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ObjectivesDespite the high prevalence of mental disorders among youth (age 12 to 17) and emerging adults (age 18 to 24), few receive mental health (MH) services. Using a cross-sectional study design, we examined population characteristics associated with MH service use in this age group from 2011 to 2016.MethodsData were from six cycles of the Canadian Community Health Survey (2011–2016). Population characteristics associated with service use were analyzed using logistic regression models for each year. Changes in odds ratios over time were used to examine trends.ResultsPresence of a mood or anxiety disorder had the largest magnitude of association on MH service use in every year. Trends suggested an increased association size between self-rated MH status and service use; lower self-rated MH was associated with a 62% increase in odds of service use in 2011 and an 83% increase in 2016. Being female was associated with increased odds of MH service use (range: 59–107%). Compared with white respondents, individuals who were East and Southeast Asian or South Asian had decreased odds of MH service use. While the association size varied for South Asians, there was a trend toward decreasing likelihood of accessing care (55% decreased odds in 2011, 74% in 2016) for East and Southeast Asians.ConclusionTrends suggest changes in population characteristics associated with access to MH care (e.g., self-rated MH status) as well as persistent inequity in MH service use in Canada for males and individuals from Asian ethnic groups.

Background Population-based studies in Canada and the United States estimate chronic physical health conditions affect between 20 to 30% of children aged 0 to 17. Challenges in measuring chronic conditions include the use of inconsistent definitions and algorithms that capture a limited number of conditions. Thus, we developed a chronic health condition (CHC) algorithm using administrative data to determine whether a child has a CHC based on (1) the diagnosis recorded for the visit, (2) the number of visits, and (3) within a specific reference period. Methods Data were from the cross-sectional 2014 Ontario Child Health Study, linked with Ontario Health Insurance Plan (OHIP) administrative health data. Unweighted prevalence estimates and agreement analyses (Cohen’s Kappa, sensitivity, specificity) were used to compare the survey parent-reported and algorithm-based presence of a CHC. Results 31.8% and 27.1% of children and youth had a CHC based on administrative and survey data, respectively. Agreement between administrative and survey data was poor ( k  = 0.17). Among a few specific conditions, agreement varied depending on the type of condition (e.g., diabetes k  = 0.77 vs health conditions k  = 0.21). Conclusion We found considerable discrepancies between administrative and survey-reported data. The results highlight the importance of using algorithms developed from multiple datasets to examine complex research questions, such as the measurement of chronicity.

Background National legislative guidelines for sleep and rest are lacking in the Canadian licensed childcare sector. No review of Canadian legislation for licensed childcare facilities has focused on sleep. This paper provides a review of the Canadian provincial and territorial legislative landscape, regarding sleep, rest, and naps in licensed childcare centers. Methods Childcare statutes and regulations for each province and territory were identified and downloaded on a particular date. Statutes and regulations were reviewed focusing on sections articulating licensed childcare facility mandates governing sleep, rest, naps, and sleep equipment. An excel file was used to facilitate systematic data retrieval and comparisons across provinces and territories. Two authors developed and discussed themes that summarized data from the documents. Results No statutes indicated recommendations for sleep, rest, or naps. Only one regulation defined rest (Alberta). Our analysis of regulations identified four themes representing sleep, rest, and naps: programming (general programming, daily programming); space (dedicated space, amount of space, age-specific space); equipment (developmental appropriateness, acceptable sleep equipment, age-specific equipment); and safety (staffing during sleep/rest, sleep position, sleep monitoring, sleep equipment safety, prohibited practices). In Canada, minimal regulatory consistency is evident in required sleep programming, space, acceptability of sleep equipment, and sleep safety considerations. Most jurisdictions’ regulations indicated necessity for developmentally appropriate rest or sleep areas and equipment, in particular for infants, but there was minimal consistency in defining infant age groups. Conclusions Although we identified themes related to sleep across regulations, childcare regulations differ in their definitions of infants and specifications for children’s sleep and rest in licensed Canadian childcare facilities. Without adequate definitions in legislative components of appropriate sleep duration linked to children’s developmental stages, childcare facilities lack guidance to support healthy sleep for children in their care. Future research can examine translation of healthy sleep guidelines into government legislation and mandates for sleep, rest, and naps among young children in licensed childcare.

IntroductionMental health conditions are a major public health challenge. Though typically diagnosed in adolescence, these conditions may arise during early childhood. Considerable evidence shows that engagement in healthy movement behaviours (ie, regular physical activity, reduced sedentary behaviour and sufficient sleep) is associated with a lower risk of mental health conditions in adolescents and adults. However, whether these behaviours have the same protective effect during early childhood is less clear. The MOvement behaviours and irritaBILITY in early childhood (MOBILITY) study was established to investigate the association between 24-hour movement behaviours and trajectories of early childhood mental health.Methods and analysisMOBILITY is a prospective observational cohort study of toddlers’ and preschoolers’ (aged 2–4 years) movement behaviours and mental health, which will be assessed at three data collection points (baseline and 6- and 12-month follow-ups). Mental health indicators (ie, irritability, internalising, externalising and prosocial behaviour) will be assessed via parent-report questionnaires, and movement behaviours will be assessed via ActiGraph accelerometers and sleep diaries. Primary analyses will include using: (1) compositional data analysis to examine prospective relationships between overall movement behaviour compositions and trajectories of mental health indicators, (2) isotemporal substitution modelling to determine whether the prospective association between independent movement behaviours and trajectories of mental health indicators is contingent on other movement behaviours and (3) the ‘Goldilocks’ approach to determine optimal time use compositions to promote favourable trajectories in mental health symptomology.Ethics and disseminationEthical approval for this study was received from the Health Sciences Research Ethics Board at Western University, London, Ontario, Canada. The findings of this novel research will have implications for informing updates of evidence-based movement behaviour guidelines, as well as the development and implementation of preventive mental health interventions. Study findings will be disseminated via publications and conference presentations for academic audiences, infographics and short videos for community partners, early childhood educators and parents, as well as actionable recommendations for physicians and healthcare providers.

The current study examined the joint effects of stress, social support, and self-esteem on adjustment to university. First-year undergraduate students (N = 115) were assessed during the first semester and again 10 weeks later, during the second semester of the academic year. Multiple regressions predicting adjustment to university from perceived social support (friends and family), self-esteem (academic, social, and global), and stress were conducted. From the fall to winter semesters, increased social support from friends, but not from family, predicted improved adjustment. Decreased stress predicted improved overall, academic, personal-emotional, and social adjustment. Increased global, academic, and social self-esteem predicted decreased depression and increased academic and social adjustment. Results are discussed with respect to potential mechanisms through which support and self-esteem may operate.

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.

Background Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders – require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. Main body In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program’s goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context – a context that requires researchers who are able to respond to multiple challenges. Conclusion We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.

Background Most health care for people with diabetes occurs in family practice, yet balancing the time and resources to help these patients can be difficult. An intervention empowering patients, leveraging community resources, and assisting self-management could benefit patients and providers. Thus, the feasibility and potential for effectiveness of “Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management” (Health TAPESTRY-HC-DM) as an approach supporting diabetes self-management was explored to inform development of a future large-scale trial. Methods Four-month pilot randomized controlled trial (RCT), sequential explanatory qualitative component. Participants—patients of an interprofessional primary care team—were over age 18 years, diagnosed with diabetes and hypertension, and had Internet access and one of the following: uncontrolled HbA1c, recent diabetes diagnosis, end-stage/secondary organ damage, or provider referral. The Health TAPESTRY-HC-DM intervention focused on patient health goals/needs, integrating community volunteers, eHealth technologies, interprofessional primary care teams, and system navigation. Pilot outcomes included process measures (recruitment, retention, program participation), perceived program feasibility, benefits and areas for improvement, and risks or safety issues. The primary trial outcome was self-efficacy for managing diabetes. There were a number of secondary trial outcomes. Results Of 425 eligible patients invited, 50 signed consent (11.8%) and 35 completed the program (15 intervention, 20 control). Volunteers ( n  = 20) met 28 clients in 234 client encounters (home visits, phone calls, electronic messages); 27 reports were sent to the interprofessional team. At 4 months, controlling for baseline, most outcomes were better in the intervention compared to control group; physical activity notably better. The most common goal domains set were physical activity, diet/nutrition, and social connection. Clients felt the biggest impact was motivation toward goal achievement. They struggled with some of the technologies. Several participants perceived that the program was not a good fit, mostly those that felt they were already well-managing their diabetes. Conclusions Health TAPESTRY-HC-DM was feasible; a large-scale randomized controlled trial seems possible. However, further attention needs to be paid to improving recruitment and retention. The intervention was well received, though was a better fit for some participants than others. Trial registration ClinicalTrials.gov, NCT02715791 . Registered 22 March 2016—retrospectively registered.

Background Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)—including, but not limited to, problems in inaccessibility and quality of services—are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices? Methods The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity. Discussion The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS. Systematic review registration Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/ .

Background: Mental health walk-in clinics (MHWCs) are a model of service delivery that has gained increasing interest and traction. The aim of the study was to better understand how MHWC use is related to use of other services provided by agencies. Objectives: (1) Explore if and how MHWCs are used alongside other services, including the different time points (e.g. MHWCs used exclusively, MHWCs used before other agency services); (2) identify correlates of MHWC use alongside other agency services. Design: Administrative data from two child and youth mental health agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods: In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared with MHWC use exclusively. Results: More than half of families used MHWCs and other agency services before or concurrently with other agency services. Child age, guardianship, and disposition at discharge emerged as correlates of MHWC use before other agency services. Conclusions: MHWCs are sufficient for some families, easing the pressure on other agency services. For the remaining families, MHWCs can help support them at the beginning of their service use journey.