Age, Sex and Relationship Strengths: Internalizing Symptom Differences in Children and Youth Within a Clinical Sample.

Background: Internalizing problems such as depression, anxiety and anhedonia are particularly problematic due to their covert nature. Due to their deleterious effects on psychological well-being, social connection and education, it is important to understand the development of internalizing problems and their unique contributors. Objectives: Examine whether internalizing symptoms vary by (i) age, and (ii) sex, and whether (iii) relationship strengths are associated with sex and internalizing symptoms. Method: Using a polynomial model with Tweedie distribution with log link, this study examined relationships for 18,701 clinically referred children and adolescents between 4 and 18 years of age assessed using the interRAI Child and Youth Mental Health assessment. Results: Internalizing symptoms reported by children and adolescents varied by age and sex. Sex differences in internalizing symptoms became prominent after about six years of age with female adolescents reporting higher levels when compared to male peers. An increase in relationship strengths corresponded with a decrease in internalizing symptoms for both sexes. However, the pattern depended on sex. In our sample, females required a greater number of relationship strengths to observe a decrease in internalizing symptoms. Conclusions: The current study illustrates a difference in internalizing symptoms between females and males with respect to age and relationship strengths. The results may have implications for prevention and intervention strategies geared towards internalizing symptoms for children and adolescents.

Contexte: Les problèmes d'internalisation comme la dépression, l'anxiété et l'anhédonie sont particulièrement problématiques en raison de leur nature cachée. À cause de leurs effets délétères sur le bien-être psychologique, la connexion sociale et l'éducation, il importe de comprendre le développement des problèmes d'internalisation et de leurs contributeurs uniques. Objectifs: Examiner si les symptômes d'internalisation varient selon (i) l'âge, et (ii) le sexe, et si (iii) les forces des relations sont associées au sexe et aux symptômes internalisants. Méthode: À l'aide d'un modèle polynomial avec distribution Tweedie et lien de connexion, la présente étude a examiné les relations pour 18 701 enfants et adolescents référés cliniquement, âgés entre 4 et 18 ans et évalués à l'aide de l'évaluation de la santé mentale des enfants et des jeunes (interRAI). Résultats: Les symptômes internalisants déclarés par les enfants et les adolescents variaient selon l'âge et le sexe. Les différences de sexe dans les symptômes internalisants sont devenues proéminentes après environ 6 ans d'âge, les adolescentes déclarant des niveaux plus élevés lorsque comparées à leurs pairs masculins. Une augmentation des forces des relations correspondait à une diminution des symptômes internalisants pour les deux sexes. Toutefois, le modèle dépendait du sexe. Dans notre échantillon, les filles avaient besoin d'un plus grand nombre de forces des relations pour observer une diminution des symptômes internalisants. Conclusions: La présente étude illustre une différence des symptômes internalisants entre les filles et les garçons relativement à l'âge et aux forces des relations. Les résultats peuvent avoir des implications pour les stratégies de prévention et d'intervention axées sur les symptômes internalisants pour les enfants et les adolescents.

Adolescent Inpatient Mental Health Admissions: An Exploration of Interpersonal Polyvictimization, Family Dysfunction, Self-Harm and Suicidal Behaviours.

The mental health system is impacted by extreme delays in the provision of care, even in the face of suicidal behaviour. The failure to address mental health issues in a timely fashion result in a dependence on acute mental health services. Improvement to the mental health care system is impacted by the paucity of information surrounding client profiles admitted to inpatient settings. Using archival data from 10,865 adolescents 12-18 years of age (Mage = 14.87, SDage = 1.77), this study aimed to examine the characteristics of adolescents admitted to psychiatric inpatient services in Ontario, Canada. Multivariate binary logistic regression revealed that adolescents reporting interpersonal polyvictimization, greater family dysfunction and higher risk of suicide and self-harm had a greater likelihood of an inpatient mental health admission. The interRAI Child and Youth Mental Health assessment can be used for care planning and early intervention to support adolescents and their families before suicide risk is imminent.

The interRAI Child and Youth Suite of Mental Health Assessment Instruments: An Integrated Approach to Mental Health Service Delivery.

Various biological, social, psychological, and environmental factors impact children and youth living with mental health problems across their lifespan. To meet the wide-ranging challenges of mental illness, service system integration is needed to improve efficiencies and reduce fragmentation. Unfortunately, the mental health system has been plagued by the lack of coordination across services. There is a general consensus that mental health service delivery must ensure a child or youth's needs are addressed in a collaborative, coordinated, and seamless manner. A key element to successful integration is the development of a comprehensive standardized screening and assessment system. Numerous assessments have been developed to assess child mental health and functioning, but they typically have a very narrow focus with limited use and utility. Not only does this reduce the ability to take a life course perspective to mental health, but this uncoordinated approach also results in redundancies in information collected, additional resources, and increased assessor burden for children, youth, and their families. The interRAI child and youth mental health assessment suite was developed in response to the need for an integrated mental health system for young persons. This suite includes screening and assessment instruments for in-patient and community settings, emergency departments, educational settings, and youth justice custodial facilities. The instruments form a mental health information system intentionally designed to work in an integrated fashion beginning in infancy, and incorporate key applications such as care planning, outcome measurement, resource allocation, and quality improvement. The design of these assessment tools and their psychometric properties are reviewed. Data is then presented using examples related to interpersonal trauma, illustrating the use and utility of the integrated suite, along with the various applications of these assessment systems.

Mental Health Service Urgency in Children's Mental Health: Factors Impacting the Need for Expedited Services.

Delayed access to mental health services for children and adolescents has been linked to an increased risk of harm and nonattendance to scheduled appointments. While studies suggest that the lack of standardized assessments for prioritizing individuals has contributed to long wait times, the inconsistent use of assessments across service sectors in Ontario continues to persist. This has contributed to a paucity of information surrounding which children and adolescents may require urgent mental health services. Using a large secondary data set, this study examined whether service sector (e.g., school), and other individual client characteristics (e.g., age, sex, legal guardianship, interpersonal and school conflict) predicted greater mental health service urgency in 61,448 children and adolescents assessed using the interRAI Child and Youth Mental Health Screener. Binary logistic regression revealed that all predictors, except for sector, showed a significant effect on service urgency. Findings are instrumental in prioritization, reducing the likelihood that children with acute needs remain on waitlists.

A cross-sectional examination of service complexity in youths with co-occurring autism spectrum disorder and psychiatric or medical diagnoses across service sectors.

Introduction: Autism spectrum disorder (ASD) is a heterogeneous, life-long, and complex condition. Youth diagnosed with ASD require several supports addressing core symptoms associated with the disorder, but also those resulting from co-occurring mental and physical health conditions. As a result, their care is overseen by numerous professionals spanning various service sectors, but communication between sectors is hindered due to the absence of a standardized assessment system to identify and triage youth to services. A paucity of information surrounding this population's service use lingers and a siloed delivery system persists. Methods: Using archival data collected from 1,020 youth between 12 and 18 years of age, this study explored service complexity among autistic youth with and without psychiatric and medical co-occurring conditions in Ontario, Canada. In doing so, a negative binomial regression was utilized to investigate which predisposing, enabling, and need variables were associated with service complexity. Results: Results revealed that experiencing financial difficulties was not associated with service complexity. However, age, sex, caregiver distress, comorbidity, intellectual disability, and evaluated health status were significant predictors. More specifically, female youth and youth with distressed caregivers had greater mental health service complexity scores. Additionally, youth diagnosed with two or more conditions in addition to ASD who required longer durations of programming, controlling for other predictors, had greater mental health service complexity scores. Yet, youth with an intellectual disability had lower service complexity scores. Discussion: Clinical implications of this study are discussed to inform future investments into mental health efforts for autistic youth.

Interpersonal polyvictimization: Addressing the care planning needs of traumatized children and youth.

BACKGROUND: Exposure to maltreatment has a detrimental impact on both physical and mental health. However, research on the relationship between polyvictimization and care planning needs is scarce. OBJECTIVES: This study investigated the associations between interpersonal polyvictimization and care planning needs for children and youth, controlling for sex and age differences. PARTICIPANTS AND SETTINGS: The sample included 18,701 children and youth (Mage = 12.33, SDage = 3.53) between 4 and 18 years. Participants were recruited from over 58 mental health agencies, facilities, and schools in Ontario, Canada between November 2012 and February 2020. METHODS: Multivariate binary logistic regression was used to investigate polyvictimization, sex and age groups, as predictors on care planning outcomes. Significant interaction effects were further examined using simple effects analyses. RESULTS: Children and youth experiencing polyvictimization, compared to those who did not, were more likely to report attachment difficulties, lack of informal support, interpersonal conflict, substance use and harm to self or others. In addition, the relationship between polyvictimization and attachment and interpersonal conflict care planning was moderated by sex. CONCLUSIONS: Findings emphasize the importance of focusing on interpersonal polyvictimization and sex differences when developing treatment plans for a variety of care planning needs. Mental health practitioners could utilize the study findings to guide their clinical practices and ensure effective services are provided to those seeking mental health care.

Exposure to childhood interpersonal trauma and mental health service urgency.

BACKGROUND: Children and youth with a history of maltreatment experience different developmental, psychiatric and health problems. Ensuring there is streamlined access to services is imperative to recovery. Yet, few reports of standardized methods for directing and prioritizing risk for children seeking services exist. OBJECTIVE: The current study aims to address this gap and explore how mental health personnel triage highly vulnerable cases. Specifically, the goal of the current study is to examine whether experiencing childhood interpersonal trauma predicts service urgency. PARTICIPANTS AND SETTING: Participants were 19,645 children and youth, ages 4-18 years (M = 11.1 SD = 3.4) who completed the interRAI Child and Youth Mental Health Screener (ChYMH-S) at various community-based and residential children's mental health facilities across Ontario. METHODS: Retrospective data collected from the ChYMH-S was used to explore differences in maltreatment history, gender, and legal guardianship and their impact on service prioritization. RESULTS: Children and youth who were exposed to some form of interpersonal trauma were more likely to have mental health issues requiring urgent follow-up service compared to those who were not exposed. Findings also suggested that gender and legal guardianship impact service urgency. CONCLUSIONS: Children and youth who have experienced maltreatment are significantly more likely to score high on mental health service urgency than those who did not. This provides valuable insight that can support the development of appropriate system-level changes to policy and practice when servicing children and youth with mental health needs in Canada.