Specialist care of children with complex needs: Insights from comparison of child development and child mental health clinics

Abstract

Paediatricians and child psychiatrists review children with complex comorbidity, noting similarities between tertiary Child Development Service (CDS) and Child and Youth Mental Health Service (CYMHS) cohorts. Mental health comorbidity is common in developmental services. Developmental comorbidity in mental health cohorts is uncharacterised. The study aimed to describe CDS and CYMHS cohorts using measures of child development, mental health, physical health and psychosocial risk. A questionnaire was completed by parents of CDS and CYMHS new clients aged 4-11. It included measures of mental health symptoms, child development, physical health, stressful life events, family functioning, parent mental health and socio-economic variables. Sample rates were compared to population norms. CDS and CYMHS cohorts were compared. The study population had elevated rates of psychosocial risk, family dysfunction, physical illness, developmental risk and mental health symptoms. CDS had higher levels of developmental risk and family dysfunction. Most CDS clients (81%) had mental health difficulties. CYMHS clients were older, and had more mental health symptoms, stressful life events and child safety contact; 81% of CYMHS clients demonstrated developmental risk. CDS and CYMHS had similar socio-demographic profiles and parent mental health difficulties, and similarly high rates of physical health problems. Consideration should be given to mental health screening and support in CDS, and to developmental screening in CYMHS. Both services support at-risk children with complex developmental, mental health and physical co-morbidity necessitating shared approaches to clinical and population health, including care integration, and collaborative cross-disciplinary models of service provision and training, and advocacy.