Child And Youth Mental Health Research Articles

The Translation of Recovery-Oriented Social Work Practice in Child and Youth Mental Health: A Scoping Review

Abstract Recovery-oriented practice has become taken for granted and seen as the most ideal way of working for social workers alongside other allied health practitioners in the mental health field. Recovery-oriented practice is defined as a person-centred and strengths-based approach, providing interventions, as well as facilitating environmental and multidisciplinary resources to support the individual’s independence. The applicability of recovery in a child and youth mental health (CYMH) context, however, continues to be questioned. Although some research has explored what recovery means for young people, there is scant literature that examines how recovery-oriented practice is enacted when working with children and their families. This scoping review, guided by the Arksey and O’Malley’s framework explores how recovery is conceptualised and translated into practice with children aged two to twelve years who have identified ‘mental health concerns’ and their families. Qualitative and grey literature from the last twenty years was thematically analysed. The findings highlight the primacy placed on global recovery-oriented principles and expose the superficial articulation of the application of recovery-oriented practice with children. Findings underscore the need to critically investigate how social workers enact recovery approaches when working in a clinical CYMH setting, dominated by the medical model which prioritises evidence-based intervention and marginalises children’s knowledge.

Identifying Factors Associated with Bullying Roles Using the interRAI Child and Youth Mental Health (ChYMH) Suite of Instruments.

Bullying is a common problem amongst school-aged children and youth and is a significant concern for caregivers and teachers. interRAI is an international not-for-profit network of roughly 150 researchers and clinicians from over 35 countries. The main goal of interRAI is to develop and support standardized assessment systems for vulnerable individuals to support care planning, evidence-based clinical decision making, outcome measurement and quality assurance. This study aimed to examine factors associated with bullying roles in a large clinical sample (n = 26,069) using interRAI Child and Youth Mental Health assessments. Findings revealed children who both bullied peers and were victims of bullying (compared to those who were solely bullies, victims, or neither) were more likely to experience interpersonal traumas including witnessing domestic violence, physical and sexual assault; increased risk of self-harm and suicide, depression; more behavioural/externalizing problems; conflict within the school and home contexts; and higher levels of financial, familial, and living instability. The potential causes and implications of these distinctions are discussed. Findings can aid professionals in tailoring preventive measures that could more effectively minimize the incidence and effect of bullying.

Accessing and re-accessing mental health walk-in clinics for children and families.

Many child and youth mental health (CYMH) agencies across Canada and in Ontario are using mental health walk-in clinics (MHWCs). (1) Explore how MHWCs are used by families (e.g. mean, mode, and median number of visits), and (2) document how often and how soon families returned for a second MHWC visit and identify correlates of time to a second MHWC visit. Administrative data from two CYMH agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared to MHWC use exclusively. About a third of children and families using MHWCs had two or more visits. Child age, guardianship, and disposition at discharge emerged as correlates of time to a second MHWC visit. MHWCs can save families' time, and both agencies' time and money by eliminating the need to complete a detailed assessment prior to treatment for cases that would go on to have a single visit within this service.

Interrupting the Cycle: Association of Parental Stress and Child/Youth Psychotropic Medication Nonadherence

Efficacy of psychotropic medication depends in large part on successful adherence to prescribed regimens. This study investigated child/youth nonadherence in relation to family dynamics and informal support. The participants were 10,225 children and youth prescribed psychotropic medication and receiving services from 50 Ontario mental health agencies, assessed with the interRAI™ Child and Youth Mental Health (ChYMH) and ChYMH-Developmental Disability (ChYMH-DD) tools. Findings suggest a cycle of parental stress and child/youth medication nonadherence possibly leading to or even perpetuated by worsening psychiatric symptoms. Informal supports do not appear to moderate this cycle. While the present data cannot speak to causes of medication nonadherence in children/youth or where the cycle begins, the results are consistent with the extant literature calling for attention to parental wellbeing to support children/youth for optimal therapeutic benefits. Understanding home dynamics related to nonadherence can assist care planning that engages the family to achieve best possible child/youth outcomes.

1.72 Psychotropic Medication Nonadherence in the Context of the Family

1.72 Psychotropic Medication Nonadherence in the Context of the Family

Following the Epidemic Waves: Child and Youth Mental Health Assessments in Ontario Through Multiple Pandemic Waves.

Emerging studies across the globe are reporting the impact of COVID-19 and its related virus containment measures, such as school closures and social distancing, on the mental health presentations and service utilization of children and youth during the early stages of lockdowns in their respective countries. However, there remains a need for studies which examine the impact of COVID-19 on children and youth's mental health needs and service utilization across multiple waves of the pandemic. The present study used data from 35,162 interRAI Child and Youth Mental Health (ChYMH) assessments across 53 participating mental health agencies in Ontario, Canada, to assess the mental health presentations and referral trends of children and youth across the first two waves of the COVID-19 pandemic in the province. Wave 1 consisted of data from March to June 2020, with Wave 2 consisting of data from September 2020 to January 2021. Data from each wave were compared to each other and to the equivalent period one year prior. While assessment volumes declined during both pandemic waves, during the second wave, child and youth assessments in low-income neighborhoods declined more than those within high-income neighborhoods. There were changes in family stressors noted in both waves. Notably, the proportion of children exposed to domestic violence and recent parental stressors increased in both waves of the pandemic, whereas there were decreases noted in the proportion of parents expressing feelings of distress, anger, or depression and reporting recent family involvement with child protection services. When comparing the two waves, while depressive symptoms and recent self-injurious attempts were more prevalent in the second wave of the pandemic when compared to the first, a decrease was noted in the prevalence of disruptive/aggressive behaviors and risk of injury to others from Wave 1 to Wave 2. These findings highlight the multifaceted impact of multiple pandemic waves on children and youth's mental health needs and underscore the need for future research into factors impacting children and youth's access to mental health agencies during this time.

Autism Spectrum Screening Checklist (ASSC): The Development of a Scale to Identify High-Risk Individuals Within the Children's Mental Health System.

Autism Spectrum Disorder (ASD) is a complex childhood onset neurodevelopmental disorder that has become the fastest growing developmental disability. Due to the increased demand for diagnostic assessments and subsequent increased wait times, standardized screening as part of regular clinical practice is needed. More specifically, there is an important need for the development of a more streamlined screening tool within an existing assessment system to identify those at greatest risk of having ASD. The current study utilized data from ~17,000 assessments obtained within the province of Ontario, based on the interRAI Child and Youth Mental Health (ChYMH) and Child and Youth Mental Health and Developmental Disability (ChYMH-DD), to develop a scale to identify children who have a higher likelihood of having autism. The scale was then tested on a trial population with data from the interRAI Early Years instrument. Further analyses examined the predictive validity of the scale. The Autism Spectrum Screening Checklist (ASSC) was found to be a good predictor of ASD with a sensitivity of 0.73 and specificity of 0.62, at the recommended cut-point of 2+. The results were consistent across several age ranges, specifically from 2 to 21 years of age. The ASSC scale provides an initial screen to help identify children and youth at heightened risk for autism within larger populations being assessed as part of routine practice. The main goal for the development and implementation of the ASSC scale is to harness the power of the existing interRAI assessment system to provide a more efficient, effective screening and referral process. This will ultimately help improve patient outcomes through needs-based care.

An Examination of Correlates of Quality of Life in Children and Youth With Mental Health Issues.

Quality of life (QoL) is significantly lower in children with mental health issues compared to those who are typically developing or have physical health problems. However, little research has examined factors associated with QoL in this particularly vulnerable population. To address this limitation, 347 clinically referred children and adolescents were assessed using the interRAI Child and Youth Mental Health (ChYMH) Assessment and Self-reported Quality of Life- Child and Youth Mental Health (QoL-ChYMH). Hierarchical multiple linear regression analyses were conducted to examine QoL at the domain-specific level. Children and adolescents who experienced heightened anhedonia and depressive symptoms reported lower social QoL (e.g., family, friends and activities; p = 0.024, 0.046, respectively). Additionally, children and youth who experienced heightened depressive symptoms reported lower QoL at the individual level (e.g., autonomy, health; p = 0.000), and level of basic needs (e.g., food, safety; p = 0.013). In contrast, no mental state indicators were associated with QoL related to services (e.g., school, treatment). Due to the paucity of research examining predictors of QoL in children and youth with mental health challenges, this study contributes to the field in assisting service providers with care planning and further providing implications for practice.

Assessing Needs and Outcomes of Children and Youth Receiving Intensive Services

ABSTRACT This study investigated whether children/youth in Ontario triaged to residential services showed a higher intensity of need than those referred to outpatient services, and whether residential treatment gains were sufficient for transition to community services. Participants included 2053 children/youth assessed at 23 diverse mental health agencies across Ontario using the interRAI™ Child and Youth Mental Health (ChYMH) instrument. Various presenting problems were examined utilizing scales including: Disruptive/Aggressive Behavior, Hyperactive/Distraction, Social Disengagement, Anxiety, and Sleep Difficulties. Analyses were conducted separately for boys and girls. Notable differences were found in the initial assessment, with residential boys scoring higher on all scales than outpatient boys, and residential girls scoring higher on the externalizing scales (Disruptive/Aggressive Behavior, Hyperactive/Distraction) than outpatient girls. Treatment gains at residential discharge included improvements in Anxiety, Social Disengagement, Hyperactive/Distraction and Sleep Difficulties for boys and girls to levels at or below the initial scores of outpatient peers. Disruptive/Aggressive Behavior is still a high need following residential services. The results highlight differences in severity of mental health presentation between children/youth receiving residential and outpatient services, and how multiple agencies in Ontario are providing services that successfully reduce the severity of mental health needs.

The mental and physical health of family mental health practitioners during COVID-19: relationships with family violence and workplace practices

ABSTRACT Objective: COVID-19 restrictions precipitated rapid work practice changes for family and mental health practitioners, including care via telehealth and secondary exposures to COVID-19 induced violence in client. This descriptive study aimed to examine stress and health among practitioners during COVID-19 restrictions. Method: Participants, recruited via professional networks, were 320 maternal and child health (MCH), child and youth mental health (CYMH) and adult mental health (AMH) practitioners from Victoria, Australia. Participants reported family violence among cases, workplace stress, and mental and physical health problems during COVID-19 restrictions, via an online survey. Results: Rising family violence incidence, including emotional abuse and serious threats against a woman (>25%), child emotional abuse/neglect, and child exposure to family violence were reported. Higher violence was reported by CYMH and AMH than MCH practitioners. We found increases in practitioner stress due to workplace practice changes and exposure to family violence. Highest stress was among CYMH and AHM practitioners. Participants reported worsening mental (63.2%) and physical (51.2%) health. Negative affect was higher among CYMH than MCH participants. Conclusion: Findings demonstrate pressure on family and mental health workforces during COVID-19. Provision of training and support to manage secondary stress from exposures to trauma and changing workplace practices is indicated. KEY POINTS What is already known about this topic: (1) Family and mental health practitioners’ mental health is below normative levels due to exposure to secondary traumatic stress exposure and associated compassion fatigue. (2) Periods of natural and community disaster elevate pressure and distress among mental health professionals and contribute to risk for workforce attrition and among client families are also associated with increased risks for intimate partner violence due to financial pressures and inadequate and confined housing. (3) Concerns about family violence during COVID-19 lockdown restrictions have arisen from publicly available reports of increases in emergency department domestic violence-related injuries and urgent applications to the Family Courts, but research data pertaining to levels of family violence during COVID-19 are scarce. What this study adds: (1) Family and mental health practitioners, especially those in child/youth and adult mental health sectors, reported increased proportions of caseloads in which incidents of family violence occurred during stage-3 COVID-19 lockdown restrictions in Victoria, Australia, contributing to exposure of practitioners to secondary trauma. (2) Practitioners reported higher workplace stress (due to changed work practices and family violence) during COVID-19 restrictions and greater stress was related to greater negative affect, sleep problems, headaches, and gastrointestinal problems. (3) Urgent attention to training and support of family and mental health workers providing care to distressed families during periods of community and natural disaster is indicated.

ATA2021ATA2021 Annual Conference & Expo(Virtual*)Tuesdays and Thursdays in June 2021(ABSTRACTS)

ATA2021ATA2021 Annual Conference & Expo(Virtual*)Tuesdays and Thursdays in June 2021(ABSTRACTS)

Psychometric Evaluation of the Depressive Severity Index (DSI) Among Children and Youth Using the interRAI Child and Youth Mental Health (ChYMH) Assessment Tool

Psychometric Evaluation of the Depressive Severity Index (DSI) Among Children and Youth Using the interRAI Child and Youth Mental Health (ChYMH) Assessment Tool

Development and psychometric validation of the interRAI ChYMH externalizing subscale

The interRAI Child and Youth Mental Health (ChYMH) is a standardized assessment instrument utilized in over 60 mental health agencies that promotes seamless transition across public healthcare sectors. The purpose of this study was to develop and assess the reliability and validity of the externalizing subscale on the interRAI Child and Youth Mental Health (ChYMH). Part one invited a panel of experts (i.e. doctoral-level clinical psychologists) to assess content validity of the items relevant to externalizing behaviors. Items that experts deemed representative of externalizing symptoms underwent unrestricted factor analyses in a sample of children/youths 4 to 18 years of age (N = 3,464) collected across 39 mental health agencies. The final externalizing subscale showed strong content representativeness, high internal consistency, and good structural validity for a two-dimensional model of reactive and proactive externalizing behavior. In part two, Bayesian correlations demonstrated that the interRAI ChYMH externalizing subscale showed strong associations with externalizing subscales, anger, and disruptive behavior measures from various assessment instruments (i.e. Beck Youth Inventories, Social Skills Improvement System, Child and Adolescent Functional Assessment Scale, Child Behavior Checklist, Brief Child and Family Phone Interview). Overall, the externalizing subscale demonstrated strong measurement properties for the assessment of behavioral disturbances.

Scale development and psychometric properties of internalizing symptoms: The interRAI Child and Youth Mental Health internalizing subscale

Internalizing difficulties in children and adolescents refer to inner-directed disordered mood and emotions. The purpose of this study was to develop and assess the reliability and validity of the internalizing subscale on the interRAI Child and Youth Mental Health (ChYMH) in assessing broadband internalizing mental health symptoms. Data were collected from clinically-referred children/youths 4 to 18 years of age between 2015 and 2016 (N = 2536). After initial items relevant to internalizing disturbances underwent expert content validation, exploratory first-order and bifactor factor analyses and multidimensional item response theory (MIRT) parameterizations were conducted to test the validity of the measurement model. The internalizing subscale demonstrated strong measurement properties for a three-factor structure (i.e., depression, anxiety, anhedonia) and MIRT analyses showed individual items had acceptable discrimination parameters across the latent continuum. A series of four competing models using confirmatory factor analyses were conducted in a separate sample of 1397 children/youth assessed in 2017 and the bifactor model showed superior fit compared to other models. Finally, concurrent validity of this measure was confirmed based on relationships with other established subscales from criterion measures. The interRAI ChYMH internalizing subscale could be used to provide useful information for triaging and prioritizing referrals for children/youths.

Coaching as a Knowledge Mobilization Strategy: Coaches' Centrality in a Provincial Research Brokering Network

Ontario’s Child and Youth Mental Health (CYMH) program is a provinciallysponsored initiative that aims to build school district capacity for developing research-informed school mental health policies. This article reports findings from a mixed-methods study that employs social network theory and analysis tools to explore the centrality of CYMH coaches within this research brokering network. Overall, CYMH coaches are central within these social networks, although the patterns of interaction differ from the program’s original design, with some coaches being more central than others. While formal CYMH professional development events appear to be the most direct approach to connecting research, policy, and practice, informal social networks provide the support necessary to make sense of research-based materials for use in local policymaking.

Locating, Appraising, and Implementing Clinical Practice Guidelines for the Treatment of Adolescent Depression

Clinical practice guidelines (CPGs) are a gold-standard information source for evidence-informed clinical decision making and for promoting optimal patient outcomes. To use CPGs, mental health clinicians need to know how to find them, how to choose which one to use, and how to contextualize the chosen CPG so it can be used in a particular setting. The objectives of this Workshop are to help participants: 1) understand the importance of CPGs for the treatment of child and adolescent mental illnesses, especially adolescent depression; 2) learn how to search for CPGs in child and youth mental health (CYMH); 3) learn how to appraise and select the best CPGs to use; 4) learn what the best guidelines for the treatment of adolescent depression suggest; and 5) learn how to navigate the implementation of adolescent depression CPGs in their settings.

Towards high-quality, useful practice guidelines for child and youth mental health disorders: protocol for a systematic review and consensus exercise

IntroductionThe quality of clinical practice guidelines (PGs) has not been evaluated in child and youth mental health (CYMH). To address this gap, we will: (1) conduct a systematic review (SR)...

The Child and Youth Mental Health Assessment (ChYMH): An examination of the psychometric properties of an integrated assessment developed for clinically referred children and youth

BackgroundThe Child and Youth Mental Health (ChYMH) assessment system was developed by interRAI (i.e., an international collective of researchers and clinicians from over thirty countries) in response to the unprecedented need for a coordinated approach to delivery of children’s mental health care. Many interRAI instruments are used across Canada and internationally, but the ChYMH represents the first assessment specifically for children and youth. In the present paper, a short overview of the development process of the ChYMH is provided, and then the psychometric properties of several embedded scales on the ChYMH are examined.MethodsParticipants included 1297 children and youth and their families who completed the ChYMH after being referred to mental health agencies within Ontario, Canada. In addition, smaller subsets of participants (N = 48–53) completed additional criterion measures, including the Social Skills Improvement System (SSIS), the Child and Adolescent Functional Assessment Scale (CAFAS), the Child Behavior Checklist (CBCL), and the Brief Child and Family Phone Interview (BCFPI).ResultsResults demonstrated that the ChYMH subscales had strong internal-consistency (Cronbach’s higher than .70), and correlated well with the criterion measures.ConclusionsFindings support the clinical utility of the ChYMH for use among clinically referred children and youth. Implications for children’s mental health assessment and practice are discussed.

What Happened? Exploring the Relation between Traumatic Stress and Provisional Mental Health Diagnoses for Children and Youth

Objective: Traumatic stress can impact behaviours and neurological functioning of children and youth, with symptoms appearing similar to behaviours associated with psychiatric diagnoses (Siegfried et al., 2016). This study sought to examine the link between provisional diagnoses and trauma in a sample of children/youth receiving mental health services. Methods: A sample of 6649 children/youth (59% males) aged 4 - 18 years (Mage = 11.99, SD = 3.57) receiving services from 45 mental health agencies in Ontario were assessed using the interRAI Child and Youth Mental Health (ChYMH) instrument (Stewart et al., 2015a). We examined the interRAI Traumatic Life Events Collaborative Action Plan (CAP; Stewart et al., 2015b) and provisional diagnoses of attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, reactive attachment disorder (RAD), mood disorders, substance-related disorders, and sleep disorders. Results: Compared to boys, girls were more likely to trigger the interRAI Traumatic Life Events CAP and to have a provisional diagnosis of anxiety, mood, and sleep disorders. Boys were more likely to have a provisional diagnosis of ADHD than girls. Multiple logistic regression analyses indicated that boys diagnosed with substance-related disorders had 1.79 higher odds of triggering the interRAI Traumatic Life Events CAP. ADHD, anxiety disorders, RAD, and mood disorders were also each significant predictors of potential traumatic stress regardless of sex. Conclusions/Implications: Findings suggest that several provisional diagnoses were significantly related to potential traumatic stress. Clinicians may find value in assessing for trauma, asking the question “What happened?” when confirming a psychiatric diagnosis in order to determine the best plan of care.

Emerging Mental Health Diagnoses and School Disruption: An Examination Among Clinically Referred Children and youth

Previous research linking school disruption with mental health problems has largely relied on assessments of academic achievement to measure school disruption. Early disruptive classroom behaviour (e.g., conflict with school staff, negative attitudes toward school), however, may precipitate poor academic performance and may stem from emerging mental health concerns, particularly among young children. To address this gap in the literature, 912 clinically referred children and youth (ages 4–18 years old) were assessed using the interRAI Child and Youth Mental Health (ChYMH) assessment utilizing a cross-sectional study design. The ChYMH assessment evaluates school disruption independently of academic achievement, and includes a comprehensive assessment of the child’s mental health functioning, needs, and preferences. A logistic regression analysis revealed that various provisional mental health diagnoses (i.e., attention-deficit/hyperactivity disorder, disruptive behaviour, mood disorders, and, to a lesser extent, anxiety) were associated with disruption in the classroom. Implications for school-based care planning are discussed.