The Development of Quality Indicators to Assess Family Wellbeing Outcomes Following Engagement with Children’s Mental Health Services in Ontario, Canada

• Shannon L. Stewart ^[1] ; Boden D. Brock ^[1] ; Abigail Withers ^[1] ; Renee M. Guerville ^[1] ; John N. Morris ; Jeffrey W. Poss ^[2]
  1. [1] University of Western Ontario

     University of Western Ontario

     Canadá

     
  2. [2] University of Waterloo

     University of Waterloo

     Canadá

     
• Localización: EJIHPE: European Journal of Investigation in Health, Psychology and Education, ISSN 2174-8144, ISSN-e 2254-9625, Vol. 15, Nº. 10, 2025, págs. 212-212
• Idioma: inglés
• DOI: 10.3390/ejihpe15100212
• Enlaces
  • Texto completo
• Resumen

  • (1) Background: Caregivers and families of children involved with mental health services face unique challenges. In Ontario, there is a dearth of information on outcomes for families following a child’s involvement with mental health services. Metrics known as Quality Indicators (QIs) offer a way to better understand these outcomes. Importantly, QIs can be risk adjusted to account for the influence of client complexity to allow for fair inter-agency comparisons. This study developed a set of risk-adjusted caregiver/family outcome QIs for children’s mental healthcare agencies. (2) Methods: Archival data from widely implemented interRAI child and youth assessment instruments was used. Previous methodology for QI calculation and risk adjustment was adapted and tested. (3) Results: Utilizing the interRAI suite of child and youth assessment instruments, a set of six QIs focusing on improvement or decline in parenting strengths, caregiver distress, and family functioning were developed. (4) Conclusions: The QIs established were sufficiently independent to represent different aspects of family wellbeing while the risk adjustment strategy developed was useful in removing client complexity from QI calculation. Implications for future directions, including the use of QIs at a systems level to more accurately direct resources and set performance benchmarks, are discussed.

• Referencias bibliográficas
  • Abidin, R. R. (1992). The determinants of parenting behaviour. Journal of Clinical Child Psychology, 21(4), 407–412.
  • Afzal, N., Ye, S., Page, A. C., Trickey, D., Lyttle, M. D., Hiller, R. M., & Halligan, S. L. (2023). A systematic literature review of...
  • Almas, A. N., Grusec, J. E., & Tackett, J. L. (2011). Children’s disclosure and secrecy: Links to maternal parenting characteristics and children’s...
  • Alvarez-Subiela, X., Castellano-Tejedor, C., Villar-Cabeza, F., Vila-Grifoll, M., & Palao-Vidal, D. (2022). Family factors related to...
  • Amrock, S. M., & Weitzman, M. (2014). Parental psychological distress and children’s mental health: Results of a national survey. Academic...
  • Anthony, L. G., Anthony, B. J., Glanville, D. N., Naiman, D. Q., Waanders, C., & Shaffer, S. (2005). The relationships between parenting stress,...
  • Auditor General of Ontario. (2025). Performance audit: Community-based child and youth mental health program. Available online: https://auditor.on.ca/en/content/annualreports/arreports/en25/pa_CYMH_en25.pdf...
  • Bahmani, T., Naseri, N. S., & Fariborzi, E. (2023). Relation of parenting child abuse based on attachment styles, parenting styles, and parental...
  • Bailey, K., Lee, S., De Los Reyes, T., Lo, L., Cleverley, K., Pidduck, J., Mahood, Q., Gorter, J. W., & Toulany, A. (2022). Quality indicators for...
  • Baumrind, D. (2013). Authoritative Parenting Revisited: History and Current Status. In R. E. Larzelere, A. S. Morris, & A. W. Harrist (Eds.),...
  • Berg, K., Mor, V., Morris, J., Murphy, K. M., Moore, T., & Harris, Y. (2002). Identification and evaluation of existing nursing homes quality...
  • Berla, N., Peisch, V., Thacher, A., Pearlstein, J., Dowdle, C., Geraghty, S., & Cosgrove, V. (2022). All in the family: How parental criticism impacts...
  • Biswas, S., Moghaddam, N., & Tickle, A. (2015). What are the factors that influence parental stress when caring for a child with an intellectual...
  • Bowden, C. F., Worsley, D., Pettit, A. R., & Doupnik, S. K. (2022). Caregiver experiences during their child’s acute medical hospitalization for...
  • Bronfenbrenner, U. (1986). Ecology of the family as a context for human development: Research perspectives. Developmental Psychology, 22(6),...
  • Canadian Institute for Health Information. (2013). CCRS Quality indicators risk adjustment methodology. Available online: https:// www.cihi.ca/sites/default/files/document/ccrs_qi_risk_adj_meth_2013_en_0.pdf...
  • Chng, G. S., Wild, E., Hollmann, J., & Otterpohl, N. (2014). Children’s evaluative skills in informal reasoning: The role of parenting practices...
  • Christou, A. I., Fanti, K., Mavrommatis, I., Soursou, G., Pergantis, P., & Drigas, A. (2025). Social affiliation and attention to angry...
  • Cooke, J. E., Deneault, A., Devereux, C., Eirich, R., Fearon, R. M. P., & Madigan, S. (2022). Parental sensitivity and child behavioral problems:...
  • Creswell, C., Violato, M., Fairbanks, H., White, E., Parkinson, M., Abitabile, G., Leidi, A., & Cooper, P. J. (2017). Clinical outcomes...
  • Crnic, K., & Ross, E. (2017). Parenting stress and parental efficacy. In K. Deater-Deckard, & R. Panneton (Eds.), Parental stress...
  • Darling, N., & Steinberg, L. (1993). Parenting style as context: An integrative model. Psychological Bulletin, 103(3), 487–496.
  • Deckert, A., Runge-Ranzinger, S., Banaschewski, T., Horstick, O., Elwishahy, A., Olarte-Peña, M., Faber, C., Müller, T., Brugnara, L., Thom,...
  • Desquenne Godfrey, G., Downes, N., & Cappe, E. (2024). A systematic review of family functioning in families of children on the autism...
  • Donabedian, A. (1983). Quality assessment and monitoring: Retrospect and prospect. Evaluation and the Health Professions, 6(3), 363–375.
  • Donabedian, A. (1985). Twenty years of research on the quality of medical care: 1964–1984. Evaluation and the Health Professions, 8(3), 243–265.
  • Donabedian, A. (2005). Evaluating the quality of medical care. The Milbank Memorial Fund Quarterly, 44(3), 691–729.
  • Downey, C., & Crummy, A. (2022). The impact of childhood trauma on children’s wellbeing and adult behavior. European Journal of Trauma...
  • Duncan, L., Boyle, M. H., Abelson, J., & Waddell, C. (2018). Measuring children’s mental health in Ontario: Policy issues and prospects for...
  • Dunst, C. J. (2023). A meta-analysis of informal and formal family social support studies: Relationships with parent and family psychological...
  • Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: A method for continuous quality improvement in health. Healthcare Policy|Politiques...
  • Fang, Y., Luo, J., Boele, M., Windhorst, D., Van Grieken, A., & Raat, H. (2024). Parent, child, and situational factors associated with parenting...
  • Feldman, M. A., & Aunos, M. (2020). Recent trends and future directions in research regarding parents with intellectual and developmental...
  • Fernández-Alonso, R., Álvarez-Díaz, M., Woitschach, P., Suárez-Álvarez, J., & Cuesta, M. (2017). Parental involvement and academic performance:...
  • Ferrey, A. E., Hughes, N. D., Simkin, S., Locock, L., Stewart, A., Kapur, N., Gunnell, D., & Hawton, K. (2016). The impact of self-harm by...
  • Fonseca, A., Moreira, H., & Canavarro, M. C. (2020). Uncovering the links between parenting stress and parenting styles: The role of psychological...
  • Forehand, R., Jones, D. J., & Parent, J. (2013). Behavioral parenting interventions for child disruptive behaviors and anxiety: What’s different...
  • Friedberg, R. D., & McClure, J. M. (2015). Clinical practice of cognitive therapy with children and adolescents: The nuts and bolts (2nd...
  • Gallant, C., & Good, D. (2023). Mental health complexity among children and youth: Current conceptualizations and future directions. Canadian...
  • Gana, M., Rad, D., & Stoian, C. (2024). Family functioning, parental attachment and students’ academic success. Journal of Infrastructure, Policy...
  • Gao, Y., Wang, Y., Wang, Z., Ma, M., Li, H., Wang, J., Liu, J., Qian, H., Zhu, P., & Xu, X. (2024). Family intimacy and adaptability and non-suicidal...
  • Gaspar, T., Gomez-Baya, D., Trindade, J. S., Botelho Guedes, F., Cerqueira, A., & De Matos, M. G. (2022). Relationship between family functioning,...
  • González Moreno, A., & Molero Jurado, M. D. M. (2022). The Moderating role of family functionality in prosocial behaviour and school climate...
  • Goudie, A., Narcisse, M.-R., Hall, D. E., & Kuo, D. Z. (2014). Financial and psychological stressors associated with caring for children with...
  • Gouin, J., Da Estrela, C., Desmarais, K., & Barker, E. T. (2016). The impact of formal and informal support on health in the context of caregiving...
  • Government of Ontario. (2019). Developing and implementing a needs-based autism program. Available online: https://www.ontario.ca/ page/developing-implementing-needs-based-autism-program...
  • Gray, D. E. (2006). Coping over time: The parents of children with autism. Journal of Intellectual Disability Research, 50(12), 970–976.
  • Greenspan, S., Harris, J. C., & Woods, G. W. (2015). Intellectual disability is “a condition, not a number”: Ethics of IQ cut-offs in psychiatry,...
  • Grey, E. B., Atkinson, L., Chater, A., Gahagan, A., Tran, A., & Gillison, F. B. (2022). A systematic review of the evidence on the effect...
  • Guthrie, D. M., Williams, N., Beach, C., Buzath, E., Cohen, J., Declercq, A., Fisher, K., Fries, B. E., Goodridge, D., Hermans, K., Hirdes,...
  • Hadjicharalambous, D. D., & Demetriou, D. L. (2021). Investigating the influences of parental stress on parents parenting practices. International...
  • Hayes, S. A., & Watson, S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress...
  • Heifetz, M., Brown, H. K., Chacra, M. A., Tint, A., Vigod, S., Bluestein, D., & Lunsky, Y. (2019). Mental health challenges and resilience among...
  • Heinrich, C. J. (2014). Parents’ employment and children’s wellbeing. The Future of Children, 24(1), 121–146.
  • Hermann, R. C., Rollins, C. K., & Chan, J. A. (2007). Risk-Adjusting Outcomes of Mental Health and Substance-Related Care: A Review of...
  • Heshmati, A., Honkaniemi, H., & Juárez, S. P. (2023). The effect of parental leave on parents’ mental health: A systematic review. The Lancet...
  • Hooper, A., Hustedt, J. T., Slicker, G., Hallam, R. A., & Gaviria-Loaiza, J. (2023). Linking early head start children’s social–emotional functioning...
  • Houseworth, J., Kilaberia, T., Ticha, R., & Abery, B. (2022). Risk adjustment in home and community based services outcome measurement....
  • Hutchison, L., Feder, M., Abar, B., & Winsler, A. (2016). Relations between parenting stress, parenting style, and child executive functioning...
  • Izzo, F., Baiocco, R., & Pistella, J. (2022). Children’s and adolescents’ happiness and family functioning: A systematic literature review. International...
  • Jones, R. N., Hirdes, J. P., Poss, J. W., Kelly, M., Berg, K., Fries, B. E., & Morris, J. N. (2010). Adjustment of nursing home quality indicators....
  • Junek, W. (2012). Government monitoring of the mental health of children in Canada: Five surveys (Part I). Journal of Canadian Academic Child...
  • Kamis, C. (2021). The long-term impact of parental mental health on children’s distress trajectories in adulthood. Society and Mental Health,...
  • Keijsers, L., & Poulin, F. (2013). Developmental changes in parent–child communication throughout adolescence. Developmental Psychology,...
  • Kelada, L., Hasking, P., & Melvin, G. (2016). The relationship between nonsuicidal self-injury and family functioning: Adolescent and parent...
  • Khaleque, A. (2013). Perceived parental warmth, and children’s psychological adjustment, and personality dispositions: A meta-analysis. Journal...
  • Kiani, B., Hojatkhah, S. M., & Torabi-Nami, M. (2016). Family functioning, identity formation, and the ability of conflict resolution among...
  • Knafl, K. A., Darney, B. G., Gallo, A. M., & Angst, D. B. (2010). Parental perceptions of the outcome and meaning of normalization. Research...
  • Koerber, M. I., Mack, J. T., Seefeld, L., Kopp, M., Weise, V., Starke, K. R., & Garthus-Niegel, S. (2023). Psychosocial work stress and parent-child...
  • Kroneman, L. M., Loeber, R., Hipwell, A. E., & Koot, H. M. (2009). Girls’ disruptive behavior and its relationship to family functioning: A...
  • Lane-Fall, M. B., & Neuman, M. D. (2013). Outcomes measures and risk adjustment. International Anesthesiology Clinics, 51(4), 10–21.
  • Lansford, J. E. (2022). Annual Research Review: Cross-cultural similarities and differences in parenting. Journal of Child Psychology and Psychiatry,...
  • Li, X., Liu, J., Hu, Y., Huang, X., Li, Y., Li, Y., Shi, Z., Yang, R., Peng, H., Ma, S., Wan, X., & Peng, W. (2025). The association of...
  • Lin, F.-Y., Rong, J.-R., & Lee. (2013). Resilience among caregivers of children with chronic conditions: A concept analysis. Journal of Multidisciplinary...
  • Lin, X., Yang, W., Xie, W., & Li, H. (2023). The integrative role of parenting styles and parental involvement in young children’s science problem-solving...
  • Lin, Y.-C., Washington-Nortey, P.-M., Hill, O. W., & Serpell, Z. N. (2019). Family functioning and not family structure predicts adolescents’...
  • Lipschitz, J. M., Yen, S., Weinstock, L. M., & Spirito, A. (2012). Adolescent and caregiver perception of family functioning: Relation...
  • Mackler, J. S., Kelleher, R. T., Shanahan, L., Calkins, S. D., Keane, S. P., & O’Brien, M. (2015). Parenting stress, parental reactions,...
  • Masarik, A. S., & Conger, R. D. (2017). Stress and child development: A review of the Family Stress Model. Current Opinion in Psychology,...
  • McDermott, B. M., & Cobham, V. E. (2012). Family functioning in the aftermath of a natural disaster. BMC Psychiatry, 12(1), 55.
  • Mendenhall, A. N., & Mount, K. (2011). Parents of children with mental illness: Exploring the caregiver experience and caregiver-focused...
  • Mesman, J., Stoel, R., Bakermans-Kranenburg, M. J., Van IJzendoorn, M. H., Juffer, F., Koot, H. M., & Alink, L. R. A. (2009). Predicting growth...
  • Mitchell, L. A., Hirdes, J., Poss, J. W., Slegers-Boyd, C., Caldarelli, H., & Martin, L. (2015). Informal caregivers of clients with neurological conditions:...
  • Morris, J. N., Fries, B. E., Frijters, D., Hirdes, J. P., & Steel, R. K. (2013). interRAI home care quality indicators. BMC Geriatrics,...
  • Nerenz, D. R., Austin, J. M., Deutscher, D., Maddox, K. E. J., Nuccio, E. J., Teigland, C., Weinhandl, E., & Glance, L. G. (2021). Adjusting quality...
  • Oltean, I. I., Perlman, C., Meyer, S., & Ferro, M. A. (2020). Child mental illness and mental health service use: Role of family functioning (family...
  • Ono, E., Friedlander, R., & Salih, T. (2019). Falling through the cracks: How service gaps leave children with neurodevelopmental disorders...
  • Penner, M., Anagnostou, E., & Ungar, W. J. (2018). Practice patterns and determinants of wait time for autism spectrum disorder diagnosis...
  • Pinquart, M. (2017a). Associations of parenting dimensions and styles with externalizing problems of children and adolescents: An updated...
  • Pinquart, M. (2017b). Associations of parenting dimensions and styles with internalizing symptoms in children and adolescents: A meta-analysis....
  • Polizzi, C., Burgio, S., Lavanco, G., & Alesi, M. (2021). Parental distress and perception of children’s executive functioning after the...
  • Priego-Ojeda, M., & Rusu, P. P. (2023). Emotion regulation, parental stress and family functioning: Families of children with disabilities vs....
  • Qian, G., Li, B., Xu, L., Ai, S., Li, X., Lei, X., & Dou, G. (2024). Parenting style and young children’s executive function mediate the relationship...
  • Ramalho, A., Castro, P., Gonçalves-Pinho, M., Teixeira, J., Santos, J. V., Viana, J., Lobo, M., Santos, P., & Freitas, A. (2019). Primary health...
  • Raphael, H., Clarke, G., & Kumar, S. (2006). Exploring parents’ responses to their child’s deliberate self-harm. Health Education, 106(1), 9–20.
  • Rayan, A., Harb, A. M., Baqeas, M. H., Al.Khashashneh, O. Z., & Harb, E. (2022). The relationship of family and school environments with...
  • Ren, Y., Lin, M., Liu, Y., Zhang, X., Wu, J. Y., Hu, W., Xu, S., & You, J. (2018). The mediating role of coping strategy in the association between...
  • Riesch, S. K., Anderson, L. S., & Krueger, H. A. (2006). Parent–child communication processes: Preventing children’s health-risk behavior....
  • Rinaldi, C. M., & Howe, N. (2012). Mothers’ and fathers’ parenting styles and associations with toddlers’ externalizing, internalizing, and...
  • Ringer, N., Wilder, J., Scheja, M., & Gustavsson, A. (2020). Managing children with challenging behaviours. Parents’ meaning-making processes...
  • Roopnarine, J. L., Krishnakumar, A., Metindogan, A., & Evans, M. (2006). Links between parenting styles, parent–child academic interaction,...
  • Rudasill, K. M., Adelson, J. L., Callahan, C. M., Houlihan, D. V., & Keizer, B. M. (2013). Gifted students’ perceptions of parenting styles: Associations...
  • Sadiq Sangawi, H., Adams, J., & Reissland, N. (2015). The effects of parenting styles on behavioral problems in primary school children: A...
  • Samartzis, L., & Talias, M. A. (2019). Assessing and improving the quality in mental health services. International Journal of Environmental Research...
  • Sameroff, A. (2009). The transactional model of development: How children and contexts shape each other. American Psychological Association.
  • Sarmadi, Y., & Khodabakhshi-Koolaee, A. (2023). Psychological and social consequences of divorce emphasis on children well-being: A systematic...
  • Scarlett, H., Moirangthem, S., & Van Der Waerden, J. (2024). The impact of paternal mental illness on child development: An umbrella review...
  • Sege, R. D., Siegel, B. S., Council on Child Abuse and Neglect, Committee on Psychosocial Aspects of Child and Family Health, Flaherty, E....
  • Seipp, V., Hagelweide, K., Stark, R., Weigelt, S., Christiansen, H., Kieser, M., Otto, K., Reck, C., Steinmayr, R., Wirthwein, L., Zietlow,...
  • Sherman, M. D., & Hooker, S. A. (2018). Supporting families managing parental mental illness: Challenges and resources. The International...
  • Sloover, M., Stoltz, S. E. M. J., & Van Ee, E. (2024). Parent–child communication about potentially traumatic events: A systematic review. Trauma,...
  • Solem, M.-B., Christophersen, K.-A., & Martinussen, M. (2011). Predicting parenting stress: Children’s behavioural problems and parents’...
  • Steele, H., Bate, J., Steele, M., Dube, S. R., Danskin, K., Knafo, H., Nikitiades, A., Bonuck, K., Meissner, P., & Murphy, A. (2016)....
  • Stewart, S. L., Celebre, A., Semovski, V., Hirdes, J. P., Vadeboncoeur, C., & Poss, J. W. (2022). The interRAI child and youth suite of mental...
  • Stewart, S. L., Hirdes, J. P., Curtin-Telegdi, N., Perlman, C., MacLeod, K., Ninan, A., Hall, M., Currie, M., Carson, S., Morris, J. N., Berg, K.,...
  • Stewart, S. L., Lapshina, N., & Semovski, V. (2021a). Interpersonal polyvictimization: Addressing the care planning needs of traumatized children...
  • Stewart, S. L., Toohey, A., & Poss, J. W. (2021b). iCCareD: The development of an algorithm to identify factors associated with distress among...
  • Stewart, S. L., Vasudeva, A., Hirdes, J. P., & Poss, J. W. (n.d.). Resource intensity in children and youth: Capturing characteristics...
  • Swartz, K., & Collins, L. G. (2019). Caregiver Care. American Familt Physician, 99(11), 699–706.
  • United Nations (UN). (2024). List of least developed countries (as of 19 December 2024). Available online: https://www.un.org/ development/desa/dpad/wp-content/uploads/sites/45/publication/ldc_list.pdf...
  • Wang, W., & Li, M. (2023). Daily work stress and parent-to-child aggression: Moderation of grandparent coresidence. Chinese Sociological Review,...
  • Whitlock, J., Lloyd-Richardson, E., Fisseha, F., & Bates, T. (2018). Parental secondary stress: The often hidden consequences of nonsuicidal...
  • Whittle, S., Pozzi, E., Rakesh, D., Kim, J. M., Yap, M. B. H., Schwartz, O. S., Youssef, G., Allen, N. B., & Vijayakumar, N. (2022). Harsh and...
  • Whittle, S., Zhang, L., & Rakesh, D. (2025). Environmental and neurodevelopmental contributors to youth mental illness. Neuropsychopharmacology,...
  • Wiggers, M., & Paas, F. (2022). Harsh physical discipline and externalizing behaviors in children: A systematic review. International Journal...
  • Wilcoxon, L. A., Meiser-Stedman, R., & Burgess, A. (2021). Post-traumatic stress disorder in parents following their child’s single-event trauma:...
  • Yang, J., Kurdyak, P., & Guttmann, A. (2016). Developing indicators for the child and youth mental health system in ontario. Healthcare Quarterly,...
  • Zapf, H., Boettcher, J., Haukeland, Y., Orm, S., Coslar, S., & Fjermestad, K. (2024). A systematic review of the association between parent-child...
  • Zhang, Y. (2020). Quality matters more than quantity: Parent–child communication and adolescents’ academic performance. Frontiers in Psychology,...