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Schraeder KE, Barwick M, Cairney J, Carter J, Kurdyak P, Neufeld RWJ, Stewart SL, St Pierre J, Tobon J, Vingilis E, Zaric G, Reid GJ. Re-Accessing Mental Health Care After Age 18: A Longitudinal Cohort Study of Youth Involved with Community-based Child and Youth Mental Health Agencies in Ontario. J Can Acad Child Adolesc Psychiatry 2021; 30:12-24. [PMID: 33552169 PMCID: PMC7837527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE About 20-26% of children and youth with a mental health disorder (depending on age and respondent) report receiving services from a community-based Child and Youth Mental Health (CYMH) agency. However, because agencies have an upper age limit of 18-years old, youth requiring ongoing mental health services must "transition" to adult-oriented care. General healthcare providers (e.g., family physicians) likely provide this care. The objective of this study was to compare the likelihood of receiving physician-based mental health services after age 18 between youth who had received community-based mental health services and a matched population sample. METHOD A longitudinal matched cohort study was conducted in Ontario, Canada. A CYMH cohort that received mental health care at one of five CYMH agencies, aged 7-14 years at their first visit (N=2,822), was compared to age, sex, region-matched controls (N=8,466). RESULTS CYMH youth were twice as likely as the comparison sample to have a physician-based mental health visit (i.e., by a family physician, pediatrician, psychiatrists) after age 18; median time to first visit was 3.3 years. Having a physician mental health visit before age 18 was associated with a greater likelihood of experiencing the outcome than community-based CYMH services alone. CONCLUSION Most youth involved in community-based CYMH agencies will re-access services from physicians as adults. Youth receiving mental health services only within community agencies, and not from physicians, may be less likely to receive physician-based mental health services as adults. Collaboration between CYMH agencies and family physicians may be important for youth who require ongoing care into adulthood.
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Affiliation(s)
| | - Melanie Barwick
- The Hospital for Sick Children, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - John Cairney
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario
| | - Jeff Carter
- Department of Psychology, Western University, London, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Vanier Children's Services, London, Ontario
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Mental Health and Addictions Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario
- Center for Addiction and Mental Health, Toronto, Ontario
| | - Richard W J Neufeld
- Department of Psychology, Western University, London, Ontario
- Department of Psychiatry, Western University, London, Ontario
| | - Shannon L Stewart
- Faculty of Education, Western University, London, Ontario
- Children's Health and Therapeutics, Children's Health Research Institute, London, Ontario
| | | | - Juliana Tobon
- Department of Psychiatry and Behavioural Sciences, McMaster University, Hamilton, Ontario
| | - Evelyn Vingilis
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario
- Department of Epidemiology and Biostatistics, Western University, London, Ontario
| | - Gregory Zaric
- Department of Epidemiology and Biostatistics, Western University, London, Ontario
- Department of Management Science, Ivey School of Business, Western University, London, Ontario
| | - Graham J Reid
- Department of Psychology, Western University, London, Ontario
- Children's Health and Therapeutics, Children's Health Research Institute, London, Ontario
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario
- Department of Paediatrics, The University of Western Ontario, London, Ontario
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Schraeder KE, Reid GJ, Brown JB. An Exploratory Study of Children's Mental Health Providers' Perspectives on the Transition to Adult Care for Young Adolescents in the Canadian Context. J Pediatr Nurs 2019; 49:51-59. [PMID: 31491694 DOI: 10.1016/j.pedn.2019.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE Many youth who receive specialized children's mental health treatment might require additional treatment as young adults. Little is known about how to prepare these youth for transitions to adult care. DESIGN AND METHODS This study gained perspectives from children's mental health providers (n = 10) about the process of caring for younger adolescents (aged 12-15) with mental health problems (e.g., depression, anxiety), who might require mental health services after age 18. Providers were asked about their clients' future mental health needs and the possibility of transition to adult care. RESULTS Using Grounded Theory analysis, an over-arching theme was providers' reluctance to consider the transition process for their younger clients (<16 years old). This stemmed from uncertainty among providers about: (1) who [which youth] will need adult mental health services; (2) when this discussion would be appropriate; and (3) what adult services would be available. CONCLUSIONS AND PRACTICE IMPLICATIONS Findings indicate a lack of treatment capacity within children's mental health to routinely monitor youth as they approach the age of transfer (18 years old). In the absence of routine monitoring (post-treatment), it may be difficult to predict who will need adult care. A comprehensive evaluation of existing follow-up practices, in children's mental health and beyond, is needed to identify strategies for ensuring adolescents with recurring conditions receive optimal transition care.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, London, ON, Canada.
| | - Graham J Reid
- Department of Psychology, The University of Western Ontario, London, ON, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada.; Department of Paediatrics, The University of Western Ontario, London, ON, Canada; Children's Health Research Institute, London, ON, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; School of Social Work, King's University College, London, ON, Canada
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Schraeder KE, Brown JB, Reid GJ. Perspectives on Monitoring Youth with Ongoing Mental Health Problems in Primary Health Care: Family Physicians Are "Out of the Loop". J Behav Health Serv Res 2019; 45:219-236. [PMID: 29260379 DOI: 10.1007/s11414-017-9577-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Children's mental health (CMH) problems often recur. Following specialized mental health treatment, youth may require monitoring and follow-up. For these youth, primary health care is highly relevant, as family physicians (FPs) are the only professionals who follow patients across the lifespan. The current study gained multiple perspectives about (1) the role of FPs in caring for youth with ongoing/recurring CMH problems and (2) incorporating routine mental health monitoring into primary health care. A total of 33 interviews were conducted, including 10 youth (aged 12-15) receiving CMH care, 10 parents, 10 CMH providers, and 3 FPs. Using grounded theory methodology, a theme of FPs being "out of the loop" or not involved in their patient's CMH care emerged. Families perceived a focus on the medical model by their FPs and believed FPs lacked mental health expertise. Findings indicate a need for improved collaboration between CMH providers and FPs in caring for youth with ongoing CMH problems.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, 361 Windermere Rd, Westminister Hall, Room 234E, London, ON, N6A 3K7, Canada.
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- School of Social Work, King's University College, London, ON, Canada
| | - Graham J Reid
- Department of Psychology, The University of Western Ontario, 361 Windermere Rd, Westminister Hall, Room 234E, London, ON, N6A 3K7, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Paediatrics, The University of Western Ontario, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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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. Qual Health Res 2018; 28:548-560. [PMID: 29160158 DOI: 10.1177/1049732317739840] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Schraeder KE, Reid GJ. Who Should Transition? Defining a Target Population of Youth with Depression and Anxiety That Will Require Adult Mental Health Care. J Behav Health Serv Res 2018; 44:316-330. [PMID: 26860728 DOI: 10.1007/s11414-015-9495-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The process of transitioning youth from child to adult mental health services is poorly managed, and many adolescents disengage from services during transfer. The waxing and waning of symptoms over time means that some youth who are asymptomatic prior to transfer (15-17 years) will be at high risk for recurrence during the transition period. There are no clear, evidence-based guidelines about who should transfer to adult care. Objectives were to propose: (1) criteria to define anxious or depressed youth (16-21 years) that should transfer and (2) levels of service needed in young adulthood. Natural history of psychopathology and treatment response for depression and anxiety was reviewed. Risk factors for recurrence and persistence, such as initial severity, comorbidity, and family functioning, can help to identify youth requiring transfer. Few controlled treatment studies have examined predictors of long-term course. Recommendations for follow-up care and ongoing monitoring during young adulthood are discussed.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, 361 Windermere Rd, Westminister Hall, Room 234E, N6A 3K7, London, ON, Canada.
| | - Graham J Reid
- Departments of Psychology, Family Medicine and Paediatrics, The University of Western Ontario, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
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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. J Abnorm Child Psychol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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