12 Overcoming barriers to addressing youth-identified mental health needs following violent injury through multisystem partnerships

Statement of purpose To identify and address barriers to meeting mental health (MH) needs of violently injured youth participating in a post-injury hospital-based case management program. Methods/approach Utilising de-identified case notes from a stratified random sample of youth (n=24) receiving hospital-based case management following violent injury, we applied a social-ecological framework to code recurring themes pertaining to individual, family, and system barriers and facilitators to successful resolution of youth-identified MH needs. Results Common barriers included: school/work schedules; limited transportation; prior negative experiences with MH care; insufficient provider availability; premature termination of care; and challenging communication between program staff, MH providers, and families. Notably, insurance and cost barriers were infrequently documented, as most youth were insured via a widely accepted public payer. Barriers to initiation of MH care were addressed by streamlining referral processes to community-based MH providers and providing a warm-hand off to reduce youth and family hesitancy to initiate care. To promote engagement and adherence, staff highlighted positive MH experiences and validated therapeutic outcomes, provided logistical support such as transportation and, when possible, provided short-term in-home therapy. Staff also routinely communicated with local MH providers to coordinate care, support transition planning, and encourage adherence. Conclusions We observed individual, family, and systems barriers to youths’ ability to engage in MH care. Support of strong, consistent, positive interpersonal relationships between program staff, injured youth, families, and MH providers addressed many barriers and supported resolution of youths’ MH needs. Significance and Contributions to Injury and Violence Prevention Science Access to trauma-focused mental health services for violently injured youth is essential to facilitate recovery. Partnerships between hospital- and community-based programs may be particularly valuable in addressing mental health barriers among youth following violent injury. Further efforts to systematise and replicate multisystem partnerships will be important in promoting well-being and recovery following violent injury.