ACCESS-Mental Health: Understanding how youth with mental health access services in Atlantics Canada Rick Audas, PhD

Atlantic Canada Children’s Effective Service Strategies (ACCES-MH) Examining Barriers and Facilitators in Child and Youth Mental Health in Atlantic Canada Researchers: Dr. Rick Audas (Nominated PI) – Health Economist (MUN) (on leave) Dr. Marshall Godwin (Nominated PI) Family Medicine (MUN) (acting) Dr. Jacques Richard (PI) – Psychologist (UdeM) Dr. Scott Ronis (PI) – Psychologist (UNB) Dr. Kate Tilleczek(PI) – Canada Research Chair (Young Lives) (UPEI & SickKids) Dr. Michael Zhang (PI) – Operations Research Expert (SMU) The project will include: Interviewing over 150 individuals: children/youth/parents, service providers (medical & community) to understand child/youth journeys in mental health. Longitudinal follow-up Analysing large datasets: Using administrative databases in four provinces & Statistics Canada datasets to examine health utilization patterns antecedents and trajectories of affected youth and link to data from various government agencies Using advanced analytical techniques and computer models to make better decisions

What is the project about? Bring together an inter-sectorial and inter-disciplinary team of decision makers, clinicians, and academic researchers from across Atlantic Canada Taking a diverse approach to studying several mental health and behavioural conditions. ASD, Anxiety, Depression, Conduct Disorders and Eating Disorders. Building on anecdotal evidence that services for children with mental health conditions are lacking, are poorly coordinated and place a tremendous burden on families.

Analysis of Large Datasets Atlantic Canada Children’s Effective Service Strategies (ACCESS-MH) Examining Barriers and Facilitators in Child & Youth Mental Health in Atlantic Canada Guiding Questions What services are being accessed? What journeys are being taken through the system? What are the barriers and facilitators to access and services? Which services are effective/ineffective and why? Can the system be better integrated, coordinated, and funded? Analysis of Large Datasets Patient Journeys Operations Research Administrative databases in four provinces & Statistics Canada datasets Health utilization patterns Antecedents and trajectories of affected youth Link to data from various government agencies Interviews & visual methods to understand child/youth journeys in mental health Interviewing 240 individuals: Children/youth Parents Service providers (medical & community) Longitudinal follow-up Using advanced analytical techniques and computer models to make better decisions Simulation models to capture complex interactions within and between different programs System and queuing optimization to create efficient/effective solutions http://access-mentalhealth.ca/

Achievements to Date Completed an environmental scan of current mental health services in Atlantic Canada. Producing an Atlantic Canada map with service providers identified with “hot spots” or links to service providers Received research ethical approval from 5 universities and several health authorities Developed qualitative tools for data collection Designed and delivered training workshop Partnered with SEAK and ASI to host a symposium on Child and Youth Mental Health entitled: Investing in Child and Youth Mental Health - Mobilizing Atlantic Canadians for a Positive Future.

Achievements to Date Collaborated on a needs assessment for the Autism Society of Newfoundland and Labrador – a significant undertaking involving over 40 interviews with parents, adults with ASD, service providers, educators and policy makers; and four distinct surveys with over 500 responses Created a website to be used as a resource for youth, parents/caregivers, service providers and researchers. Website (http://access-mentalhealth.ca/) Building capacity through the training of approximately 30 graduate students, including master’s, PhD and Post docs Nearing completion of Phase I data collection with over 150 interviews completed Have built a partnership with the Atlantic Regional Training Centre for Applied Health Services Research (ARTC) to facilitate training and capacity building.

Student Thesis Projects Health Utilization Patterns of Children and Youth with Mental Health Conditions in NL An Atlantic Canadian Urban and Rural Communities Mixed Methods Comparison: An Examination of the Differences in Self-Perceived and Potential Need for Mental Health Care and Actual Mental Health Service Use Among Youth (Aged 15- 24). Results from the Canadian Community Health Survey – Mental Health. Key Factors Associated with Help- Seeking Behaviours Among Atlantic Canadian Adolescents with Depressive Symptoms Examination of factors linked to service utilization among Atlantic Canadian Youth with conduct disorders Youth and Mental Health Access to Primary Care Services in Atlantic Canada: Exploring the relationship(s) between the client/youth and their service provider Youth Mental Health Access in Atlantic Canada: A critical ethnography of youth diagnosis and treatment with a focus on interpreting psychological disorders within a specific historic and cultural context Examining the Transitioning of Pediatric Patients with Autism into Adult Care Access and Barriers to Services for Youth with Anxiety and Depression Early Diagnosis and Treatment for Autism Spectrum Disorder in Elementary aged children Barriers and facilitators of access to mental healthcare among incarcerated youths with substance use disorders in New Brunswick Overview of Emergency Health Services for Children and Youth with Mental Health Conditions Socio-economic Impact of Children’s Mental Health Conditions on Families in Atlantic Families Journeys: Exploring Family Perspectives on Access to Mental Health Services for Children and Youth in New Brunswick Comparative access to youth mental health services across francophone and annglophone communities in Atlantic Canada Modeling the HR needs for youth with mental health conditions.

Work to Come We are just starting to scratch the surface of what is possible Working to try to link individuals across datasets (which is starting to happen in NB, hopefully will follow elsewhere) Longitudinal analysis of qualitative data. Focus on ‘solutions’ from the OR team – lead by Michael Zhang. Key that these solutions will be data driven, but will also have input from qualitative approaches Trying to use multiple lenses to study this problem from a variety of perspectives.

Outcomes and Expected Impact of Research Program Short Term Outcomes Medium Term Long Term Increase Awareness Knowledge Attitudes Skills Change Culture By improving clinical practice attitudes towards children and youth mental health Change Practice Implementing best practices in youth and mental health treatment Increase Dialogue between all sectors At the organizational level: Improve accessibility to treatment and care Reduce wait times Increase cost effective programs At the patient level: Improve mental health for children and youth in Atlantic Canada Provide platform for patient voice

Main Messages Children with mental health conditions have a tough time of it The way services are delivered varies tremendously across the provinces, and quite often within each provinces There tends to be a lack of services available outside of larger centres Parents and caregivers play a crucial role in advocating, arranging and coordinating care Few health service, or other providers/educators take on the coordination role Often this places an undue amount of stress on families Can result in both physiological and economic hardship Concern that care is not being efficiently provided.

Future Work Eager to potentially carry on through the life course and seeing how these youth transition to adulthood Especially interested in barriers to employment – identified as a key area in the ASNL Needs Assessment Interested in examining the longer-term impact on families Extending to other mental health conditions and other forms of disability.

Questions?