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Giving youth a voice: breaking barriers to better care

Dr. Joanna Henderson’s career began with kids who started fires. As a graduate student at the University of Toronto, she volunteered with TAPP-C, the arson-prevention program at CAMH. The nature of the issue demanded collaboration among vastly different groups—fire prevention teams, child welfare services, and mental health organizations.
 
“I built a lot of skills around thinking very broadly and connecting people who had previously been disconnected,” she says.
 
This was back in 1993. Today, she is a clinical psychologist and full-time scientist in the Child, Youth and Family Program at CAMH, having made her way up the ranks. And she’s still working with children and young adults—examining their competing needs, connecting them with services, and bridging gaps in treatment.
 
When she started, there was little evidence to support the development and implementation of collaborative programs in youth services. Dr. Henderson sought to change that when she began working with CAMH’s Youth Addictions Service. “My goals included extending the service so it had a concurrent-disorders focus [treating youth with multiple issues], viewed through an evidence-based practice lens.”
 
Finding that evidence has fuelled her research ever since.
  
A better start
 
Why focus on youth? For Dr. Henderson there are myriad reasons. Current youth services are directed toward those aged 12 to 24, a period of rapid development and change, which current systems of care don’t take into account.
 
“There is a fallacy of thinking of children and youth share a lot of commonalities as a group,” she says, “when really where a 12-year-old is and where a 20-year-old is, in terms of needs and complexity of care, can be vastly different.”
 
There is also a discord in the transition from youth to adult services. Often the breach is too wide, with 17- or 18-year-olds pushed into adult services without any clear strategy to prepare them and ensure they’re using the programs effectively. Services for adults, conversely, may be better equipped to deal with those in their 30s and 40s and do not have the capacity to take on challenges of those on the threshold of adulthood.

And perhaps most importantly, as youth are still developing, there are opportunities for prevention. Most adults who are affected by mental health or substance abuse issues show signs in adolescence, when the onset of these usually begin.
 
“From my perspective, anything we do in childhood or in adolescence is really about preventing adult difficulties. Youth have so much strength, and perhaps are not quite yet as affected as adults with long histories and substance abuse issues.”
 
Opening doors
 
Dr. Henderson has recently spearheaded a series of focus groups in Manitoba, Ontario, PEI, Nova Scotia and Newfoundland with patients and services providers to ascertain why some youth can’t, and don’t, access services. She’s learned that transportation to get to appointments can be a significant obstacle in rural areas.  Social determinants of health—getting enough food, having a safe place to live, and generating income—affect whether treatment is prioritized. And she’s realized that the system is not flexible to youth. All these factors work together against youth seeking services.
 
Case in point: “Most of our services are offered from 9 to 5, Monday to Friday. So if you’re concerned about whether or not you can afford to eat or help pay rent and you have a part-time job, you have to choose between getting treatment or making money. Treatment becomes a secondary concern.”
 
Forging smooth pathways to treatment also involves linking service provides to ensure optimal care. Currently, models of care tend to operate in silos, and Dr. Henderson is working hard to change that.
 
“In our current youth system,” she explains, “if you have an addiction to a substance and experience psychotic episodes, mental health service providers may say they can’t help you until you clear the addiction. Or conversely, if you seek treatment for addiction, but have had suicidal thoughts, you could be told ‘That’s too serious for us, you need to go to the mental health providers.’”
 
Because substance abuse is often linked to mental health conditions and vice versa, it is necessary and makes sense to treat them together, she says. To help ensure youth get access to all the services they need, she’s worked with communities across Canada to implement a common, validated screening tool (GAIN-SS) that targets both addiction and mental health issues. When identified together, they can be treated together.
 
Taking action
 
Dr. Henderson advocates strongly for giving youth a voice and through the Child, Youth and Family Program has just hired two youth with lived experience to lead an initiative to build an advisory committee with other youth to transform the youth mental health system. Nearly 100 people from across Canada have signed on.
 
Dr. Henderson spent her own adolescence lost in books. By chance, she began reading about youth who seemed unreachable, and the interest persisted. “I was really drawn to the idea that there were people out there who society gave up on, and I wanted that to change. It was a fundamental sense of justice to me.”
 
 
 
 
Dr. Joanna Henderson is an Independent Clinician Scientist and Head of Research at the Child, Youth & Family Program at CAMH.
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