Externally Funded Projects
Development of interRAI Child/Youth Instruments
Funded in-part by:
The London Community Foundation The Volunteer Organization of CPRI
An international effort to develop a system of child and youth assessment tools is underway led by Dr. Shannon Stewart, Program Manager, Applied Research and Education at CPRI, and interRAI, a research network of assessment and treatment experts from 39 countries.
The interRAI child and youth suite of assessment tools is the first integrated response to identifying and responding to child/youth mental health needs.
With interRAI tools already used for service and funding planning for adults worldwide, some mandated by the province of Ontario, addition of the child/youth tools will mean information can be gathered and shared across sectors and all age groups.
The interRAI child/youth suite addresses shortcomings of currently used assessment tools by meeting the needs of all stakeholders involved along the service continuum.
• For children, youth and their families, the tools will streamline the intake process so they tell their story fewer times and receive quicker access to appropriate services.
• For service providers, the tools support clinical decision-making in client-specific care plan development and support clinician capacity-building. Software provides immediate access to identified needs, areas of risk and Clinical Assessment Protocols.
• For service agencies, the tools will provide information to support triaging and management of wait lists, as well as program evaluation, service planning and continuous quality improvement efforts such as scorecards.
• For funders and policy makers, the tools will provide comprehensive, consistent and accurate information about child/youth needs and associated costs. The information can also be used to identify best practices among funded agencies.
In early May 2012, interRAI announced that the Child and Youth Mental Health (ChYMH) assessment tool was accepted as the first official child and youth instrument in a suite of assessment tools for vulnerable populations. The interRAI Child and Youth Mental Health-Developmental Disability (ChYMH-DD) assessment tool has also been developed and is in the process of approval by interRAI international.
CPRI is leading the development of Clinical Assessment Protocols (CAPs) as part of ChYMH and ChYMH-DD. There are 24 CAPs that flag children and youth with potential problems in need of clinical review. The CAPs have the potential to build capacity in individuals and communities by enhancing interpretation and knowledge of best practice and emerging strategies.
In October 2012, implementation of the ChYMH and ChYMH-DD began at CPRI. Seven additional sites are also piloting the ChYMH: Centre for Addiction and Mental Health (CAMH Toronto); Vanier Children’s Services (London); Lutherwood (Kitchener/Waterloo); Regional Mental Health Care (London); Windsor Regional Children’s Services (Windsor); Ontario Community Care and Access Centres (CCACs); and Keystone Child, Youth and Family Services (Owen Sound). In addition, the ChYMH -DD is being implemented in New York and Arkansas (USA) as part of its state-wide needs assessment across the lifespan. In the near future, the ChYMH will be translated into different languages for international piloting and use.
Interest in piloting the tools is growing and other sites are requesting to participate in the pilot.
A commitment has been garnered of more than $500,000 contributions-in-kind from Child and Youth Mental Health facilities in Ontario to support and participate in the pilot of ChYMH tools. In addition, a $100,000 donation has been made by the Volunteer Organization of CPRI (VOCPRI) and an additional $100,000 has been donated by The London Community Foundation (LCF).
Predicting and Understanding of Service Utilization within Children's Mental Health Agencies (Reid, G., Stewart, S.L. (Co-PIs), Barwick, M., Carter, J., Evans, B., Leschied, A., Neufeld, R., St. Pierre, J., Tobon, J., Vingilia, E., & Zaric, G.)
In conjunction with Dr. Graham Reid at the University of Western Ontario, Dr. Stewart is co-leading an examination of patterns of use over multiple years among children 4-11 years at the time of their first recorded visit to a child/youth mental health agency. This is the second study in a program of research designed to move toward the development and testing of new models of chronic care for children within the mental health service system. Using data regularly collected by participating agencies, this study:
• examines patterns of service use by clients within children's mental health agencies and how that might relate to presenting problems
• determines how often various types of patterns of use occur
• identifies how these patterns might differ across agencies
Development of a Measure of Continuity of Care (Reid, G.J. (PI), Tobon, J., Stewart S.L., Evans, B., Brown, J.B., Goffin, R.)
Continuity of care (how a patient experiences care over time as coherent and linked) has been identified as an indicator of health. No instrument exists to measure continuity of care experienced by families receiving children's mental health services. This two year study, conducted in collaboration with researchers at the University of Western Ontario and the Thames Valley District School Board, was funded by the Canadian Institutes of Health Research. The development of a Continuity of Care Scale for Children's Mental Health is an important step in measuring integration and coordination of services from the perspective of parents.
Internally Funded Projects
Data from the division’s ongoing program evaluations have been used to inform management decisions about service delivery planning and forecasting. These include evaluations of both outpatient (Clinic) and inpatient (Intensive Services/Residential) services.
Data collection is ongoing in a specialized outpatient clinic at CPRI:
The Attachment Consultation and Education Service (ACES) clinic serves children and youth who are having attachment problems, having suffered abuse or trauma in their past. Current research pertains to the The Circle of SecurityTM (COS) Parent group, a specialized parent education group for adoptive and long term foster parents of children up to 12 years old, aimed at increasing knowledge and insight into the attachment needs and behaviours of children with early disturbances in attachment. Parents complete pre- and post- program measures, as well as a six-month follow-up in order to evaluate the efficacy of the clinic.
Intrusive Measures Studies
In the mental health environment, intrusive measures are used to stop harmful behaviour when alternative methods have not been successful. Reduction of intrusive measures is a strategic goal for CPRI. Using intensive services evaluation data and intrusive measures data, current/recent research projects focusing on intrusive measure use at CPRI include:
• Patterns of utilization of restraints in Dual Diagnosis and Mental Health programs
• Comparison of use of intrusive measures with Children’s Aid Society (CAS)-involved children/youth compared to children/youth not involved with CAS
• Rates of chemical restraint use for behavioural control
Child & Youth Subjective Quality of Life (CYSQL)
The CYSQL is a measure of client satisfaction and wellbeing while in intensive (residential) or outpatient services at CPRI. The CYSQL promotes youth engagement and enables clients to influence service delivery at the individual level. Children and youth fill out the questionnaire within one week prior to discharge, and are asked about their perceptions in areas such as privacy, safety, autonomy, staff and peer relationships, recreation, school, family support, health, and overall well-being.