Due to increasing demand for mental health services and ongoing limitations in access to specialty care, primary care providers (PCPs) are increasingly required to manage complex pediatric mental health concerns. The COVID-19 pandemic has intensified these demands, highlighting gaps in support for PCPs who work with children and youth. Simultaneously, Ontario faces a growing primary care human resources crisis, with millions of residents lacking connection to a regular PCP. In this context, PCPs require increased support, resources, and training to meet patient needs effectively.
Although collaborative care models and pediatric mental health education initiatives have been implemented internationally and across North America, there is limited evaluation in Canadian settings. Existing studies suggest that PCPs benefit most from a range of educational formats, from brief workshops to sustained consultation models. However, few Canadian programs have assessed these training needs across different settings or in a post-pandemic landscape.
This project represents the first phase of a two-step needs assessment aimed at informing pediatric mental health education program development in Ontario. The primary objective is to survey PCPs across the province to understand their:
This summary highlights the results of the electronic survey component, analyzing both quantitative and qualitative responses to inform future education planning and system improvements.
Prepared by Hassan Abdulrasul. For questions about methods or code, contact hassan.abdulrasul@camh.ca.
Respondents’ professional role, gender, years in practice and practice setting. Hover over a bar for the full answer wording and any “Other” answers written in.
| Characteristic | n (%) |
|---|---|
| Role (n = 45) | |
| Family physician | 16 (36%) |
| Pediatrician | 9 (20%) |
| Psychiatrist | 1 (2%) |
| Nurse practitioner | 7 (16%) |
| Registered nurse | 4 (9%) |
| Social worker | 5 (11%) |
| Administrator | 0 (0%) |
| Other | 3 (7%) |
| Gender (n = 45) | |
| Man | 9 (20%) |
| Woman | 36 (80%) |
| Gender-fluid or non-binary person | 0 (0%) |
| Other | 0 (0%) |
| Years in practice (n = 45) | |
| Under 5 years | 10 (22%) |
| Between 5 and 15 years | 16 (36%) |
| Over 15 years | 19 (42%) |
| Practice location (select all that apply) (n = 45) | |
| Urban | 26 (58%) |
| Suburban | 15 (33%) |
| Rural | 11 (24%) |
| Remote | 3 (7%) |
| Practice setting (select all that apply) (n = 45) | |
| Community setting | 37 (82%) |
| Hospital-based setting | 13 (29%) |
| Other | 2 (4%) |
The age ranges providers work with, and their estimates of how much of their child and youth patient base presents with mental health concerns or identifies as BIPOC or LGBTQIA2S+.
Providers rated how far they agree that each area is a gap in care for their patients, and how useful a set of services would be. Items are sorted by agreement; the numbers at the ends are the percentages disagreeing (left) and agreeing (right).
| Theme | Quote |
|---|---|
| Therapy Access | “Providing therapy sessions” |
| “there is limited programs available for parent coaching.” | |
| “Specifically trauma therapy, and DBT. The few available options for psychotherapy are brief-solution based options, typically 6-8 sessions max.” | |
| Geography / Travel | “for medical treatment they have to travel 1.5 hours away.” |
| “transportation resources for rural geographic boundaries for referrals” | |
| School-Based Mental Health | “School collaboration” |
| “Supports within the school environment. Addressing social issues such as bullying in the school environment.” | |
| Access to OHIP-Covered Psychological Services | “timely access to OHIP-covered services provided by clinical psychologists e.g. autism assessment, ADHD support, DBT etc.” |
| Service Coordination and Resources | “disjointed services in the county” |
| Theme | Quote |
|---|---|
| Embedded Therapy & Counselling Teams | “Mental health counsellor or social worker within our clinic would be advantageous. We recently had a job posting for this but no interest.” |
| “On site psychotherapy would be ideal (inpatient and outpatient), most youth come to this hospital looking for this, but it isn't offered here” | |
| Access to Psychiatry & Psychology | “Access to a psychiatrist and to a clinical psychologist for case reviews.” |
| “Psychiatry or psychology for complex cases needing more intensive diagnostic clarification or management.” | |
| “it would be great if a psychiatrist is available to share or discuss a case so get opinion quickly” | |
| Community Navigation / Support Teams | “Embedded help with forms and systems navigation” |
| “individuals can access support without having to seek out specialized clinics.” | |
| Timely & Accessible Care | “availability via OTN/Teams on an immduate-availabilty basis” |
| “Evening services when families can drive and attend” | |
| Funding & Resources | “Funding to have a CYW or even a mental health specific clinician” |
| “access to low cost therapy” | |
| School/Family Support Integration | “Social Work Psychotherapists Counsellors Case workers who can help families address school related concerns” |
| On-site Programs & Crisis Services | “Alliedpsych counselling services Crisis lines Psychiatrist in office” |
| Services for Specific Populations | “Would like parental support for caregivers of children with complex medical needs” |
| “Mental health supports directed toward children with chronic illnesses - again OHIP funded.” | |
| “Personality Disorders Groups and services” | |
| Existing Supports in Place | “We have social workers at fht to problem solve and a mental health navigator and scope at local hospital. Problem is when out of cachement.” |
| Allied Health & Assessment Services | “OT, OTA, counselling, play therapy, SLP, psych/ed, neuro/psych, ADOS” |
| Reducing Stigma & Early Intervention | “Early identification and intervention Reduced stigma Accessibility” |
The topics providers want education or training in. Substance use topics were asked only of those who chose substance use disorders.
| Theme | Quote |
|---|---|
| Emotion Regulation & DBT for Youth | “DBT/Emotion Regulation aimed for children & youth.” |
| Support for Refugee Children | “Help for refugee children to gain access to schooling and supports (psychoeducational assessments)” |
How interested providers are in each format for education and capacity-building.
| Theme | Quote |
|---|---|
| Asynchronous Access / Flexibility | “Recorded seminars to allow for flexibility with viewing.” |
| General Online Learning Preference | “online” |
Challenges providers expect in accessing education and training (free text), coded into themes. A comment that names several barriers counts once in each. A few answers suggested how to deliver training instead of naming a barrier; they are shown as their own theme.
Q15 asked for any additional suggestions to improve child and youth mental health care access in Ontario. Comments are grouped by theme.
| Theme | Quote |
|---|---|
| Funding | “I think that we need OHIP funded psychotherapy to be ubiquitously available.” |
| “Funded counselling is a joke-3 sessions is what kids get” | |
| Access & System Navigation | “could initial consult be completed by a nurse or social worker before psychiatrist consult?” |
| “streamlined or centralized mental health referral process” | |
| “Differential referrals to psychiatry sources based on whether the need is for short or long term support” | |
| Schools & Community Programs | “Public health outreach to youth in the educational environment” |
| “More providers available in schools/ communities that are OHIP funded” | |
| “Increasing mental health education in schools through periodic presentations.” | |
| Specialist Availability | “psychiatrists who will actually see patients and follow-up” |
| “more involvement of primary care pediatricians” | |
| “Frustrated that many specialties have initiatives to upgrade primary care skills instead of investing in greater availability of specialist consults and ongoing care.” | |
| Timely Access | “Review case in the moment as often crisis presentation more helpful or within 2 business days” |
| “Timely access-9-12 months wait time!!” | |
| “wait time should be short” | |
| Family & Community Involvement | “parents should also help us in talking and caring for the child and youth, so as to make our work easier” |
| “Having to involve not just medical practitioners alone, but also the community and parents” | |
| Parent Support & Coaching | “Parenting training for children with complex needs” |
| “more parent coaching should be available.” | |
| Culturally Specific Resources | “Chinese cultural specific resources - challenge in helping children/youth navigating mental health when parents are not fluent in English and hold stigma against mental health issues” |
| Education Program Design | “in the design of education and capacity building initiatives, consider to work in partnership with ECHO programs” |
Every written answer to the open-ended questions, exactly as entered (extra spaces removed). Answers that said nothing about the question (“n/a”, “none”, “yes” to “please specify”) are left out. Respondents are not identified.
Q9a. If other delivery gaps for patients, please specify: 8 respondents answered
| Specifically trauma therapy, and DBT. The few available options for psychotherapy are brief-solution based options, typically 6-8 sessions max. Youth are often looking for more long-term, or the issues they are looking to have addressed are too large for brief-solution based options. Many don’t have family doctors/primary care givers. In our area there is only 1 psychiatrist which limits access in a timely manner. When it comes to those under 18, it is even more limited as there is a single option for counselling and for medical treatment they have to travel 1.5 hours away. |
| timely access to OHIP-covered services provided by clinical psychologists e.g. autism assessment, ADHD support, DBT etc. |
| Supports within the school environment. Addressing social issues such as bullying in the school environment. |
| transportation resources for rural geographic boundaries for referrals |
| there is limited programs available for parent coaching. |
| disjointed services in the county |
| Providing therapy sessions |
| School collaboration |
Q10a. If embedded mental health supports in current practice setting would be useful to support patients, please specify: 25 respondents answered
| Access to a psychiatrist and to a clinical psychologist for case reviews. Access to mental health counselor (focus practice physician, social worker, nurse, mental health worker) for individuals and groups. Parent support to assist them to care for the mental health and developmental needs of their children with ADHD, ASD |
| Psychiatry or psychology for complex cases needing more intensive diagnostic clarification or management. I would also settle for community support teams that actually picked up referrals. |
| Social Work Psychotherapists Counsellors Case workers who can help families address school related concerns Supports (non-CAS) for families in crisis |
| We have social workers at fht to problem solve and a mental health navigator and scope at local hospital. Problem is when out of cachement. |
| Mental health counsellor or social worker within our clinic would be advantageous. We recently had a job posting for this but no interest. |
| -in house psychiatrist who provides consultation, management , and/or case discussions -social worker /mental health resource navigator |
| I work in an addiction and mental health community program and we do have some mh supports in place for our youth |
| Increase supports for newly established Youth Wellness Hubs Ontario servicing clients 12-25 years of age. |
| it would be great if a psychiatrist is available to share or discuss a case so get opinion quickly |
| For easy access. individuals can access support without having to seek out specialized clinics. |
| Embedded psychotherapy and parenting supports Embedded help with forms and systems navigation |
| Would like parental support for caregivers of children with complex medical needs |
| providing adequate resources and equipment to carry out health care services. |
| Shared-care support/consultations within academic family health team. |
| Alliedpsych counselling services Crisis lines Psychiatrist in office |
| OT, OTA, counselling, play therapy, SLP, psych/ed, neuro/psych, ADOS |
| Early identification and intervention Reduced stigma Accessibility |
| Funding to have a CYW or even a mental health specific clinician |
| Time limited psychotherapy supports, access to low cost therapy |
| availability via OTN/Teams on an immduate-availabilty basis |
| Access to psychiatrist, long wait list however |
| Easily accessible and timely |
| Counselor on site |
| groups, therapy |
| counselling, |
Q10b. If other services useful to support patients, please specify: 4 respondents answered
| On site psychotherapy would be ideal (inpatient and outpatient), most youth come to this hospital looking for this, but it isn’t offered here (for any age demographic). Large amount struggle with emotion regulation and would benefit from DBT skills learning. |
| Mental health supports directed toward children with chronic illnesses - again OHIP funded. |
| Evening services when families can drive and attend |
| Personality Disorders Groups and services |
Q11c. If interested in other education/training initiatives, please specify: 2 respondents answered
| Help for refugee children to gain access to schooling and supports (psychoeducational assessments) |
| DBT/Emotion Regulation aimed for children & youth. |
Q12a. If other, please specify: 0 respondents answered
No written answers yet.
Q13a. If you are interested in child & youth mental health case-based discussions, specify the number of hours you could commit per month: 31 respondents answered
| 1-2 hrs, ideally with accreditations for CME/CHE |
| I can commit to 4 hours a week 16 hours a month |
| Unknown, due to requirement of client consent. |
| 2-6 pending workload acuity. |
| 1 (Eg: lunch & learn) |
| 10 hours per month |
| 5-10 hours |
| 8 to 10hrs |
| 10 hours |
| 200hours |
| 4 hours |
| 4 hours |
| 10-20 |
| 3-5 |
| 130 |
| 1-2 |
| 20 |
| 1 |
| 2 |
| 2 |
| 2 |
| 4 |
| 4 |
| 2 |
| 1 |
| 5 |
| 4 |
| 4 |
| 4 |
| 2 |
| 8 |
Q13b. If interested in other formats, please specify: 2 respondents answered
| Recorded seminars to allow for flexibility with viewing. |
| online |
Q14. Please share any challenges or barriers you would anticipate in accessing additional educational/training resources: 32 respondents answered
| I completed the Project Echo in Child and Youth Mental Health, which provided lots of useful information but there is still a lack of resources in my community and support for care in my practice is limited. |
| Workload acuity. Patient care comes first, so pending how the unit, workload and severity of presenting issues would change the amount of available time for me. |
| Would be good to embed this within already developed structures like community pediatric rounds or through the regional maternal child health networks or PCMCH. |
| Time. Needing training that is advanced, moving thoroughly through information (not at an introductory level) to support ongoing growth. |
| the clinical time to implement these services. Allied health support (even virtually) like the navigator or SW, or nursing to assist |
| Don’t know any challenges for now , but I feel travel might be a barrier if it would have to be outside Ontario . |
| lack of access to education opportunities for care providers in rural areas Diverse learner needs Time barrier |
| Finance Access to education and training opportunities cultural competence flexibility Time constraint |
| virtual would be helpful, especially if CPD accreditation |
| How often I would use the data, ability to find mentors |
| time, funding, location (ie. virtual vs. in-person) |
| online best way to support board engagement |
| Limitations on continuing education time |
| time commitment required outside of work |
| Time constraints. Cost should be zero. |
| working full-time and taking classes |
| Support from management to take time |
| Scheduling during office hours |
| Time away from seeing patients |
| time ,income restraints |
| language/ understanding |
| non compensated time |
| Geographical area |
| time constraints |
| funding time off |
| time management |
| time commitment |
| lack of time |
| Time Money |
| Cost Time |
| time |
| time |
Q15. Please add any additional suggestions in improving child and youth mental health care access in Ontario: 17 respondents answered
| Increased access to counselling in an ongoing way. I am in a community where there is an agency that proports to support children, but also only offers them single sessions through a large chunk of the year, routinely. While I can offer psychotherapy to some, it is a huge need and creating a gap that is acting as though it is filled. Which creates a difficult job around advocating for dollars or increased supports. Differential referrals to psychiatry sources based on whether the need is for short or long term support to increase access for diagnostic clarification referrals as we support our children and youth. Increasing mental health education in schools through periodic presentations. Increased community groups that hold spaces for youth to come together and socialize while discussing relevant mental health topics. (Not all virtual). |
| Frustrated that many specialties have initiatives to upgrade primary care skills instead of investing in greater availability of specialist consults and ongoing care. Psychiatry and rheumatology seem to be the biggest bottle neck, at least in Ottawa. |
|
| Chinese cultural specific resources - challenge in helping children/youth navigating mental health when parents are not fluent in English and hold stigma against mental health issues |
| Timely access-9-12 months wait time!! Trauma counseling is non existent in our area unless families can pay for it Funded counselling is a joke-3 sessions is what kids get |
| Having to involve not just medical practitioners alone, but also the community and parents their suggestions matters because they have some few ideas on what works too. |
| Review case in the moment as often crisis presentation more helpful or within 2 business days Parent and child know you are taking them seriously |
| psychiatrists who will actually see patients and follow-up CAMH rejects most referrals and the ones that go through are not very helpful |
| There would be much improvement if these challenges are worked on. I would be happy to explain more in an interview or interview. |
| wait time should be short, more parent coaching should be available. timely access to psychologist and psychiatrist |
| in the design of education and capacity building initiatives, consider to work in partnership with ECHO programs |
| parents should also help us in talking and caring for the child and youth, so as to make our work easier |
| could initial consult be completed by a nurse or social worker before psychiatrist consult? |
| More providers available in schools/ communities that are OHIP funded |
|
| the more funding and resources available the better |
| more involvement of primary care pediatricians |
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