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Lyzwinski L, Mcdonald S, Zwicker J, Tough S. Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis. JMIR Pediatr Parent 2024; 7:e55100. [PMID: 38916946 PMCID: PMC11234057 DOI: 10.2196/55100] [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: 12/02/2023] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. OBJECTIVE The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health. METHODS We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022). RESULTS A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space. CONCLUSIONS There is an opportunity to reduce the barriers to implementing tele-mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele-mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation.
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Affiliation(s)
- Lynnette Lyzwinski
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- The School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Sheila Mcdonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jennifer Zwicker
- The School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Varatharasan N, Chiodo D, Hanna M, Henderson JL. Lessons Learned from the Implementation of Youth Wellness Hubs Ontario, an Integrated Youth Services Network: Perspectives from Network Leads. Int J Integr Care 2024; 24:7. [PMID: 38618044 PMCID: PMC11012022 DOI: 10.5334/ijic.7605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Mental health and substance use services for youth in Canada continue to be fragmented. In response, Integrated Youth Services (IYS) has been proposed to address gaps in youth mental health services that can lead to improved youth outcomes. Youth Wellness Hubs Ontario (YWHO) was launched in 2017 as Ontario's IYS Network for youth ages 12-25, prioritizing continuous improvement through evaluation. Description At the end of the first three years of the YWHO initiative, an evaluation was carried out to identify the barriers and facilitators to the initial implementation of YWHO and service delivery modifications resulting from the COVID-19 pandemic across ten sites. Reporting on these is the focus of this article. Key informant interviews were conducted in early 2021 with Network Leads from all ten initial YWHO sites. Reflexive thematic analysis was used to analyze all interview data. Discussion Facilitators to the implementation of the YWHO model included diversified funding models, YWHO Provincial Office implementation supports, clear hub processes, robust community partnerships, organizational support and dedicated staff. Common barriers included certain challenges related to staffing and finances, implementation of the shared data collection platform, implementation of measurement-based care, partnerships, integrated service delivery, and branding and communications. Conclusion Implementation of IYS is highly collaborative and quite complex. As interest in such models increase, so does the need for knowledge related to optimal implementation. Learnings have informed developments and improvements made to the YWHO model. Insights will also inform how stakeholders support youth in their communities in designing and implementing services that improve youth mental health and overall well-being.
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Affiliation(s)
| | - Debbie Chiodo
- Youth Wellness Hubs Ontario, CA
- Centre for Addiction and Mental Health, CA
- Western University, CA
| | - Mary Hanna
- Youth Wellness Hubs Ontario, CA
- Western University, CA
| | - Jo Lyn Henderson
- Youth Wellness Hubs Ontario, CA
- Centre for Addiction and Mental Health, CA
- University of Toronto, CA
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Gibson K, Trnka S, Jonas M, Pomare P, Thompson S, Tiatia-Siau J, Aimiti Ma'ia'i KD, Aoake M, Bouttier-Esprit T, Spray I, Vyas S. Digital mental health strategies used by young people in Aotearoa New Zealand during the COVID-19 pandemic: 'Just do it yourself, DIY'. Digit Health 2024; 10:20552076241260116. [PMID: 39070892 PMCID: PMC11282513 DOI: 10.1177/20552076241260116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/22/2024] [Indexed: 07/30/2024] Open
Abstract
Objective With rising rates of mental health distress amongst youth during the COVID-19 pandemic, digital resources have been identified as a valuable tools for delivering support to young people. However, many of the websites and apps developed by professionals to support the youth do not take account of the importance young people place on exercising their own agency in managing their mental health. This article investigates how young people in Aotearoa New Zealand used digital resources to manage their mental health needs during the COVID-19 pandemic. Methods The study gathered information from semi-structured interviews with 34 young people aged 16-22 years. The data was analysed using reflexive thematic analysis. Results Six themes were identified including: searching for online information about mental health; evaluating digital mental health resources; controlling mood through online activity; looking for escape in the virtual world; staying connected online; and giving and receiving support. Conclusion Young people's practices demonstrated their investment in their own agency, a general reluctance to engage with professional resources and recognition of the need to balance the risks and benefits of the informal strategies they preferred. Young people appeared sceptical of professionally-designed mental health resources and interventions and preferred to adapt and re-purpose the wide range of platforms and networks available in their informal digital worlds.
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Affiliation(s)
- Kerry Gibson
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Susanna Trnka
- Social Anthropology, University of Auckland, Auckland, New Zealand
| | - Monique Jonas
- Population Health, University of Auckland, Auckland, New Zealand
| | | | | | - Jemaima Tiatia-Siau
- Māori and Pacific Studies, The University of Auckland, Auckland, New Zealand
| | | | - Miriama Aoake
- Social Anthropology, University of Auckland, Auckland, New Zealand
| | | | - Imogen Spray
- Social Anthropology, University of Auckland, Auckland, New Zealand
| | - Sanchita Vyas
- Social Anthropology, University of Auckland, Auckland, New Zealand
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Campbell LA, Clark SE, Chorney J, Emberly D, Carrey NJ, Bagnell A, Blenus J, Daneff M, Campbell JC. Understanding the uptake of virtual care for first and return outpatient appointments in child and adolescent mental health services: a mixed-methods study. BMJ Open 2023; 13:e074803. [PMID: 38110381 DOI: 10.1136/bmjopen-2023-074803] [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: 12/20/2023] Open
Abstract
OBJECTIVE To describe patterns of virtual and in-person outpatient mental health service use and factors that may influence the choice of modality in a child and adolescent service. DESIGN A pragmatic mixed-methods approach using routinely collected administrative data between 1 April 2020 and 31 March 2022 and semi-structured interviews with clients, caregivers, clinicians and staff. Interview data were coded according to the Consolidated Framework for Implementation Research (CFIR) and examined for patterns of similarity or divergence across data sources, respondents or other relevant characteristics. SETTING Child and adolescent outpatient mental health service, Nova Scotia, Canada. PARTICIPANTS IWK Health clinicians and staff who had participated in virtual mental healthcare following its implementation in March 2020 and clients (aged 12-18 years) and caregivers of clients (aged 3-18 years) who had received treatment from an IWK outpatient clinic between 1 April 2020 and 31 March 2022 (n=1300). Participants (n=48) in semi-structured interviews included nine clients aged 13-18 years (mean 15.7 years), 10 caregivers of clients aged 5-17 years (mean 12.7 years), eight Community Mental Health and Addictions booking and registration or administrative staff and 21 clinicians. RESULTS During peak pandemic activity, upwards of 90% of visits (first or return) were conducted virtually. Between waves, return appointments were more likely to be virtual than first appointments. Interview participants (n=48) reported facilitators and barriers to virtual care within the CFIR domains of 'outer setting' (eg, external policies, client needs and resources), 'inner setting' (eg, communications within the service), 'individual characteristics' (eg, personal attributes, knowledge and beliefs about virtual care) and 'intervention characteristics' (eg, relative advantage of virtual or in-person care). CONCLUSIONS Shared decision-making regarding treatment modality (virtual vs in-person) requires consideration of client, caregiver, clinician, appointment, health system and public health factors across episodes of care to ensure accessible, safe and high-quality mental healthcare.
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Affiliation(s)
- Leslie Anne Campbell
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Debbie Emberly
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - N J Carrey
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexa Bagnell
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jaime Blenus
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Miriam Daneff
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
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Williams TS, Burek B, Deotto A, Ford MK, Green R, Wade SL. Pandemic Perils and Promise: Implementation of a Virtual Parenting Intervention during COVID-19 among Children with Early Neurological Conditions. Dev Neurorehabil 2022; 25:505-517. [PMID: 35918818 DOI: 10.1080/17518423.2022.2099996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In this study, we examined feasibility, acceptability, and preliminary efficacy of a telepsychological positive parenting intervention (I-InTERACT-North, Internet-basedInteracting Together Everyday: Recovery After Childhood Traumatic Brain Injury) during the COVID-19 pandemic among Canadian families of children at-risk for neurodevelopmental challenges given congenital or neonatal conditions. I-InTERACT-North was developed to improve behavioral and emotional outcomes in children with neurological conditions by utilizing and adapting parenting strategies from several established family-focused programmes. METHODS A pragmatic prospective pre-post single-site pilot study design was used to assess feasibility, acceptabilty, and preliminary efficacy of I-InTERACT North during the COVID-19 pandemic. RESULTS Thirty-five families of children ages three to nine years were referred between March 2020 and January 2021. Eighteen families enrolled, and 12 (67% adherence) completed the programme. Parents reported strong therapeutic alliance and programme acceptability with barriers due to competing time demands. Therapists reported high acceptability but perceived parental burnout. Parenting confidence (d = 0.70), and child behavior (d = 1.30) improved following the intervention. CONCLUSIONS Results demonstrate the programme's value to families during the pandemic, while underscoring unique participation barriers. Future research and clinicial implications are discussed.
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Affiliation(s)
- Tricia S Williams
- The Hospital for Sick Children, Toronto, ON, Canada.,The University of Toronto, Toronto, ON, Canada.,York University, Toronto, ON, Canada
| | - Brittany Burek
- The Hospital for Sick Children, Toronto, ON, Canada.,The University of Toronto, Toronto, ON, Canada
| | - Angela Deotto
- The Hospital for Sick Children, Toronto, ON, Canada.,York University, Toronto, ON, Canada
| | - Meghan K Ford
- The Hospital for Sick Children, Toronto, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - Rivka Green
- The Hospital for Sick Children, Toronto, ON, Canada.,York University, Toronto, ON, Canada
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Toulany A, Kurdyak P, Gandhi S, Fu L, Grewal S, Kulkarni C, Saunders N, Vigod S, Guttmann A, Chiu M, Pignatiello A. Health System-Level Evaluation of Tele-Mental Health Services Among Children and Adolescents in Ontario, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:462-469. [PMID: 34569295 PMCID: PMC9149526 DOI: 10.1177/07067437211043395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the characteristics of children and adolescents receiving tele-mental health services in Ontario, Canada and examine access to a psychiatrist, in-person or via tele-mental health services, following a mental health and addictions (MHA)-related emergency department (ED) visit or hospitalization. METHOD Using linked health and administrative data, we described two cohorts: (1) children and adolescents (1-18 years) who used a provincial tele-mental health programme from January 1, 2013 to March 31, 2017, comparing their MHA-related service use (outpatient, ED, hospitalization) in the 1 year prior to and the 1 year following initial consultation; (2) children and adolescents with high mental health service needs, defined as those with an incident MHA-related ED visit or hospitalization between January 1, 2013 and December 31, 2016, examining their 1-year follow-up with telemedicine and other health care utilization. RESULTS In the first cohort, 7,216 children and adolescents (mean age 11.8 [±3.8] years) received tele-mental health services. The proportion of MHA-related ED visits [15.1% pre vs. 12.6% post (test statistic 23.57, P < 0.001)] or hospitalizations [10.2% pre vs. 8.7% post (test statistic 11.96, P < 0.001)] declined in the year following tele-mental health consultation, while local psychiatry visits increased [8.4% pre vs. 17.0% post (test statistic 298.69, P < 0.001)]. In the second cohort (n = 84,033), only 1.5% received tele-mental health services, 40.7% saw a psychiatrist in-person, and 32.5% received no MHA-related outpatient care in follow-up. CONCLUSIONS Tele-mental health services were rarely used in Ontario, even among high-needs children and adolescents, despite their association with increased access to care and less need for acute mental health care.
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Affiliation(s)
- Alene Toulany
- Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario.,ICES, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,50010Child Health Evaluative Sciences, 483367SickKids Research Institute, Toronto, Ontario
| | - Paul Kurdyak
- ICES, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,Institute for Mental Health Policy Research, 7978Centre for Addiction and Mental Health, Toronto, Ontario
| | | | | | - Seena Grewal
- Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,TeleLink Mental Health Program, Department of Psychiatry, 7979The Hospital for Sick Children, Toronto, Ontario
| | - Chetana Kulkarni
- Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,TeleLink Mental Health Program, Department of Psychiatry, 7979The Hospital for Sick Children, Toronto, Ontario
| | - Natasha Saunders
- ICES, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,50010Child Health Evaluative Sciences, 483367SickKids Research Institute, Toronto, Ontario.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario.,Women's College Research Institute, 7985Women's College Hospital, Toronto, Ontario
| | - Simone Vigod
- ICES, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,Women's College Research Institute, 7985Women's College Hospital, Toronto, Ontario
| | - Astrid Guttmann
- ICES, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,50010Child Health Evaluative Sciences, 483367SickKids Research Institute, Toronto, Ontario.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario.,Women's College Research Institute, 7985Women's College Hospital, Toronto, Ontario.,Leong Centre for Healthy Children, 12366University of Toronto, Toronto, Ontario
| | - Maria Chiu
- ICES, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario
| | - Antonio Pignatiello
- Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,TeleLink Mental Health Program, Department of Psychiatry, 7979The Hospital for Sick Children, Toronto, Ontario
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Barriers and Facilitators to the Implementation of an Integrated Youth Services Network in Ontario. Int J Integr Care 2022; 22:19. [PMID: 36569415 PMCID: PMC9756906 DOI: 10.5334/ijic.6737] [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: 04/19/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction In response to the challenges of the traditional mental health system for youth both in Canada and abroad, models of integrated youth services (IYS) that span the integration of mental health, health, substance use, eucation, employment, peer support, and navigation into 'one-stop shops' are being established nationally and internationally. IYS models, however, need to be better described and evaluated to inform the replicability of this approach in other jurisdictions. Description This paper describes the implementation of an IYS in a small urban city and rural county in Ontario, Canada, including insights from key informants into barriers, facilitators, and lessons learned. Discussion This evaluation identified a number of barriers and facilitators to the implementation of the IYS model in this specific context. Implementation facilitators included youth and family engagement, network partner collaboration, leadership, governance structure, community enthusiasm and support, and collaborative funding models. Barriers to implementation included the COVID-19 pandemic and related public health restrictions, the diverse needs of youth, change management, sustainable funding, and transportation. Lessons learned By establishing a shared vision of delivering youth services across the integrated network, and engaging youth early in the process of model development, IYS have the potential to transform the service system for youth and their families. Meeting the diverse needs and challenges of youth who live in rural or small urban communities will enhance service delivery and experience for young people.
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Stewart SL, Vasudeva AS, Van Dyke JN, Poss JW. Following the Epidemic Waves: Child and Youth Mental Health Assessments in Ontario Through Multiple Pandemic Waves. Front Psychiatry 2021; 12:730915. [PMID: 34867522 PMCID: PMC8635704 DOI: 10.3389/fpsyt.2021.730915] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/18/2021] [Indexed: 02/01/2023] Open
Abstract
Emerging studies across the globe are reporting the impact of COVID-19 and its related virus containment measures, such as school closures and social distancing, on the mental health presentations and service utilization of children and youth during the early stages of lockdowns in their respective countries. However, there remains a need for studies which examine the impact of COVID-19 on children and youth's mental health needs and service utilization across multiple waves of the pandemic. The present study used data from 35,162 interRAI Child and Youth Mental Health (ChYMH) assessments across 53 participating mental health agencies in Ontario, Canada, to assess the mental health presentations and referral trends of children and youth across the first two waves of the COVID-19 pandemic in the province. Wave 1 consisted of data from March to June 2020, with Wave 2 consisting of data from September 2020 to January 2021. Data from each wave were compared to each other and to the equivalent period one year prior. While assessment volumes declined during both pandemic waves, during the second wave, child and youth assessments in low-income neighborhoods declined more than those within high-income neighborhoods. There were changes in family stressors noted in both waves. Notably, the proportion of children exposed to domestic violence and recent parental stressors increased in both waves of the pandemic, whereas there were decreases noted in the proportion of parents expressing feelings of distress, anger, or depression and reporting recent family involvement with child protection services. When comparing the two waves, while depressive symptoms and recent self-injurious attempts were more prevalent in the second wave of the pandemic when compared to the first, a decrease was noted in the prevalence of disruptive/aggressive behaviors and risk of injury to others from Wave 1 to Wave 2. These findings highlight the multifaceted impact of multiple pandemic waves on children and youth's mental health needs and underscore the need for future research into factors impacting children and youth's access to mental health agencies during this time.
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Affiliation(s)
| | | | | | - Jeffrey W. Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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