Service provision for depressed children and youth: a survey of the scope and nature of services in Ontario

Abstract

BackgroundThe worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines.MethodsSeveral government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities.Results413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13–17 (70%) and transition aged youth (18–25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities.ConclusionsThis study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts.

Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment

“…The project included samples of youth, caregivers, and service providers 37,38 ; this paper presents youth findings. Flyers with survey links were distributed to organizations on an internal database of Ontario youth-serving organizations 39 , with a request to circulate the flyer in their networks. The database, developed largely through thorough internet searches, includes an extensive range of organizations with various specific target populations, supporting diversity in recruitment.…”

Severe and complex youth depression: Clinical and historical features of young people attending a tertiary mood disorders clinic

“…The majority of YMC patients had been previously engaged with mental health treatment. Whilst a proportion of young people are known to experience limited engagement with therapy and early treatment discontinuation (e.g., Seidler et al, 2020; Watson, Mehra, Hawke, & Henderson, 2019), given that a high percentage (72.6%) of the present cohort received prior mental health care, many YMC patients may therefore have exhibited insufficient treatment response (or treatment resistance) to recommended first‐ and second‐line interventions (e.g., NICE, 2019). This underscores the urgent need for novel youth‐specific treatment approaches to mood disorders in adolescents and emerging adults (e.g., Osuch et al, 2019).…”

Service providers endorse integrated services model for youth with mental health and substance use challenges: findings from a discrete choice experiment

“…Indeed, the majority of youth with mental health challenges do not access them [ 12 ]. Among those who do access services, dropout rates are high [ 13 , 14 ], missing the opportunity to provide the support young people need to get back on track and show improvements that can have lifelong impacts.…”