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Exploring Patterns of Service Utilization Within Children’s Mental Health Agencies

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Abstract

The natural history of psychopathology indicates that many children will re-experience mental health problems. However, little is known about service use over extended time periods. We explored service use of a 5-year time period, and expected to find that some children received mental health services for many months, and some received services in episodes. Administrative visit data from 6 child and youth mental health service agencies and over 7000 children, 4 to 11 years old at their first visit in 2000–2003, were analyzed. Episodes of care were coded based on having a minimum of three visits with 180-day free period between episodes. Chart reviews were conducted for a stratified random sample of 319 cases to obtain clinical and demographic sample characteristics not available in the administrative data. Five patterns of service use were identified in 5 years of visit data using latent class cluster analyses. Close to a third of children were involved for longer than a year, and 19% received two or more episodes of care within the 5-year study period. Children who had patterns of service use with long durations of involvement tended to have a higher percentage of cases with child welfare involvement, and children had fewer strengths in terms of relationships with peers and adults, and abilities to manage negative life experiences. Best methods of caring for children with ongoing or episodic problems need to be developed, and we need to improve methods for identifying those children who might benefit from alternative models of care.

Highlights

  • Up to a third of children and youth with mental health problems may require care lasting more than a year and/or repeated episodes of care.

  • Matching children to a level of service early in care might result in better engagement, lower dropout, and perhaps better outcomes.

  • Ways to identify children/families at intake who may need ongoing care are needed.

  • How to best care for children who may need episodic care over time needs to be determined.

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Acknowledgements

The research team would like to thank the staff at each of the participating agencies for their time and energy, and the research staff who contributed to this project including Gesine Alders and Stephanie Mowat. We acknowledge the advisory board (Nadia Mazaheri, Ministry of Child and Youth Services; Sandra Cunning, Kinark Child and Family Services; Don Buchanan, McMaster Children’s Hospital; John Lyons, University of Ottawa) for providing valuable ideas related to the interpretation and implications of our results.

Funding

This project was supported by a grant from The Ontario Centre of Excellence for Child and Youth Mental Health at CHEO (#RG-665). G.J.R. was supported by the Children’s Health Foundation. G.Z. was supported by the Canada Research Chairs Program. C.C. was supported by the Jack Laidlaw Chair in Patient-Centered Health Care. M.B. was supported by the SickKids Research Institute.

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Authors and Affiliations

  1. Department of Psychology, The University of Western Ontario, London, ON, Canada

    Graham J. Reid, Jeffrey Carter, Richard W. J. Neufeld, Jeff St. Pierre & Juliana Tobon

  2. Department of Family Medicine, The University of Western Ontario, London, ON, Canada

    Graham J. Reid & Evelyn Vingilis

  3. Department of Paediatrics, The University of Western Ontario, London, ON, Canada

    Graham J. Reid

  4. Children’s Health and Therapeutics, Children’s Health Research Institute, London, ON, Canada

    Graham J. Reid & Shannon L. Stewart

  5. Faculty of Education, The University of Western Ontario, London, ON, Canada

    Shannon L. Stewart & Alan Leschied

  6. The Hospital for Sick Children, Toronto, ON, Canada

    Melanie Barwick

  7. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Melanie Barwick

  8. The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Melanie Barwick

  9. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada

    Charles Cunningham

  10. Madame Vanier Children’s Services, London, ON, Canada

    Jeffrey Carter

  11. Department of Psychiatry, University of Western Ontario, London, ON, Canada

    Jeffrey Carter

  12. Thames Valley District School Board (Retired), London, ON, Canada

    Barrie Evans

  13. Department of Psychiatry, The University of Western Ontario, London, ON, Canada

    Richard W. J. Neufeld

  14. Neuroscience Program, The University of Western Ontario, London, ON, Canada

    Richard W. J. Neufeld

  15. Department of Psychology, University of British Columbia, Okanagan, BC, Canada

    Richard W. J. Neufeld

  16. Child and Parent Resource Institute, London, ON, Canada

    Jeff St. Pierre

  17. Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada

    Juliana Tobon

  18. Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada

    Evelyn Vingilis & Gregory Zaric

  19. Department of Management Science, The University of Western Ontario, London, ON, Canada

    Gregory Zaric

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This study received ethics approval from the The University of Western Ontario Research Ethics Board and from the local ethics board for each participating CYMHS agency.

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Reid, G.J., Stewart, S.L., Barwick, M. et al. Exploring Patterns of Service Utilization Within Children’s Mental Health Agencies. J Child Fam Stud 30, 556–574 (2021). https://doi.org/10.1007/s10826-020-01859-2

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