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Wong R, Podolsky A, Levitt A, Da Silva A, Kodeeswaran S, Markoulakis R. A Qualitative Exploration of Ontario Caregivers' Perspectives of Their Role in Navigating Mental Health and/or Addiction Services for Their Youth. J Behav Health Serv Res 2023; 50:486-499. [PMID: 37311969 DOI: 10.1007/s11414-023-09843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023]
Abstract
Many youth experiencing mental health and/or addiction (MHA) concerns rely on their caregivers to find and access services. Considering that caregivers often play a significant role in their youth's treatment trajectory, a descriptive qualitative study was used to explore how caregivers (n = 26) in the Greater Toronto Area perceive their role in navigating MHA care for their youth (ages 13 to 26). The Person-Environment-Occupation model was used to guide the thematic analysis. The findings reveal three main themes (1) the internal experience of caregiving, which describes caregivers' emotions and thought processes; (2) the external factors impacting the caregiver's ability to find and access youth MHA services, which explores systemic and social factors that impact navigation; and (3) the demands of the caregiving role. The discussion highlights the importance of supporting the wellbeing of caregivers as they navigate youth MHA services and can provide useful information for healthcare professionals and policy-makers to increase equitable access to youth MHA services.
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Affiliation(s)
- Rachel Wong
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anna Podolsky
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, ON, Canada
- Family Navigation Project, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue, RM 205, Toronto, ON, M4G 3E8, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue, RM 205, Toronto, ON, M4G 3E8, Canada
| | - Roula Markoulakis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
- Sunnybrook Research Institute, Toronto, ON, Canada.
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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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Predictors of barriers to accessing youth mental health and/or addiction care. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2023; 32:27-37. [PMID: 36776928 PMCID: PMC9879035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/03/2022] [Indexed: 02/14/2023]
Abstract
Background It is estimated that 1.2 million Canadian youth are affected by mental health and/or addiction issues; yet only a small proportion of young people receive appropriate and specialized treatment. Given caregivers are often tasked with navigating the complex mental health and/or addiction care systems for their youth, it is important to identify and understand the characteristics, such as those related to youth and their families, that are associated with caregivers' perceived barriers to accessing youth mental health and/or addiction services. Objective The objective of this cross-sectional survey study was to examine the unique predictors of caregivers' perceived barriers to accessing youth mental health and/or addiction services. Method Participants were 259 caregivers of at least one youth, aged 4 to 29 years (M age = 16.7, SD = 5.3) with mental health and/or addiction issues in Ontario, Canada identified from a community-based online survey. Results Regression results showed that caregivers' demographics (i.e., living in a rural area, having an education level of college/university degree or higher), youth having concurrent issues, and service use patterns (i.e., currently accessing and/or seeking services) significantly predicted a higher level of barriers to accessing mental health and/or addiction services. Conclusion In order to improve access to care for youth with mental health and/or addiction issues, understanding the predictors of barriers to accessing appropriate services is an important step in making services more accessible for youth and families.
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Ozturk Y, Ozyurt G, Gormez V, Aslankaya ZD, Baykara B, Ekinci O, Kaya I, Adak I, Esin IS, Turan S, Sari M, Ozcan GG, Ermis C, Ekinci N, Dogan OI, Tiryaki I, Kitapcioglu S, Tufan AE, Inal N, Akay AP. Parent rated bedtime resistance and comorbidity may predict levels of attention among Turkish children diagnosed with ADHD in on-line education classes during the COVID-19 outbreak. North Clin Istanb 2023; 10:197-204. [PMID: 37181063 PMCID: PMC10170383 DOI: 10.14744/nci.2022.77674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/15/2022] [Accepted: 09/17/2022] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE This study aimed to compare the attention levels, of Turkish children and adolescents with Attention Deficit/ Hyperactivity Disorder (ADHD) in on-line education classes with healthy controls. METHODS This study is a cross-sectional, internet-based, case-control study that recruited 6-18 years old patients diagnosed with ADHD and receving treatment and healthy controls from eight centers. The measurements used in the study were prepared in the google survey and delivered to the participants via Whatsapp application. RESULTS Within the study period, 510 children with ADHD and 893 controls were enrolled. Parent- rated attention decreased significantly in both groups during on-line education classes due to COVID-19 outbreak (p<0.001; for each). Children and adolescents with ADHD had significantly elevated bedtime resistance, problems in family functioning difficulties than control children according to parental reports (p=0.003; p<0.001; p<0.001, respectively). Furthermore, bedtime resistance and comorbidity significantly predicted attention levels in on-line education. CONCLUSION Our findings may underline the need to augment student engagement in on-line education both for children without attention problems and those with ADHD. Interventions shown to be effective in the management of sleep difficulties in children as well as parent management interventions should continue during on-line education.
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Affiliation(s)
- Yusuf Ozturk
- Department of Child and Adolescent Psychiatry, Bolu Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkiye
- Correspondence: Yusuf OZTURK, MD. Abant Izzet Baysal Universitesi Tip Fakultesi, Cocuk ve Ergen Psikiyatrisi Anabilim Dali, Bolu, Turkiye. Tel: +90 374 275 25 25 e-mail:
| | - Gonca Ozyurt
- Department of Child and Adolescent Psychiatry, Katip Celebi University Faculty of Medicine, Izmir, Turkiye
| | - Vahdet Gormez
- Department of Child and Adolescent Psychiatry, Medeniyet University, Istanbul, Turkiye
| | | | - Burak Baykara
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
| | - Ozalp Ekinci
- Department of Child and Adolescent Psychiatry, University of Health Sciences Faculty of Medicine, Erenkoy Health Practice and Research Center, Istanbul, Turkiye
| | - Ilyas Kaya
- Department of Child and Adolescent Psychiatry, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkiye
| | - Ibrahim Adak
- Department of Child and Adolescent Psychiatry, University of Health Sciences Faculty of Medicine, Erenkoy Health Practice and Research Center, Istanbul, Turkiye
| | - Ibrahim Selcuk Esin
- Department of Child and Adolescent Psychiatry, Ataturk University Faculty of Medicine, Erzurum, Turkiye
| | - Serkan Turan
- Department of Child and Adolescent Psychiatry, Tekirdag State Hospital, Izmir, Turkiye
| | - Mesut Sari
- Department of Child and Adolescent Psychiatry, Istanbul Cam and Sakura City Hospital, Istanbul, Turkiye
| | - Guler Gol Ozcan
- Department of Child and Adolescent Psychiatry, Bilecik State Hospital, Bilecik, Turkiye
| | - Cagatay Ermis
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
| | - Nazan Ekinci
- Department of Child and Adolescent Psychiatry, University of Health Sciences Faculty of Medicine, Erenkoy Health Practice and Research Center, Istanbul, Turkiye
| | - Ozge Ipek Dogan
- Department of Child and Adolescent Psychiatry, University of Health Sciences Faculty of Medicine, Erenkoy Health Practice and Research Center, Istanbul, Turkiye
| | - Ibrahim Tiryaki
- Department of Child and Adolescent Psychiatry, Ataturk University Faculty of Medicine, Erzurum, Turkiye
| | | | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Bolu Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkiye
| | - Neslihan Inal
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
| | - Aynur Pekcanlar Akay
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
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Markoulakis R, Khalid M, Da Silva A, Kodeeswaran S, Sinyor M, Cheung A, Redelmeier D, MacKillop J, Scarpitti M, Laird H, Foot J, Levitt A. Cross-sectional survey of the Mental health and Addictions effects, Service impacts and Care needs of children, youth and families during the COVID-19 pandemic: the COVID-19 MASC study protocol. BMJ Open 2022; 12:e066190. [PMID: 36288837 PMCID: PMC9615177 DOI: 10.1136/bmjopen-2022-066190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a tremendous negative effect on the mental health and well-being of Canadians. These mental health challenges are especially acute among vulnerable Canadian populations. People living in Canada's most populous province, Ontario, have spent prolonged time in lockdown and under public health measures and there is a gap in our understanding of how this has impacted the mental health system. This protocol describes the Mental health and Addictions Service and Care Study that will use a repeated cross-sectional design to examine the effects, impacts, and needs of Ontario adults during the COVID-19 pandemic. METHODS AND ANALYSIS A cross-sectional survey of Ontario adults 18 years or older, representative of the provincial population based on age, gender and location was conducted using Delvinia's AskingCanadians panel from January to March 2022. Study sample was 2500 in phases 1 and 2, and 5000 in phase 3. The Alcohol, Smoking and Substance Involvement Screening Test and Diagnostic Statistical Manual-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult were used to assess for substance and mental health concerns. Participants were asked about mental health and addiction service-seeking and/or accessing prior to and during the pandemic. Analyses to be conducted include: predictors of service access (ie, sociodemographics, mental illness and/or addiction, and social supports) before and during the pandemic, and χ2 tests and logistic regressions to analyse for significant associations between variables and within subgroups. ETHICS AND DISSEMINATION Ethics approval was obtained from the Sunnybrook Research Ethics Board. Dissemination plans include scientific publications and conferences, and online products for stakeholders and the general public.
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Affiliation(s)
- Roula Markoulakis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maida Khalid
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | | | - Mark Sinyor
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Amy Cheung
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Donald Redelmeier
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University, Hamilton, Ontario, Canada
| | - Michael Scarpitti
- Canadian Mental Health Association Ontario Division, Toronto, Ontario, Canada
| | - Hannah Laird
- Youth Advisory Council, Family Navigation Project at Sunnybrook, Toronto, Ontario, Canada
| | - Jeanne Foot
- Family Advisory Council, Family Navigation Project at Sunnybrook, Toronto, Ontario, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Kourgiantakis T, Markoulakis R, Hussain A, Lee E, Ashcroft R, Williams C, Lau C, Goldstein AL, Kodeeswaran S, Levitt A. Navigating inequities in the delivery of youth mental health care during the COVID-19 pandemic: perspectives of youth, families, and service providers. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:806-816. [PMID: 35852728 PMCID: PMC9663755 DOI: 10.17269/s41997-022-00670-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16-24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers. METHODS Using a descriptive qualitative research design and a university-community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data. RESULTS The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic. CONCLUSION At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health 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 ,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Eunjung Lee
- 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
| | - Charmaine Williams
- 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
| | - Abby L. Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON Canada
| | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON Canada ,Faculty of Medicine, University of Toronto, Toronto, ON Canada
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Markoulakis R, Da Silva A, Kodeeswaran S, Levitt A. Youth mental health and/or addiction concerns and service needs during the COVID-19 pandemic: a qualitative exploration of caregiver experiences and perspectives. Child Adolesc Psychiatry Ment Health 2022; 16:35. [PMID: 35538588 PMCID: PMC9088718 DOI: 10.1186/s13034-022-00471-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
The COVID-19 pandemic has undoubtedly had a significant impact on youth mental health and/or addiction concerns and exacerbated pre-existing gaps in access to mental health and/or addiction care. Caregivers can support their youth in seeking and participating in care, however, their experiences in doing so in the pandemic and their perspectives of their youth's care needs are not well-understood. A descriptive qualitative study was conducted to better understand youth's and caregivers' experiences accessing care during the pandemic, from the caregivers' standpoint. Participants completed semi-structured qualitative interviews that focused on experiences seeking and accessing mental health and/or addiction services, with specific questions regarding their experiences accessing services during the pandemic. A total of 46 interviews were included in the thematic analysis of the data. Study findings highlight the impacts of the pandemic on everyday life, on youth mental health and/or addiction needs, on caregiver's experiences seeking and accessing services for their youth, and on service access, including perceptions of virtual care modalities. The discussion highlights the importance of focusing on factors that enable youth's participation in care, to ensure accessibility of appropriate and timely care that meets youth's and families' needs. Also highlighted is the frustration and despair experienced by caregivers seeking critical mental health and addictions supports for their youth during the pandemic, as well as the sense of isolation and of being left behind by the system. Identifying caregiver perspectives of youth mental health and addiction needs and service access during the COVID-19 pandemic provided important insights that can help inform approaches to youth mental health and addictions care during the pandemic and beyond.
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Affiliation(s)
- Roula Markoulakis
- Sunnybrook Research Institute, 1929 Bayview Avenue, Toronto, ON, M4G 3E8, Canada. .,Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Andreina Da Silva
- grid.17063.330000 0001 2157 2938Sunnybrook Research Institute, 1929 Bayview Avenue, Toronto, ON M4G 3E8 Canada
| | - Sugy Kodeeswaran
- grid.413104.30000 0000 9743 1587Family Navigation Project, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue, Toronto, ON M4G 3E8 Canada
| | - Anthony Levitt
- grid.413104.30000 0000 9743 1587Family Navigation Project, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue, Toronto, ON M4G 3E8 Canada ,grid.413104.30000 0000 9743 1587Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
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Hawke LD, Thabane L, Wilkins L, Mathias S, Iyer S, Henderson J. Don't Forget the Caregivers! A Discrete Choice Experiment Examining Caregiver Views of Integrated Youth Services. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 14:791-802. [PMID: 33855684 PMCID: PMC8046579 DOI: 10.1007/s40271-021-00510-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
Abstract
Background The design and implementation of community-based integrated youth service hubs (IYSHs) is burgeoning around the world. This collaborative model of care aims to address barriers in youth service access by designing services that meet the needs of youth and caregivers. However, heterogeneity across models requires a better understanding of the preferences for key service characteristics. Method A discrete choice experiment was conducted among 274 caregivers of youth aged 14–29 years with mental health challenges. The experiment consisted of 12 attributes with four levels each, representing different service components; additional measures were collected, including demographics and burden assessments. Utility values were calculated, representing the degree of preference for a given level of an attribute. Latent class analysis was conducted to understand subgroups with different service preferences, identifying three latent classes with differing IYSH service preferences. Results The largest class (n = 173, 63.1%), entitled ‘Comprehensive, Integrative Service Access’, strongly valued practical aspects of service design, such as rapid access and support for a wide range of needs. The ‘Service Process Features’ class (n = 67, 24.5%) expressed a relative prioritization of process features of service access, while the smaller ‘Caregiver Involvement’ (n = 34, 12.4%) class most highly prioritized caregiver involvement in their youths’ services. Similar demographic characteristics and caregiver burden were found across classes, although participants in the Caregiver Involvement latent class were supporting younger youth. Discussion and Conclusions Caregivers have diverse youth service preferences and relative priorities that should be taken into account when designing services. System designers and service providers are encouraged to take caregivers’ preferences and priorities into account, alongside youth priorities, whether designing service delivery models or an individual service plan for a youth. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00510-6.
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Affiliation(s)
- Lisa D Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health; University of Toronto, Toronto, ON, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Leanne Wilkins
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Srividya Iyer
- McGill University; ACCESS Open Minds (Youth Mental Health Services Research Network), Montreal, QC, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health; University of Toronto, Toronto, ON, Canada.
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