title: Program manager perspectives on the service system to meet the needs of youth with concurrent disorders: findings from a Canadian national survey.
abstract: BACKGROUND
  Concurrent mental health and substance use issues are a serious problem for adolescents and transition-aged youth. Service providers across sectors must be involved in informing system change to meet youth needs. This study examines stakeholder perspectives on services for youth with concurrent disorders including 1) clinical issues in youth services; 2) priority system issues; and 3) optimal knowledge translation strategies to enhance researcher-stakeholder communication.
  
  
  METHODS
  A database of youth clinical services across Canada was developed. Program managers (n = 481) at cross-sectoral (mental health, addictions, justice, child welfare, advocacy, and outreach) youth-serving (aged 12-24) programs were invited to complete an online survey; 232 responded. Survey questions concerned youth needs, program characteristics, priorities for service system enhancement; and usual and preferred knowledge translation methods.
  
  
  RESULTS
  Across service sectors, the mean estimated proportion of youth using services with concurrent mental health and substance use problems was 55%. Program managers reported routine screening for mental health and substance use concerns (66%), referring to other agencies to meet the concurrent disorder needs of youth (54%), offering specific programming for concurrent disorders (42%), and program evaluation (48%). Notably, mental health programs were significantly less likely to offer concurrent disorders services than addictions programs. Where services do exist, most are targeted at youth aged 12-18 years, with fewer services available for transition-aged youth. Endorsement of various system change goals exceeded 80%, with a particular emphasis on improving access to services (49%), ensuring a continuum of services for varying levels of severity (37%), and improved integration across sectors (36%). Preferred knowledge exchange methods were workshops and websites for receiving information; and focus groups or surveys, rather than intensive participation on research teams, to inform research.
  
  
  CONCLUSIONS
  There is a high need to build capacity across most sectors for meeting the needs of youth with co-occurring mental health and substance use problems, especially for transition-aged youth. In addition, limits in program evaluation should be addressed. Innovative knowledge exchange strategies are needed to better meet the needs of youth with concurrent disorders. Although service providers expressed readiness to participate in service enhancement and knowledge translation activities, effective, feasible approaches must integrate strategies likely to result in desired clinical outcomes, given clinical workload challenges.
authors.affiliation: Child Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Canada. joanna.henderson@camh.ca.|Department of Psychiatry, University of Toronto, Toronto, Canada. joanna.henderson@camh.ca.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Henderson
authors.affiliation: Child Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Gloria
authors.initials: G
authors.lastname: Chaim
authors.affiliation: Hospital for Sick Children, Toronto, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Luca
authors.affiliation: Child Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: E B
authors.initials: EB
authors.lastname: Brownlie
authors.affiliation: Child Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Rosenkranz
authors.affiliation: Child Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Tracey A
authors.initials: TA
authors.lastname: Skilling
authors.affiliation: Child Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Beitchman
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002669:Child Welfare; D015897:Comorbidity; D003695:Delivery of Health Care; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006270:Health Facility Administrators; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D019966:Substance-Related Disorders; D057170:Translational Research, Biomedical; D055815:Young Adult