Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory CYDL Project One Symposium Health and Mental Health Service Use Leslie Twilley, PhD October 1, 2012

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory The CYDL is a research facility that links and analyzes administrative data from five child- and youth-serving ministries in Alberta The data are anonymous and population-wide The research results make unique contributions to the knowledge base, and can be used for integrated policy and program development and evaluation A key outcome of CYDL’s work is to inspire further policy-relevant research CYDL Overview Slide 2

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Data were from a single year (2008/09) 713,830 youth aged 12 to 24 years were included in the analyses Data came from 10 databases held by 5 ministries Several key indicators were available for each youth: agegender region of residencesocio-economic status mental health statuseducational achievement health service use Other indicators were database-specific Within- and cross-ministry analyses were carried out Project One Overview Slide 3

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Canadian data for youth aged 12 to 19 years showed that physician visits were more likely for Females Older adolescents Youth from single parent families Youth with lower health status or disability Youth with higher rates of distress Youth whose lifestyle practices compromised health Canadians most likely to visit emergency rooms include those who Have severe or chronic health problems Are heavy users of other medical services Have mental health conditions Are living with low income Have low levels of education Slide 4 Context – Literature Physician visits and ER visits

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Canadian data show that injuries or poisoning, respiratory diseases, digestive system diseases, and mental disorders are common reasons for hospitalizations. The leading cause of injury hospitalizations for youth under 15 was unintentional falls, with motor vehicle collisions the leading cause for youth 15 to 19 years old. Childbirth is the most common reason for females of childbearing age to be hospitalized. Slide 5 Context – Literature Hospitalizations

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Approximately one in seven Canadians aged 4 to 17 years are affected by mental health disorders that are serious enough to cause distress or impairment at home, school, and in the community. Youth with untreated mental health disorders have been found to have elevated rates of use of services such as health care, justice and corrections, special education programs, foster care, and income support. Children who are resilient to mental health problems tend to have strong learning abilities, good social skills, long-term support from one or more adults, feelings of competency, positive beliefs about their purpose in the world, and cohesive families and communities. Slide 6 Context – Literature Mental health

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Physician visits reflect fee claims made by physicians when patients visit their offices. Multiple claims by a given physician for a given patient on the same day were counted as a single visit. Reason for visit was only available for mental-health related visits. Emergency room visits refer to visits to emergency departments for assessment or treatment. Reason for visit was available. Hospitalizations refer to admissions to hospital for assessment or treatment. Type of service was available. Slide 7 Context – Indicators

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental health status was determined by the presence of a mental health-related diagnosis code in the record for a physician visit, emergency room visit, hospitalization, or in the FSCD Information System. – Mental health conditions were grouped into mood/anxiety disorders, behavioural disorders, neurodevelopmental disorders, or schizophrenia/psychoses, using an established algorithm. Slide 8 Context – Indicators

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Physician visit, emergency room visit, and hospitalization analyses included all youth 12 to 24 years old in the Project One population who were registered in the Alberta Health Care Insurance Plan at any point in 2008/09 (655,758 youth) – 2,361,770 physician visits were made by 496,787 youth (76% of youth had at least one physician visit) – 329,697 emergency room visits were made by 163,411 youth (25% of youth had at least one emergency room visit) – 29,676 hospitalizations occurred for 24,067 youth (3.7% of youth had at least one hospitalization) Context – Population Description Slide 9

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental health analyses included only youth 12 to 24 years old registered in the AHCIP for the full fiscal year 2008/09 (623,952 youth) – 11% of this population (66,792 youth) received services (physician, ER, hospitalization, or FSCD) for one or more mental health conditions in 2008/09 Context – Population Description Slide 10

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Physician Visits – Number of visits Slide 11

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Physician Visits – Educational achievement Slide 12

Slide 13 Physician Visits – Cross-ministry service usage

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Slide 14 Physician Visits – Summary Number of physician visits minimally associated with most key indicators Cross-service use patterns also show limited variation, with the exception of FSCD and Income Support clients

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Emergency Room Visits – Number of visits Slide 15

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Emergency Room Visits – Region of residence Slide 16

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Emergency Room Visits – Socio-economic status Slide 17

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Emergency Room Visits – Educational achievement Slide 18

Slide 19 Emergency Room Visits – Cross-ministry service usage

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Slide 20 Emergency Room Visits – Summary Rural youth and youth living in the lowest SES neighbourhoods made more visits to ERs than urban youth or youth living in the highest SES neighbourhoods Educational achievement was higher when ER visits were lower Youth receiving intervention services, and youth charged with offences or involved in corrections, visited emergency rooms more often Income support clients were the most likely to make multiple visits to emergency rooms

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Hospitalizations– Number of hospitalizations Slide 21

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Hospitalizations– Type of service Slide 22

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Hospitalizations– Type of service Slide 23

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Hospitalizations– Type of service and SES Slide 24

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Hospitalizations– Type of service and educational achievement Slide 25

Slide 26 Hospitalizations– Type of service and cross-service use

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Slide 27 Hospitalizations – Summary Pregnancy-related services were the most common, and were more common among youth living in the lowest SES neighbourhoods than those living in the highest SES neighbourhoods Surgeries/procedures were more common among those meeting or above educational expectations, while psychiatric and pregnancy-related services were more common among students performing below expectations Pregnancy-related services were most common for programs serving older youth High rates of psychiatric services occurred among youth receiving intervention services or in the justice/corrections systems

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental Health Type of condition Slide 28

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental Health Type of condition Slide 29

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental Health Educational achievement Slide 30

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental Health Intervention services Slide 31

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental Health Number of offence charges Slide 32

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental Health Post-secondary enrolment status Slide 33

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental Health Income support Slide 34

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Mental Health – Summary Slide 35 Strong association with educational achievement, receipt of intervention services, and being charged with an offence (or involved in corrections) Part-time post-secondary students have elevated rates of mood/anxiety disorders compared to youth not in post- secondary programs Neurodevelopmental disorders and schizophrenia/psychoses are more common in youth not in post-secondary programs than those in post-secondary programs Income support clients have elevated rates of mental health conditions

Alberta Centre for Child, Family and Community Research Child and Youth Data Laboratory Acknowledgements Slide 36