Improving Child and Adolescent Mental Health Services: A Qualitative and Quantitative Exploration into the Current State of Services in Alberta, Canada
Creators: Reeson, Matthew A.
Publisher: name: University of Alberta Library
Year: 2023

<p>Background<br>
There is a paucity of evidence-based research aimed at determining best-practice treatment in the context of child and adolescent mental health services (CAMHS). Despite the high prevalence of mental illness in youth, no gold-standard for treatment currently exists. Assessment tools are necessary to monitor treatment outcomes but are often overlooked. The overarching aim of this dissertation is to investigate ways in which CAMHS can be improved, with a specific focus on the use of outcome measures. </p>

<p>Objectives<br>
The objectives of this work are to explore stakeholder perceptions of treatment success in a child and adolescent psychiatric inpatient unit; to investigate the impact of early-life trauma on mental illness and treatment outcomes, and to implement the use of standardized outcome measures in a youth treatment program.</p>

<p>Methods <br>
A qualitative analysis of focus groups was conducted to determine stakeholder perceptions of treatment success in a youth psychiatric inpatient unit. Caregivers of children and adolescents undergoing treatment, as well as the service providers of the unit, were interviewed (Chapter 2). Subsequently, a regression analysis of the reported number of Adverse Childhood Experiences (ACEs) in youth child sexual abuse (CSA) survivors and their biological caregivers was conducted (Chapter 3). This was followed up with a longitudinal study of changes in cognitive performance for CSA survivors aged 8-12 (Chapter 4). The longitudinal analysis approach was extended to a study of changes in mental health and well-being for adolescent female CSA survivors (Chapter 5a). Based off these preliminary results, a longitudinal study of changes in mental health and well-being was extended to the first half of the program in both the children and adolescent CSA survivors. Changes for pre-COVID and COVID-era cohorts were compared (Chapter 5b). </p>

<p>Results<br>
Five primary themes emerged as relevant determinants of treatment success: (1) youth mental health and well-being; (2) caregiver mental health and well-being; (3) the health of the caregiver-child dyad; (4) education, socialization, &amp; occupation; (5) institutional interactions. A moderate correlation was found between parent and child ACE scores (r[90] = 0.44, p &lt; 0.0001). Compared to the standard population. Over the course of treatment, statistically significant improvements in mean cognitive scores occurred for executive function (13.8% improvement, p&lt;0.001), attention (13.5%, p=0.009), working memory (7.3%, p=0.02), and overall cognitive score (9.1%, p=0.005. Overall, decreases in mean questionnaire scores for depression (-23.8%, p=0.001), anxiety (-20.6%, p = 0.006), and PTSD (-20.3%, p = 0.002) were reported; improvements in ratings for quality of life (17.6%, p = 0.022), self-esteem (22.9%, p = 0.010), and resilience (6.9%, p=0.019) were also reported. </p>

<p>In Chapter 5b, the children reported significant improvements for PTSD (-26.0%, p=0.036), depression (-36.6%, p=0.05), and anxiety (-26.2%, p=0.001). In the adolescent program, significant improvements in pre-COVID cohorts was reported for PTSD (-31.3%, p=0.005), depression (-21.4%, p=0.03), anxiety (-31.3%, p=0.007)), and self-esteem (20.0%, p=0.005). Pre-COVID cohorts generally reported larger improvements than COVID-era cohorts. </p>

<p>Discussion/Conclusion<br>
This dissertation provides new knowledge in the field of child and adolescent mental health treatment and services. This is the first study to qualitatively investigate stakeholder perceptions of treatment success in a Canadian youth psychiatric inpatient unit. These interviews provided unique insights into the determinants of inpatient treatment outcomes.</p>

<p>Following this analysis, a novel multimodal treatment program specifically designed for youth survivors of CSA was evaluated. These studies provide examples of routine outcome collection as a method of assessing a novel residential child and adolescent mental health treatment program. The findings of this dissertation provide preliminary evidence that the intensive and multimodal design of the BRR is effective and appropriate for this population and warrants further longitudinal investigation with larger samples. The unexpected onset of the COVID-19 pandemic provided a unique opportunity to assess the pandemic’s impact on a vulnerable population. The results appeared to indicate that the pandemic induced treatment resistance in participants undergoing treatment, but further investigation is needed. Considering the well-established impact early-life trauma has on the onset and severity of mental illness, treatment approaches directed at specific experiences, such as CSA, may be more appropriate and effective for young people than those directed at treating symptoms or a specific diagnosis. Further investigation into best-practice approaches in CAMHS is needed. </p>