Development of Quality Indicators for Quantifying Youth Risk of Suicide and Risk of Harm to Others

Self-harm and risk of harm to others are large contributors to youth mortality. These mental health trends suggest a need for a quantifiable and comparable approach to evaluating outcomes related to risk harm to self and others. Canada has significant gaps in the ability to assess the quality of mental health services across jurisdictions — the development of Quality Indicators can fill these gaps. Quality Indicators allow comparisons across different agencies and provinces, promoting uniform quality of care despite disparities in youth demographics, social determinants of health, and mental illness complexity. Data were collected using two standardized assessment instruments: the interRAI ChYMH (Child and Youth Mental Health) and ChYMH-DD (Developmental Disabilities). The difference in assessment values between baseline and follow-up, as well as risk-adjusted variables, formed the basis for the Quality Indicators, ensuring they reflect care quality. Youth characteristic measures, including interpersonal trauma, abuse, and trauma, influence patient improvement or worsening for the risk of harm to self and others. Other risk adjustors were retained based on their significance determined by a multiple logistic regression model with the Quality Indicators outcomes. Challenges for the youth or parent/primary caregivers were associated with higher rates of worsening risk, as well as lower rates of improvement. While the median risk of harm to self and others improved across agencies, many agencies saw that risk of harm to self and others shifted in the same direction (i.e., both worsening or improving). With respect to provider/system-level factors, youth in inpatient services were less likely to improve in either domain compared to youth in community-based services. The study focused on developing Quality Indicators to measure the care quality for children and youth at risk of harm to themselves or others. These Quality Indicators can be utilized by mental health agencies to evaluate care for youth, provide feedback to providers and agencies to improve care, and compare care across jurisdictions.