An engagement and access model for healthcare delivery to adolescents with mood and anxiety concerns

Abstract

This study evaluated a mental healthcare delivery system that identified individuals with significant distress and functional impairment from mood/anxiety concerns and previous unsuccessful treatment attempts, verifying that they were in need of mental health services. This approach provides a model for outreach and assessment in this population, where earlier intervention has the potential to prevent chronic mental illness and disability.

Early Intervention in Mood and Anxiety Disorders: The First Episode Mood and Anxiety Program

“…Phase I has undergone a process evaluation to determine whether it has been meeting its goals as a pathway to care; the results indicate that the outreach was effective and the model was attracting youth in need of specialty psychiatric care, as indicated by their severity of symptoms and level of functional impairment (Ross et al 2012;Osuch et al 2015). Given the ability of youth to access FEMAP without a physician referral, careful screening according to FEMAP inclusion/exclusion criteria and a full in-person assessment by a skilled clinician have been important in reducing over-inclusion of inappropriate patients, a potential negative unintended consequence of open access.…”

“…The causal and logic models, updated from previous versions (Ross et al 2012;Osuch et al 2015), are illustrated in Figure 1. The upper diagram reflects experiences/changes expected in youth with mood/anxiety problems on their pathway to and through care; the logic model presents program activities to effect the expected changes.…”

Access and Health System Impact of an Early Intervention Treatment Program for Emerging Adults with Mood and Anxiety Disorders

“…18 FEMAP patients reported missing an average of 2.6 days per week of work or school and being underproductive an average of 4.2 days per week. 18 Data from FEMAP also showed that emerging adults treated by the program showed reductions in mood and anxiety symptoms, improved levels of functioning, and high levels of patient satisfaction at both short-and intermediate-term follow-up. 25,26 Although it is unlikely that all emerging adults identified in our study cohort were in need of the specialized care provided by FEMAP, the program treated less than 2% of identified cases over the study time period.…”

“…4 To our knowledge, there is currently only one established early intervention program for mood and anxiety disorders in Canada-the First Episode Mood and Anxiety Program (FEMAP) in London, Ontario, targets emerging adults between the ages of 16 and 25 years who are experiencing moderate to severe symptoms and who have not yet experienced longstanding functional deterioration. 18 The goal of FEMAP is "to identify youth at critical developmental life stages who are just beginning to depart from their expected developmental trajectory and intervene by providing outpatient treatment before these youth become chronically disabled from mental illness." 18 This program is based on the early intervention for psychosis model, and its evolution has been described in detail elsewhere.…”

Partners in Recovery: an early phase evaluation of an Australian mental health initiative using program logic and thematic analysis

“…Use of PLMs in evaluation is said to “provide learning opportunities, better documentation of outputs and outcomes, and shared knowledge about what works and why ” [38]. Program logic approaches to evaluation have been described as helpful in understanding and evaluating complicated and dynamic systems [39, 40] including in mental health domains [41, 42] and also in primary health systems [43–45]. A PLM approach was particularly suited to evaluating the NBMPIR in a demographically diverse local community with complex needs.…”