ACCESS-Mental.Health: Understanding Youth Mental Health Services in Atlantic Canada

1. ACCESS-Mental Health:Understanding how youth with mental health access services in Atlantics CanadaRick Audas, PhD

2. Atlantic Canada Children’s Effective Service Strategies (ACCES-MH)Examining Barriers and Facilitators in Child and Youth Mental Health in Atlantic CanadaResearchers: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

3. 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 behaviouralconditions. • 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.

4. 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? Patient Journeys Operations Research Analysis of Large Datasets • 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/

5. 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.

6. 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.

8. 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.

10. 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.

11. 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.

12. Questions?