Skip to main content

Advertisement

SpringerLink
Log in

Money, Case Complexity, and Wait Lists: Perspectives on Problems and Solutions at Children’s Mental Health Centers in Ontario

  • Regular Article
  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

Senior managers of children’s mental health centers across Ontario, Canada were interviewed regarding the challenges and solutions of access and delivery of care. The central challenges—funding, case complexity, waitlists, staffing, and system integration—revealed a complex interplay between the policies and financing of children’s mental health services and the provision of clinical services at the agency level and within the community. The desire for integration and collaboration was countered by competition for funding and service demands. A need for policies that allow for local solutions while providing leadership for sustained improvements in the ease and timeliness of access to care and effective clinical services emerged.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The best estimates of operating expenses are reported; however, the components within the programs may not have been exactly the same in 1992–1993 and 2003–2004 due to changes in structure of the ministries and the reporting methods for Ministry of Finance.

References

  1. Offord DR, Boyle M, Fleming J, et al. Ontario child health study: summary of selected results. Canadian Journal of Psychiatry. 1989;34:483–391.

    CAS  Google Scholar 

  2. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health; 1999.

  3. Stroul BA. Children's Mental Health: Creating Systems of Care in a Changing Society. Baltimore, MD: Paul H. Brookes Publishing Co.; 1996.

    Google Scholar 

  4. Knitzer J, Cooper J. Beyond integration: challenges for children's mental health. Health Affairs. 2006;25(3):670–679.

    Article  PubMed  Google Scholar 

  5. Kenny H, Oliver L, Poppe J. Mental Health Services for Children: An Overview. Washington, DC: National Conference of State Legislatures; 2002.

    Google Scholar 

  6. Ministry of Community and Social Services. Making Services Work for People: A New Framework for Children and for People with Developmental Disabilities. 97–012 ed. Toronto, Ontario: Queen’s Printer for Ontario; 1997.

  7. Rawlinson S, Williams R. The primary/secondary care interface in child and adolescent mental health services: the relevance of burden. Current Opinion in Psychiatry. 2000;13(4):389–395.

    Article  Google Scholar 

  8. Department of Health U. Child and Adolescent Mental Health: National Service Framework for Children, Young People and Maternity Services. 40492 ed. London, UK; 2004.

  9. Remschmidt H, Belfer ML, Goodyear I. Facilitating Pathways: Care, Treatment and Prevention in Child and Adolescent Mental Health. New York: Springer; 2004.

    Google Scholar 

  10. Bickman L. A continuum of care—more is not always better. American Psychologist. 2001;51(7):689–701.

    Article  Google Scholar 

  11. Kendziora K, Burns E, Osher D, et al. Wraparound: stories From the Field. Systems of Care: Promising Practices in Children's Mental Health, 2001 Series. Washington, DC: Center for Effective Collaboration and Practice, American Institutes for Research; 2001.

  12. Appelbaum PS. The ‘quiet’ crisis in mental health services. Health Affairs. 2003;22(5):110–116.

    Article  PubMed  Google Scholar 

  13. Glied S, Cuellar AE. Trends and issues in child and adolescent mental health. Health Affairs. 2003;22(5):39–50.

    Article  PubMed  Google Scholar 

  14. Hutchinson AB, Foster EM. The effect of Medicaid managed care on mental health care for children: a review of the literature. Mental Health Services Research. 2003;5(1):39–54.

    Article  PubMed  Google Scholar 

  15. Marchildon GP. Canadian health system reforms: lessons for Australia. Australian Health Review. 2005;29(1):105–119.

    Article  PubMed  Google Scholar 

  16. Statistics Canada. Consumer Price Indexes for Canada, Monthly, 1914–2006. V41690973 series ed. Ottawa, ON: Statistics Canada; 2006.

  17. Ontario Ministry of Finance. Public Accounts, 2004–2005. Toronto, ON: Ontario Ministry of Finance; 2006.

    Google Scholar 

  18. Trocmé N, Fallon B, MacLaurin B, et al. The Canadian Incidence Study of Reported Child Abuse and Neglect-2003: Major Findings (CIS-2003). Ottawa, ON: Minister of Public Works and Government Services Canada; 2005.

    Google Scholar 

  19. King CB, Leschield AW, Whitehead PC, et al. Child protection legislation in Ontario: past, present and future. Education and Law Journal. 2003;13(1):105–126.

    Google Scholar 

  20. Carrington PJ, Schulenberg JL. Introduction: the Youth Criminal Justice Act—a new era in Canadian juvenile justice. Canadian Journal of Criminology and Criminal Justice. 2004;46(3):219.

    Google Scholar 

  21. Madore O. The Canada Health Act: Overview and Options. PRB 94–4E ed. Ottawa, ON: Library of Parliament; 2003.

  22. Ministry of Children and Youth Services. McGuinty government investing in more services for children and youth with autism. Government of Ontario. August 17, 2007.

  23. Ministry of Community, Family and Children’s Services. Business plan 2002–2003: Ministry of Community, Family and Children’s Services. 2002. Toronto, ON, Publications Ontario. https://ozone.scholarsportal.info/handle/1873/4741 (Accessed 13 May 2008).

  24. Patton MQ. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage; 2002.

    Google Scholar 

  25. Reid GJ, Brown JB. Money, case complexity and wait lists: managers’ perspectives on problems and solutions at children’s mental health centres in Ontario. Symposium presented at: The Children’s Mental Health Ontario Summit; November 14–15, 2005; Toronto, ON. 2005.

  26. The Standing Senate Committee on Social Affairs SaT. Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. Ottawa, ON: Senate of Canada; 2006.

    Google Scholar 

  27. Macdonald E, Mohay H, Sorensen D, et al. Current delivery of infant mental health services: are infant mental health needs being met. Australasian Psychiatry. 2005;13(4):393–398.

    Article  PubMed  Google Scholar 

  28. Green CA, Lynch FL, Polen MR, et al. Talk about costs: health care professionals’ views about expenses related to substance abuse treatment. Administration and Policy in Mental Health. 2004;31(6):483–494.

    Article  PubMed  Google Scholar 

  29. Kazdin AE, Weisz JR. Evidence-based Psychotherapies for Children and Adolescents. New York: Guilford; 2003.

    Google Scholar 

  30. Barwick MA, Boydell KM, Stasiulis E, et al. Knowledge Transfer and Implementation of Evidence-based Practice in Children’s Mental Health. Toronto, ON: Children’s Mental Health Ontario; 2005.

    Google Scholar 

  31. Wolff N, Clark R. Money, innovation, and access: the mental health system in motion. International Journal of Law and Psychiatry. 2005;28(5):457–466.

    Article  PubMed  Google Scholar 

  32. Jensen PS, Weersing R, Hoagwood KE, et al. What is the evidence for evidence-based treatments? A hard look at our soft underbelly. Mental Health Services Research. 2005;7(1):53–74.

    Article  PubMed  Google Scholar 

  33. Latimer E. Community-based care for people with severe mental illness in Canada. International Journal of Law and Psychiatry. 2005;28(5):561–573.

    Article  PubMed  Google Scholar 

  34. Browne G, Roberts J, Gafni A, et al. Economic evaluations of community-based care: lessons from twelve studies in Ontario. Journal of Evaluation in Clinical Practice. 1999;5(4):367–385.

    Article  CAS  PubMed  Google Scholar 

  35. Cunningham CE, Pettingill P, Boyle M. The Brief Child and Family Phone Interview (BCFPI-3) — A Computerized Intake and Outcome Assessment Tool: Interviewers Manual. March 2002 ed. Hamilton, ON: Canadian Centre for the Study of Children at Risk, Hamilton Health Sciences; 2002.

  36. Hodges K. Child and Adolescent Functional Assessment Scale. Ypsilanti, MI: Eastern Michigan University, Department of Psychology; 1994.

    Google Scholar 

  37. Huang L, Stroul B, Friedman R, et al. Transforming mental health care for children and their families. American Psychologist. 2005;60(6):615–627.

    Article  PubMed  Google Scholar 

  38. Frank RG, Glied S. Changes in mental health financing since 1971: implications for policymakers and patients. Health Affairs. 2006;25(3):601–613.

    Article  PubMed  Google Scholar 

  39. Scheffler RM, Kirby PB. The occupational transformation of the mental health system. Health Aff (Millwood). 2003;22(5):177–188.

    Article  Google Scholar 

  40. Robiner WN. The mental health professions: workforce supply and demand, issues, and challenges. Clinical Psychology Review. 2006;26(5):600–625.

    Article  PubMed  Google Scholar 

  41. Breton JJ, Plante MA, St-Georges M. Challenges facing child psychiatry in Quebec at the dawn of the 21st Century. Canadian Journal of Psychiatry. 2005;50(4):203–212.

    Google Scholar 

  42. Canadian Institute for Health Information. Health Personnel Trends in Canada-1995 to 2004: Health Personnel Database. Ottawa, ON: Canadian Institute for Health Information; 2006.

    Google Scholar 

  43. Birch S, Thomson D, Xiaoqiang L et al. Nurse Human Resource Requirements in Canada: Implications of Changes in Service Delivery. 0-9738051-4-5 ed. Ottawa, ON: Project The Nursing Sector Study Corporation Management; 2004.

  44. Stephens T, Joubert N. The economic burden of mental health problems in Canada. Chronic Diseases in Canada. 2001;22(1):18–23.

    CAS  PubMed  Google Scholar 

  45. Dick PT, Kavanagh L. ICES Investigative Report: Ontario’s Mosaic of Children’s Treatment Services. Toronto, ON: Institute for Clinical Evaluation Sciences; 2005.

    Google Scholar 

  46. Lyons JS, Rogers L. The U.S. child welfare system: a de facto public behavioral health care system. Journal of the American Academy of Child and Adolescent Psychiatry. 2004;43(8):971–973.

    Article  PubMed  Google Scholar 

  47. Evens CC, Vander SA II. Risk factors for juvenile justice system referral among children in a public mental health system. Journal of Mental Health Administration. 1997;24(4):443–455.

    CAS  PubMed  Google Scholar 

  48. Children's Mental Health Ontario. A Summary of Discussions Regarding Ontario’s Policy Framework for Child and Youth Mental Health. Toronto, ON: Children’s Mental Health Ontario; 2006.

    Google Scholar 

  49. Ministry of Children and Youth Services. A Shared Responsibility: Ontario’s Policy Framework for Child and Youth Mental Health. Toronto, ON: Queen’s Printer for Ontario; 2006.

    Google Scholar 

Download references

Acknowledgements

This project was supported by a grant from the Canadian Health Services Research Foundation (RC1-0959-06). G.J. Reid was supported as the Bill and Anne Brock Professor in Child Health at the time this manuscript was written. The assistance of Children’s Mental Health Ontario was appreciated, as was the time and effort of all participants. The Advisory Board for the project was invaluable and included: Marian Archibald, Judith Belle Brown, Charles E. Cunningham, Barrie Evans, Barbara Lent, Helen Lowe, Nadia Mazaheri, Lynn Ryan Mackenzie, Richard Neufeld, Moira A. Stewart, Shannon Stewart, William Tucker, Gail Ure, Claire Wallace-Piccin, Tom Walters, Evelyn R. Vingilis, and Gregory Zarik. Comments from Katherine Boydell on an early version of this manuscript were helpful and much appreciated.

Author information

Authors and Affiliations

  1. Departments of Psychology and Family Medicine, The University of Western Ontario, London, ON, Canada

    Graham J. Reid PhD

  2. Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, UWO Research Park, Suite 245, London, ON, N6G 4X8, Canada

    Judith Belle Brown PhD

  3. School of Social Work, King’s University College, London, ON, Canada

    Judith Belle Brown PhD

Authors
  1. Graham J. Reid PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judith Belle Brown PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Graham J. Reid PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reid, G.J., Brown, J.B. Money, Case Complexity, and Wait Lists: Perspectives on Problems and Solutions at Children’s Mental Health Centers in Ontario. J Behav Health Serv Res 35, 334–346 (2008). https://doi.org/10.1007/s11414-008-9115-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-008-9115-5

Keywords

Search

Navigation