The Role of Ontario's First School-Based Health Clinic in Accessing Developmental and Mental Health Care for Children from Inner City Elementary Schools: A Retrospective Chart Review.
CPS ePoster Library. Cheung A. 06/01/17; 176576; 15
Arnold Cheung
Arnold Cheung
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Background: Children with developmental and mental health challenges face an uphill battle to reach the academic milestones of their peers. These challenges are exacerbated by social inequity. Early access to developmental and mental health assessments has been shown to improve long-term outcomes. Unfortunately, the wait-time for developmental assessment in Ontario is 15.5 months and the wait-time for mental health assessment in Ontario has not been well documented. The first School-Based Health Clinic (SBHC) in Ontario was established through the Model Schools Pediatric Health Initiative as a partnership between St. Michael's Hospital and the Toronto District School Board. The clinic was modeled after SBHCs in the United States which provide comprehensive medical and mental health care to underserved children. A feasibility study conducted in 2012 during the first eight months of the program demonstrated 20% of SBHC users went on to receive a developmental assessment. The current proportion of users receiving a developmental or mental health assessment at the SBHC and wait-times to assessment has not been explored.

Objectives: To assess the impact of a School-Based Health Clinic on wait-times for developmental assessments and mental health care for inner-city children.

Methods: A retrospective chart review was performed on 404 children aged 4-14 with at least one visit to an inner-city School-Based Health Clinic from 2011-2014. Developmental impact measures included the proportion of children presenting with a developmental concern and the wait-time for receiving a developmental assessment. Mental health impact measures included the proportion of children with mental health concerns, proportion of children with new mental health diagnoses, proportion of children receiving a referral to a mental health professional, and wait-times for receiving a mental health diagnosis.

Results: Of the 404 children with at least one visit to the School-Based Health Clinic, 71.3% had a developmental concern and the wait-time for receiving a developmental assessment was 27.6 weeks. Mean age of children receiving a developmental assessment was 7.0 years. With respect to mental health impact, 55.9% presented to the school clinic with at least one mental health concern, 13.6% received a new mental health diagnosis including at least one of attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, depression, anxiety disorder, or selective mutism, and 25.7% of the children received a referral to a psychiatrist or psychologist. The wait-time for receiving a mental health diagnosis was 27.1 weeks.

Conclusion: School-Based Health Clinics are an effective and feasible model to decrease wait-times for receiving developmental assessments and to provide mental health services to inner-city children.

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