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Rethinking service design for youth with mental health needs: The
development of the Youth Wellness Centre, St. Joseph's Healthcare Hamilton

Article in Early Intervention in Psychiatry · November 2019

DOI: 10.1111/eip.12904

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Received: 3 January 2019 Revised: 4 October 2019 Accepted: 31 October 2019
DOI: 10.1111/eip.12904

EARLY INTERVENTION IN THE REAL WORLD

Rethinking service design for youth with mental health needs:

The development of the Youth Wellness Centre, St. Joseph's
Healthcare Hamilton

Alyssa Wang1 | Juliana I. Tobon1,2 | Peter Bieling1,2 | Lisa Jeffs2 |

3 4,5
Eamon Colvin | Robert B. Zipursky

1
Department of Psychiatry and Behavioural
Neurosciences, McMaster University,
Hamilton, Ontario, Canada
2
Youth Wellness Centre, St. Joseph's
Healthcare Hamilton, Hamilton, Ontario,
Canada
3
School of Psychology, University of Ottawa,
Ottawa, Ontario, Canada
4
Centre for Addiction and Mental Health,
Toronto, Ontario, Canada
5
Department of Psychiatry, University of
Toronto, Toronto, Ontario, Canada
Correspondence
Alyssa Wang, Department of Psychiatry and
Behavioural Neurosciences, St. Joseph's
Healthcare Hamilton, West 5th Campus,
100 West 5th Street, Hamilton, ON L9C 0E3,
Canada.
Email: alyssa.wang@medportal.ca
Abstract
Aim: This article describes the development and design of the Youth Wellness Centre
(YWC), an innovative, youth-friendly centre providing mental health and addiction
services for emerging adults aged 17 to 25 in Hamilton, Canada. We also report on
demographic and clinical characteristics of clients to evaluate how the YWC is serv-
ing populations at increased risk of developing mental disorders.
Methods: Data were extracted from clinic databases for 1520 youth at the YWC
between March 2015 and 2018 to report on demographic characteristics, clinical
profiles, primary presenting problems, service use and overall satisfaction with
services.
Results: Marginalized groups, particularly street-involved individuals and LGBTQ+
youth, are highly represented at the YWC, keeping with the centre's mandate of
reaching at-risk populations. Youth at the YWC carry significant mental health bur-
dens, with 80.8% having a history of suicidal ideation and 32.8% having a history of a
substance use disorder. The primary route of referral is self-referral and the number
of new clients has increased by nearly 20% in the first 3 years of operations. Overall
satisfaction with the centre is on par with or slightly above provincial averages.
Conclusions: The YWC was developed to meet the mental health needs of
transition-aged youth in Hamilton by providing early intervention, system navigation
and transition services. The success of the YWC in reaching high-risk youth is dem-
onstrated by the significant proportion of clients reporting demographic and clinical
risk factors associated with increased risk for development of mental disorders. The
increasing referrals to the YWC highlight the ongoing need for similar services.

KEYWORDS

adolescent health services, delivery of health care, early intervention, mental health services,
young adult

1 | I N T RO DU CT I O N Public Health Agency of Canada, 2006). In Ontario, one in five youth

have a mental illness or substance use problem (Cairney, 2015), yet
It is well known that the majority of mental illnesses emerge in adoles- only 20% to 50% of children and youth access mental health and
cence and early adulthood (Kessler et al., 2007; Kessler et al., 2007; addiction (MH&A) services (Davidson et al., 2010; Kataoka, Zhang, &

Early Intervention in Psychiatry. 2019;1–8. wileyonlinelibrary.com/journal/eip © 2019 John Wiley & Sons Australia, Ltd 1
2 WANG ET AL.
Wells, 2002; Kessler, Avenevoli, & Ries Merikangas, 2001; Offord,
Boyle, Fleming, Blum, & Grant, 1989). Within the young adult popula-
tion, certain marginalized groups (Kessler, Davis, & Kendler, 1997)
including low-income (Canadian Mental Health Association, 2007),
indigenous (King, Smith, & Gracey, 2009; Kirmayer, Brass, & Tait,
2000), street-involved (Boivin, Roy, Haley, & du Fort, 2005) and
LGBTQ+ youth (Davidson, 2015; Meyer, 2003) are at increased risk
of developing mental illnesses. In light of this, models of care focusing
on early detection and intervention have been on the rise (Rickwood,
Telford, Parker, Tanti, & McGorry, 2014; Wilson et al., 2017). Interna-
tionally, mental healthcare centres focusing on young adults (ages
12-29) have emerged in the past 20 years in Australia (Orygen, head-
space), the United Kingdom (Young Minds) and Ireland (Jigsaw). The
Mental Health Commission of Canada has identified emerging adult-
hood as a developmental period needing increased attention and
resource allocation (Mental Health Commission of Canada, 2017). In
2017, the Ontario government announced funding for nine Youth
Wellness Hubs ‘as fully integrated “one-stop-shops” for mental health,
substance use, primary care, education/employment/training, housing
and other community and social services’ (Youth Wellness Hubs
Ontario, 2018, para. 1).
This article (a) describes the development and design of the Youth
Wellness Centre (YWC), St. Joseph's Healthcare Hamilton, which
arose to address the gaps in mental health services for transition-aged
youth. We then (b) report on the demographic characteristics, clinical
needs and service use of youth engaged in services at the YWC to
assess how the centre is achieving its mandate of reaching youth at
elevated risk for developing mental illness.
1.1 | Service development
In 2010, prior to the Ontario Youth Wellness Hubs initiative, munici-
pal healthcare leaders in Hamilton, Ontario began developing an
evidence-based and sustainable solution for local youth mental health
services. The service was initially constructed around the concept of
patient navigators (Bieling, Madsen, & Zipursky, 2013), linking clients
to existing services. The preferences of young people and clinicians
for a variety of services parameters were collected from a quantitative
study (Becker et al., 2016, 2017). Youth preferences included: choice
of multiple treatment modalities; family involvement; availability of
physicians, nurses and doctoral level staff; integrated addictions ser-
vices and text message or phone support (Becker et al., 2017). The
service was designed outside a hospital setting in a central, downtown
location to reach youth from marginalized populations.
As development continued, youth, family members, stakeholders
and community partners were again consulted. These consultations
resulted in maintaining ongoing youth involvement in the design of
services and strong partnerships with other youth-based agencies.
Youth with lived experience of mental illness set the mandate for the
Youth Council at the YWC, which mirrors existing practices for includ-
ing youth perspectives in service provisions at the national level
(Carver, Cappelli, & Davidson, 2015; MHCC Youth Council, 2018).
Staff with knowledge of community resources consolidated partner-
ships with community agencies, post-secondary institutions, primary
care and existing MH&A services to ensure integration with existing
services. The YWC maintains bidirectional communication with com-
munity partners, who both provide and accept referrals.
Youth and stakeholder consultations also identified specific gaps
in services for youth with MH&A concerns. The first was the lack of
an early intervention service for youth experiencing mental health
concerns other than psychosis, which resulted in the creation of an
Early Intervention stream. The second gap identified was a lack of
support for youth who had relied heavily on child MH&A services and
were at risk of not connecting with adult services after age 18. The
Transition Support stream was thus developed to engage youth
before they left the child system and ensure continuity of care. A third
stream was designed with a Mobile Team to target two populations:
post-secondary students with barriers to accessing off-campus
MH&A support and street-involved youth. The fourth stream that
was developed was the Re-Engagement stream. After a year of opera-
tions, a trend emerged, whereby numerous youth who self-referred
were found not to be new to adult services, but rather had not
engaged long enough to receive treatment in the adult system. This
stream aimed to provide a short-term service to help self-motivated
youth reconnect with appropriate adult services.
The final stages of planning included creating a multi-disciplinary
staffing model and designing a physical space. For ongoing program
evaluation and comparison with similar international youth-centred
models (Rickwood et al., 2014; Rickwood et al., 2015), a clinic data-
base was created. A minimal data set was chosen that allowed for
integration with clinical operations and Research Ethics Board
approval was obtained to allow for dissemination of results beyond
the scope of internal quality improvement projects. Finally, a profes-
sional communications firm was consulted to publicize the centre. A
campaign was put together using the hashtag #ReachOut, based on
input from a youth focus group, and publicized through both tradi-
tional and social media. In March 2015, the YWC opened to the
public.
1.2 | Service design
The YWC operates upon principles of providing (a) accessible,
(b) evidence-based, (c) youth-centred and (d) community-linked care
to individuals aged 17 to 25 with MH&A concerns. To reduce barriers
to access, referrals are accepted from youth (via an online self-referral
platform), family and friends, community agencies and healthcare pro-
viders. The YWC is co-located with Alternatives for Youth, an inde-
pendently run service addressing substance use and addictions in
youth, allowing for concurrent access to both services. Treatments at
the YWC range in intensity and frequency to address varying levels of
readiness and need, ranging from low-barrier drop-in options, such as
1:1 drop-in counselling, Art Drop-in and an Open Peer Support Circle,
to short-term individual psychotherapy and specific group interven-
tions. Specific evidence-based interventions offered include a Family
WANG ET AL. 3

TABLE 1 YWC service streams referral criteria

Early intervention Transition support Mobile team Re-engagement

Description To offer assessment and To provide transition support To provide service to post- A short-term stream for youth
structure a treatment plan and system navigation to secondary students and with later stage presentation
for youth with untreated youth with pre-identified street involved youth who who self-refer needing
mental health and/or MH&A concerns who are have significant barriers to specialized adult services
addictions concerns aging out of the child and accessing MH&A care
adolescent system (≤17 y
old) and moving into the
adult system (18+)
Age criteria 17-25 y of age at referral 16-17 y of age at referral 17-25 y of age at referral 17-25 y of age at referral
Gap criteria Youth who do not meet criteria Youth who do not meet criteria 1. Students without existing Youth who have had
for: for: campus services and unsuccessful attempts at
1. Existing primary care mental 1. Existing primary care mental 2. Street-involved youth engaging with adult MH&A
health services or health services or identified through the Street
2. Existing adult MH&A 2. Existing adult MH&A Youth Planning
services services due or Collaborative
3. Experience access barriers
Treatment No prior specialized child and Receiving specialized child and Youth meeting criteria for early Has had an unsuccessful
history adolescent MH&A treatment adolescent MH&A services intervention attempt at engaging with
for presenting problems at time of referral and not adult MH&A services
within previous 12 mo. eligible for child and
adolescent services within
the next 12 mo.
Accepted • Self, family, friends • Community and hospital • Self • Self
referral • Community providers (eg, partners providing child and • Campus-based MH&A
sources school social worker, adolescent MH&A services services at local post-
community youth program, secondary institutions
family doctor) • Site partners with the
Hamilton Street Youth
Planning Collaborative

Abbreviations: MH&A, mental health and addiction.

Connections group (Hoffman et al., 2005) and transdiagnostic applica-

TABLE 2 YWC services and staff
tions of dialectical behaviour therapy (Ritschel, Lim, & Stewart, 2015),
Clinical services
both of which have been adopted in an Ontario trial on Youth Well-
ness Hubs (Henderson et al., 2017). Peer support was also seen as • Peer support

important to increase the likelihood of continued engagement and • Group programming

successful transition between child and adult services (Carver et al., • Family education/support
2015; Repper & Carter, 2011). • System navigation
The YWC's four service streams, Early Intervention, Transition • Drop-in counselling
Support, Mobile Team and Re-Engagement, have individual intake • Addictions counselling
criteria outlined in Table 1. Additional information regarding clinical • Family counselling
services and staff is outlined in Table 2. • Psychiatric consultation
• Brief individual therapy
Clinical staff
2 | METHODS
• 1 addictions specialist • 2 psychiatrists (part-time)
• 2 clinical therapists • 1 psychologist
The YWC's Client Activity Tracking System (CATS) is a database that
• 1 family educator • 1 transition coach
contains demographic and service use data collected by clinicians at
referral and during clinical interactions, including initial assessment. • 1 intake worker • 4 youth mentors

The Global Appraisal of Individual Needs Q3 (GAIN-Q3; Titus et al., • 1 LGBTQ+ outreach • 1 indigenous youth wellness
worker coordinator
2012) provided additional demographic information from clients in
the Early Intervention and Mobile streams. It is a clinician-reported • 4 nurse care • 1 sexual violence/trauma
coordinators counsellor
questionnaire administered during initial assessment and is electroni-
• 1 occupational therapist
cally hosted by Chestnut Health Systems. Clinical information is
4 WANG ET AL.

collected electronically via self-report questionnaires emailed to cli- TABLE 3 (Continued)

ents at orientation, initial assessment and at 3-month intervals via Age Years
Research Electronic Data Capture (REDCap; Harris et al., 2009). Ques-
Some community college, technical 45 12.1
tionnaires include the GAIN short screener (GAIN-SS) and Difficulties college, or CEGEP
in Emotion Regulation Scale (DERS) and Kessler Psychological Distress Completed community college, 19 5.1
technical college, or CEGEP
Some university 82 22.1
TABLE 3 Demographic characteristics
Completed university degree 12 3.2
Age Years (bachelors, post-graduate)

Rangea 13-26 Total 371 100.0

a
Mean (SD) 19.3 (2.4) Age range is inclusive of clients from a transgender peer support group
that is open to teens of all ages, despite the YWC's mandate to cater to
Gender n %
youth 17 to 25 y of age.
Female 734 59.0
Male 436 35.0
Transgender 52 4.2 Scale (K10). The Social and Occupational Functioning Assessment
Non-binary 9 0.7 Scale (SOFAS) is clinician-administered and recorded in CATS. The
Gender queer 8 0.6 Ontario Perception of Care (OPOC) was offered in a ‘blitz’ to clients in
Other 6 0.5 January 2017; this data were collected electronically from self-report
Total 1245 100.0 and is housed in a province-wide database.
Sexual orientation n %
Heterosexual or straight 236 64.5
Bisexual 56 15.3
2.1 | Measures
Not sure or questioning 22 6.0
Demographic and service use information was extracted from CATS
Pansexual 13 3.6
and the GAIN-Q3 and included: age, gender, sexual orientation, eth-
Asexual or non-sexual 12 3.3
nicity, housing status, level of education, client use of the four streams
Queer 12 3.3
of care, source of referral, annual number of referrals, wait times and
Lesbian 8 2.2
attendance at orientation and initial assessment. Clinical information
Gay 7 1.9 was extracted from REDCap and CATS and included: lifetime history
Total 366 100.0 of substance use and suicidal ideation (SI) and measures of psycholog-
Ethnicity n % ical distress as follows. The GAIN-SS is a 3 to 5 minute screener for
White 278 75.1 internalizing and externalizing disorders, substance abuse and criminal
Multiple or mixed 32 8.6 and violent behaviour (Dennis, Chan, & Funk, 2006; Stucky, Edelen, &
Asian 26 7.0 Ramchand, 2014). The SOFAS is a measure of social and work func-

Middle Eastern 15 4.1 tioning independent of psychological symptom severity (Rybarczyk,

2011). The DERS is a multi-dimensional questionnaire that quantifies
Latin American 8 2.2
emotion regulation problems (Gratz & Roemer, 2004; Neumann, van
Black 6 1.6
Lier, Gratz, & Koot, 2010). The K10 is a 10-item screening question-
First Nations/Inuit/Métis 5 1.4
naire for anxiety and affective disorders (Andrews & Slade, 2001). Cli-
Total 370 100.0
ent satisfaction was collected from the OPOC tool (Rush et al., 2013).
Housing n %
The OPOC was administered in January 2017 to a subsample of cli-
Private housing 344 92.7
ents who attended appointments, had recently completed a therapy
Public, subsidized or temporary 6 1.6 group, or were discharged that month. Three items classified under
housing, shelters
‘Overall Satisfaction’ were extracted and compared with
Friend or relative's house 7 1.9
provincial data.
Other 14 3.8
Total 371 100.0
Highest level of education n % 2.2 | Participants
Primary school/some secondary or high 150 40.4
school Clients who were engaged in services and presented to the clinic on,
Completed secondary or high school 63 17.0 or prior to, 17 March 2018 were included to create three 12-month
(Continues) periods for analysis. In total, 1520 clients from CATS were included in
WANG ET AL. 5

TABLE 4 Service use 3 | RE SU LT S

Streams of care n %
Early intervention 702 55.1 3.1 | Demographic characteristics
Mobile 274 21.5
The mean age of clients was 19.3 years old; 59% were female, 35%
Transition 174 13.7
male and 6.0% transgender/gender diverse; 29.5% reported sexual
Re-engagement 123 9.7
orientation as LGBQ+; 24.9% identified as a visible minority (non-
Total 1273 100.0
Caucasian ethnicity) and 1.4% identified as Indigenous (Table 3).
Referrals by source n %
Self 686 46.5
Provider 561 38.1 3.2 | Clinical characteristics and presenting
Community 227 15.4 problems
Total 1474 100.0
Accepted referrals by year n % The top five primary presenting problems at the time of referral
Year 1, 2015-2016 480 31.6 included problems with mood (25.6%), anxiety (24.5%), difficulties
Year 2, 2016-2017 465 30.6 coping (15.8%), substance use (9.1%) and suicidality (7.3%). The mode

Year 3, 2017-2018 575 37.8 SOFAS score was between 61 and 70 indicating, ‘some difficulty in
social, occupational or school functioning’ (Rybarczyk, 2011). The
Total 1520 100.0
mean DERS score at orientation was 114.35 (SD = 25.10) and mean
Wait times Days SD
K10 was 32.81 (SD = 7.87), indicating very high emotion dys-
Referral to orientation 46.6 25.0
regulation and psychological distress. Lifetime SI was present for
Orientation to initial assessment 56.2 58.4
80.8% of youth, with 40.2% reporting SI in the last month. A history
Referral to initial assessment 72.7 95.9
of substance use disorder based on Diagnostic and Statistical Manual
Attendance n % of Mental Disorders, Fifth Edition (DSM-V) criteria was present for
Initial assessment 32.8% of clients.
Did not attend, notice given 19 1.8
Did not attend, no notice given 115 11.0
Attended 910 87.2 3.3 | Service use and overall satisfaction
Total 1044 100.0
Orientation Across all streams, 46.5% of youth self-referred. Referrals from com-

Did not attend, notice given 2 0.3 munity and healthcare partners came from 44 discrete clinics and
organizations. The number of new clients per 12-month period has
Did not attend, no notice given 61 8.8
increased since the YWC's opening, from 480 clients during the first
Attended 630 90.9
12 months to 575 during the third 12-month period of operation.
Total 693 100.0
The majority of youth (55.1%) were engaged in the Early Inter-
vention stream. The mean number of days from referral to orientation
was 46.6 days (SD = 25.0). The mean wait from orientation to initial
assessment was 56.2 days (SD = 58.4) and from referral to initial
analyses. Of these clients, 756 had data in REDCap; 376 from the assessment was 72.7 days (SD = 95.9). Orientation and initial assess-
Early Intervention and Mobile streams had data from the GAIN-Q3 ment appointments were attended by 90.9% and 87.2% of youth,
and 135 completed the OPOC. respectively (Table 4).

TABLE 5 OPOC overall satisfaction scores

YWC mean Provincial mean Welch's Effect size

OPOC itema score score t-test (Cohen's d)
‘The services I have received have helped me deal more 3.37 3.44 P = .28 d = 0.11
effectively with my life's challenges’.
‘I think the services provided here are of high quality’. 3.72 3.52 P < .05 d = 0.36
‘If a friend were in need of similar help I would recommend 3.75 3.59 P < .05 d = 0.28
this service’.
a
Each item is scored on a Likert scale of 1 to 5, with 5 = ‘Strongly Agree’.
6 WANG ET AL.
For the three measures of overall satisfaction on the OPOC, mean
scores at the YWC were significantly higher than provincial averages
for two items with effect sizes of d = 0.36 and d = 0.28, and not signif-
icantly different than provincial averages for one item (d = 0.11;
Table 5).
4 | DISCUSSION
The YWC was created to address a local need that also reflected a pri-
ority at the national level – to reach youth who, based on age alone,
are more likely to present with symptoms of an initial psychiatric ill-
ness, in addition to reaching subpopulations at further risk for devel-
opment of mental illness.
4.1 | Demographic characteristics
The YWC is reaching many of the at-risk populations identified during
its development, including visible minorities, LGBTQ+ and street-
involved youth. The 24.9% of YWC youth who identify as a visible
minority is comparable to the 19.0% from Hamilton 2016 census data
(Statistics Canada, 2017). There is limited Canadian data on the preva-
lence of LGBTQ+ individuals. A 2011 US report indicated 0.3% of the
general population identify as transgender and 3.5% identify as les-
bian, gay or bisexual (Gates, 2011). In comparison, transgender youth
represent 4.2% of the YWC's clientele and 29.5% of our clientele
identify as LGBQ+. The high proportion of the YWC's clientele who
identify as LGBTQ+ highlights a success of the YWC fostered by a
transgender support group, LGBTQ+ staff and a self-referral stream
(Colvin, Tobon, Jeffs, & Veltman, 2019). The prevalence of homeless-
ness in youth is thought to be underreported at 0.07% to 0.1% of the
Canadian population (Kidd, Gaetz, & O'Grady, 2017). The lifetime
prevalence of homelessness of 18.5% and preceding 12-month preva-
lence of 9.2% at the YWC is well beyond prevalence rates expected in
Canada and highlights that the mobile stream is successfully reaching
street-involved youth. Efforts should focus on reaching Indigenous
youth, who are underrepresented at the YWC (1.4%) when compared
with 3.3% of the 2016 Hamilton population (Statistics Canada, 2017).
4.2 | Clinical characteristics and presenting
problems
Strikingly, 80.8% of youth at the YWC reported lifetime SI. In compar-
ison, 13.5% to 14% of Canadian youth aged 15 to 24 report a lifetime
history of SI (Cheung & Dewa, 2006; Findlay, 2016). This highlights
that the YWC is meeting its mandate to reach youth with elevated
mental health concerns.
The 32.8% of YWC youth who meet criteria for a substance use
disorder is considerably greater than the estimate of 5.5% of Canadian
youth aged 15 to 24 who suffered harm or functional impairment in
one or more domains due to substance use (Health Canada, 2014)
and is much greater than the 1% of youth in Ontario accessing treat-
ment for substance use related concerns (Cairney, 2015). While this
indicates that the YWC is engaging youth with high-risk substance
use, it could also indicate that youth who visit the YWC feel more
comfortable speaking about substance use in this setting.
The top four primary presenting problems at YWC are reflective
of the most commonly self-reported rates of mental disorders pro-
vincially (mood, anxiety, alcohol-related and drug disorders; Cairney,
2015), suggesting that the YWC's clients' concerns are broadly rep-
resentative of the youth population in Ontario. The mean SOFAS
score for YWC clients of 61 to 70 indicating ‘some difficulty’ in func-
tioning is slightly higher than Australian headspace clients, who pre-
sent with a mean score of 51 to 60 indicating ‘moderate difficulty’ in
functioning (Rickwood et al., 2015; Rybarczyk, 2011). The mean
DERS score of 116.4 demonstrates that high emotional dys-
regulation considering this is over 2 SDs above mean scores for a
healthy sample of men (M = 80.7) and women (M = 78.0; Gratz &
Roemer, 2004). Youth at the YWC present with very high levels of
psychological distress based on the K10 (μ = 33.0), with levels
slightly higher than youth at headspace centres in Australia
(μ = 28.8) (Rickwood et al., 2015); this difference may be partly due
to the lower age range of headspace clients (ages 12-25) compared
with YWC clients (ages 17-25).
4.3 | Service use and overall satisfaction
The YWC was an early adopter of national and international guide-
lines outlining the need for early intervention and youth-centred
mental health services. The need for youth-centred, accessible and
evidence-based mental health service delivery likely surpasses cur-
rent resources; indeed the number of new clients at the YWC has
increased nearly 20% in its first 3 years. Moreover, the 72.7 days
between referral and initial assessment is greater than provincial
and municipal averages for individuals 0 to 24 years of age, which
have hovered around 50 days (Cairney, 2015). This indicates a
need for services similar to the YWC and also attests to the
acceptability of the YWC for the emerging adults who may not
otherwise utilize traditional models of MH&A services. Despite its
wait times, a strength of the YWC's programming lies in weekly
offerings of orientation sessions and the immediate access youth
have to drop-in groups and counselling after attending orientation.
The high rate of attendance for both orientation and initial assess-
ment appointments is encouraging and suggests that our services
are accessible and valued by youth. The large proportion of clients
who self-refer highlights the importance of self-referral as a path-
way for accessing services. Additionally, the YWC's mandate to
provide system navigation and maintain close ties with existing
services is reflected in the 44 different community and healthcare
partners from which clients are referred. Finally, analysis of OPOC
data indicates a statistically significant difference between the
YWC and provincial means for two of the three items under ‘Over-
all Satisfaction’ with small-to-moderate effect sizes.
WANG ET AL.
4.4 | Limitations
While ensuring each client profile is fully completed remains a priority, a
number of variables had missing data (Table S1). This may be due to client
responsiveness to emailed screeners and time constraints for clinicians
who are completing questionnaires while also providing assessment and
treatment. It is important to consider that missing data may compose of a
group with particular characteristics, perhaps with an increased clinical
burden, and thus current data could be an underreport of severity of
symptoms. Future research might assess demographic characteristics and
vulnerability factors of youth who were eligible for intake, but did not
engage in services, to examine how engagement can be improved upon.
Comparisons with similar international models and the effects of inter-
ventions on outcomes in YWC clients will be the focus of future reports.
5 | C O N CL U S I O N S
While improving access to mental health services for youth continues
to be a priority nationally, the YWC has shown that in its local con-
text, it is reaching youth at risk for developing mental illness as
evidenced by the demographic and clinical characteristics of its cli-
ents. The YWC has created a space where youth feel welcomed and
staff and services are tailored to their particular needs. In order to pro-
vide services in a timely manner, efforts are continually made to main-
tain strong ties to community and healthcare partners for both
receiving and sending referrals. The data collection built into the
YWC's daily clinical operations will enable the YWC to continue to
assess how it is reaching its target populations and better understand
the demographics of its clientele, ultimately, to break down barriers
affecting accessibility and engagement in treatment for youth.
ACKNOWLEDGEMEN TS
The authors would like to acknowledge the staff at the YWC whose
daily work contributed to this report as well as our research students
for their help with data entry and cross-checking: Sophie Liu and Mat-
thew Faltyn.
DATA AVAILABILITY STATEMENT
The data from this study are available from the corresponding author
upon reasonable request.
ORCID
Alyssa Wang https://orcid.org/0000-0001-9071-9198
Robert B. Zipursky https://orcid.org/0000-0002-1655-883X
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SUPPORTING INF ORMATION
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How to cite this article: Wang A, Tobon JI, Bieling P, Jeffs L,
Colvin E, Zipursky RB. Rethinking service design for youth
with mental health needs: The development of the Youth
Wellness Centre, St. Joseph's Healthcare Hamilton. Early
Intervention in Psychiatry. 2019;1–8. https://doi.org/10.1111/
eip.12904