Objective

To examine the usage of a standardized screening tool bundle in guiding care recommendations within a regional coordinated access service (1Call1Click.ca) for children, youth and their families seeking mental health, addictions, and substance use health (MHASUH) care. To explore how the screening tools align with each other and with Level of Need, an assigned designation used to indicate acuity, needs, and guide service recommendations.

Method

Between May 31, 2021, and December 31, 2023, 8,280 clients aged 6–21 were administered the CASH screening tool bundle (CASH is an acronym for the included screening tools, the CRAFFT, Ask Suicide Questions {ASQ}, HEADS-ED (Over 6 and Under 6) and assigned a Level of Need (used to describe acuity and guide referrals). We describe the most common needs, correlations between Level of Need and each screening tool, and agreement between the HEADS-ED Domains of Suicidality and Drugs and alcohol with the ASQ and CRAFFT screening tools.

Results

We observe a significant moderate correlation (r(8,280) = .507, p < .001) between the total HEADS-ED score and the assigned Level of Need and significant differences in HEADS-ED total score between each Level of Need (F(4, 8,275) = 766.810, p < .001). Additionally, ASQ and CRAFFT results align with the Suicidality and Drugs and alcohol domains of the HEADS-ED. Referrals were accepted by services at a rate of 94.4%.

Conclusion

The CASH screening tool bundle is effective for screening child and youth MHASUH concerns. The HEADS-ED can give a non-specialist healthcare provider an overview of the nature and acuity of child and youth MHASUH and guide the application of more specialized tools included in the bundle. Used as described in this manuscript, the standardized screening bundle is a useful means for assessing needs and guiding referrals to specialized care, including in-depth specialized assessments.

Plain Language Summary Title

The CASH Bundle: a set of 3 screening tools used together at 1Call1Click.ca, a program designed to connect children and youth to the mental health, addictions, and substance use health care they need

Plain Language Summary

Screening tools are questionnaires that can help identify individuals at heightened risk for mental health, addictions, and substance use (MHASUH) challenges so they can be prioritized for more in-depth assessment and treatment. We examined the use of a set of screening tools (The CASH Bundle) in combination with each other. The CASH Bundle includes screening tools for substance use (the CRAFFT), suicide risk (the Ask Suicide Questions (ASQ)), and a general assessment screening tool for children and youth (the HEADS-ED (Over 6 and Under 6)).

The CASH bundle is used at 1Call1Click.ca, a program for infants, children, and youth struggling with MHASUH concerns to find the service that matches their needs. When someone contacts 1Call1Click.ca, they speak to a healthcare provider who uses the CASH Bundle to determine their Level of Need (a measure of severity that is linked to treatment types). The provider uses this information to connect the client directly to a local MHASUH treatment resource. This study included 8280 1Call1Click.ca clients aged 6 to 21 who were screened with the CASH bundle and assigned a Level of Need.

Our results showed that each of the tools in the CASH Bundle supported the healthcare providers' assessment of the clients' Level of Need.

The CASH Bundle can help healthcare providers quickly gain an overview of the client's MHASUH needs and determine which type and level of care those clients will benefit from the most. This is important because care resources are both limited and in high demand. Assigning care resources quickly, efficiently, and appropriately is critical to making the best use of available resources and making sure that people receive the care they need as quickly as possible.