November 19, 2013 Kyleigh Schraeder: Studying Access to Care and Transitions in Ontario s Child and Youth Mental Health System About Kyleigh Kyleigh completed a Bachelor of Science Honours degree in Psychology at Queens University in 2010, which included a one-year exchange at the University of Edinburgh in Scotland. She then earned a Master of Science in Clinical Psychology at Western University, working with Dr. Graham J. Reid in the area of children s mental health care in Ontario. She is What you need to know Kyleigh is a second year PhD student studying clinical psychology at Western University in London, Ontario. For her Master s degree, she explored how wait times for children s mental health services in Ontario affect whether parents will try to find care at multiple agencies. For her PhD research, she is hoping to identify the characteristics of youth with mental health problems who are most likely to need to transition to adult mental health care services. Kyleigh hopes that the evidence from her research will help support the development of new models of care that are responsive to clients needs and feasible for the system. currently in her second year of a PhD program in Clinical Psychology at Western University, again working under the supervision of Dr. Reid. Kyleigh is originally from St. Thomas, Ontario, but currently lives in London. What is Kyleigh s Research About? Mental Health Care Access for Children and Youth in Ontario Kyleigh became interested in studying the mental health care system while she was an undergraduate
Page 2 of 5 student at Queens. As a volunteer at the university s Psychology Clinic, she participated in a quality assurance committee that looked at how long people were on waitlists before they received treatment. This experience sparked her interest in studying access to mental health care in Ontario. So, for her Master s degree, she decided to study how wait times for children s mental health services in the province affect whether parents will seek help from other agencies. She used data from a study conducted by Dr. Reid and his colleagues, which included information from 15 mental health agencies across Ontario. (More information about Dr. Reid s study can be found in the article Help- Seeking for Children with Mental Health Problems: Parents Efforts and Experiences, published in the journal Administration and Policy in Mental Health in 2011.) Wait times in children s mental health are a big system issue right now. Basically, parents helpseeking process first involves recognizing the problem, then figuring out available options for treatment, then trying to access those services, says Kyleigh. But what is unique about children s mental health is that there is no single or coordinated entry point into the system. This means that families who are waitlisted at one agency can call up the next agency and try to get services. This clogs the system, drives up the cost for families, and is generally an inefficient use of health care resources. To study this issue, Kyleigh used an innovative application of a statistical technique not commonly used in mental health research, known as survival analysis. This approach allowed her to examine how wait times affected parents tendency to approach other mental health agencies. I found that almost 25% of families sought help at a new agency within one month of waiting at the initial agency they contacted, she says. The longer families had to wait for service, the more likely they were to engage in subsequent helpseeking, meaning that they looked for help even though they were on a waitlist for service somewhere else. I also found that even families who received help at that first agency after being on a waitlist continued to look for help elsewhere. She also found that families who lived in communities with 10 or more agencies that provide mental health services for children and youth were more likely to contact additional care providers when placed on a waitlist, compared to families in communities with fewer resources. In addition, she found that parents help-seeking behaviour was affected by their own history of receiving treatment in the mental health system. Specifically, parents who had received mental health treatment for themselves and/or couples counselling tended to seek help for their child from additional agencies faster than parents who did not have personal experience in the mental health care system. Kyleigh is currently writing academic papers relating to her Master s research and will be submitting them for publication in the coming months. At the same time, she is continuing to develop her PhD research plan, which focuses on
Page 3 of 5 a different aspect of mental health care in Ontario transitions from youth to adult services and new models of ongoing care in mental health. Transitions from Youth to Adult Services and New Models of Ongoing Care Kyleigh s initial interest in this topic was prompted by a report published by the Ontario Centre of Excellence for Child and Youth Mental Health. This report discussed the many barriers to transitions in mental health care in Ontario (see We ve Got Growing Up to Do). The report highlighted the need for improved transitions between child and adult systems of care in the province, and outlined transition models and recommendations for Ontario stakeholders. After reading the report and learning more about transitions from child to adult mental health care, Kyleigh decided that more information on this topic was needed. Existing research tends to focus on how the transition happens, for example, studying transition workers or transition clinics, she explains. This is very important, but we also need to look at who should transfer from children s mental health to adult care. I am trying to explore criteria for defining this target population. Kyleigh searched the academic literature and found that youth with serious mental health problems are most likely to transfer from the youth to the adult system. In contrast, youth with mood and anxiety disorders might require ongoing mental health care, but are not always transferred to the adult system. Childhood mental health problems, like anxiety and depression, often recur following periods of remission. The waxing and waning of symptoms over time means that some youth who are asymptomatic prior to transfer of care (typically 18 years in Ontario) will be at high risk for recurrence and will likely require transition services. There are no guidelines, however, to help clinicians determine who should transfer to the adult mental health system, says Kyleigh. If only youth with the most severe problems are seen as needing to transfer to the adult system, we re missing all the other youth whose problems might reappear and who might need help in the future these are the ones who are falling through the cracks, she explains. Kyleigh is hoping that, by looking at how mental health problems develop over time, she will be able to better understand which youth are most likely to need ongoing care. I ve been looking at the developmental psychopathology literature on anxiety and depression research on the natural course of these disorders for predictors of relapse and recurrence, in order to look at the characteristics of youth that would be most likely to need to transition to adult mental health care services, she says. The findings from Kyleigh s literature review have set the stage for the next steps of her doctoral research. Her work will be part of a larger project on
Page 4 of 5 perspectives of transitions and ongoing mental health care needs. For this research, Kyleigh is working with colleagues from Western University, including faculty members from the Departments of Family Medicine (Dr. Judith Brown, Dr. Jamie Wickett, Dr. Bridget Ryan), Education (Dr. Alan Leschied) and Nursing (Dr. Cheryl Forchuk), as well as colleagues from the Child and Parent Resource Institute (Dr. Shannon Stewart) and Vanier Children s Services (Dr. Jeff Carter). Four groups of individuals will be included in the study: (1) youth with ongoing mental health issues; (2) parents of children or youth with ongoing mental health issues; (3) community mental health care providers (social workers; psychologists); and (4) primary health care providers (family physicians; nurse practitioners; nurses). Kyleigh is interested in understanding the views of these different groups on when discussions about transitions to adult care should start, and about possible levels of ongoing care for youth with varying mental health needs during young adulthood. Her approach to this topic will be different than previous research. The few studies that have looked at this subject have asked youth who have already transitioned about the barriers they faced, and the youth commonly say that they wish discussions about transitioning to adult services and the actual transition process would have started sooner, she explains. Our research is going to be focused on youth with mental health problems between the ages of 12 to 16 and their families. These youth won t have transitioned yet, so it will be really interesting to get their views about the possible need for transition, to see what they think their future will be like and where they would turn for help if their problems came back in young adulthood, says Kyleigh. What Will This Research Bring to the Sector? Kyleigh hopes that her research will contribute to the development of new models of care for children and youth with mental health problems. She hopes the system will start to focus on the need for ongoing care over time. This would be different from the current mental health system model, which largely deals with acute problems when they happen. Right now, our mental health care is based on an acute-illness model youth are presenting in crisis over and over again. Maybe if we were monitoring youth on an ongoing basis we could avoid or reduce this revolving door and prevent youth from disengaging from services when they need them the most. We know mental health problems are remitting and recurring, but the system isn t set up to match this reality, says Kyleigh. What s Next for Kyleigh? In the coming years, Kyleigh will continue to conduct her PhD research while also completing clinical work as part of her training to become a psychologist. She is currently gaining clinical experience in the area of child mental health,
Page 5 of 5 working under Dr. Jeff Carter at Vanier Children s Services and Dr. Julie Eichstedt at Victoria Hospital in London. As for her long-term career goals, she s keeping her options open. She hopes to continue system-level research but is also passionate about providing evidence-based mental health care as a clinician. For the time being, she is enjoying gaining a range of experience spanning both research and clinical practice. For more information about Kyleigh s work, please contact her at kschraed@uwo.ca. Author: Andrea Flynn November 19, 2013 Project Title: Kyleigh s Master s thesis was entitled Why wait? The effects of waiting time on subsequent helpseeking among families looking for children s mental health services. Project Supervisors: Dr. Graham J. Reid (Western University Departments of Psychology, Family Medicine, and Paediatrics; Children s Health Research Institute)