Mental Health Complexity Among Children and Youth: Current Conceptualizations and Future Directions
Publication: Canadian Journal of Community Mental Health
26 September 2023
Abstract
There is growing evidence that a number of children and youth experience persistent mental health symptoms and repeated service use over time. Collectively, these children and youth are deemed to have “complex mental health needs” and they are the most difficult cases encountered by providers. However, there has been significant confusion surrounding the terminology used to refer to this group and these cases are often defined by their outcomes, impeding identification efforts. This article provides a commentary on current conceptualizations and discusses ways to advance our conceptual understanding of complexity to improve outcomes.
Résumé
Il y a une évidence croissante que nombre d’enfants et de jeunes font l’expérience de symptômes de santé mentale persistants qui occasionnent un surplus d’interventions à répétition. En général, ces enfants et ces jeunes ont des besoins complexes en matière de santé mentale et ce sont les cas les plus difficiles que rencontrent les professionnels. Cependant, il y a une confusion significative quant à la désignation de ce groupe et ces cas ne sont souvent définis que par les résultats, ce qui rend difficile l’identification des efforts effectués pour améliorer la situation. Cet article constitue un commentaire sur les conceptualisations en cours et se penche sur les possibilités d’enrichir notre compréhension conceptuelle de la complexité d’améliorer les résultats.
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References
American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders, 5th edition. Arlington, VA: American Psychiatric Association.
Baiden P., den Dunnen W., and Stewart S. L. 2013 Discharge of adolescents with mental health problems against medical advice: Findings from adult mental health inpatient facilities across Ontario, Canada Psychiatry Research 210 3 1161 -1167 https://doi.org/10.1016/j.psychres.2013.09.024
Barrett B., Mosweu I., Jones C. R., Charman T., Baird G., Simonoff E., Pickles A., Happé F., and Byford S. 2015 Comparing service use and costs among adolescents with autism spectrum disorders, special needs and typical development Autism 19 5 562 -569 https://doi.org/10.1177/1362361314536626
Billawala A. S., Hamza C. A., and Stewart S. L. 2018 Risk factors for complex special needs among male children seeking mental health services Journal on Developmental Disabilities 23 2 17 -26
Blader J. C. 2004 Symptom, family, and service predictors of children’s psychiatric rehospitalization within one year of discharge Journal of the American Academy of Child & Adolescent Psychiatry 43 4 440 -451 https://doi.org/10.1097/00004583-200404000-00010
Bobier C. and Warwick M. 2005 Factors associated with readmission to adolescent psychiatric care Australian & New Zealand Journal of Psychiatry 39 7 600 -606 https://doi.org/10.1080/j.1440-1614.2005.01632.x
Boulter E. and Rickwood D. 2013 Parents’ experience of seeking help for children with mental health problems Advances in Mental Health 11 2 131 -142 https://doi.org/10.5172/jamh.2013.11.2.131
Brannan A. M., Heflinger C. A., and Foster E. M. 2003 The role of caregiver strain and other family variables in determining children’s use of mental health services Journal of Emotional and Behavioral Disorders 11 2 77 -91 https://doi.org/10.1177/106342660301100202
Chang G., Weiss A. P., Orav E. J., and Rauch S. L. 2014 Predictors of frequent emergency department use among patients with psychiatric illness General Hospital Psychiatry 36 6 716 -720 https://doi.org/10.1016/j.genhosppsych.2014.09.010
Children’s Mental Health Ontario (CMHO). (2020). Kids can’t wait: 2020 report on wait lists and wait times for child and youth mental health care in Ontario. https://cmho.org/wp-content/uploads/CMHO-Report-WaitTimes-2020.pdf
Children’s Mental Health Ontario (CMHO). (2019, May). 2019 Update on CIHI’s hospitalization utilization data and CMHO’s costing data. https://cmho.org/wpcontent/uploads/FINAL_CMHO_CIHIreport_2019_DRAFT4.pdf
Chiu M., Gatov E., Fung K., Kurdyak P., and Guttmann A. 2020 Deconstructing the rise in mental health-related ED visits among children and youth in Ontario, Canada: Study examines the rise in mental health-related emergency department visits among children and youth in Ontario Health Affairs 39 10 1728 -1736 https://doi.org/10.1377/hlthaff.2020.00232
Clark A. F., O’Malley A., Woodham A., Barrett B., and Byford S. 2005 Children with complex mental health problems: Needs, costs and predictors over one year Child and Adolescent Mental Health 10 4 170 -178 https://doi.org/10.1111/j.1475-3588.2005.00349.x
Cloutier P., Thibedeau N., Barrowman N., Gray C., Kennedy A., Leon S. L., Polihronis M. A., and Cappelli M. 2017 Predictors of repeated visits to a pediatric emergency department crisis intervention program Canadian Journal of Emergency Medicine 19 2 122 -130 https://doi.org/10.1017/cem.2016.357
Cosgrave E. M., Yung A. R., Killackey E. J., Buckby J. A., Godfrey K. A., Stanford C. A., and McGorry P. D. 2008 Met and unmet need in youth mental health Journal of Mental Health 17 6 618 -628 https://doi.org/10.1080/09638230701506267
Cuthbert R., Pierre J. S., Stewart S. L., Cook S., Johnson A. M., and Leschied A. W. 2011 Symptom persistence in seriously emotionally disordered children: Findings of a two-year follow-up after residential treatment Child Youth Care Forum 40 267 -280 https://doi.org/10.1007/s10566-010-9137-z
De Haan A. M., Boon A. E., de Jong J. T., Hoeve M., and Vermeiren R. R. 2013 A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care Clinical Psychology Review 33 5 698 -711 https://doi.org/10.1016/j.cpr.2013.04.005
Duncan L., Boyle M. H., Abelson J., and Waddell C. 2018 Measuring children’s mental health in Ontario: Policy issues and prospects for change Journal of the Canadian Academy of Child and Adolescent Psychiatry 27 2 88 -98
Epstein, M. H., Kutash, K., & Duchnowski, A. (2004). Outcomes for children and youth with emotional disorders and their families: Programs and evaluation best practices (2nd ed.). Austin, TX: PRO-ED.
Francis S. E., Ebesutani C., and Chorpita B. F. 2012 Differences in levels of functional impairment and rates of serious emotional disturbance between youth with internalizing and externalizing disorders when using the CAFAS or GAF to assess functional impairment Journal of Emotional and Behavioral Disorders 20 4 226 -240 https://doi.org/10.1177/1063426610387607
Gallant C. and Good D. 2022a Examining the role of neuropsychology in community-based pediatric mental health care Applied Neuropsychology: Child 1 -18 https://doi.org/10.1080/21622965.2022.2038169
Gallant C. and Good D. 2022b Predictors of mental health service use among children and adolescents with and without neurodevelopmental disorders Journal of Mental Health Research in Intellectual Disabilities 1 -20 https://doi.org/10.1080/19315864.2022.2105996
Gandhi S., Chiu M., Lam K., Cairney J. C., Guttmann A., and Kurdyak P. 2016 Mental health service use among children and youth in Ontario: Population-based trends over time The Canadian Journal of Psychiatry 61 2 119 -124 https://doi.org/10.1177/0706743715621254
Government of Ontario. (2015). Working with children and youth with complex mental health needs: An integrated training project. http://www.complexneeds.ca/about-the-project/
Hodges K. and Wong M. M. 1996 Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale Journal of Child and Family Studies 5 4 445 -467
Kazdin A. E., Siegel T., and Bass D. 1990 Drawing upon clinical practice to inform research on child and adolescent psychotherapy Professional Psychology: Research and Practice 21 189 -198
Kazdin A. E. and Whitley M. K. 2006 Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior Journal of Consulting and Clinical Psychology 74 3 455 -467 https://doi.org/10.1037/0022-006X.74.3.455
Kessler R. C., Avenevoli S., Costello J., Green J. G., Gruber M. J., McLaughlin K. A., Petukhova M., Sampson N. A., Zaslavsky A. M., and Merikangas K. R. 2012 Severity of 12-month DSM-IV disorders in the national comorbidity survey replication adolescent supplement Archives of General Psychiatry 69 4 381 -389
Kessler R. C., McLaughlin K. A., Green J. G., Gruber M. J., Sampson N. A., Zaslavsky A. M., Aguilar-Gaxiola S., Alhamzawi A. O., Alonso J., Angermeyer M., Benjet C., Bromet E., Chatterji S., de Girolamo G., Demyttenaere K., Fayyad J., Florescu S., Gal G., Gureje O., and Williams D. R. 2010 Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys The British Journal of Psychiatry 197 5 378 -385 https://doi.org/10.1192/bjp.bp.110.080499
Lapshina N. and Stewart S. L. 2019 Examining service complexity in children with intellectual disability and mental health problems who receive inpatient or outpatient services Journal of Intellectual & Developmental Disability 44 4 464 -473 https://doi.org/10.3109/13668250.2018.1440878
Lee R. S., Hermens D. F., Redoblado-Hodge M. A., Naismith S. L., Porter M. A., Kaur M., White D., Scott E. M., and Hickie I. B. 2013 Neuropsychological and socio-occupational functioning in young psychiatric outpatients: A longitudinal investigation PLoS One 8 3 e58176 https://doi.org/10.1371/journal.pone.0058176
Leon S. L., Cappelli M., Ali S., Craig W., Curran J., Gokiert R., Klassen T., Osmond M., Scott S. D., and Newton A. S. for Pediatric Emergency Research Canada 2013 The current state of mental health services in Canada’s paediatric emergency departments Paediatrics & Child Health 18 2 81 -85 https://doi.org/10.1093/pch/18.2.81
Leung B. M., Wandler C., Pringsheim T., and Santana M. J. 2022 Working with parents of children with complex mental health issues to improve care: A qualitative inquiry Journal of Child Health Care 26 4 548 -567 https://doi.org/10.1177/13674935211028694
Mapelli E., Black T., and Doan Q. 2015 Trends in pediatric emergency department utilization for mental health-related visits The Journal of Pediatrics 167 4 905 -910 https://doi.org/10.1016/j.jpeds.2015.07.004
Mark T. L. and Buck J. A. 2006 Characteristics of US youths with serious emotional disturbance: Data from the National Health Interview Survey Psychiatric Services 57 11 1573 -1578
Marsh D. T. 2004 Serious emotional disturbance in children and adolescents: Opportunities and challenges for psychologists Professional Psychology: Research and Practice 35 5 443
Marshall C., Semovski V., and Stewart S. L. 2020 Exposure to childhood interpersonal trauma and mental health service urgency Child Abuse & Neglect 106 104464 https://doi.org/10.1016/j.chiabu.2020.104464
McMorris C. A., Weiss J. A., Cappelletti G., and Lunsky Y. 2013 Family and staff perspectives on service: Use for individuals with intellectual disabilities in crisis Journal of Mental Health Research in Intellectual Disabilities 6 1 14 -28 https://doi.org/10.1080/19315864.2011.606393
Mental Health Commission of Canada (MHCC). (2015, May). The mental health strategy for Canada: A youth perspective. https://www.mentalhealthcommission.ca/sites/default/files/2016-07/Youth_Strategy_Eng_2016.pdf
Merikangas K. R., He J. P., Brody D., Fisher P. W., Bourdon K., and Koretz D. S. 2010 Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES Pediatrics 125 1 75 -81 https://doi.org/10.1542/peds.2008-2598
Ministry of Children and Youth Services (MCYS). (2015, July). Community-based child and youth mental health program guidelines and requirements: Core services and key processes. http://www.children.gov.on.ca/htdocs/English/documents/specialneeds/mentalhealth/pgr1.pdf
Newton A. S., Ali S., Johnson D. W., Haines C., Rosychuk R. J., Keaschuk R. A., Jacobs P., Capelli M., and Klassen T. P. 2010 Who comes back? Characteristics and predictors of return to emergency department services for pediatric mental health care Academic Emergency Medicine 17 2 177 -186
Olfson M., Druss B. G., and Marcus S. C. 2015 Trends in mental health care among children and adolescents New England Journal of Medicine 372 21 2029 -2038
Reddy L. A. 2001 Serious emotional disturbance in children and adolescents: Current status and future directions Behavior Therapy 32 4 667 -691 https://doi.org/10.1016/S0005-7894(01)80015-0
Reid G. J. and Brown J. B. 2008 Money, case complexity, and wait lists: Perspectives on problems and solutions at children’s mental health centers in Ontario The Journal of Behavioral Health Services & Research 35 3 334 -346 https://doi.org/10.1007/s11414-008-9115-5
Reid G. J., Stewart S. L., Barwick M., Cunningham C., Carter J., Evans B., Leschied A., Neufeld R. W. J., St. Pierre J., Tobon J., Vingilis E., and Zaric G. 2020 Exploring patterns of service utilization within children’s mental health agencies Journal of Child and Family Studies 1 -19 https://doi.org/10.1007/s10826-020-01859-2
Reid G. J., Brown J. B., and Mowat S. 2021 Caring for children and youth with ongoing mental health problems: Perspectives of family physicians, nurse practitioners, social workers, and psychologists in primary health care Canadian Journal of Community Mental Health 39 3 51 -73 https://doi.org/10.7870/cjcmh-2020-024
Ringeisen H., Stambaugh L., Bose J., Casanueva C., Hedden S., Avenevoli S., Blau G., Canino G., Carter A., Colpe L., Copeland W. E., Fisher P. W., Kaufman J., Merikangas K., Narrow W., Stroul B., and West J. 2017 Measurement of childhood serious emotional disturbance: State of the science and issues for consideration Journal of Emotional and Behavioral Disorders 25 4 195 -210 https://doi.org/10.1177/1063426616675165
Romansky J. B., Lyons J. S., Lehner R. K., and West C. M. 2003 Factors related to psychiatric hospital readmission among children and adolescents in state custody Psychiatric Services 54 3 356 -362 https://doi.org/10.1176/appi.ps.54.3.356
Ryan S. M., Jorm A. F., Toumbourou J. W., and Lubman D. I. 2015 Parent and family factors associated with service use by young people with mental health problems: A systematic review Early Intervention in Psychiatry 9 6 433 -446 https://doi.org/10.1111/eip.12211
Saeed H., Ouellette-Kuntz H., Stuart H., and Burge P. 2003 Length of stay for psychiatric inpatient services: A comparison of admissions of people with and without developmental disabilities The Journal of Behavioral Health Services & Research 30 4 406 -417 https://doi.org/10.1007/BF02287428
Sarmiento C. and Reid G. J. 2020 Re-accessing community mental health services for children and adolescents The Journal of Behavioral Health Services & Research 47 1 21 -37 https://doi.org/10.1007/s11414-019-09668-2
Sciberras E., Lycett K., Efron D., Mensah F., Gerner B., and Hiscock H. 2014 Anxiety in children with attentiondeficit/hyperactivity disorder Pediatrics 133 5 801 -808 https://doi.org/10.1542/peds.2013-3686
Shaffer D., Fisher P., Lucas C. P., Dulcan M. K., and Schwab-Stone M. E. 2000 NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses Journal of the American Academy of Child & Adolescent Psychiatry 39 1 28 -38 https://doi.org/10.1097/00004583-200001000-00014
Shaffer D., Gould M. S., Brasic J., Ambrosini P., Fisher P., Bird H., and Aluwahlia S. 1983 A Children’s Global Assessment Scale (CGAS) Archives of General Psychiatry 40 11 1228 -1231
Stalker, K., Carpenter, J., Phillips, R., Connors, C., MacDonald, C., Eyres, J., Noyes, J., Chaplin, S., & Place, M. (2003). Care and treatment? Supporting children with complex needs in healthcare settings. (Research into Practice). Pavilion.
Stewart S. L. and Hirdes J. P. 2015 Identifying mental health symptoms in children and youth in residential and inpatient care settings Healthcare Management Forum 28 4 150 -156 https://doi.org/10.1177/0840470415581240
Stewart S. L., Falah Hassani K., Poss J., and Hirdes J. 2017 The determinants of service complexity in children with intellectual disabilities Journal of Intellectual Disability Research 61 11 1055 -1068
Stewart S. L., Kam C., and Baiden P. 2014 Predicting length of stay and readmission for psychiatric inpatient youth admitted to adult mental health beds in Ontario, Canada Child and Adolescent Mental Health 19 2 115 -121
Stewart S. L., Poss J. W., Thornley E., and Hirdes J. P. 2019 Resource intensity for children and youth: The development of an algorithm to identify high service users in children’s mental health Health Services Insights 12 https://doi.org/10.1177/1178632919827930
Substance Abuse and Mental Health Services Administration (SAMHSA 1993 Definition of children with a serious emotional disturbance Federal Register 58 96 29425
Sunseri P. A. 2004 Family functioning and residential treatment outcomes Residential Treatment for Children & Youth 22 1 33 -53 https://doi.org/10.1300/J007v22n01_03
Waddell C., Offord D. R., Shepherd C. A., Hua J. M., and McEwan K. 2002 Child psychiatric epidemiology and Canadian public policy-making: The state of the science and the art of the possible The Canadian Journal of Psychiatry 47 9 825 -832 https://doi.org/10.1177/070674370204700903
Williams M. E., Latta J., and Conversano P. 2008 Eliminating the wait for mental health services The Journal of Behavioral Health Services & Research 35 1 107 -114 https://doi.org/10.1007/s11414-007-9091-1
Williams N. J., Scott L., and Aarons G. A. 2018 Prevalence of serious emotional disturbance among US children: A meta-analysis Psychiatric Services 69 1 32 -40 https://doi.org/10.1176/appi.ps.201700145
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Canadian Journal of Community Mental Health
Volume 42 • Number 3 • November 2023
Pages: 1 - 12
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Version of record online: 26 September 2023
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Caitlyn Gallant and Dawn Good. 2023. Mental Health Complexity Among Children and Youth: Current Conceptualizations and Future Directions. Canadian Journal of Community Mental Health.
42(3): 1-12. https://doi.org/10.7870/cjcmh-2023-018
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