Do anxiety and depression symptoms moderate the effect of motivational enhancement therapy as a pretreatment to dialectical behaviour therapy skills training? A follow-up analysis of a pilot randomised controlled trial for youth.

AIM: We conducted a follow-up analysis of a pilot randomised controlled trial to examine whether baseline depression and anxiety symptoms moderated the impact of a motivational enhancement therapy (MET) pretreatment to dialectical behaviour therapy skill training (DBT-ST) for EA experiencing emotion dysregulation. METHODS: All participants completed a 12-week DBT-ST group intervention and participants in the MET/DBT-ST condition also completed a 4-week group MET pretreatment. Nineteen MET/DBT-ST participants and 26 DBT-ST only participants completed the treatment as per protocol. RESULTS: Baseline anxiety and depression symptoms moderated the impact of the MET pretreatment for participants' reductions in emotion dysregulation and psychological distress, respectively, at a 3-month follow-up: participants with more severe baseline symptoms benefited more from the pretreatment. However, baseline symptoms did not moderate the effect of MET immediately after treatment. CONCLUSIONS: These results identified for whom MET is most effective as a pretreatment for DBT-ST amongst a heterogenous sample of EA in a real-world setting.

Motivational Enhancement as a Pretreatment to a Transdiagnostic Intervention for Emerging Adults with Emotion Dysregulation: A Pilot Randomized Controlled Trial.

OBJECTIVE: New approaches are needed to help the large number of emerging adults (EA) presenting with early-stage mental health problems. The goal of this pilot study was to carry out a randomized controlled trial to investigate whether motivational enhancement therapy (MET) improved the treatment effects of a 12-week psychological intervention, Dialectical Behaviour Therapy Skills Training (DBT-ST), for EA presenting in the early stages of mental health difficulties. Participants were recruited from the Youth Wellness Centre at St. Joseph's Healthcare Hamilton and McMaster University's Student Wellness Centre in Hamilton, Canada. METHODS: Seventy-five participants were randomized to receive MET followed by DBT-ST or to DBT-ST alone. We assessed psychological distress, emotion dysregulation, and depression and anxiety symptoms as outcomes. RESULTS: We found that both treatment groups had significant reductions in emotional dysregulation, psychological distress, depression, and anxiety at post-treatment and at the three-month follow-up. Participants assigned to MET pre-treatment experienced greater improvement in psychological distress at the end of treatment. CONCLUSION: This pilot study provides preliminary evidence of the potential augmentation of DBT-ST using MET in a real-world setting. Future studies should examine whether MET uniquely augments DBT-ST through the use of a comparable pre-treatment control group.

OBJECTIF: De nouvelles approches sont nécessaires pour aider le grand nombre d'adultes émergeants (AE) qui présentent des problèmes de santé mentale au stade précoce. La présente étude pilote avait pour but d'exécuter un essai randomisé contrôlé afin de rechercher si la thérapie d'amélioration motivationnelle (TAM) améliorait les effets du traitement d'une intervention psychologique de 12 semaines, soit la formation technique à la thérapie comportementale dialectique (FT-TCD), pour les AE qui présentent les premiers stades de difficultés de santé mentale. Les participants ont été recrutés au centre Youth Wellness de St. Joseph's Healthcare Hamilton et au centre Student Wellness de l'Université McMaster, à Hamilton, Canada. MÉTHODES: Soixante-quinze participants ont reçu au hasard la TAM suivie de la FT-TCD ou uniquement la FT-TCD. Nous avons évalué la détresse psychologique, la dérégulation émotionnelle, et les symptômes dépressifs et anxieux comme résultats. RÉSULTATS: Nous avons constaté que les deux groupes du traitement avaient des réductions significatives de la dérégulation émotionnelle, de la détresse psychologique, de la dépression et de l'anxiété au post-traitement et au suivi de 3 mois. Les participants affectés à la TAM de prétraitement ont eu une plus grande amélioration de la détresse psychologique en fin de traitement. CONCLUSION: Cette étude pilote offre des données probantes préliminaires de l'augmentation potentielle de la FT-TCD utilisant la TAM dans une situation réelle. Les futures études devraient examiner si la TAM n'augmente seulement la FT-TCD que par le recours à un groupe témoin prétraitement comparable.

Rethinking service design for youth with mental health needs: The development of the Youth Wellness Centre, St. Joseph's Healthcare Hamilton.

AIM: This article describes the development and design of the Youth Wellness Centre (YWC), an innovative, youth-friendly centre providing mental health and addiction services for emerging adults aged 17 to 25 in Hamilton, Canada. We also report on demographic and clinical characteristics of clients to evaluate how the YWC is serving populations at increased risk of developing mental disorders. METHODS: Data were extracted from clinic databases for 1520 youth at the YWC between March 2015 and 2018 to report on demographic characteristics, clinical profiles, primary presenting problems, service use and overall satisfaction with services. RESULTS: Marginalized groups, particularly street-involved individuals and LGBTQ+ youth, are highly represented at the YWC, keeping with the centre's mandate of reaching at-risk populations. Youth at the YWC carry significant mental health burdens, with 80.8% having a history of suicidal ideation and 32.8% having a history of a substance use disorder. The primary route of referral is self-referral and the number of new clients has increased by nearly 20% in the first 3 years of operations. Overall satisfaction with the centre is on par with or slightly above provincial averages. CONCLUSIONS: The YWC was developed to meet the mental health needs of transition-aged youth in Hamilton by providing early intervention, system navigation and transition services. The success of the YWC in reaching high-risk youth is demonstrated by the significant proportion of clients reporting demographic and clinical risk factors associated with increased risk for development of mental disorders. The increasing referrals to the YWC highlight the ongoing need for similar services.

Predicting patterns of service utilization within children's 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's 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: Parent, Youth and Provider Perspectives.

Continuity of care, how individuals experience care over time as coherent and linked, is considered an ethical principle of care. While continuity has been examined extensively in the adult health literature, there is a paucity of studies examining continuity in children's mental health care. Using qualitative semi-structured interviews with parents, youth, and service providers, the current study found themes and issues unique to this healthcare context, such as coordination across sectors; risks to discontinuity, such as transitions; and consequences of discontinuity, such as parents acting as liaisons. Implications of these findings are discussed.

Defining Episodes of Care in Children's Mental Health Using Administrative Data.

Criteria to define an episode of care in children's mental health services are needed. Various criteria were applied to 5 years of visit data from children 4-11 years (N = 5,206) at their first visit to 1 of 3 children's mental health agencies. A minimum of 3 visits with 180 days between episodes optimized agreement with other dates (e.g., telephone intake assessment) marking the start and end of an episode, and clinician-rated number of episodes. Grouping visits into episodes provides a clearer representation of how services are distributed over extended periods of time, facilitating research and enhancing accuracy in service planning.

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.

Group cognitive-behavioral therapy for anxiety in a clinic setting: does child involvement predict outcome?

The current study examined the relationship between child involvement and treatment outcome in a group cognitive-behavioral treatment (GCBT) program for children with anxiety, using an adapted version of the Child Involvement Rating Scale (CIRS). Thirty-four children with a primary diagnosis of an anxiety disorder, referred for outpatient treatment at a hospital, and their parents participated in a manualized 12-session GCBT program. The Multidimensional Anxiety Scale for Children (MASC), administered at pretreatment, posttreatment, and at 4-month follow-up, served as the outcome measure. The psychometric properties of the adapted CIRS were good. Early involvement (EI) was calculated as the average score from Sessions 1 to 6 and late involvement (LI), the average score from Sessions 7 to 12. EI predicted lower MASC scores at posttreatment, after controlling for pretreatment MASC scores and for LI, B=-1.05, t(3)=-2.34, p<.05. EI did not predict outcomes at follow-up. Results were replicated using the original CIRS measure. Exploratory analyses suggested that the relationship between LI and treatment outcomes was moderated by medication. Involvement in therapy prior to exposures might be an important predictor of posttreatment outcomes in GCBT in a community setting.

Worried no more: The effects of medication status on treatment response to a CBT group for children with anxiety in a community setting.

The present study compared preexisting groups of medicated and non-medicated children aged 8-13 years, with a primary diagnosis of an anxiety disorder, participating in a 12-session, manualized cognitive-behavior therapy group (GCBT). Of the 42 children, 13 (31%) were concurrently treated with Selective Serotonin Reuptake Inhibitors (SSRIs) for anxiety while they attended group treatment. Treatment outcomes for these medicated children were compared to those of children who were not on any medications for anxiety. Results suggested that both groups showed a significant decrease in their anxiety symptoms from pre- to post-treatment and from pre-treatment to 4-month follow-up, based on both child- and parent-report. No significant differences in anxiety symptoms were found between the medicated and non-medicated groups at pre-, post-, or 4-month follow-up, suggesting that the two groups benefited similarly from GCBT.

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.

What is a mental health clinic? How to ask parents about help-seeking contacts within the mental health system.

We compared parents' endorsement of having contacted a "mental health clinic or agency" when seeking help for their child, with parents' recognition of having contacted specific, named mental health agencies in their geographic region. Data were from two studies involving parents of children and adolescents seeking mental health services. Across the two studies, only 28 and 41% of parents reported having contacted a "mental health agency," but 100% reported contact when asked about specific agencies by name. Incorporating this simple modification in future studies could provide more accurate documentation of help-seeking for, and utilization of, children's mental health services.