Acute and outpatient service utilisation prior to, during, and following enrolment in community‐based mental health treatment among children and youth in Central Ontario: A proof of concept for cross‐sectoral data linkage

Abstract

Aim Given the fragmentation of mental health and addictions (MHA) services for children and youth, comprehensive data on utilisation patterns are lacking. We sought to describe MHA‐related service use across the community, acute and outpatient sectors. Methods We used linked health‐administrative data sets to identify a cohort of individuals aged <18 who received MHA treatment in a large community organisation in Ontario, Canada between 1 April 2007 and 31 March 2012. We described their socio‐demographic characteristics, examined their MHA‐related concurrent service use in acute care and outpatient physician settings (primary care providers, paediatricians and psychiatrists), and compared service utilisation prior to, during and following enrolment using Poisson regressions. Results Among 7285 children and youth receiving community MHA treatment, there were 481 concurrent MHA‐related emergency department visits, 173 hospitalisations and 12140 outpatient physician visits. The average age at enrolment was 10.5 years, and 64% of clients were enrolled for ≥3 months. MHA‐related emergency department use significantly declined from 1 year prior, compared to 1 year following receipt of community MHA treatment (112 vs. 82 visits per 1000 person‐years, P < 0.001), particularly in females, ages 10–14, those living in higher‐income neighbourhoods and urban areas, and those with anxiety disorders. MHA hospitalisations also declined (45 vs. 32, P < 0.001), while outpatient physician visits increased (1750 vs. 1874, P < 0.001). Conclusions Our study suggests that community‐based MHA treatment may be effective in diverting children and youth away from acute care and highlights the importance of data linkage as a means to better understand the complexity of cross‐sectoral MHA service use.

The relationship between outpatient service use and emergency department visits among people treated for mental and substance use disorders: analysis of population-based administrative data in British Columbia, Canada

“…Similarly, among people with SUDs having one or more outpatient psychiatrist visit was associated with both lower odds of any ED visit and a lower count of ED visits. Findings point to the importance of specialized expertise in managing more serious conditions [ 41 , 42 ] and mirror associations observed elsewhere [ 14 , 15 , 20 , 23 – 25 ].…”

The Longitudinal Youth in Transition Study (LYiTS) Cohort Profile: Exploration by Hospital- Versus Community-Based Mental Health Services

“…These findings underscore the need for further research examining factors leading to receiving care in different service types, particularly as there is evidence that demographic or socio-economic factors such as sex and income may predict service use patterns in addition to clinical factors. 21 Further, average wait times for CAMHS in Ontario are consistently over two months, with some regions stretching up to 2 years. 4 Given lengthy wait times and lack of centralized intake across CAMHS sectors, youth often seek care from multiple agencies simultaneously, 22 potentially resulting in youth receiving treatment where they can first access it, rather than where it is most clinically appropriate.…”

“…This could, alongside the similar symptom profiles, suggest that the hospital-and community-based programmes are serving youth with a similar level of acuity, or that connection to either type of service has a similar effect on adolescents' need for crisis services. Ongoing connection to community or outpatient CAMHS has been shown to be accompanied by reduced use of acute care and crisis services, 21 although there is also conflicting evidence suggesting that these programmes have minimal impact on ED visits for mental health. 39 Four-profile symptom models have been identified previously in pre-adolescents from the general population using the parent-report version of the YSR, 40 and in adolescents recruited from inpatient mental health services using the YSR.…”

“…19 While pathways into care can differ for hospital- and community-based CAMHS, 20 youth often seek community-based care and physician services concurrently. 21 This is expected given the numerous access points for mental health care 20 , 22 and a system that often lacks a common/uniform intake process. 19 Given the lack of systems coordination, it is not known if there are clinical differences between youth who end up receiving care in hospital- versus community-based CAMHS.…”

Association of mental health and behavioral disorders with health care and service utilization in children before and after diagnosis

“…The literature has not explicitly addressed the potential selection bias of the study population. Another strand of literature has focused on service utilization patterns or predictors of service utilization in children enrolled in specific community-based mental health service organizations [ 32 ] or in communities that have implemented evidence-based practices (EBPs) [ 33 ].…”