Background Flashcards
What is the cost-effectiveness of investing in IYS / in ensuring severe needs are met in IYS?
- cheaper to reduce transitions / handoffs / system redundancies
- [look up early intervention cost effectiveness]
- [read Jai’s economic eval]
What are the benefits of transdiagnostic approaches? Particularly for severe mental illnesses?
- comorbidities
- recovery oriented i.e. not a static label of illness
- reduce diagnostic siloes and wait times
Why are you focussing on the ”most severe” - often the most severe cases receive care and the “problem” is actually the missing middle; the sub-threshold cases that are difficult to fit into boxes.
- may be true, it’s a good question. actually almost first focussed on missing middle think this study very much aligns with that movement.
- the “missing middle” is also unclearly defined - part of this whole conversation of how measure and assess and operationalize needs. i don’t think the “middle” is a clear category either (i.e. middle of what, just subthreshold but possibly very complex?)
- I don’t believe the “most” are more important necessarily than the “middle” but I also don’t think these are clear categories - what we all have in common is a recognition that solutions aren’t necessarily benefiting all needs + needs are inconsistently defined.
Why is it important to look at most severe? Can IYS serve mild + moderate + severe needs?
- 69-77% of kids seeking help in IYS at least in 2017 were in the highest need categories (Hetrick review)
- very possible to conceive of a system where services for mild presentations are provided alongside more intensive services - stepped care for example with mild = peer support, mh lit, single session + more severe alongside
- actually needed for long term service provision, needs aren’t severe for lift, in recovery may want peer support, single session etc.
- kid shouldn’t have to learn the whole healthcare system and what they need and where it is to get help, they should be able to show up and be helped
Can you tell me more about the Canadian mh system and why it’s important to integrate care?
- current system - is no system
- Cdn healthcare system is GPs + specialist care by referral - psychiatrists
- also other mh services smattered across the country - schools, communities, private therapists…
- also ER, particularly for most severe cases
- all fragmented, all discoordinated, all unclear. If anything is physically wrong with you, you go to a doctor and they help you. If anything is mentally wrong with you, you have many unclear options that are inconsistently funded that don’t speak to each other that you have to figure out how to navigate and what you most need.
Why is Indigenous leadership important?
- colonial history - residential schools, hospitals, displacement, violence
- ongoing disparities; disproportionately high suicide / substance use rates
- western / biomedical services not often culturally relevant, culturally safe + historical distrust (i.e. hair cutting example)
- need for co-production and collaboration - shared leadership to ensure needs are met + limit harm + align with community conceptions of wellness
- AOM has an Ind advisory council, so does KHP
Why youth? How define youth?
- many definitions of youth - UN=15-24; StatsCan = 15-29
- KHP was “age agnostic”
- need for it - youth are a particularly vulnerable time - transitions, biology (brain devt) - need a space that’s suited particularly for these needs (can use peer support example)
- pro of capping - you preserve the space (i.e. no louder dude who feels youthy walks in); con of capping - always exclude someone
How kids access IYS? How get in?
What are the most frequent referral sources of IYS?
What do IYS do to improve awareness / outreach?
Are these variables fixed effect or time-varying?
What is meant by clinical stage in the BMC dataset?
Different measures in BMC (treatment utilization, comorbidities, suicide etc.)
https://bmjopen.bmj.com/content/bmjopen/10/3/e030985.full.pdf
Why is it helpful / necessary to look at ED presentation?
Are IYS intending to replace EDs?
- IYS should function as much as possible to offer mental health crisis support
- Interesting if IYS turn crises away to ER (Foundry)
- Youth with high needs not going to IYS
Why is pre-IYS a confounder?
- relates to both level of need + outcome
- pattern of behaviour might continue irrespective of IYS presentation
- muddies relationship between IYS + ED presentation
