Stronger, Straightforward Service and Support Provision: A New Methodological Approach to Infant and Early Mental Health Care Pathway Creation Through Multisectoral Collaboration

doi:10.21203/rs.3.rs-4919953/v1

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Stronger, Straightforward Service and Support Provision: A New Methodological Approach to Infant and Early Mental Health Care Pathway Creation Through Multisectoral Collaboration

https://doi.org/10.21203/rs.3.rs-4919953/v1

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Background:

Early childhood plays a pivotal role in shaping positive mental health outcomes, yet navigating the path to appropriate services in Ontario is often hindered by fragmented systems, lack of collaboration, and unclear pathways to care.

The Infant and Early Mental Health (IEMH) Care Pathways Initiative addresses the critical need for accessible and comprehensive mental health support for at-risk children under the age of 6 in Ontario.

This paper outlines the IEMH Care Pathways methodology to develop and implement systems of care pathways that lead families with children 0-6 to, through, and out of care.

Methods:

The IEMH Care Pathways Initiative employs a 5-phased approach: 1) Community Engagement, 2) Service Mapping and Inventory Assessment, 3) Aspirational Pathway Building, 4) Ages and Stages Questionnaire and Developmental Support Plan Training and Implementation, and 5) Aspirational Pathway Implementation. Evaluation throughout the process is informed by the Consolidated Framework for Implementation Research.

Conclusions:

The IEMH Care Pathways methodology represents a significant step forward in promoting positive mental health outcomes and overall well-being for children before they reach school age. By prioritizing the science of brain development, early developmental delay identification, and access to timely and appropriate support services, the process presented aims to mitigate the risk of adverse outcomes and increase opportunities for positive developmental trajectories. Continued efforts to refine and expand upon the methodology outlined in this paper are underway. Through collaborative partnerships and equitable access to care, a more cohesive and effective system to ensure healthier communities can be created.

Introduces a structured methodology for developing and implementing infant and early mental health (IEMH) care pathways, filling a gap in the literature by addressing the specific needs of young children under 6 years old in Canada, thereby providing a practical solution to a pressing issue.
Offers a replicable framework for other regions to adapt and implement similar initiatives, contributing to the scalability and generalizability of implementation science research in the context of early childhood mental health.
Demonstrates the tailorable application of evidence-based strategies in addressing complex mental health system challenges, offering clear guidelines for implementing and sustaining IEMH care pathways.

Multisectoral collaboration: “multiple sectors and stakeholders intentionally coming together and collaborating in a managed process (i.e. not ad hoc) to achieve shared outcomes and common goals” [1, 2].
Infant and early mental health: “the young child's capacity to experience, regulate, and express emotions, form close and secure relationships, and explore the environment and learn. All of these capacities will be best accomplished within the context of the caregiving environment that includes family, community, and cultural expectations for young children. Developing these capacities is synonymous with healthy social and emotional development” [3].
IEMH Care Pathways: structured framework designed to guide the provision of equitable and timely access to prevention, identification, and treatment services for infants and young children under the age of 6, addressing their socio-emotional needs through multisectoral collaboration and integrated care approaches.
Ages and Stages® Questionnaires (ASQs): standardized developmental screening tools designed to assess children’s developmental progress across multiple domains from birth to age 6.
Developmental Support Plan (DSP): tailored strategies to target areas of developmental need.
Change agents: individuals or entities responsible for driving and facilitating the adoption of new practices, policies, or interventions within organizations or systems to promote desired outcomes
Care providers: frontline practitioners that provide services and supports to families with children under the age of 6. This term encompasses service providers, support workers, public health nurses, rehabilitation workers, primary care providers, and educators across many sectors.

Early childhood is a pivotal period for promoting positive mental health outcomes and overall well-being [4]. Providing support and services for at-risk infants and children under the age of 6 is essential for ensuring more opportunities for positive health and development [5]. However, the path from the need for support to receipt of services is often not straightforward or clear for families and care providers alike [6]. Families that need support for their child’s developmental challenges often face barriers to receiving services, such as service fragmentation and discrepancies in information regarding what steps to take to access services [7, 8]. Care providers, including frontline practitioners and supervisors, experience barriers to identifying and addressing early socio-emotional challenges, such as lack of communication between sectors and insufficient collaborative approaches to care across regional organizations [9].

It has been recognized that the approach to identifying and addressing infant mental health concerns must be multisectoral, due to the complexities of development in the early years of life [10]. As such, the current siloed system to recognize and respond to mental health in Canada often falls short of effectively meeting the critical needs of infants and young children, leading to delayed interventions and missed early support opportunities [11].Therefore, developing unambiguous and equitable multisectoral care pathways that navigate families and care providers through infant and early mental health care services is vital to reducing barriers to accessing appropriate and timely support.

The call for multisectoral collaboration stems from acknowledging that achieving shared outcomes and common goals requires orchestrated efforts beyond singular sector actions [12, 13]. Multiple studies underscore the complexity and necessity of multisectoral partnerships in improving child health services [6, 14, 15]. Integrating services spanning healthcare, early intervention, social services, and education is critical to addressing multifaceted issues, such as the mental health of preschool-aged children [6, 16].

To achieve a systematic approach to infant and early mental health care service provision, interested parties must mobilize around mutual concerns, establish shared norms, understanding, and goals, and leverage existing processes while investing in collaborative and multisectoral relationships [13, 15, 17]. Moreover, contextual factors, governance arrangements, and implementation plans must be considered to tailor multisectoral partnership strategies [1, 15, 17]. Further, strong trusting relationships and shared visions are essential for success while navigating capacity to sustain change, power dynamics and differences within and between partnering institutions [12, 15].

To respond to this national need for Canadian systems of IEMH care, Infant and Early Mental Health Promotion (IEMHP) at the Hospital for Sick Children partnered with the Knowledge Institute on Child and Youth Mental Health and Addictions in 2019 to develop and pilot the Infant and Early Mental Health Care Pathways intervention. The objective of the intervention was to guide communities to develop and implement IEMH care pathways and provide equitable access to prevention, identification, and treatment of less-than-optimal IEMH to children under 6. Expanding on the work completed in the pilot, the ‘Infant and Early Mental Health (IEMH) Care Pathways: Establishing Community Systems of Care Initiative’ was designed to build a framework for the creation of IEMH care pathways and evaluate the implementation of the IEMH Care Pathways intervention in various communities in Ontario. Ultimately, the IEMH Care Pathways Initiative is a pioneering effort to transform care provision for children under the age of 6, leading to straightforward pathways that increase ease of access and appropriateness of care for early mental health concerns.

This paper will delineate the systematic approach employed in developing IEMH care pathways (henceforth referred to as ‘Pathways’) through a multisectoral collaborative process. By detailing the steps, methodologies, and key considerations, this paper seeks to elucidate the intricate process of designing and implementing these Pathways. The main goal of this paper is to provide a comprehensive methodology, outlining the collaborative framework used to construct Pathways. This paper emphasizes the integration of diverse sectors, fostering interdisciplinary partnerships, and establishing a coherent system to expedite access to critical services for vulnerable young children.

Guiding this methodology paper is the overarching research question: Does a multisectoral collaborative approach effectively facilitate the development and implementation of Infant and Early Mental Health Care Pathways, enhancing access to essential services for at-risk infants and children under 6?

The synthesis of diverse literature emphasizes that robust multisectoral partnerships, underpinned by collaborative frameworks and inclusive governance, are essential to effectively constructing care pathways. The terms “multisectoral collaboration” and “partnerships” are often used interchangeably but, in practice, reflect an implementation approach rooted in a shared language, equitable resources, and capacity building across individuals, organizations, and communities [18]. These partnerships necessitate understanding of contextual nuances, shared goals, and a concerted effort toward establishing sustainable, collaborative relationships. To achieve multisectoral pathway development and implementation, common factors include defined roles and responsibilities, joint strategic planning, data monitoring and quality improvement, shared training, local champions, and system-level change management [19, 20].

Recent approaches to establishing and improving the implementation of mental health care pathways for children emphasize the process of bringing together partners from various sectors (e.g. public health, primary care, education, and other child-serving organizations) to ensure a collaborative system of mental health care [21–25].

Implementation efforts to advance collaboration between education and community-based sectors for improved mental health access and service delivery have included various strategies [26, 27]. Learning collaboratives (LC) are one strategy (traditionally used in healthcare) whereby multiple organizations collectively develop methods to address a specified need and potential barriers to care delivery [27, 28]. In 2009, the School-Based Pathway to Care Model [29] was piloted in multiple Canadian jurisdictions to address youth mental health. This model promotes a collaborative approach to mental health care by linking all key partners along the school-to-community pathway and facilitating a series of implementation modules focused on mental health literacy, family engagement, and shared educator and mental health care provider training [29, 30].

Developments toward a standard approach for measuring collaboration between the education and community sectors have also been made to evaluate the types, considerations, and perceived benefits of collaboration for school and community-based mental health professionals [31, 32]. However, challenges with measuring multisectoral partnerships have been well recorded, particularly in the context of child and youth mental health, because of poorly defined and community-specific variables that influence how different organizations work together in their local context [32, 33].

There has also been increased focus on collaboration between healthcare (e.g. primary care, acute care, public health) and community-based mental health and social services to improve integrated mental health care access, delivery, and outcomes. Documented methods for implementing multi-sector partnerships include the wraparound model and systems of care approach [34]. A combination of these approaches is often used to create integrated mental health systems [34]. For example, systems of care use a wraparound approach to providing services through four phases of multisectoral care: 1) Bringing together families and community partners, 2) Co-developing a strengths-based care plan and pathway, 3) Implementing the care plan with ongoing monitoring and feedback, and 4) Facilitating transitions for youth through the different phases of care [35]. Implementing these approaches is challenging due to communication barriers that are especially problematic for pediatric primary care and mental health care providers who do not have standardized and efficient information-sharing policies or practices compared to those between primary care and many other health specialists [36, 37].

While the value of multisectoral, collaborative mental health care is increasingly recognized, less attention has been paid to methodological approaches specific to IEMH pathway development and implementation (prenatal to age 6). Care providers often rely on specialists, educators, and resource consultants to collaboratively problem-solve care planning for solutions that address social-emotional development concerns in young children, and these multisectoral relationships are essential for positive health outcomes [38]. In Ontario, a range of child and youth mental health services are available, yet there remains substantial inconsistencies and gaps in mental health services for infants, young children, and their families [38, 39]. The lack of consistent, evidence-informed methods to promote IEMH pathway development and implementation contributes to these barriers.

To address this issue, we propose a methodology that supports communities in creating, implementing, and sustaining a multisectoral system of care specific to infants and young children under six years old.

The IEMH Care Pathways Initiative leverages community strengths through collaborative organizational and regional partnerships to develop Pathways, using a 2 to 3-year process. The process encompasses 5 phases: 1) Community Engagement, 2) Service Mapping and Inventory Assessment, 3) Aspirational Pathway Building, 4) Ages and Stages Questionnaire and Developmental Support Plan Training and Implementation, and 5) Aspirational Pathway Implementation and Evaluation.

The Consolidated Framework for Implementation Research (CFIR) guides the evaluation during each phase, including the interpretation of survey and focus group data. The CFIR was chosen due to its applicability in health system research [40], and its relevant constructs of inner setting (e.g., relational connections and available resources) and outer setting (e.g., partnerships and connections and systemic conditions). Informed consent is obtained from all participants involved in the evaluation pieces (e.g., prior to survey and focus group participation).

Each phase is discussed in detail below.

Phase 1: Community Engagement

The Community Engagement phase is characterized by relationship-building and collaborative groundwork. The first phase begins with an initial meeting with organizational and regional leaders who will act as local change agents. During the initial meeting, leaders begin curating a contact list encompassing diverse regionally based potential change agents across sectors vested in supporting children under six years old. This inclusive approach fosters a broad representation of perspectives crucial for the initiative's success. Following this meeting, comprehensive follow-up actions are undertaken: a project overview is disseminated through a recorded video presentation, invitations to learn about and join the initiative are sent to all newly identified potential partners, and the IEMH Care Pathways Initiative Brief is circulated. The IEMH Care Pathways Initiative Brief includes the background and rationale for the work, the phases, roles and responsibilities, the evaluation plan, and expected outcomes. The Brief provides a unified understanding of the project's process and objectives. Shared knowledge and language are essential in implementation work to reduce confusion and increase agreement between partners [9].

Subsequently, a meeting is held with all key change agents, wherein project specifics are elucidated, including further outlining and agreeing to roles and responsibilities, sharing an initial draft of the Memorandum of Understanding (MOU) and Terms of Reference (TOR), and sharing the project protocol that has been approved by an appropriate institutional or regional research ethics board.(Of note, protocols and research ethics board considerations may differ across organizations, institutions, and regions; it is pertinent to include discussions regarding different institutional and organizational planning needs and regulatory requirements such that all can be adequately met at this stage.) The current body of literature indicates that creating shared agreements can improve communication and collaboration across sectors [41]. A MOU and TOR were developed by IEMHP and reviewed by leadership from each partnering agency. These documents help to clearly define expectations and responsibilities amongst partners [42, 43]. Following partner review, feedback is incorporated as needed, thus ensuring alignment with partner expectations, organizational protocols, and policies.

With attention to collaboration and consensus-building, Phase 1 culminates with community partners approving and signing the MOU and TOR, underscoring a shared commitment to achieving the initiative’s objectives through collaborative partnerships.

Phase 2: Service Mapping and Inventory Assessment

The Service Mapping and Inventory Assessment phase involves hosting a series of focused meetings (at least one, and typically three) to understand the landscape of existing services supporting IEMH within the community.

Through guided discussions, partners identify the existing services and the current tools for recognizing and responding to IEMH used in the community, evaluate their efficacy and challenges, examine current referral mechanisms, and explore opportunities for improvement. See Table 1 for a template of the questions asked during the first service mapping meeting.

Table 1

Service Mapping Question Guide for Guiding Discussions of Existing Services
Guiding Prompt/Question	Follow-Up Questions
A developmental, behavioural, or social-emotional concern has been raised for a child.	a. Who raises concern about the child? b. Why did the child come to your organization? c. What is the organization’s role in supporting young children in the community? d. What supports and services can your organization offer (e.g. parental education, developmental screening, etc.)
What happens next?	e. Does your organization need families to have a referral to access services? f. What happens during your first point of contact with the child (e.g. intake process, screenings, questionnaires, meetings, etc.)? g. What kind of support do you know of in the community that you can send this family to, or provide them? h. How do you support the family in accessing those services/agencies?
What does the referral process look like?	i. Who decides whether a referral is needed? How is it decided? j. How is a referral made? k. Is there follow-up with the family and the agency receiving the referral? l. What does follow-up look like after the referral (from both the referring agency and the agency receiving the referral)?
Is there anything else you would like to share, or want us to know about the current pathway?

Subsequent meetings include questions such as “what are the strengths and challenges of the current pathway?”, “which sectors should be involved in developmental screening and triaging children who need additional services?”, and “where do you see your sector/agency fitting into a system of care pathway?”

Following these meetings and subsequent deliberations, IEMHP amalgamates insights to develop an initial draft of the community's current Pathway, providing the first overview of existing services and processes. This preliminary outline serves as a focal point for collaborative refinement in subsequent sessions, where partners reconvene to scrutinize, amend, and ultimately agree on the components and process outlined in the Pathway.

At the end of Phase 2, findings are consolidated into a comprehensive "Project Summary Report.” This report includes milestones achieved, emergent insights, and next steps. Ensuring information is accessible to relevant change agents, such as through data sharing and reporting, is key to driving feedback cycles and promoting successful implementation [12, 13].

Phase 3: Aspirational Pathway Building

Of note: Phase 3 and Phase 4 occur concurrently, as different collaborators are involved in each phase.

The Aspirational Pathway Building phase begins with an invitation for organization leaders/supervisors to complete the “Infant and Early Mental Health (IEMH) Core Components Evaluation Tool”, which is a self-evaluation survey tool that includes questions related to the organization (e.g. number of employees, number of families with children under the age of 6 served in the last year, sector(s) of activity involved in the work, etc.), and questions related to the five core components identified as being important and relevant to serving IEMH needs (i.e. a system of care pathways, resources and tools for strengthening IEMH practice, leadership specific to IEMH, knowledge and skill building, and research and reporting). Answering this survey helps identify how “IEMH friendly” the organization’s current practices and services are. This survey is re-sent to each respondent 180 days (approximately six months) after Phase 5 begins, to allow for comparing pre- and post-aspirational pathway implementation.

Following initial surveying of IEMH service readiness, partnering agencies are brought together for an in-person meeting to develop the first draft of the aspirational Pathway(s). The meeting begins with IEMHP presenting the draft of the community's current Pathway, allowing community partners to review and provide feedback for any necessary changes to better reflect the service processes. Once the draft has been thoroughly reviewed, IEMHP makes the proposed modifications before re-presenting the draft through e-mail correspondence to the partners.

After the first round of pathway revisions, a Local Pathways Implementation Team (LPIT) is established in the community. The LPIT consists of individuals from the agencies who drive pathway development and implementation in their communities (generally, individuals in supervisory or leadership roles). The LPIT identifies, using the draft of the aspirational Pathway(s), which agencies take priority for developmental screening and early intervention training. The draft of the aspirational Pathway(s) is then revised, as needed, by the LPIT and IEMHP in iterative cycles, until approval of the final aspirational Pathway(s) draft is confirmed by the LPIT and partnering agencies.

In partnership with the LPIT, dissemination materials for the aspirational Pathway are created. Dissemination materials may include pamphlets (i.e. that outline the purpose and process of the pathway) and ‘map’ magnets (i.e. that can be placed throughout organizations for ease of use, and in family homes). Focus groups are then held with parents/caregivers and frontline practitioners to make any changes to the materials based on feedback. Supplemental materials for families to complement the aspirational Pathway(s) are also developed, and a focus group is held with parents/caregivers to receive feedback on whether the materials are appropriate for use. Supplemental materials may include such items as a ‘Frequently Asked Question’s’ brochure and/or a ‘legend’ for understanding the terminology and process on the aspirational Pathway.

Following focus group feedback and material revision, the LPIT reviews and approves revised dissemination materials. Together, they develop a communication plan that outlines how to share updates, approved materials, and resources with broader partners.

Phase 4: Ages and Stages Questionnaire and Developmental Support Plan Training and Implementation

In Phase 3, staff members that require developmental screening and early intervention training are identified. In Phase 4, frontline practitioners and supervisors begin training on the Ages and Stages® Questionnaires (ASQ®s) and Developmental Support Plan (DSP) administration.

The first part of ASQ-DSP training is an initial survey to gain a baseline understanding of a participant’s current practice, standard of care, collaboration, and organizational policies. If staff have already been trained on ASQ®s and DSPs prior to beginning a partnership, then they fill out a survey to assess their “baseline” of inter-sectoral and inter-organizational collaboration, personal practice, the standard of care, and systems of care prior to aspirational pathway creation. The response options are offered in a Likert scale from ‘Strongly Agree’ to ‘Strongly Disagree.’ Depending on the participant’s response, they will be prompted with a follow-up question to garner deeper insight into their response. See Table 2 for an example of a survey question.

Table 2

Example of Pre- and Post- Training and Pre- and Post-Implementation Survey Questions.
Survey Question	Follow-up Question if Respondent Chooses ‘Strongly Agree’ or ‘Agree’:	Follow-Up Response Options if Respondent Chooses ‘Strongly Agree’ or ‘Agree’:	Follow-up Question if Respondent Chooses ‘Strongly Disagree’ or ‘Disagree’:	Follow-up Response Options if Respondent Chooses ‘Strongly Disagree’ or ‘Disagree’:
“Rate your level of agreement with the following statement: My organization collaborates well with other organizations in my community.”	“In which ways is your organization collaborating with other organizations? Select all that apply.”	1, Referrals to/from other organizations 2, Resource sharing between organizations 3, Data sharing between organizations 4, Frequent communication between organizations 5, Good coordination between organizations (e.g., joint advocacy efforts) 6, Other (please describe)	“Why is your organization not collaborating well with other organizations? Select all that apply.”	1, Lack of capacity 2, Lack of time 3, Lack of resources 4, Lack of confidence 5, Unsure of who to reach out to 6, Other (please describe)

Participants receive the survey again 90 days (approximately three months) and 270 days (approximately nine months) after initial survey completion to allow for a comparative analysis of pre-ASQ®-DSP training and post-ASQ®-DSP training. Focus groups are held with direct service providers, leadership (e.g. supervisors and managers), and parents/caregivers 180 days (approximately six months) after initial survey completion. Member checking is conducted after initial focus group data analysis and interpretation. Member checking is a method of maintaining validity and ensuring an accurate account of participants experience by re-meeting with participants to discuss insights such that feedback can confirm or modify the initial interpretations [44]. Following completion of ASQ®-DSP training, surveys, and focus groups, IEMHP develops and shares a summary report of the findings with the community partners.

Phase 5: Aspirational Pathway Implementation and Evaluation

Phase 5 begins when the LPIT disseminates the final aspirational Pathway(s) to all agencies. LPIT works with partner agencies to implement the pathway into practice.

Similar to the evaluation plan laid out in Phase 4, inter-sectoral and inter-organizational collaboration, personal practice, standard of care, and systems of care are evaluated through surveys at 90 days (approximately three months) and 270 days (approximately nine months) following Pathway distribution, and through focus groups with leadership/supervisors/managers, frontline practitioners, and parents/caregivers at 180 days (approximately six months) following Pathway distribution. Again, member checking is conducted after initial focus group data analysis and interpretation.

Supervisors/organization leaders who completed the IEMH Core Components Evaluation Tool in Phase 3 are invited to complete the survey again now that the Pathway has been implemented in their community.

Results are analyzed and a summary report of surveys, focus groups, and IEMH Core Components results are shared with the community as outlined in the communication plan developed in Phase 2.

Results for dissemination and implementation adoption, effectiveness, and maintenance will include framework-guided thematically analyzed qualitative data from focus groups and open-ended survey questions [45], as well as results from the comparative analyses for pre- and post-surveys in Phases 3, 4, and 5 [46]. All results should be interpreted in collaboration with the organizational partners such that the findings are meaningful and appropriate for the contexts in which they are presented.

The methodology described in this paper builds on the policy paper “Beyond Building Blocks: Investing in the lifelong mental health of Ontario’s three-to six-year-olds”, co-developed by the Knowledge Institute, IEMHP and School Mental Health Ontario (SMH-ON) that outlines eight recommendations to support positive social-emotional development of Ontario’s youngest children [47]. One of these recommendations focused on creating pathways to care for IEMH.

While the proposed framework is structured such that implementation science best practice is followed, this methodology is meant to be flexible and can be tailored to the community in which it is being implemented; that is, the timing and format of meetings may vary across contexts, and the survey questions may differ depending on which needs are being addressed. Ultimately, this methodology is designed to leverage community strengths and relationships while breaking down sectoral silos and reducing barriers to accessing care for families with children under the age of 6.

Multisectoral partnerships, while valuable, can be challenged by several barriers. One of the main challenges is the significant amount of time and commitment they demand. Bringing together different voices, aligning diverse interests, and agreeing to a standard process may take several meetings and iterative feedback loops with diverse partners, extending past the initial time allotted for decisions or actionable items. Additionally, the need for consistent involvement from all partners may be a limitation, as a lack of partner engagement or partners juggling competing priorities can hinder progress.

Another limitation is the logistical challenge posed by scheduling conflicts, which may result in key collaborators being unable to attend meetings consistently. Given the collaborative nature of this initiative, the absence of critical voices can impede the comprehensive understanding of the strengths and challenges within a community. For example, policy makers and decision-makers at the system level should be involved in the process (as it is working towards making system-level change), but are generally hard to reach and get involved, for reasons including competing priorities and lack of vested interest. Despite efforts to mitigate this constraint (e.g. by offering multiple meeting options to all participants and choosing the option with the most votes), occasional gaps in attendance may impact the richness of discussions and the breadth of perspectives considered, potentially influencing the outcomes of the Pathway map(s). Proactively engaging absent stakeholders through alternative channels, such as e-mail or additional surveys, can mitigate this limitation.

Further, health/human resource availability poses a significant challenge, particularly regarding dedicated personnel/staff. Staff turnover within organizations may disrupt the continuity of care and hinder the establishment of sustainable systems. Additionally, internal organizational capacities vary, impacting the ability to implement and maintain care pathways effectively. Fragmented funding bodies further exacerbate these challenges, as different sectors may have to navigate varying expectations and funding structures, potentially leading to disparities in service provision. Sustainability, particularly tied to Phase 5, relies on the necessary people and processes for ongoing monitoring and feedback loops, which resource constraints and competing priorities may hinder. Addressing these limitations will be essential for ensuring the long-term success and impact of the IEMH Care Pathways Initiative.

In conclusion, developing and implementing IEMH Care Pathways represents a crucial step forward in addressing the complex needs of at-risk infants and children under the age of 6 in Ontario. Early childhood is a critical period for promoting positive mental health outcomes and overall well-being, making early intervention essential for ensuring optimal development. However, the path to accessing appropriate support and services for families and care providers is often fragmented and unclear, leading to missed opportunities for timely interventions.

This initiative aims to bridge existing gaps in Ontario's mental health care system for infants and young children by focusing on multisectoral collaboration and establishing comprehensive care pathways. The integration of services across healthcare, early intervention, social services, and education sectors is essential for addressing the multifaceted challenges faced by this vulnerable population. Moreover, the methodology outlined in this paper emphasizes the importance of building strong relationships, fostering trust, and navigating inter-sectoral dynamics to effectively implement and sustain collaborative partnerships.

The significance of prioritizing infant and early mental health cannot be overstated. Current evidence underscores the long-term impact of early experiences on mental health outcomes throughout life, highlighting the urgency of targeted interventions during the formative years. Investing in equitable and predictable access to early intervention and support services can mitigate the risk of adverse outcomes and promote positive developmental trajectories for young children.

Furthermore, this initiative fills a critical gap in Ontario's mental health landscape by providing a structured framework for developing and implementing multisectoral care pathways specifically tailored to the needs of infants and young children. By mobilizing community strengths and fostering interdisciplinary partnerships, we can create a more cohesive and accessible care system that addresses this population’s unique needs.

It is important to recognize that this work is part of an ongoing provincial initiative, reflecting a commitment to sustained efforts in improving mental health outcomes for Ontario's youngest residents. As we continue to refine and expand upon the methodologies outlined in this paper, we move closer to realizing our shared goal of creating a more equitable and effective system of care for infants and young children across the province. By prioritizing infant and early mental health and fostering collaborative partnerships, we can pave the way for brighter futures and healthier communities for generations to come.

ASQ: Ages and Stages Questionnaires
CFIR: Consolidated Framework for Implementation Research
DSP: Developmental Support Plan
IEMH: Infant and Early Mental Health
IEMHP: Infant and Early Mental Health Promotion
MOU: Memorandum of Understanding
TOR: Terms of Reference

Ethics approval and consent to participate: The protocol was approved by the Queen’s University Health Sciences Research Ethics Board in accordance with the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board guidelines and regulations.

Consent for publication: Not applicable.

Data availability statement: The datasets generated and/or analyzed during the current study are not publicly available due to agreements with the partnered community-based and child welfare organizations, but they may be accessed from the corresponding author upon reasonable request, provided the organizations consent to the sharing of their information.

Code availability statement: Not applicable.

Conflicts of interesting/competing interests: The authors declare that they have no conflicts of interest, nor competing interests.

Author’s contributions: Teams from PS’s, CK’s, and JNR’s institutions designed the methodology alongside Ontario community-based partners. KPKand AD wrote the first draft of the manuscript. NS, PS, CK, and JNR reviewed and edited the manuscript. KPK finalized all edits. All authors approved the final manuscript version prior to submission.

Funding: This work is funded by the Canadian Institutes of Health Research.

Acknowledgements: Thank you to all the champions from the community-based organizations that generously gave their time and efforts to co-develop the IEMH Care Pathways Initiative alongside Infant and Early Mental Health Promotion, the Knowledge Institute on Child and Youth Mental Health and Addictions, and Queen’s University.

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No competing interests reported.

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Stronger, Straightforward Service and Support Provision: A New Methodological Approach to Infant and Early Mental Health Care Pathway Creation Through Multisectoral Collaboration

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Version 1

Abstract

Contributions to the Literature

Key Definitions

Introduction

Literature Review

Methodological Proposal: IEMH Care Pathways

Phase 1: Community Engagement

Phase 2: Service Mapping and Inventory Assessment

Phase 3: Aspirational Pathway Building

Phase 4: Ages and Stages Questionnaire and Developmental Support Plan Training and Implementation

Phase 5: Aspirational Pathway Implementation and Evaluation

Results

Discussion

Barriers to Implementation

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1