Lining up for children's mental health services: a tool for prioritizing waiting lists

The Western Canada Waiting List Project (WCWL) is a federally funded partnership of 19 health-related organizations that was created to develop tools to manage waiting lists for five types of health services.

The children's mental health (CMH) panel developed and tested a set of standardized clinical criteria for setting priorities among patients awaiting CMH services. The criteria were applied to 817 patients by 92 mental health professionals in three western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' global urgency ratings. To assess reliability, raters used the criteria to score six standardized "paper cases."

The criteria accounted for about 40% of the observed variance in overall urgency ratings (R2 = 41.7%). The panel modified the criteria on the basis of the initial empirical work. Reliability assessment of the revised tool indicated that half of the items had excellent or fair/good interrater agreement; test-retest reliability was good.

Priority criteria were able to capture clinicians' judgments of relative urgency in the CMH setting. A number of operational challenges remain with the use of priority criteria for scheduling CMH services. Further development and testing of the tool appear warranted.