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There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children's mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children's unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using individual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children's mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed. [ABSTRACT FROM AUTHOR]

Background: Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)—including, but not limited to, problems in inaccessibility and quality of services—are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices? Methods: The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity. Discussion: The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS. Systematic review registration: Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/. [ABSTRACT FROM AUTHOR]

This paper reports on the outcomes of an intensive collaborative community-based perinatal and infant mental health (PIMH) Day Program designed to improve the emotional-social wellbeing of mothers with a moderate to severe mental illness and attachment to their infant. Coordinated by the Queensland Centre for Perinatal and Infant Mental Health, Child and Youth Mental Health, Children's Health Queensland Hospital and Health Service, the program was delivered in 2016 to twenty six mother-infant dyads through an interagency partnership between adult mental health, child and youth mental health and community child health across two Hospital and Health Service sites in Queensland, Australia. The study resulted from recommendations of a pilot project conducted in Brisbane in 2009. An infant's developmental outcomes are predicated by their earliest attachment to their caregivers. It is estimated 40% to 60% of children whose parent has a mental illness are at risk to their mental wellbeing. With more than 16% of Australian women and 10% of fathers developing a perinatal mental illness, there is an identified gap in both the availability and flexibility of services to this vulnerable population. Evidence suggests that service delivery to perinatal mothers with complex mental health issues is typically 'siloed' and that treating maternal mental health alone does not improve outcomes for infants. The unique feature of the PIMH Day Program is the collaboration of three separate health services delivering one program to mothers and infants together. Cairns and Hinterland Hospital and Health Service (HHS) and Townsville HHS are two large regional cities located in north Queensland. Clinicians from adult mental health, child and youth mental health and child health from each HHS delivered three (3) six week (one day per week) perinatal and infant mental health programs between May to November 2016 through a collaborative and integrative methodology. Multidisciplinary clinicians from the three services worked together to deliver the program using a dedicated program manual. The intervention resulted in statistically significant improvements in pre-post quantitative measures relating to mother's emotional-social wellbeing and infant attachment, positive feedback from selfreport surveys on program elements, and engagement in post referral pathways. Clinicians reported high level satisfaction with the collaborative process, resource sharing and transfer of knowledge and skills. They support the intervention as a sustainable, effective and efficient model of service. The findings support the premise that interagency collaboration between health services brings about improved mental health outcomes for mothers with a mental illness and enhanced understanding and sensitivity to their infants. The study resulted in statistically significant results in both sites supporting the results of the 2009 study. This program demonstrates that collaboration, partnerships and integration across service boundaries and professional disciplines offers a promising opportunity to deliver a service that supports parenting and an infant's emotional-social development. The Day Program translates across settings while building workforce capacity in perinatal and infant mental health. [ABSTRACT FROM AUTHOR]