Do wait times affect care pathways for children’s mental health services?

Research Snapshot

In brief

In Ontario, children and adolescent mental health services (CAMHS) are unable to keep up with demand. The result is wait lists for these services. In an effort to get help, some families may contact more than one mental health service provider. This can lead to lost time and emotional stress for families, and duplication of services and other inefficiencies for the CAMHS system.

In this Research Snapshot, we look at the article, “Why Wait? The Effect of Wait-Times on Subsequent Help-Seeking Among Families Looking for Children’s Mental Health Services,” by Kyleigh Schraeder and Graham Reid. The article appeared in the Journal of Abnormal Child Psychology, volume 43 (2015).

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What you need to know

The length of time a family spends on a wait list for children and adolescent mental health services affects whether it will contact another service provider. In this study, close to half contacted a new agency, potentially causing inefficiencies for families and care providers. Families contacted a new agency at similar rates whether or not they received service at the first agency.

For those who did not receive services, the rate of contacting another agency increased when a parent had their own treatment experience or when the area they lived in had more service providers. 

What is this research about?

In Ontario, children and adolescent mental health services (CAMHS) are unable to keep up with demand. The result is wait lists for these services. In an effort to get help, some families may contact more than one mental health service provider. This can lead to lost time and emotional stress for families, and duplication of services and other inefficiencies for the CAMHS system. 

To better understand this wait-list effect, researchers measured the impact of wait times for CAMHS on families’ efforts to seek help from more than one service provider. The researchers tried to answer two broad questions: 

  • Does time on a wait list affect the time it takes for families to contact a new service provider for CAMHS?
  • What effect do particular influencing factors have on the length of time parents wait before contacting a new agency?

What did the researchers do?

The researchers analysed data from a study of parents who were seeking help for four- to 17-year-old children from CAMHS agencies across Ontario. The data included a series of baseline and follow-up interviews, completed at intake, after six months, and after 12 months. 

What did the researchers find?

Almost half of the families (46%) contacted a new agency for help during the study period. Two groups stood out: (1) those that continuously waited for help; and (2) those that received help at the first agency, but still sought help at another agency. Surprisingly, the percentage of families who contacted a new agency was similar in the two groups.

Of those families that didn’t receive help during the study period, a quarter contacted a new agency within one month of being wait-listed, and 50% did so within 7.5 months of waiting. As expected, the likelihood of contacting a new agency increased as the wait time got longer. 

Those who were waiting for help tended to contact a new agency sooner if a parent had their own treatment experience or they lived in an area with 10 or more agencies. The burden of the child’s illness on the family and the level of severity of illness didn’t significantly predict how long a family waited to contact a new agency.

Of the families who received help at the first agency, 44% sought additional help. Families who waited up to two months before they received help were significantly more likely to contact a new agency than those who waited more than two months. 

How can you use this research?

This study contributes to knowledge of how service users seek help for child and adolescent mental health issues. It indicates that:

  • help-seeking is often not linear: families commonly “back-track” along care pathways when their needs or expectations are not met by service providers, and 
  • particular internal and external factors can predict how soon they will seek help elsewhere. 

The research also informs our understanding of how CAMHS wait lists affect service provision as a whole. For instance, wait times are increased across the system when children are on multiple wait lists simultaneously. Consequently, the study can shape discussions regarding the development of agency- and system-level policies and procedures to address wait list and pathway problems in CAMHS, such as coordinated intake systems. 

Limitations and next steps

The researchers looked at how long families waited before contacting the first additional agency; however, parents contacted four agencies on average in the previous year. Therefore, future studies could examine the rate at which families contact a series of providers in their efforts to receive care. In addition, the study relied on the self-report of parents. This may have led to inaccuracies in the amount of wait-time experienced and differences in the understanding of what help meant within a particular agency. Finally, more research is needed before the findings can be generalized. 

About the researchers 

Kyleigh Schraeder is a third year PhD student in clinical psychology at the University of Western Ontario, London, ON.

Graham Reid is an Associate Professor in the Departments of Psychology, Family Medicine, and Paediatrics, at the University of Western Ontario.

Keywords

Wait-list, mental health, help-seeking, service utilization, children and adolescents 

This Research Snapshot is based on their article: “Why Wait? The Effect of Wait-Times on Subsequent Help-Seeking Among Families Looking for Children’s Mental Health Services,” published in Journal of Abnormal Child Psychology, volume 43, 2015, http://link.springer.com/article/10.1007%2Fs10802-014-9928-z.

EENet has partnered with the Knowledge Mobilization Unit at York University to produce Research Snapshots in the field of mental health and addictions in Ontario. 

This Research Snapshot was written by Michael Weyman.