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Gardner W, Nicholls SG, Reid GJ, Hutton B, Hamel C, Sikora L, Salamatmanesh M, Duncan L, Georgiades K, Gilliland J. A protocol for a scoping review of equity measurement in mental health care for children and youth. Syst Rev 2020; 9:233. [PMID: 33028412 PMCID: PMC7542722 DOI: 10.1186/s13643-020-01495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)-including, but not limited to, problems in inaccessibility and quality of services-are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices? METHODS The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity. DISCUSSION The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS. SYSTEMATIC REVIEW REGISTRATION Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/ .
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Affiliation(s)
- William Gardner
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. .,CHEO Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada.
| | | | - Graham J Reid
- Departments of Psychology, Family Medicine & Paediatrics, Children's Health Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Brian Hutton
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Candyce Hamel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Library, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Laura Duncan
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | | | - Jason Gilliland
- Departments of Geography, Paediatrics, Health Studies, Epidemiology & Biostatistics, Children's Health Research Institute, University of Western Ontario, London, Ontario, Canada
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Duncan L, Georgiades K, Birch S, Comeau J, Wang L, Boyle MH. Children's Mental Health Need and Expenditures in Ontario: Findings from the 2014 Ontario Child Health Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:275-284. [PMID: 30978141 PMCID: PMC6463359 DOI: 10.1177/0706743719830036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate the alignment between the Ontario Ministry of Children and Youth Services (MCYS) expenditures for children's mental health services and population need, and to quantify the value of adjusting for need in addition to population size in formula-based expenditure allocations. Two need definitions are used: "assessed need," as the presence of a mental disorder, and "perceived need," as the subjective perception of a mental health problem. METHODS Children's mental health need and service contact estimates (from the 2014 Ontario Child Health Study), expenditure data (from government administrative data), and population counts (from the 2011 Canadian Census) were combined to generate formula-based expenditure allocations based on 1) population size and 2) need (population size adjusted for levels of need). Allocations were compared at the service area and region level and for the 2 need definitions (assessed and perceived). RESULTS Comparisons were made for 13 of 33 MCYS service areas and all 5 regions. The percentage of MCYS expenditure reallocation needed to achieve an allocation based on assessed need was 25.5% at the service area level and 25.6% at the region level. Based on perceived need, these amounts were 19.4% and 27.2%, respectively. The value of needs-adjustment ranged from 8.0% to 22.7% of total expenditures, depending on the definition of need. CONCLUSION Making needs adjustments to population counts using population estimates of children's mental health need (assessed or perceived) provides additional value for informing and evaluating allocation decisions. This study provides much-needed and current information about the match between expenditures and children's mental health need.
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Affiliation(s)
- Laura Duncan
- Offord Centre for Child Studies & Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Katholiki Georgiades
- Offord Centre for Child Studies & Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Stephen Birch
- Department of Economics, McMaster University, Hamilton Ontario, Canada
| | - Jinette Comeau
- Department of Sociology, King’s University College at Western University, London, Ontario, Canada
- Children’s Health and Therapeutics, Children’s Health Research Institute, Western University, London, Ontario, Canada
| | - Li Wang
- Offord Centre for Child Studies & Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michael H. Boyle
- Offord Centre for Child Studies & Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - 2014 Ontario Child Health Study Team
- (in alphabetical order) Tracie O. Afifi (University of Manitoba), William R. Avison (Western University), Kathryn Bennett (McMaster University), Terry Bennett (McMaster University), Khrista Boylan (McMaster University), Michael H. Boyle (McMaster University), Michelle Butt (McMaster University), John Cairney (University of Toronto), Corine Carlisle (University of Toronto), Kristin Cleverley (Centre for Addiction and Mental Health, University of Toronto), Ian Colman (University of Ottawa), Jinette Comeau (King’s University College at Western University), Charles Cunningham (McMaster University), Scott Davies (University of Toronto), Claire de Oliveira (Centre for Addiction and Mental Health, University of Toronto), Melanie Dirks (McGill University), Eric Duku (McMaster University), Laura Duncan (McMaster University), Jim Dunn (McMaster University), Mark A. Ferro (University of Waterloo), Katholiki Georgiades (McMaster University), Stelios Georgiades (McMaster University), Andrea Gonzalez (McMaster University), Geoffrey Hall (McMaster University), Joanna Henderson (Centre for Addiction and Mental Health, University of Toronto), Magdalena Janus (McMaster University), Jennifer Jenkins (University of Toronto), Melissa Kimber (McMaster University), Ellen Lipman (McMaster University), Harriet MacMillan (McMaster University), Ian Manion (Royal’s Institute of Mental Health Research), John McLennan (University of Ottawa), Amelie Petitclerc (Northwestern University), Anne Rhodes (University of Toronto), Graham Reid (Western University), Peter Rosenbaum (McMaster University), Roberto Sassi (McMaster University), Louis Schmidt (McMaster University), Cody Shepherd (Simon Fraser University), Noam Soreni (McMaster University), Peter Szatmari (Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto), Brian Timmons (McMaster University), Juliana Tobon (McMaster University), Ryan Van Lieshout (McMaster University), Charlotte Waddell (Simon Fraser University), Li Wang (McMaster University), Christine Wekerle (McMaster University)
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Campo JV, Geist R, Kolko DJ. Integration of Pediatric Behavioral Health Services in Primary Care: Improving Access and Outcomes with Collaborative Care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:432-438. [PMID: 29673268 PMCID: PMC6099777 DOI: 10.1177/0706743717751668] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine collaborative care interventions to integrate pediatric mental health services into primary care as a means of addressing barriers to mental health service delivery, improving access to care, and improving health outcomes. METHOD Selective review of published literature addressing structural and attitudinal barriers to behavioural health service delivery and the integration of behavioural health services for pediatric mental problems and disorders into primary care settings, with a special focus on Canadian and U.S. RESULTS Integration of pediatric behavioural health services in primary care has potential to address structural and attitudinal barriers to care delivery, including shortages and the geographical misdistribution of behavioural health specialists. Integration challenges stigma by communicating that health cannot be compartmentalized into physical and mental components. Stepped collaborative care interventions have been demonstrated to be feasible and effective in improving access to behavioural health services, outcomes, and patient and family satisfaction relative to existing care models. CONCLUSION Collaborative integration of behavioural health services into primary care is a promising means of improving access to care and outcomes for children and adolescents struggling with mental problems and disorders. Dissemination to real-world practice settings will likely require changes to existing models of reimbursement and the culture of health service delivery.
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Affiliation(s)
- John V Campo
- 1 Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Rose Geist
- 2 Medical Psychiatry Alliance, Mental Health Program, Trillium Health Partners, University of Toronto, Toronto, Ontario, Canada
| | - David J Kolko
- 3 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Schraeder KE, Reid GJ. Why wait? The effect of wait-times on subsequent help-seeking among families looking for children's mental health services. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:553-65. [PMID: 25178864 DOI: 10.1007/s10802-014-9928-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Placement on a wait-list may increase families' help-seeking efforts, leading them to contact more than one children's mental health (MH) agency/professional. Two issues were examined in the current study: 1) Does time on a wait-list for families impact the time to contact a new agency for children's MH services? 2) What are the effects of predisposing (e.g., child age), need (e.g., child psychopathology), and enabling/system-level factors (e.g., parent treatment history) on the length of time parents wait before they contact a new agency for help with their child's MH problems? A total of 273 families seeking help for their child (64% boys, M = 10.7 years old, SD = 3.3) were asked about their contact with MH agencies/professionals during the previous year. Survival analyses, modeling time from initial wait-list placement to when a new agency was contacted, were conducted separately for families who did (n = 114), and those who did not (n = 159), receive help prior to contacting a new agency. Almost half of wait-listed families contacted a new agency by the end of the study period. Longer wait-time was associated with a greater likelihood of seeking help at a second agency with 25% of families contacting a new agency within the first month of being wait-listed. Parents with previous treatment experience and families living in areas with more agencies contacted a new agency sooner. Subsequent help-seeking behaviour suggests parents' intolerance for lengthy treatment delays may result in disorganized pathways to care. These findings suggest a highly fragmented service delivery system.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, 363 Windermere Rd, Room 326E, Westminister Hall, N6A 3K7, London, ON, Canada,
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Rodney AM, Hill PS. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. Int J Equity Health 2014; 13:72. [PMID: 25928840 PMCID: PMC4192297 DOI: 10.1186/s12939-014-0072-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/04/2014] [Indexed: 11/13/2022] Open
Abstract
Introduction Equity should be implicit within universal health coverage (UHC) however, emerging evidence is showing that without adequate focus on measurement of equity, vulnerable populations may continue to receive inadequate or inferior health care. This study undertakes a narrative review which aims to: (i) elucidate how equity is contextualised and measured within UHC, and (ii) describe tools, resources and lessons which will assist decision makers to plan and implement UHC programmes which ensure equity for all. Methods A narrative review of peer-reviewed literature published in English between 2005 and 2013, retrieved from PubMed via the search words, ‘universal health coverage/care’ and ‘equity/inequity’ was performed. Websites of key global health organizations were also searched for relevant grey literature. Papers were excluded if they failed to focus on equity (of access, financial risk protection or health outcomes) as well as focusing on one of the following: (i) the impact of UHC programmes, policies or interventions on equity (ii) indicators, measurement, monitoring and/or evaluation of equity within UHC, or (iii) tools or resources to assist with measurement. Results Eighteen journal articles consisting mostly of secondary analysis of country data and qualitative case studies in the form of commentaries/reviews, and 13 items of grey literature, consisting largely of reports from working groups and expert meetings focusing on defining, understanding and measuring inequity in UHC (including recent drafts of global/country monitoring frameworks) were included. Discussion The literature advocates for progressive universalism addressing monetary and non-monetary barriers to access and strengthening existing health systems. This however relies on countries being effectively able to identify and reach disadvantaged populations and estimate unmet need. Countries should assess the new WHO/WB-proposed framework for its ability to adequately track the progress of disadvantaged populations in terms of achieving equitable access, effective coverage and financial risk protection within their own settings. Conclusions Recently published resources contextualise equity as a measurable component of UHC and propose several useful indicators and frameworks. Country case-studies also provide useful lessons and recommendations for planning and implementing equitable UHC which will assist other countries to consider their own requirements for UHC monitoring and evaluation. Electronic supplementary material The online version of this article (doi:10.1186/s12939-014-0072-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna M Rodney
- School of Population Health, University of Queensland, Room 116, Level 1, Public Health Building, Herston, Brisbane, QLD, 4006, Australia.
| | - Peter S Hill
- Global Health Systems, School of Population Health, University of Queensland, Brisbane, Australia.
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Barwick M, Urajnik D, Sumner L, Cohen S, Reid G, Engel K, Moore JE. Profiles and service utilization for children accessing a mental health walk-in clinic versus usual care. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2013; 10:338-52. [PMID: 23879357 DOI: 10.1080/15433714.2012.663676] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Many children and adolescents with mental health problems do not receive the treatment they need. Unmet need raises questions about specific barriers that may prevent service use, and/or the characteristics of children and families who are less likely to receive care. Brief interventions or single-session psychotherapy delivered in a highly accessible manner are methods of addressing the problems associated with waitlists and limited access to care. In the current study the authors offer an exploratory evaluation of the West End Walk-In Counseling Centre for children and youth with psychosocial problems. Children 4 to 18 years of age who accessed the Walk-In Counseling Centre and a comparison group of clients who accessed usual care were assessed at intake, post-treatment, and 3-month follow-up on demographic characteristics, behavioral/emotional adjustment and functioning, client satisfaction, and service use. Children in the walk-in group had more severe behavioral/emotional adjustment and functioning than usual care clients at baseline. At post-treatment, walk-in clients had lower scores on Total Mental Health Problems and Internalizing Behaviors, and exhibited fewer problems across all scales at follow-up. Walk-in clients found the wait time for service more reasonable and at follow-up, felt the service addressed concerns and had higher regard for counselor availability and cultural sensitivity of the service than usual care clients. Service utilization, assessed at post-treatment and 3-month follow-up, showed that both groups were more likely to access mental health and education services rather than health or child welfare services, and were more likely to have used services in the 12 months prior to service than the 3 months following service completion. Walk-in clients had steeper rates of improvement compared to usual care clients despite equivalence in psychosocial functioning at baseline. The walk-in model may be an effective alternative to usual care, particularly for those clients only willing to wait up to 2 weeks for service.
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Affiliation(s)
- Melanie Barwick
- Research Institute and Learning Institute, The Hospital for Sick Children, Toronto, Canada.
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Carlisle CE, Mamdani M, Schachar R, To T. Predictors of psychiatric aftercare among formerly hospitalized adolescents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:666-76. [PMID: 23149282 DOI: 10.1177/070674371205701104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization. METHOD We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge. RESULTS Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare. CONCLUSIONS Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth.
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Affiliation(s)
- Corine E Carlisle
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Carlisle CE, Mamdani M, Schachar R, To T. Aftercare, emergency department visits, and readmission in adolescents. J Am Acad Child Adolesc Psychiatry 2012; 51:283-293.e4. [PMID: 22365464 DOI: 10.1016/j.jaac.2011.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 11/17/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. METHOD We conducted a population-based cohort analysis using linked health administrative databases with accrual from April 1, 2002, to March 1, 2004. The study cohort included all 15- to 19-year-old adolescents with first psychiatric admission. Adolescents with and without aftercare in the month post-discharge were matched on their propensity to receive aftercare. Our primary outcome was time to first psychiatric ED visit or readmission. Secondary outcomes were time to first psychiatric ED visit and readmission, separately. RESULTS We identified 4,472 adolescents with first-time psychiatric admission. Of these, 57% had aftercare in the month post-discharge. Propensity-score-based matching, which accounted for each individual's propensity for aftercare, produced a cohort of 3,004 adolescents. In matched analyses, relative to those with no aftercare in the month post-discharge, those with aftercare had increased likelihood of combined outcome (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.05-1.42), and readmission (HR = 1.38, 95% CI = 1.14-1.66), but not ED visits (HR = 1.14, 95% CI = 0.95-1.37). CONCLUSIONS Our results are provocative: we found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit. Over and above confounding by severity and Canadian/U.S. systems differences, our results may indicate a relative lack of psychiatric services for youth. Our results point to the need for improved data capture of pediatric mental health service use.
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Reid GJ, Cunningham CE, Tobon JI, Evans B, Stewart M, Brown JB, Lent B, Neufeld RWJ, Vingilis ER, Zaric GS, Shanley DC. Help-Seeking for Children with Mental Health Problems: Parents’ Efforts and Experiences. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 38:384-97. [DOI: 10.1007/s10488-010-0325-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Geist R. Improving access to mental health services for youth and parents. Paediatr Child Health 2004; 9:533-535. [PMID: 19680477 PMCID: PMC2724157 DOI: 10.1093/pch/9.8.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Rose Geist
- Medical Psychiatry Program, Division of Child Psychiatry, University of Toronto, Toronto, Ontario
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