One in five children and youth in Ontario will experience mental health challenges in their lifetimes, according to the Canadian Mental Health Association (CMA).
The CMA also notes early diagnosis and intervention are key in addressing these problems and can lead to improved achievement in school and better health outcomes in life.
But a recent report by Ontario's auditor general shows children and youth are at risk, unable to quickly and effectively access the mental health services they need because of long wait times, an absence of services within their communities and a lack of coordination, oversight and monitoring of services.
Shannon Stewart (Submitted)
Ongoing research by Western professor Shannon Stewart aims to address these challenges, with a goal to optimize the health and well-being of children, youth and their families and by measuring mental health services for their quality and care.
Stewart, a registered psychologist and professor in school and applied child psychology within the Faculty of Education, brings a breadth of experience to her work. She is an associate scientist at the Children's Health Research Institute and a fellow and board member of InterRAI - a collaborative network of researchers and practitioners from more than 35 countries committed to developing assessment-to-intervention systems for vulnerable populations.
With the support of a Canadian Institutes of Health Research project grant, Stewart's team is now developing a set of meaningful quality indicators (QIs) to measure mental health services for children and youth.
Western News sat down with Stewart to learn how outcomes of her work can help improve the delivery of evidence-based care in the children and youth mental health services sector.
Is there a common factor contributing to the challenges impeding the delivery of timely, effective mental health services for children and youth?
Shannon Stewart: One of the biggest issues is a lack of integration.
There are different ministries, agencies and organizations providing services for children with mental health issues, but there is a lack of integration resulting in duplication of services and poor communication. Everyone is utilizing a different tool to evaluate the needs of their clients, resulting in the inability to understand, fairly compare outcomes and provide a needed health information system to support improved care.
What is needed is a mandated evidence-based assessment-to-intervention system that utilizes high quality data across agencies, jurisdictions and ministries to support decision making at multiple levels.
What happens without this type of assessment system?
SS: Important information about a child, youth or family's care is not obtained, resulting in missed opportunities to properly treat the child or youth based on their individualized needs. As a result, kids are often matched with services that are available, rather than with services based on their needs, which often leads to ineffective interventions.
Additionally, this can increase wait times and demands for services resulting in inefficiencies across multiple service sectors. We need to make changes that facilitate best practices and evidence-based, client-centered care.
How can the InterRAI Child and Youth Mental Health Suite of Instruments help address these challenges and improve the system?
SS: The suite was developed in response to the need for an integrated mental health system for young persons.
Right now, Canada lacks system-wide information to make important decisions about children's mental health services. There is no system-wide data base that can help with service and system planning. The interRAI child and youth system can provide this.
It includes screening and assessment instruments for care providers across agencies and institutions: in-patient and community settings, emergency departments, educational settings and youth justice custodial facilities.
The instruments form a mental health information system intentionally designed to work in an integrated fashion beginning in infancy, incorporating key applications to assist with care planning, evaluate services, identify costs and foster improved quality. It provides multiple applications and is used worldwide.
What makes this platform unique and how can it specifically help alleviate the challenges?
SS: The assessment component is based on needs, preferences and strengths of children, youth and their families.
That's the first step in understanding what needs to happen in terms of outcomes and what is required in terms of care planning.
What makes the system unique is that it is a stepped assessment process to support screening, triaging and prioritization. The assessment gathers information about the child and youth's emotional health and behaviour, family environment, developmental needs and risk factors. Anonymized data from the assessment can then be used for service and system-wide planning.
How do you use the assessment?
SS: The assessment provides needed information to make decisions about the care of the child using best practice and the most up-to-date research in the field. That way we can tailor intervention or treatment to the specific needs of the child or youth. It's an individualized, holistic approach, giving us the ability to prioritize and triage children based on the level of urgency which could help reduce wait times.
How do you determine the best treatment plan?
SS: Algorithms built into the interRAI suite are designed to flag urgent needs, recommend care plans, track progress and support clinicians with clinical decisions.
For example, with the touch of a button, clinicians can receive information showing if the patient is at heightened risk for suicide or self-harm as well as a care planning protocol based on best practice to support care. The information is provided within the software platform as soon as the risk algorithm is triggered to assist clinicians in evidence-based decision making.
How will the QIs your team is developing help navigate and improve the system?
SS: Right now there is very little information about the quality of child mental health care in Canada. We are in the midst of developing valid, reliable QIs which are essential for benchmarking and monitoring children's mental health services to support continuous quality improvement. These QIs will help to champion best practice for agencies and identify areas for improvement to foster the delivery of optimal care to children and their families.
A common assessment system that is mandated across ministries would allow opportunities to measure care in a standardized way to improve the quality of children's mental health services, provide benchmarking for comparisons and inform policy makers about specific gaps that require attention or funding.
This approach can also foster continuity of care as many of the adult services are already utilizing this approach, thereby supporting transition planning.
People often say the root of the many challenges facing the child and youth mental health sector is rooted in a lack of funding.
SS: There will likely never be enough money, so we need to be good stewards of the funds available to treat as many children and youth as effectively as possible. The more we use scientific evidence and best practices to improve outcomes for kids, the less likely we're going to provide services that don't work.
The more we understand, with good high-quality data, how children and youth respond differently to treatments, the better we can allocate resources and services more effectively and more efficiently. This will allow us to save more money in the end to ensure we can serve more families.
What do you wish more people understood about child and youth mental healthcare?
SS: Approximately 70 per cent of mental health issues begin in adolescence. Early intervention and prevention can save extensive costs by circumventing the need for chronic care later in life.
Investing in our children is crucial. We need a proper evidence-based, data-driven assessment system based on best practice to allocate the appropriate resources for specific needs and provide the best treatment possible.
When we can intervene early to circumvent any trauma, we can prevent negative long-term sequelae. Many children seeking mental health services are at increased risk for school absenteeism, substance use and underemployment. By treating mental health issues early, the hope is we can also keep children in schools so they can graduate and meet their full potential.
We know a good education has a huge impact on their long-term ability to support their own families, to remain out of the judicial system and off social assistance. This can reduce suffering for generations to come. Too many children have been given difficult early life experiences, with high levels of trauma, poverty and marginalization. As a society, it really behooves us to support those vulnerable kids who need it most.
