An Innovative Model of Pediatric Acute Mental Health and Addictions Care

University of Alberta

Status: Completed

Conditions: Pediatrics; Mental Disorders; Emergency Psychiatric; Mental Health

Treatments: Other: Care Bundle; Other: Standard care

Study type: Interventional

Funder types: Other

Identifiers

NCT04292379

REB19-0357 (Other Identifier)

Pro00092862

Details and patient eligibility

About

The investigators will implement and evaluate an integrated, evidence-based bundle of family-centred, pediatric emergency mental health and addictions care.

Full description

The investigators will implement and evaluate an integrated, evidence-based bundle of family-centred, emergency mental health and addictions care. This care bundle will provide high value to families, matching resources and services to need while eliminating healthcare inefficiencies and closing care gaps. The bundle will introduce two well-established tools for healthcare providers to use in EDs, walk-in clinics, and urgent mental health care appointments. These tools are the Ask Suicide-Screening Questions (ASQ) and HEADS-ED, an assessment mnemonic (Home; Education & Employment; Activities & Peers; Drugs & Alcohol; Suicidality; Emotions & Behaviours; Discharge or Current Resources).

The bundle will also introduce new processes to improve healthcare system efficiencies, navigation and transitions between healthcare sectors. For families who receive care in the ED, the investigators will remove the physician gatekeeper role so that children/youth who are screened as low-risk will be offered a follow-up appointment in an urgent mental health care clinic within 24-48 hours. Those who screen as high-risk will see a mental health specialist and undergo a HEADS-ED assessment. Families who follow up in the clinic will receive care that applies a Choice And Partnership Approach (CAPA). CAPA is a collaborative approach to healthcare, where healthcare providers work in partnership with children/youth and their parents to identify choices for care that best match individual needs and preferences.

Study Goal: The investigators' goal is the right care, with the right people, at the right place and time.

Study Design: To measure the bundle's impact, the investigators will use an interrupted time series (ITS) design.

Enrollment: 1,992 patients

Sex: All

Ages: Under 17 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patient is under 18 years of age
• Patient came to the emergency department with a mental health and/or addiction concern
• Patient presented with one of the following CEDIS complaints:

Anxiety, bizarre behaviour, concern for patient's welfare, deliberate self-harm, depression/suicidal, homicidal behaviour, insomnia, pediatric disruptive behaviour, situational crisis, violent behaviour

Exclusion criteria

• Brought to the ED by police, peace officer or EMS?
• Held under Form 10
• Features of schizophrenia, schizotypal and delusional disorders (e.g., hallucinations, delusions, active psychosis)
• Behavioural syndromes or other medical concerns requiring medical clearance (e.g., eating disorders)
• Significant self-harm requiring medical clearance (e.g., deep laceration, ingestion, hanging)
• Barriers to communication at triage (e.g., language)
• Previous participation in the study

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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1,992 participants in 2 patient groups

Standard care

Active Comparator group

Description:

Mental health visits involve an assessment by a triage nurse who classifies visit urgency into one of five acuity levels using the Canadian Triage and Acuity Scale (CTAS) score. Following triage, children could be assessed by a range of health care providers: emergency department nurse, emergency department physician, mental health nurse, and/or a child and adolescent psychiatrist. Standardized tools are not typically used to guide assessments. Most discharge instructions require families to organize the child's follow-up care.

Treatment:

Other: Standard care

Care Bundle

Experimental group

Description:

The bundle standardized suicide risk screening at triage, introduced a focused mental health assessment to guide discussions across health care providers, and included a booked follow-up appointment after the emergency department visit.

Treatment:

Other: Care Bundle