Christian Hahn: Examining multi-sector service use by children in Ontario’s mental health system

“We know that a lot of children and youth with mental health issues are receiving help from different sectors – from mental health care providers, from the education system, from primary care, from specialized mental health, in some cases from the juvenile justice system. We don’t really know why some children are involved with all five sectors, some are receiving help from two or three sectors, and others are only involved with the mental health sector.” Christian Hahn

In brief

Christian Hahn is a second year Master’s student in Clinical Psychology at Western University in London, Ontario. He is exploring why some children with mental health concerns in Ontario are involved only with mental health agencies while others receive care in multiple sectors, such as mental health, primary care, education, and justice.

Christian hopes that his research will help service providers know which children are most likely to need cross-sectoral collaborative care. In the future, he plans to complete a PhD in Clinical Psychology and looks forward to building a career that includes both clinical practice and research.

EENet’s Andrea Flynn has developed a Student Spotlight on Christian’s work. Student Spotlights are brief profiles of up-and-coming student researchers.

Read this Student Spotlight below or download the PDF.

Man sitting
Christian Hahn

About Christian

Originally from Cole Harbour, Nova Scotia, Christian earned an Honours Bachelor of Arts degree in Psychology from Saint Mary’s University in Halifax. Early on in his undergraduate career, he was drawn to psychology and felt that it was a natural fit for him. He started considering possible career options, and became interested in the scientist-practitioner model of clinical psychology.

“The idea of generating knowledge through research and then bringing evidence into practice in clinical settings was very appealing to me,” says Christian.

He began to pursue this interest by connecting with professors who were also clinicians. He completed his undergraduate thesis under the supervision of Darren Fowler, a clinician and part-time faculty member at Saint Mary’s. In this thesis, he looked at whether knowledge about different types of treatments for depression and anxiety affected undergraduate students’ treatment preferences.

This experience strengthened Christian’s interest in pursuing a career in clinical psychology.  He investigated possible graduate schools, and came in contact with Dr. Graham Reid at Western University. Fascinated by Dr. Reid’s systems-level research in children’s mental health, Christian chose to enrol in Western’s Clinical Psychology graduate program and moved to London, Ontario.

What is Christian’s research about?

Predicting Multi-Sector Service Use by Children with Mental Health Concerns

Christian is analyzing data from over 350 charts of children/youth aged 4 to 17 seen at one of 6 different children’s mental health agencies in Ontario. Data obtained from anonymous chart reviews include demographics, assessment/intake information, education, diagnoses, and service involvement over five years.

Christian is specifically focusing on the different service sectors that children with mental health issues are accessing and is aiming to identify factors that lead some children to receive help in multiple sectors.

“We know that a lot of children and youth with mental health issues are receiving help from different sectors – from mental health care providers, from the education system, from primary care, from specialized mental health, in some cases from the juvenile justice system. We don’t really know why some children are involved with all five sectors, some are receiving help from two or three sectors, and others are only involved with the mental health sector,” he explains.

“I wanted to figure out what is driving children with mental health issues to be involved with specific sectors. Theoretically, it would be case complexity – the more complex a child’s issues, the more the child would need different types of providers to be involved,” he says. “Typically, becoming involved with child welfare – Children’s Aid Society – is due to issues related to the family situation, while involvement with the juvenile justice system is mainly due to delinquent activity on the part of the youth. But it doesn’t always seem to work that way, meaning that there’s something else going on that is affecting the services that children are using,” explains Christian.

“I’m hoping to show that different patterns of service use across sectors depend both on case complexity and on protective factors.  Some children have a high number of risks, meaning they have high case complexity, and thus will end up receiving different kinds of care. But children who have high case complexity might not end up using multiple services across different sectors because of protective factors in their life,” says Christian.

Christian is using a resiliency framework to address his research question. This framework, Christian explains, suggests that risks (such as having a non-parent guardian) and problems that a child is experiencing are important factors affecting the sectors they’ll be involved with. However, the framework also suggests that there are protective factors (such as doing well in school) that keep some children with mental health issues from needing complex care.

“I’m hoping to show that different patterns of service use across sectors depend both on case complexity and on protective factors.  Some children have a high number of risks, meaning they have high case complexity, and thus will end up receiving different kinds of care. But children who have high case complexity might not end up using multiple services across different sectors because of protective factors in their life,” says Christian.

Christian is using data collected as part of a larger study on patterns of service use within children’s mental health agencies. In this larger study, the Child and Adolescent Needs and Strengths (CANS) scale was completed by researchers based on their reading of the child’s clinical chart. Using the CANS ratings, Christian is looking at both the risks and protective factors that children are experiencing both at intake to and discharge from the children’s mental health agency. He is analysing whether those risks and protective factors are linked to the number and types of services that the child or youth is using.

“This information could provide another building block to show clinicians that we need to keep talking, we need to collaborate. Although I think people are generally supportive of the need for collaboration, it is sometimes hard to pinpoint what is needed and when. If we can find evidence that offers some predictive ability, it can help inform us about the cases around which collaboration is most needed,” Christian explains.

What will this research bring to the sector?

Although Christian is still in the process of analysing the data, preliminary results are promising, and he is hopeful that his findings will contribute useful knowledge to the children’s mental health field. His research has important implications for how children are assessed when they first become involved with a service for mental health concerns.

crowd of children“If we know that specific factors affect the number and types of services that children with mental health issues will typically use, it makes assessment that much more important – in other words, the information that is pulled together when the child is first seen can help identify those who are likely to go on to need complex care across multiple sectors,” says Christian.

He thinks the research will provide further support for encouraging collaboration among service providers across sectors.

“This information could provide another building block to show clinicians that we need to keep talking, we need to collaborate. Although I think people are generally supportive of the need for collaboration, it is sometimes hard to pinpoint what is needed and when. If we can find evidence that offers some predictive ability, it can help inform us about the cases around which collaboration is most needed,” Christian explains.

What’s next for Christian?

After completing his Master’s degree, Christian hopes to pursue a PhD under the continued supervision of Dr. Reid. He is looking forward to gaining more exposure to clinical work and is particularly interested in cognitive-behavioural models of therapy. Christian’s long-term goal is to be a clinician-scientist in the area of children’s mental health. As his career progresses, he wants to balance providing clinical care with conducting research that has policy implications for the children’s mental health system. He also welcomes the possibility of teaching at the university level.

For more information about Christian’s work, please contact him at chahn [at] uwo [dot] ca.

Project Title: Multi-Sector Service Use by Children in Contact with Ontario Mental Health Agencies.

Project supervisor: Dr. Graham Reid (Western University, Departments of Psychology, Family Medicine, and Paediatrics; Children’s Health Research Institute)

Author: Andrea Flynn

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