Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Graham J. Reid, Ph.D.


Continuity of care, which is how a patient experiences care over time as coherent and linked, has been identified as an indicator of health system performance and is considered an ethical principle of care. Yet, no instrument exists to measure continuity of care as experienced by families receiving services through the children's mental health (CMH) system. A new measure, Continuity of Care in Children’s Mental Health (C3MH), is presented. The project involved four phases: item generation, pre-testing, pilot testing, and validation. In the validation study, the 42-item C3MH was administered to 364 parents of children and youth (M =12 years; SD =3.50; 57% boys), recruited from 13 CMH agencies in Ontario. Using EQS, a CFA was conducted to determine the fit of data to the hypothesized model. A five-factor model had an excellent fit (Y-B χ2 = 514.93, p < .001; NNFI = .93; CFI = .94; IFI = .94; RMSEA = .046; 90% C.I. = .039, .053). Cronbach’s alphas for the subscales ranged from .80 to .93 and test-retest reliabilities ranged from .75 to .92. The C3MH was related to: higher satisfaction with services; higher child internalizing problems; less impact of problems on the family; having a case manager, and not dropping out of treatment. The transitions scale was negatively related to parental depression, externalizing problems, total problems, child impairment, and impact of problems on the family. A youth-report version was also piloted with 57 youth and these results are presented. The C3MH is the first parent-report measure of continuity in CMH and will be useful for assessing and tracking improvements in system integration and service coordination.