least twice daily. All participants will be asked to complete outcome measures at baseline, after 2 weeks, and after 4 weeks. DISCUSSION This trial will evaluate the effectiveness of the JoyPop app as a tool to support Indigenous youth waiting for mental health services. Should findings show that using the JoyPop app is beneficial, there may be support from partners and other organizations to integrate it into usual care pathways. TRIAL REGISTRATION https://clinicaltrials.gov/study/NCT05898516 [registered on June 1, 2023].
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Affiliation(s)
- Aislin R Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, Canada.
- Dilico Anishinabek Family Care, Fort William First Nation, Canada.
| | - Teagan Neufeld
- Department of Psychology, Lakehead University, Thunder Bay, Canada
| | - Ishaq Malik
- Department of Psychology, Lakehead University, Thunder Bay, Canada
| | - Elaine Toombs
- Department of Psychology, Lakehead University, Thunder Bay, Canada
| | - Janine V Olthuis
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Fred Schmidt
- Department of Psychology, Lakehead University, Thunder Bay, Canada
- Children's Centre Thunder Bay, Thunder Bay, Canada
| | | | - Kristine Stasiuk
- Dilico Anishinabek Family Care, Fort William First Nation, Canada
| | - Tina Bobinski
- Ontario Native Women's Association, Thunder Bay, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Amanda Newton
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Sherry H Stewart
- Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Halifax, Canada
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Kelleher KJ, Gardner W, Kemper AR, Chavez L, Pajer K, Rosic T. Principles for Primary Care Screening in the Context of Population Health. Acad Pediatr 2024:S1876-2859(24)00073-1. [PMID: 38458490 DOI: 10.1016/j.acap.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
A key component of primary care pediatrics is health promotion through screening: applying a test or procedure to detect a previously unrecognized disease or disease risk. How do we decide whether to screen? In 1965, Wilson and Jungner published an influential set of screening principles focused on the health problem's importance, the screening tool's performance, and the evidence for treatment efficacy. However, if we want realistic estimates of the population effects of routine screening, we must also account for the healthcare system's real-world functioning and disparities in care. We offer revised principles to guide discussions about routine screening in the primary care setting. We add to Wilson and Jungner's principles: 1. A focus on life course epidemiology and its consequences for population health, 2. A need to screen for the early stages of chronic health problems, 3. A concern for screening's acceptability to providers and the community, 4. A recommendation for estimating the uncertainty in benefits and harms in evaluating screening, 5. Inclusion of systematic plans for population data collection and monitoring, and 6. Recognition that achieving population health improvement requires a high-performing system with sufficient throughput and monitoring to deliver accessible, affordable, and effective care, especially for the groups experiencing the greatest inequities in access. Above all, instead of assuming best practices in treatment delivery and monitoring after screening, we argue for realism about the healthcare system functioning in routine practice. WHAT'S NEW: We update Wilson and Jungner's (1965) principles for routine screening. If we want realistic estimates of the population effects of routine screening, we must consider not just screening accuracy and efficacy but also the healthcare system's real-world functioning and inequities.
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Affiliation(s)
- Kelly J Kelleher
- Department of Pediatrics, The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital. 700 Children's Drive, Columbus, OH 43205 United States.
| | - William Gardner
- School of Epidemiology and Public Health and CHEO Research Institute. 401 Smyth Rd, Ottawa, ON Canada K1H 5B2.
| | - Alex R Kemper
- Department of Pediatrics, The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital.
| | - Laura Chavez
- Department of Pediatrics, The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital.
| | - Kathleen Pajer
- Department of Psychiatry, University of Ottawa, and CHEO Research Institute. 401 Smyth Rd, Ottawa, ON Canada K1H 5B2.
| | - Tea Rosic
- Children's Hospital of Eastern Ontario. 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada.
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3
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Adams DR. Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic. Community Ment Health J 2024; 60:88-97. [PMID: 37097491 PMCID: PMC10127985 DOI: 10.1007/s10597-023-01127-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.
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Affiliation(s)
- Danielle R Adams
- Center for Mental Health Services Research, Brown School of Social Work and Public Health, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, USA.
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4
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Pajer K, Pastrana C, Gardner W, Sivakumar A, York A. A scoping review of the Choice and Partnership Approach in child and adolescent mental health services. J Child Health Care 2023; 27:707-720. [PMID: 35422129 DOI: 10.1177/13674935221076215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Child and adolescent mental health (CAMH) problems are prevalent and inefficient mental health (MH) care systems can contribute to poor outcomes. The Choice and Partnership Approach (CAPA) is a MH care delivery model aiming to provide efficient, high-quality care. Although widely used, no CAPA research review exists. We conducted a scoping review to fill this gap. Medline, Embase, and PsycINFO databases were searched from inception to June 2021. Grey Matters and Google were used to search the grey literature. We identified 5322 records. Removal of duplicates left 4720 documents, which were successively screened and data extracted by pairs of co-authors. The final dataset comprised six published and three non-published studies, conducted primarily at CAMH sites in England, Scotland, Australia, or Canada. Each study had multiple research objectives, which we summarized into seven categories. Positive outcomes were reported for most objectives, but attributing causality to CAPA was hampered by research methodology. Observational designs were used in all studies and approaches to analyzing data varied considerably. Research gaps included the lack of healthcare economics studies of CAPA and no assessment of facilitators and barriers. Current research on CAPA provides intriguing findings meriting further investigation. We suggest strategies to improve future studies.
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Affiliation(s)
- Kathleen Pajer
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Carlos Pastrana
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, Canada
| | - Aditi Sivakumar
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Ann York
- Children and Young People's Mental Health Young People's Mental Health (Clinical Advisor), Healthy London Partnership, London, UK
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5
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Furman DJ, Hall SA, Avina C, Kulikov VN, Lake JI, Padmanabhan A. Assessing the Efficacy and Safety of a Digital Therapeutic for Symptoms of Depression in Adolescents: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48740. [PMID: 37971800 PMCID: PMC10690536 DOI: 10.2196/48740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Depression is a serious, prevalent, recurrent, and undertreated disorder in adolescents. Low levels of treatment seeking and treatment adherence in this age group, combined with a growing national crisis in access to mental health care, have increased efforts to identify effective treatment alternatives for this demographic. Digital health interventions for mental illness can provide cost-effective, engaging, and accessible means of delivering psychotherapy to adolescents. OBJECTIVE This protocol describes a virtual randomized controlled trial designed to evaluate the efficacy and safety of a self-guided, mobile app-based implementation of behavioral activation therapy, SparkRx, for the adjunct treatment of symptoms of depression in adolescents. METHODS Participants are recruited directly through web-based and print advertisements. Following eligibility screening and consenting, participants are randomly assigned to a treatment arm (SparkRx) or a control arm (assessment-enhanced usual care) for 5 weeks. The primary efficacy outcome, total score on the 8-item Patient Health Questionnaire (PHQ-8), is assessed at the end of the 5-week intervention period. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and 1-month follow-up. The safety of the intervention is assessed by participant report (and legal guardian report, if the participant is younger than 18 years) and by patterns of symptom deterioration on the PHQ-8, as part of a larger clinical safety monitoring protocol. The primary efficacy outcome, total PHQ-8 score at the postintervention time point, will be compared between SparkRx and enhanced usual care arms using mixed effect modeling, with baseline PHQ-8 and current antidepressant medication status included as covariates. Secondary efficacy outcomes, including the proportion of participants exhibiting treatment response, remission, and minimal clinically significant improvement (all derived from total PHQ-8 scores), will be compared between groups using chi-square tests. Symptom severity at 1-month follow-up will also be compared between arms. Planned subgroup analyses will examine the robustness of treatment effects to differences in baseline symptom severity (PHQ-8 score <15 or ≥ 15) and age (younger than 18 years and older than 18 years). The primary safety outcome, the number of psychiatric serious adverse events, will be compared between trial arms using the Fisher exact test. All other adverse events will be presented descriptively. RESULTS As of May 2023, enrollment into the study has concluded; 223 participants were randomized. The analysis of the efficacy and safety data is expected to be completed by Fall 2023. CONCLUSIONS We hypothesize that the results of this trial will support the efficacy and safety of SparkRx in attenuating symptoms of depression in adolescents. Positive results would more broadly support the prospect of using accessible, scientifically validated, digital therapeutics in the adjunct treatment of mental health disorders in this age range. TRIAL REGISTRATION ClinicalTrials.gov NCT05462652; https://clinicaltrials.gov/study/NCT05462652. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48740.
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Affiliation(s)
- Daniella J Furman
- Limbix Health, Inc, San Francisco, CA, United States
- Big Health, Inc, San Francisco, CA, United States
| | - Shana A Hall
- Limbix Health, Inc, San Francisco, CA, United States
- Big Health, Inc, San Francisco, CA, United States
| | - Claudia Avina
- Limbix Health, Inc, San Francisco, CA, United States
| | | | - Jessica I Lake
- Limbix Health, Inc, San Francisco, CA, United States
- Big Health, Inc, San Francisco, CA, United States
| | - Aarthi Padmanabhan
- Limbix Health, Inc, San Francisco, CA, United States
- Big Health, Inc, San Francisco, CA, United States
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6
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Capon W, Hickie IB, Fetanat M, Varidel M, LaMonica HM, Prodan A, Piper S, Davenport TA, Mughal S, Shah JL, Scott EM, Iorfino F. A multidimensional approach for differentiating the clinical needs of young people presenting for primary mental health care. Compr Psychiatry 2023; 126:152404. [PMID: 37524044 DOI: 10.1016/j.comppsych.2023.152404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES There is an ongoing necessity to match clinical interventions with the multidimensional needs of young people. A key step toward better service planning and the design of optimal models of care is to use multidimensional assessment to understand the clinical needs of those presenting to primary mental health care. METHODS 1284 people aged 12-25 years presenting to primary youth mental health services completed an online assessment at service entry. Latent class analysis was conducted for seven scales assessing anxiety, depression, psychosis, mania, functioning (indexed by Work and Social Adjustment Scale), and suicidality. RESULTS A three-class solution was identified as the optimal solution. Class 1 (n = 305, 23.75%), an early illness stage group, had low and mixed symptomatology with limited functional impairment, class 2 (n = 353, 27.49%) was made up of older persons with established depression and functional impairment, and class 3 (n = 626, 48.75%) had very high and complex needs, with functional impairment, suicidality, and at-risk mental states (psychosis or mania). Additional differentiating characteristics included psychological distress, circadian disturbances, social support, mental health history, eating disorder behaviours, and symptoms of post-traumatic stress disorder. CONCLUSIONS A large proportion of help-seeking young people present with symptoms and functional impairment that may exceed the levels of care available from basic primary care or brief intervention services. These subgroups highlight the importance of multidimensional assessments to determine appropriate service pathways and care options.
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Affiliation(s)
- William Capon
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Masoud Fetanat
- Brain and Mind Centre, The University of Sydney, Australia.
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Australia.
| | | | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Australia; Translational Health Research Institute, Western Sydney University, Australia; School of Computer, Data and Mathematical Sciences, Western Sydney University, Australia.
| | - Sarah Piper
- Brain and Mind Centre, The University of Sydney, Australia.
| | | | - Sarah Mughal
- McGill University, Department of Psychiatry, Montreal, Canada.
| | - Jai L Shah
- McGill University, Department of Psychiatry, Montreal, Canada.
| | | | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Australia.
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7
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Kourgiantakis T, Markoulakis R, Lee E, Hussain A, Lau C, Ashcroft R, Goldstein AL, Kodeeswaran S, Williams CC, Levitt A. Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers. Int J Ment Health Syst 2023; 17:4. [PMID: 36918893 PMCID: PMC10011786 DOI: 10.1186/s13033-023-00572-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/31/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers. METHODS This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data. RESULTS The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do." CONCLUSION Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | - Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Carrie Lau
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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8
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Becker KD, Chorpita BF. Future Directions in Youth and Family Treatment Engagement: Finishing the Bridge Between Science and Service. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:284-309. [PMID: 36787342 DOI: 10.1080/15374416.2023.2169926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The field has spent more than 50 years investing in the quality of youth mental healthcare, with intervention science yielding roughly 1,300 efficacious treatments. In the latter half of this period, concurrent efforts in implementation science have developed effective methods for supporting front-line service organizations and therapists to begin to bridge the science to service gap. However, many youths and families still do not benefit fully from these strategic investments due to low treatment engagement: nearly half of youths in need of services pursue them, and among those who do, roughly another half terminate prematurely. The negative impact of low engagement is substantial, and is disproportionally and inequitably so for many. We contend that to build a robust and "finished" bridge connecting science and service, the field must go beyond its two historical foci of designing interventions and preparing therapists to deliver them, to include an intentional focus on the youths and families who participate in these interventions and who work with those therapists. In this paper, we highlight the significance of treatment engagement in youth mental healthcare and discuss the current state of the literature related to four priorities: conceptualization, theory, measurement, and interventions. Next, we offer an example from our own program of research as one illustration for advancing these priorities. Finally, we propose recommendations to act on these priorities.
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9
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Seidler ZE, Wilson MJ, Oliffe JL, Kealy D, Ogrodniczuk JS, Walther A, Rice SM. "I could hang up if the practitioner was a prat": Australian men's feedback on telemental healthcare during COVID-19. PLoS One 2022; 17:e0279127. [PMID: 36516184 PMCID: PMC9749969 DOI: 10.1371/journal.pone.0279127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic restrictions, uncertainties and management inconsistencies have been implicated in men's rising distress levels, which in turn have somewhat normed the uptake of telemental healthcare services (i.e., phone and/or video-conference-based therapy). Given past evidence of poor engagement with telemental health among men, this mixed-methods study examined Australian men's use of, and experiences with telemental health services relative to face-to-face care during the pandemic. A community sample of Australian-based men (N = 387; age M = 47.5 years, SD = 15.0 years) were recruited via Facebook advertising, and completed an online survey comprising quantitative items and open-response qualitative questions with the aim of better understanding men's experiences with telemental healthcare services. In total, 62.3% (n = 241) of participants reported experience with telemental health, and regression analyses revealed those who engaged with telemental health were on average younger, more likely to be gay and university educated. Men who had used telemental health were, on average, more satisfied with their therapy experience than those who had face-to-face therapy. Among those who had telemental healthcare, marginally lower satisfaction was observed among regional/rural based relative to urban men, and those who had to wait longer than 2 months to commence therapy. Qualitative findings highlighted positive aspects of telemental healthcare including comfort with accessing therapy from familiar home environments and the convenience and accessibility of telemental health alongside competing commitments and COVID-19 restrictions. Conversely, drawbacks included technical limitations such as crosstalk impeding therapeutic progress, disconnects and audio-visual lag-times and the 'impersonal' nature of telemental healthcare services. Findings broadly signal COVID-19 induced shifts norming of the use of virtual therapy services, with clear scope for improvement in the delivery of therapeutic practice using digital modalities, especially among help-seeking men.
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Affiliation(s)
- Zac E. Seidler
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Movember, Melbourne, Australia
- * E-mail:
| | - Michael J. Wilson
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
- Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Andreas Walther
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Simon M. Rice
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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10
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Leung BMY, Wandler C, Pringsheim T, Santana MJ. Working with parents of children with complex mental health issues to
improve care: A qualitative inquiry. J Child Health Care 2022; 26:548-567. [PMID: 34180250 PMCID: PMC9667073 DOI: 10.1177/13674935211028694] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study objective was to explore the experiences of parents of children (6-17 years) with complex mental healthcare needs in accessing healthcare services in Alberta, Canada. Parents were interviewed using a semi-structured guide with open-ended and probing questions. Interviews were audio recorded and transcribed verbatim. Thematic analysis revealed three main themes: (1) Fragmented healthcare services profoundly impacted participants' experience of mental health care due to (a) a lack of a collaborative approach across disciplines in the healthcare system; (b) unavailability of information related to mental health care and (c) a lack of patient-centred care. (2) Navigating the complex healthcare system was difficult due to fragmented services and was hindered by gaps in accessing and receiving care, lack of continuity of care and lack of resources. (3) Distressed parents discussed the emotional challenges, financial burdens, self-advocacy and stigma they experienced in navigating the system. Parents offered insights into potential solutions to these gaps. Parents recommended the creation of a one-stop shop service with a team approach led by a navigator to facilitate and support navigations across healthcare services that work collaboratively across disciplines among healthcare services and across sectors inclusive of social services, education, policing and community programmes.
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Affiliation(s)
- Brenda MY Leung
- Faculty of Health Sciences, University of
Lethbridge, Lethbridge, AB Canada,Brenda MY Leung, Faculty of Health
Sciences, University of Lethbridge, Lethbridge T1K3M4, AB Canada.
| | | | - Tamara Pringsheim
- Department of Clinical
Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming
School of Medicine, University of Calgary, Calgary, AB Canada
| | - Maria J Santana
- Departments of Paediatrics and
Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
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11
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Williamson V, Larkin M, MacDonald I, Morgan F, Ford T, Spence SH, Reardon T, Creswell C. Primary school based mental health practitioners’ perspectives of school-based screening for childhood mental disorders and intervention delivery: A qualitative study. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2022. [DOI: 10.1080/13632752.2022.2110704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Victoria Williamson
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, Warneford Hospital, Warneford Ln, Headington, Oxford
| | - Michael Larkin
- Aston Institute for Health & Neurodevelopment, Department of Psychology, Aston University, Birmingham, UK
| | | | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Susan H. Spence
- School of Applied Psychology and Australian Institute of Suicide Research and Prevention, Griffith University, Brisbane, Queensland, Australia
| | - Tessa Reardon
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, Warneford Hospital, Warneford Ln, Headington, Oxford
| | - Cathy Creswell
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, Warneford Hospital, Warneford Ln, Headington, Oxford
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12
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Semovski V, King CB, Stewart SL. Mental Health Service Urgency in Children's Mental Health: Factors Impacting the Need for Expedited Services. Child Psychiatry Hum Dev 2022; 53:765-775. [PMID: 33835279 DOI: 10.1007/s10578-021-01161-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
Delayed access to mental health services for children and adolescents has been linked to an increased risk of harm and nonattendance to scheduled appointments. While studies suggest that the lack of standardized assessments for prioritizing individuals has contributed to long wait times, the inconsistent use of assessments across service sectors in Ontario continues to persist. This has contributed to a paucity of information surrounding which children and adolescents may require urgent mental health services. Using a large secondary data set, this study examined whether service sector (e.g., school), and other individual client characteristics (e.g., age, sex, legal guardianship, interpersonal and school conflict) predicted greater mental health service urgency in 61,448 children and adolescents assessed using the interRAI Child and Youth Mental Health Screener. Binary logistic regression revealed that all predictors, except for sector, showed a significant effect on service urgency. Findings are instrumental in prioritization, reducing the likelihood that children with acute needs remain on waitlists.
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Affiliation(s)
- Valbona Semovski
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada.
| | - Colin B King
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada
| | - Shannon L Stewart
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada
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13
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Noorain S, Paola Scaparra M, Kotiadis K. Mind the gap: a review of optimisation in mental healthcare service delivery. Health Syst (Basingstoke) 2022; 12:133-166. [DOI: 10.1080/20476965.2022.2035260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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14
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A multifactorial model for the etiology of neuropsychiatric disorders: the role of advanced paternal age. Pediatr Res 2022; 91:757-770. [PMID: 33674740 DOI: 10.1038/s41390-021-01435-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/07/2021] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
Mental or neuropsychiatric disorders are widespread within our societies affecting one in every four people in the world. Very often the onset of a mental disorder (MD) occurs in early childhood and substantially reduces the quality of later life. Although the global burden of MDs is rising, mental health care is still suboptimal, partly due to insufficient understanding of the processes of disease development. New insights are needed to respond to this worldwide health problem. Next to the growing burden of MDs, there is a tendency to postpone pregnancy for various economic and practical reasons. In this review, we describe the current knowledge on the potential effect from advanced paternal age (APA) on development of autism spectrum disorder, schizophrenia, attention-deficit/hyperactivity disorder, bipolar disorder, obsessive-compulsive disorder, and Tourette syndrome. Although literature did not clearly define an age cut-off for APA, we here present a comprehensive multifactorial model for the development of MDs, including the role of aging, de novo mutations, epigenetic mechanisms, psychosocial environment, and selection into late fatherhood. Our model is part of the Paternal Origins of Health and Disease paradigm and may serve as a foundation for future epidemiological research designs. This blueprint will increase the understanding of the etiology of MDs and can be used as a practical guide for clinicians favoring early detection and developing a tailored treatment plan. Ultimately, this will help health policy practitioners to prevent the development of MDs and to inform health-care workers and the community about disease determinants. Better knowledge of the proportion of all risk factors, their interactions, and their role in the development of MDs will lead to an optimization of mental health care and management. IMPACT: We design a model of causation for MDs, integrating male aging, (epi)genetics, and environmental influences. It adds new insights into the current knowledge about associations between APA and MDs. In clinical practice, this comprehensive model may be helpful in early diagnosis and in treatment adopting a personal approach. It may help in identifying the proximate cause on an individual level or in a specific subpopulation. Besides the opportunity to measure the attributed proportions of risk factors, this model may be used as a blueprint to design prevention strategies for public health purposes.
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15
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Mertan E, Croucher L, Shafran R, Bennett SD. An investigation of the information provided to the parents of young people with mental health needs on an internet forum. Internet Interv 2020; 23:100353. [PMID: 33365258 PMCID: PMC7749433 DOI: 10.1016/j.invent.2020.100353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Access to Children and Adolescent Mental Health Services (CAMHS) can be difficult, with lengthy wait times. Many of the young people and their parents are not signposted to any form of support during their wait for initial assessment or treatment and people are increasingly turning towards web-based resources for help and advice. However, there are some concerns about the quality of the information shared online. Research on the use and quality of information shared on online platforms for mental health inquiries is limited. AIMS We aimed to investigate the content and quality of the responses shared by forum users on an online forum for parents of young people with mental health needs (Mumsnet 'Talk'). Forum users were primarily parents, but 8 posts were written by posters identifying as a healthcare worker, teacher, or autism spectrum specialist. METHODS Qualitative methodology was adopted for this study. Forum content from Mumsnet was extracted in an anonymised form and thematic analysis was conducted to explore the content. Information shared in the online forum was assessed for quality by comparing the responses with clinical guidelines. RESULTS Thread topics related to 16 mental health problems. "Autistic Traits/Autism Spectrum Disorder", "Obsessions and Intrusive Thoughts/ Obsessive Compulsive Disorder" and "Comorbid Anxiety and Depression" were the most prevalent thread topics, consisting 38.3% of the extracted content. The investigation focused on "Information Offered" as the general dimension. Based on the thematic analysis, there were four second-order themes regarding the information offered by forum users; referral, advice, anecdotal information and opinion on case. The quantitative assessment of responses found that 58.3% of the knowledge exchange on Mumsnet was congruent with evidence-based clinical guidelines. CONCLUSIONS Themes indicate that parents of children and young people with mental health needs seem to use online fora for informational support. It is promising that a significant proportion of the information shared within the extracted forum content is congruent with evidence-based knowledge. However, further investigation is needed to generate better understanding of the overall quality of mental health information available on online platforms.
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16
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Abstract
A substantial number of children experience persistent or recurrent problems and may need more than one episode of care. However, there is a paucity of research on recurrent service use. The present study examined the rates and predictors of re-accessing community-based care. Secondary data analyses were conducted on administrative data from 5 mental health agencies in Ontario (N = 1802). Approximately a third (29.6%) of children who had an episode of care re-accessed services again within 4 years; the median time to re-access was 386 days or 12.68 months. Social content (e.g., age, parental marital status) and treatment system (e.g., spacing of visits) variables predicted re-accessing services, although predictors varied based on how services were re-accessed. A better understanding of the factors that influence recurrent service use may help mental health agencies better prepare for and facilitate this process for families.
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Abstract
BACKGROUND Access to timely care is a quality standard underpinning many international healthcare models, and long waiting times for child and adolescent mental health services are often reported as a barrier to help-seeking. AIMS The aim of this study was to examine whether young people with more severe problems have shorter waiting times for mental health services. METHOD Multilevel multinomial regression analysis controlling for service-area deprivation, age, gender, ethnicity, referral source and contextual factors was conducted on N = 21 419 episodes of care (mean age 12.37 years (s.d. = 3.71), 11 712 (55%) female) using data from child and adolescent mental health services. RESULTS There was high variation in waiting times, which ranged from 0 days to 1629 days (mean 50.65 days (s.d. = 78.03), median 32 days). Compared with young people with less severe problems young people with severe problems, self-harm, psychosis or eating disorders were less likely to experience longer waiting times. Moreover, referrals from sources other than primary care were generally less likely to have longer waiting times than referrals from primary care sources, especially referral from accident and emergency services. CONCLUSIONS The findings suggest that young people with more severe problems had shorter waiting times. Intermediary information and resources for support before access to services is needed to prevent escalation of problems and to support individuals and families while waiting for care. Interventions to reduce waiting times should be considered without compromising on the quality and experience of care that young people and families deserve when seeking help.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, UK
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18
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Stunden C, Zasada J, VanHeerwaarden N, Hollenberg E, Abi-Jaoudé A, Chaim G, Cleverley K, Henderson J, Johnson A, Levinson A, Lo B, Robb J, Shi J, Voineskos A, Wiljer D. Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study. J Med Internet Res 2020; 22:e18514. [PMID: 33016882 PMCID: PMC7573698 DOI: 10.2196/18514] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 01/29/2023] Open
Abstract
Background Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help. Objective The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada. Methods A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes. Results Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help. Conclusions Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth.
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Affiliation(s)
- Chelsea Stunden
- School of Population and Public Health, Simon Fraser University, Burnaby, BC, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Julie Zasada
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Nicole VanHeerwaarden
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kristin Cleverley
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrea Levinson
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Health and Wellness, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janine Robb
- Health and Wellness, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Education, Technology & Innovation, University Health Network, Toronto, ON, Canada
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19
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Timely Access to Mental Health Services for Patients with Pain. Pediatr Qual Saf 2019; 4:e240. [PMID: 32010866 PMCID: PMC6946233 DOI: 10.1097/pq9.0000000000000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022] Open
Abstract
Efficient access to pediatric mental health services is a growing concern as the number of patients increases and outpaces efforts to expand services. This study outlines interventions implemented using quality improvement (QI) science and methodology to demonstrate how a clinic embedded in a large children's hospital can improve access to the first appointment for a population seeking pain management services. METHODS A process improvement project started with a QI team, whose members designed interventions to change scheduling practices. Initial changes involved decreased time between calls to families, and efforts to streamline notifications among clinicians. Additional interventions included a close examination of waitlist assignment based on appropriateness and assessing patient interest in treatment. RESULTS Within 3 months of implementation, a significant decline in wait time occurred for patients seeking services for pain management, from 106 to 48 days. This change remained stable for 6 months. In light of a sharp increase in referrals and wait time during the study period, efforts to engage additional clinicians in managing referrals resulted in wait time to stabilize at an average of 63 days to the first appointment. This change remained for 10 months. Scheduling changes did not negatively affect other providers. CONCLUSIONS This study demonstrates the application of QI science to improve patient access to mental health care. Future directions will focus on enhancing the use of the electronic health record, along with previsit family engagement.
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20
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Bonati M, Cartabia M, Zanetti M. Waiting times for diagnosis of attention-deficit hyperactivity disorder in children and adolescents referred to Italian ADHD centers must be reduced. BMC Health Serv Res 2019; 19:673. [PMID: 31533711 PMCID: PMC6751639 DOI: 10.1186/s12913-019-4524-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers. METHODS Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013-2017 were analyzed. RESULTS The sample comprised 2262 children and adolescents aged 5-17 years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177 days (range 66-375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path. CONCLUSIONS To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered.
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Affiliation(s)
- Maurizio Bonati
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy.
| | - Massimo Cartabia
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy
| | - Michele Zanetti
- Laboratory for Mother Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Giuseppe La Masa 19, 20156, Milan, Italy
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21
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Preliminary Validation of the Parental Help-Seeking Stage of Change Measure for Child Behavior Problems. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09525-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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22
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Johnston OG, Burke JD. Parental Problem Recognition and Help-Seeking for Disruptive Behavior Disorders. J Behav Health Serv Res 2019; 47:146-163. [DOI: 10.1007/s11414-018-09648-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Schraeder KE, Reid GJ, Brown JB. "I Think He Will Have It Throughout His Whole Life": Parent and Youth Perspectives About Childhood Mental Health Problems. QUALITATIVE HEALTH RESEARCH 2018; 28:548-560. [PMID: 29160158 DOI: 10.1177/1049732317739840] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Children's mental health (CMH) problems can be long-lasting. Even among children and youth who receive specialized CMH treatment, recurrence of problems is common. It is unknown whether youth and their parents view the possibility of future mental health problems. This has important implications for how CMH services should be delivered. This grounded theory study gained perspectives from youth (aged 12-15 years) who received CMH treatment ( n = 10) and their parents ( n = 10) about the expected course of CMH problems. Three disorder trajectories emerged: (a) not chronic, (b) chronic and persistent, and (c) chronic and remitting, with the majority of youth falling in the third trajectory. A gap in available services between CMH and adult care was perceived by parents, leaving them either help hopeful or help hungry about their child's future care. Improving care for youth with ongoing mental health problems is needed to minimize costs to families and the system.
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Affiliation(s)
| | - Graham J Reid
- 1 Western University, London, Ontario, Canada
- 2 Lawson Health Research Institute, London, Ontario, Canada
- 3 Children's Health Research Institute, London, Ontario, Canada
| | - Judith Belle Brown
- 1 Western University, London, Ontario, Canada
- 4 King's University College, London, Ontario, Canada
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24
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Smith J, Kyle RG, Daniel B, Hubbard G. Patterns of referral and waiting times for specialist Child and Adolescent Mental Health Services. Child Adolesc Ment Health 2018; 23:41-49. [PMID: 32677372 DOI: 10.1111/camh.12207] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND During 12-month period (2012/13) around 21,480 children and young people (CYP) were referred to Child and Adolescent Mental Health Service (CAMHS) in Scotland (NHS Scotland, 2013, Child and Adolescent Mental Health Services waiting times in Scotland). At the end of September 2012, there were 3,602 CYP still waiting for 'start of treatment' or 'removal from the waiting list', 375 (10%) CYP had waited over 26 weeks and 1,204 (33%) CYP had waited over 18 weeks (NHS Scotland, 2013, Child and Adolescent Mental Health Services waiting times in Scotland). Referral source, referral reason and the sociodemographic characteristics of CYP are not routinely collected, and therefore, associations between these factors and wait times for 'start of treatment' or 'removal from the waiting list' (i.e. the referral outcome) are unknown. METHOD In this exploratory study, a retrospective analysis of referral data was conducted in one CAMHS. Data for 476 referrals between 1st May 2013 and 31st May 2014 were initially analysed to define categories for each of the following key variables: referral source, referral reason and referral outcome. Data on CYP sociodemographic characteristics were extracted from referral records, including age, gender and postcode, from which Scottish Index of Multiple Deprivation quintile of residence was derived. Descriptive statistics were calculated for referral source, referral reason and CYP sociodemographic characteristics. Regression models were then built to determine predictors of a referral being rejected by CAMHS and waiting time for referrals accepted by CAMHS. Data were analysed in SPSS (Version 20). RESULTS Of the 476 referrals, 72% (n = 342) were accepted and 12% (n = 59) were rejected. Most referrals were made by general practitioners. Just under a third of referrals to CAMHS (31%) were for CYP with emotional and behavioural difficulties. The odds of being rejected by CAMHS were significantly higher if referred by teachers and for CYP with emotional and behavioural difficulties. Age and referral reason were significant independent predictors of waiting time after referral to CAMHS, with CYP referred for hyperactivity/inattention waiting significantly longer. CONCLUSIONS Policymakers should consider ways to foster dialogue and collaboration between different groups of professionals making and accepting referrals to CAMHS in order to improve timely access to appropriate mental health support services for CYP. Research is urgently needed to investigate the experiences of CYP who are either rejected by CAMHS or wait lengthy periods of time before starting their treatment with CAMHS.
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Affiliation(s)
- Joanna Smith
- Faculty of Health Science and Sport, Centre for Health Science, University of Stirling, Highland Campus, Old Perth Road, Inverness, IV2 3JH, UK
| | - Richard G Kyle
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Brigid Daniel
- Faculty of Applied Social Science, University of Stirling, Stirling, UK
| | - Gill Hubbard
- Faculty of Health Science and Sport, Centre for Health Science, University of Stirling, Highland Campus, Old Perth Road, Inverness, IV2 3JH, UK
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25
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Clark S, Emberly D, Pajer K, Delong E, McWilliam S, Bagnell A, Abidi S, Casey B, Gardner W. Improving Access to Child and Adolescent Mental Health Care: The Choice and Partnership Approach. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:5-14. [PMID: 29375628 PMCID: PMC5777686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Choice and Partnership Approach (CAPA) is designed to improve access and quality of pediatric mental health care. We tested whether CAPA improved access in an academic pediatric hospital. METHOD We used de-identified administrative data to compare access pre- (2011) and post-CAPA (2013). RESULTS Wait time to first appointment in 2011 was 225.3 days (95% CI = [211.0, 239.6], N = 364), compared to 93.0 days (95% CI = [89.2, 96.8], N = 838) in 2013 (p<.001). Mean wait time between the first and second appointments was 59.2 days (95% CI = [46.5, 71.9], N = 86) in 2011, compared to 95.9 days (95% CI = [90.3, 101.5], N = 487) in 2013 (p < .001). However, overall mean wait time from referral to second appointment decreased from 271.2 days (95% CI = [236.5, 305.9], N = 86) in 2011 to 168.9 days (95% CI = [161.6, 176.2], N = 487) in 2013 (p < .001). Provider productivity increased from 32.6 to 57.0 first appointments/FTE/year. Depending on the question, 65 to 95% of parents and children gave positive answers about CAPA. CONCLUSIONS CAPA implementation was associated with more patients served, decreased waiting time to first appointment, and higher productivity.
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Affiliation(s)
| | | | - Kathleen Pajer
- Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Faculty of Medicine, Ottawa, Ontario
| | | | | | | | | | - Barbara Casey
- Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Faculty of Medicine, Ottawa, Ontario
| | - William Gardner
- CHEO Research Institute and Department of Epidemiology, University of Ottawa, Ottawa, Ontario
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26
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Reid G, Stewart SL, Zaric GS, Carter JR, Neufeld RWJ, Tobon JI, Barwick M, Vingilis ER. Defining Episodes of Care in Children's Mental Health Using Administrative Data. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:737-47. [PMID: 25403258 DOI: 10.1007/s10488-014-0609-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Criteria to define an episode of care in children's mental health services are needed. Various criteria were applied to 5 years of visit data from children 4-11 years (N = 5,206) at their first visit to 1 of 3 children's mental health agencies. A minimum of 3 visits with 180 days between episodes optimized agreement with other dates (e.g., telephone intake assessment) marking the start and end of an episode, and clinician-rated number of episodes. Grouping visits into episodes provides a clearer representation of how services are distributed over extended periods of time, facilitating research and enhancing accuracy in service planning.
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Affiliation(s)
- Graham Reid
- Department of Psychology, University of Western Ontario, London, ON, Canada. .,Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. .,Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. .,Children's Health Research Institute, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada.
| | - Shannon L Stewart
- Faculty of Education, University of Western Ontario, London, ON, Canada.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Gregory S Zaric
- Ivey Business School, University of Western Ontario, London, ON, Canada
| | | | - Richard W J Neufeld
- Department of Psychology, University of Western Ontario, London, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,Neuroscience Program, University of Western Ontario, London, ON, Canada
| | - Juliana I Tobon
- Department of Psychology, University of Western Ontario, London, ON, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Melanie Barwick
- Community Health Systems Research Group, Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Evelyn R Vingilis
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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