Exploring Patterns of Service Utilization Within Children’s Mental Health Agencies

• Published in: Journal of child and family studies 2021-02, Vol.30 (2), p.556-574
• Main Authors: Reid, Graham J., Stewart, Shannon L., Barwick, Melanie, Cunningham, Charles, Carter, Jeffrey, Evans, Barrie, Leschied, Alan, Neufeld, Richard W. J., St. Pierre, Jeff, Tobon, Juliana, Vingilis, Evelyn, Zaric, Gregory
• Format: Article
• Language: English
• Subjects: Analysis; Behavioral Science and Psychology; Chart reviews; Child & adolescent mental health; Child and School Psychology; Child welfare; Children; Clinical outcomes; Demography; Dropping out; Health problems; Life experiences; Medical care; Mental disorders; Mental health; Mental health care; Mental Health Programs; Mental health services; Natural history; Original Paper; Peer Relationship; Peer relationships; Psychological aspects; Psychology; Psychopathology; Social Sciences; Sociology; Utilization; Youth
• ISSN: 1062-1024; 1573-2843
• DOI: 10.1007/s10826-020-01859-2

The natural history of psychopathology indicates that many children will re-experience mental health problems. However, little is known about service use over extended time periods. We explored service use of a 5-year time period, and expected to find that some children received mental health services for many months, and some received services in episodes. Administrative visit data from 6 child and youth mental health service agencies and over 7000 children, 4 to 11 years old at their first visit in 2000–2003, were analyzed. Episodes of care were coded based on having a minimum of three visits with 180-day free period between episodes. Chart reviews were conducted for a stratified random sample of 319 cases to obtain clinical and demographic sample characteristics not available in the administrative data. Five patterns of service use were identified in 5 years of visit data using latent class cluster analyses. Close to a third of children were involved for longer than a year, and 19% received two or more episodes of care within the 5-year study period. Children who had patterns of service use with long durations of involvement tended to have a higher percentage of cases with child welfare involvement, and children had fewer strengths in terms of relationships with peers and adults, and abilities to manage negative life experiences. Best methods of caring for children with ongoing or episodic problems need to be developed, and we need to improve methods for identifying those children who might benefit from alternative models of care. Highlights Up to a third of children and youth with mental health problems may require care lasting more than a year and/or repeated episodes of care. Matching children to a level of service early in care might result in better engagement, lower dropout, and perhaps better outcomes. Ways to identify children/families at intake who may need ongoing care are needed. How to best care for children who may need episodic care over time needs to be determined.