A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study

Segal, Leonie; Guy, Sophie; Leach, Matthew; Groves, Aaron; Turnbull, Catherine; Furber, Gareth

doi:10.1016/s2468-2667(18)30075-6

Cited by 24 publications

(32 citation statements)

References 20 publications

(31 reference statements)

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“…Most of these programmes offer a limited amount of free or subsidised treatment sessions, which may not be sufficient for children and adolescents with more complex treatment needs; this might, in part, explain why cost for those with a partially met need remained one of the most important barriers at both time points. These findings may also support recent estimates that a fivefold increase in community-based state-funded child and adolescent services is needed to meet current clinical need in Australia (Segal et al, 2018).…”

Section: Discussionsupporting

confidence: 84%

Barriers to mental health care for Australian children and adolescents in 1998 and 2013–2014

Schnyder

Sawyer

Lawrence

et al. 2020

Aust N Z J Psychiatry

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Objective: To assess changes in barriers to mental health care for children and adolescents over 16 years. Methods: We used data from two nationally representative surveys of Australian children and adolescents (4–17 years old), conducted in 1998 ( N = 4509) and 2013–2014 ( N = 6310). Barriers to care were assessed among parents who had reported a perceived partially met or unmet need for their child in the past 6 months in 1998, and the past 12 months in 2013–2014; barriers were similarly assessed among adolescents in relation to themselves. We addressed measurement inconsistencies between surveys by harmonising barriers to accommodate differences in wording and performing sensitivity analyses among those with a 1-month disorder to equalise the timeframes in which barriers were assessed. To assess change, we examined whether the rank order of the three most commonly endorsed barriers changed and whether the 95% confidence intervals (CI) around their estimates overlapped. Results: Similar proportions of parents reported a partially met or unmet need in 1998 (12.9%, 95% CI = [11.7, 14.0]) as in 2013–2014 (14.3%, 95% CI = [13.2, 15.3]), but the ratio of unmet to partially met need decreased from 3:1 in 1998 to 1:1 in 2013–2014. Top three parent-endorsed barriers (‘self-reliance’, ‘unsure where to get help’, and ‘cost’) were the same at both time points; ‘self-reliance’ decreased from 65.9% (95% CI = [61.1%, 70.7%]) to 34.9% (95% CI = [31.5%, 38.3%]). Top two adolescent-endorsed barriers (‘self-reliance’ and ‘concerned what others might think’) were the same at both time points, the third differed, but none of them decreased. Conclusion: Perceived unmet need for mental health care for children and adolescents may have decreased between 1998 and 2013–2014, but the gap in receiving sufficient care may have increased. Despite investments in community awareness and treatment during this period, key barriers seemed largely unchanged. For parents, the decrease in self-reliance may reflect a positive shift in beliefs about the potential benefits of treatment.

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Section: Discussionsupporting

confidence: 84%

Barriers to mental health care for Australian children and adolescents in 1998 and 2013–2014

Schnyder

Sawyer

Lawrence

et al. 2020

Aust N Z J Psychiatry

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“…For pediatricians, primary care physicians, psychiatrists, and other clinicians working with children and adolescents, the need to be alert to the maltreating family context when seeing emotional and behavioral problems is reinforced. 12 Other research by the lead author 34 found that mental health services in SA are grossly inadequate to support the mental health of infants, children, adolescents, and their families. In this mortality study, we highlight the tragic consequences of this gap.…”

Section: Policy Implicationsmentioning

confidence: 99%

Child Maltreatment and Mortality in Young Adults

et al. 2021

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BACKGROUND: Child maltreatment (CM) is a global public health issue, with reported impacts on health and social outcomes. Evidence on mortality is lacking. In this study, we aimed to estimate the impact of CM on death rates in persons 16 to 33 years. METHODS: A retrospective cohort study of all persons born in South Australia 1986 to 2003 using linked administrative data. CM exposure was based on child protection service (CPS) contact: unexposed, no CPS contact before 16 years, and 7 exposed groups. Deaths were observed until May 31, 2019 and plotted from 16 years. Adjusted hazard ratios (aHRs) by CPS category were estimated using Cox proportional hazards models, adjusting for child and maternal characteristics. Incident rate ratios (IRRs) were derived for major causes of death, with and without CPS contact. RESULTS: The cohort included 331 254 persons, 20% with CPS contact. Persons with a child protection matter notification and nonsubstantiated or substantiated investigation had more than twice the death rate compared with persons with no CPS contact: aHR = 2.09 (95% confidence interval [CI] = 1.62–2.70) to aHR = 2.61 (95% CI = 1.99–3.43). Relative to no CPS contact, persons ever placed in out-of-home care had the highest mortality if first placed in care aged ≥3 years (aHR = 4.67 [95% CI = 3.52–6.20]); aHR was 1.75(95% CI = 0.98–3.14) if first placed in care aged <3 years. The largest differential cause-specific mortality (any contact versus no CPS contact) was death from poisonings, alcohol, and/or other substances (IRR = 4.82 [95% CI = 3.31–7.01]) and from suicide (IRR = 2.82 [95% CI = 2.15–3.68]). CONCLUSIONS: CM is a major underlying cause of potentially avoidable deaths in early adulthood. Clinical and family-based support for children and families in which CM is occurring must be a priority to protect children from imminent risk of harm and early death as young adults.

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“…Factors contributing to the high prevalence of mental illness in regional settings are believed to be largely socioeconomic in origin, including unemployment/low household income, social isolation, low educational attainment, and limited physical/financial access to health services (Handley, Rich, Lewin, & Kelly, 2019; Sengupta & Benjamin, 2015). With this in mind, while increased access to evidence‐based therapies is integral to improving health outcomes in regional populations living with mental/behavioural disorders (Asarnow, Rozenman, Wiblin, & Zeltzer, 2015), so must be the provision of appropriate psychosocial services and preventive measures (Dreger, Buck, & Bolte, 2014; Furber, Segal, Leach, & Guy, 2017; Furber et al., 2015; Segal et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey

Leach

Gillam

González‐Chica

et al. 2020

Health Soc Care Community

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Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44‐item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard‐copy. The survey was conducted between April 2017 and March 2018. A multi‐modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60 + years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional‐urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas.

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A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study

Abstract: National Health and Medical Research Council (Australia), Department of Health SA.

Cited by 24 publications

References 20 publications

Barriers to mental health care for Australian children and adolescents in 1998 and 2013–2014

Barriers to mental health care for Australian children and adolescents in 1998 and 2013–2014

Child Maltreatment and Mortality in Young Adults

Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey

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