Perspectives on Monitoring Youth with Ongoing Mental Health Problems in Primary Health Care: Family Physicians Are “Out of the Loop”
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.
We would like to thank all of the families and providers that participated in this study for their time and willingness to take part in this research.
This project was supported by a grant from the Lawson Health Research Institute. K.E. Schraeder was supported by a Transdisciplinary Understanding and Training on Research–Primary Health Care (TUTOR-PHC) fellowship from the Canadian Institutes of Health Research and by the Children’s Health and Research Institute. G.J Reid was supported by the Children’s Health Foundation.
Compliance with Ethical Standards
The study was approved by the Research Ethics Board at both CMH agencies and at The University of Western Ontario.
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 9.Davis M, Koroloff N. The great divide: how mental health policy fails young adults. Research on Community-Based Mental Health Services for Children and Adolescents. 2010;14(1):53–74.Google Scholar
- 12.Weisz J, Kazdin AE. Evidence-Based Psychotherapies for Children and Adolescents. New York, NY: Guilford Publications, 2003.Google Scholar
- 13.Kendall PC, Hedtke K. Cognitive-Behavioural Therapy for Anxious Children: Therapist Manual. 3rd ed. Ardmore, PA: Workbook, 2006.Google Scholar
- 14.Clarke GN, DeBar LL, Lewinsohn PM. Cognitive-behavioral group treatment for adolescent depression. In: Kazdin AE, Weisz JR (Eds). Evidence-Based Psychotherapies for Children and Adolescents. New York: Guilford Press, 2003, pp. 120–134.Google Scholar
- 16.Davidson S, Cappelli M, Vloet MA. We’ve Got Growing up to Do: Transitioning Youth from Child and Adolescent Mental Health Services to Adult Mental Health Services. Report by Ontario Centre of Excellence for Child and Youth Mental Health: Ottawa, ON; 2011, 1–51.Google Scholar
- 18.Cappelli M, Davidson S, Racek J, et al. Transitioning youth into adult mental health and addiction services: an outcomes evaluation of the Youth Transition Project. Journal of Behavioural Health Services & Research. 2014;(C):597–610.Google Scholar
- 20.Singh SP, Anderson B, Liabo K, et al. Supporting young people in their transition to adults’ services: summary of NICE guidance. BMJ Open. 2016;335(May):1–3.Google Scholar
- 23.Leitch KK. Reaching for the Top: A Report by the Advisor on Healthy Children and Youth. Ottawa, ON: Health Canada; 2007.Google Scholar
- 24.Kutcher S. Facing the challenge of care for child and youth mental health in Canada: A critical commentary, five suggestions for change and a call to action. Healthcare Quarterly. 2011;14(April 2011):15–21.Google Scholar
- 26.Kates N, Mazowita G, Lemire F, et al. The evolution of collaborative mental health care in Canada: a shared vision for the future. Canadian Journal of Psychiatry. 2011;56(5):1–10.Google Scholar
- 27.Gilbert A, Maheux B, Frappier JY, et al. Adolescent care - Part 1: Are family physicians caring for adolescents’ mental health? Canadian Family Physician. 2006;52(11).Google Scholar
- 39.Reid GJ, Brown J, Hahn C. Caring for Children and Youth with Ongoing Mental Health Problems: Perspectives of Providers in Primary Health Care. Poster presented at the Trillium Primary Health Care Research Day, Toronto, ON, June 19, 2013.Google Scholar
- 41.Charmaz K. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. Thousand Oaks, CA: Sage, 2006.Google Scholar
- 42.Charmaz K. Constructing Grounded Theory, 2nd Edition. London, UK: Sage, 2014.Google Scholar
- 46.Carroll W. Unpacking and contextualizing critical research strategies. In: Critical Strategies for Social Research. Toronto: Canadian Scholars’ Press, 2004.Google Scholar
- 47.NVivo. Cambridge, MA, QSR International Inc. 2012:Version 9.Google Scholar
- 48.Miles M, Huberman A. Qualitative Data Analysis: An Expanded Sourcebook. New York: Sage, 1994.Google Scholar
- 49.O’Brien BC, Harris IB, Beckman T, et al. Standards for reporting qualitative research: a synthesis of recommendations. Academic Medicine. 2014;89(9):1–7.Google Scholar
- 50.Guion LA, Diehl DC, Mcdonald D. Triangulation: establishing the validity of qualitative studies. University of Florida, IFAS. 2002:1–3.Google Scholar
- 52.Statistics Canada. Median total income, by family type, by census metropolitan area (all census families). 2015; Table 111–0009. Retrieved at: http://www.statcan.gc.ca/tables-tableau.
- 60.Chen L, Farwell WR, Jha AK. Primary care visit duration and quality. Health Care Reform. 2011;169(20):1866–1872.Google Scholar
- 66.Foy JM, Kelleher KJ, Laraque D. Enhancing pediatric mental health care: strategies for preparing a primary care practice. Pediatrics. 2010;125 Suppl(Supplement_3):S87-S108.Google Scholar
- 70.Larson JJ, Lynch S, Tarver LB, et al. Do parents expect pediatricians to pay attention to behavioral health? Clinical Pediatrics. 2015;1:1–6.Google Scholar
- 75.Ontario Ministry of Children and Youth Services. Moving on Mental Health: A System That Makes Sense for Children and Youth. November; 2012.Google Scholar
- 78.Steele M, Shapiro J, Davidson, B, et al. Survey comparing criteria used by rural and urban primary care physicians for referrals to child and adolescent psychiatrists and children’s mental health agencies in Ontario. Journal of Canadian Academy of Children and Adolescent Psychiatry. 2010;19(4):284–289.Google Scholar
- 81.Stewart M, Brown JB, McWhinney IR, et al. Patient-Centered Medicine: Transforming the Clinical Method, Third Edition. Oxford: Radcliffe Publishing, 2014.Google Scholar
- 83.McGorry PD, Tanti C, Stokes R, et al. headspace: Australia’s National Youth Mental Health Foundation - where young minds come first. Medical Journal of Australia. 2007;187(7):68–70.Google Scholar
- 84.Voursney D De, Huang LN. Meeting the mental health needs of children and youth through integrated care: a systems and policy perspective. Psychological Services. 2016;13(1):77–91.Google Scholar