Continuity of Care in Children’s Mental Health: Development of a Measure

Continuity of care, which is how a patient experiences care over time as coherent and linked, has been identified as an indicator of health system performance and is considered an ethical principle of care. Yet, no instrument exists to measure continuity of care as experienced by families receiving services through the children\u27s mental health (CMH) system. A new measure, Continuity of Care in Children’s Mental Health (C3MH), is presented. The project involved four phases: item generation, pre-testing, pilot testing, and validation. In the validation study, the 42-item C3MH was administered to 364 parents of children and youth (M =12 years; SD =3.50; 57% boys), recruited from 13 CMH agencies in Ontario. Using EQS, a CFA was conducted to determine the fit of data to the hypothesized model. A five-factor model had an excellent fit (Y-B χ2 = 514.93, p \u3c .001; NNFI = .93; CFI = .94; IFI = .94; RMSEA = .046; 90% C.I. = .039, .053). Cronbach’s alphas for the subscales ranged from .80 to .93 and test-retest reliabilities ranged from .75 to .92. The C3MH was related to: higher satisfaction with services; higher child internalizing problems; less impact of problems on the family; having a case manager, and not dropping out of treatment. The transitions scale was negatively related to parental depression, externalizing problems, total problems, child impairment, and impact of problems on the family. A youth-report version was also piloted with 57 youth and these results are presented. The C3MH is the first parent-report measure of continuity in CMH and will be useful for assessing and tracking improvements in system integration and service coordination

Predicting patterns of service utilization within children\u27s mental health agencies

Background: Some children with mental health (MH) problems have been found to receive ongoing care, either continuously or episodically. We sought to replicate patterns of MH service use over extended time periods, and test predictors of these patterns. Methods: Latent class analyses were applied to 4 years of visit data from five MH agencies and nearly 6000 children, 4-to 13-years-old at their first visit. Results: Five patterns of service use were identified, replicating previous findings. Overall, 14% of cases had two or more episodes of care and 23% were involved for more than 2 years. Most children (53%) were seen for just a few visits within a few months. Two patterns represented cases with two or more episodes of care spanning multiple years. In the two remaining patterns, children tended to have just one episode of care, but the number of sessions and length of involvement varied. Using discriminant function analyses, we were able to predict with just over 50% accuracy children\u27s pattern of service use. Severe externalizing behaviors, high impairment, and high family burden predicted service use patterns with long durations of involvement and frequent visits. Conclusions: Optimal treatment approaches for children seen for repeated episodes of care or for care lasting multiple years need to be developed. Children with the highest level of need (severe pathology, impairment, and burden) are probably best served by providing high intensity services at the start of care

Continuity of Care in Children’s Mental Health: Development of a Measure

A new measure, Continuity of Care in Children’s Mental Health (C3MH), is presented. The study involved item generation, pre-testing, pilot testing, and validation. The C3MH was administered to 364 parents recruited from 13 children’s mental health agencies in Ontario, Canada. The measure includes five scales supported by confirmatory factor analysis. Scale validity was supported through analyses of relationships with established measures of satisfaction, problem severity, and therapeutic alliance, as well as through known-group differences. The results of a pilot youth-report version (N = 57) are presented. The C3MH will be a useful tool for assessing improvements in system integration

Help-seeking for children with mental health problems: parents' efforts and experiences

Parents who contacted 1 of 15 children's mental health agencies in Ontario, Canada reported on where and why they were seeking mental health services for their 4-to 17-year-old children. Parents contacted an average of four agencies (±1.7; range = 1-14) in the previous year. Approximately one-half of parents were looking for either multiple types of treatment, or help for different problems, across agencies. The complex pattern of help-seeking evidenced in our study likely increases the burden on the mental health care system and on families, and may reduce the likelihood that families will connect with the most appropriate treatment

Continuity of Care in Children’s Mental Health: Development of a Measure

A new measure, Continuity of Care in Children’s Mental Health (C3MH), is presented. The study involved item generation, pre-testing, pilot testing, and validation. The C3MH was administered to 364 parents recruited from 13 children’s mental health agencies in Ontario, Canada. The measure includes five scales supported by confirmatory factor analysis. Scale validity was supported through analyses of relationships with established measures of satisfaction, problem severity, and therapeutic alliance, as well as through known-group differences. The results of a pilot youth-report version (N = 57) are presented. The C3MH will be a useful tool for assessing improvements in system integration