Background Psychosocial concerns in youth are prevalent and undertreated. Early identification through screening may promote appropriate management before youth present in crisis. Objectives Our primary objective was to assess the acceptability of psychosocial screening in the pediatric emergency department (ED) setting. Secondarily, we report the prevalence of psychosocial issues among youth with non-psychiatric ED presentations, and the impact of screening on mental health resource-seeking behaviour. Design/Methods We conducted a prospective cohort study of youth aged 10-17 years at two pediatric EDs. Youth with a mental health-related reason for visiting the ED were excluded. Eligible and consenting youth (and their families) completed a comprehensive psychosocial self-assessment delivered on an electronic tablet, followed by standardized clinician assessment. Consent to participate in the study was used as a proxy measure for acceptability of screening. Participants with identified psychosocial resource needs were followed up at 30 days with a semi-structured telephone/email interview to assess whether they had sought recommended resources and to explore barriers to accessing care. Results Of the 1432 eligible youth given the opportunity to enrol, 795 consented. Among the 637 youth who declined enrolment, 467 specified that they declined for reasons other than not wanting to conduct a psychosocial self-assessment. This suggests that at least 55.5% (95% CI = 52.9%, 58.1%) and up to 88.1% (95% CI = 86.4%, 89.8%) find screening acceptable. Among the 760 participants who completed clinician assessment, 276 (36.3%) were identified as having a psychosocial resource need. Resources were already in place for 105 youth, leaving 171 (22.5%) with newly identified or unmet psychosocial needs. Only 41 (33.1%) of the 124 participants and/or their families who completed a 30-day follow up interview reported attempting to access the recommended resources, despite 92 (74.2%) stating they agreed with the original recommendations. The most common reason for not accessing care was the belief that the recommendations were not yet necessary or were not a priority. Of those who had attempted to access resources, 18 (43.9%) were unsuccessful at the time of interview, with the most common barrier being access delay (e.g. on a waitlist). Conclusion We found that previously unidentified/unmet psychosocial needs are prevalent among youth in the ED, and that screening is generally acceptable. However, a limited number of those who screened positive attempted to access resources, and when they did, access was often unsuccessful or delayed. More work is needed to address barriers to timely psychosocial care.
Background Mental health concerns in childhood and adolescence are prevalent, affecting nearly one million Canadian youth. In the absence of screening, up to 98% of these concerns can go undiagnosed, leading to significant health, educational, and social consequences. Consequently, the American Academy of Pediatrics recommends the development of screening tools to facilitate early identification and access to treatment. The Emergency Department (ED) represents a unique environment to implement such universal screening, as it is immediately accessible and may be the only point of contact for some vulnerable youth with undiagnosed illness. However, there are few existing instruments which take into account commonly cited barriers such as time constraints, disruption of ED flow, limited resources, and patient privacy. Objectives To facilitate efficient screening with minimal impact on ED flow, our team developed MyHEARTSMAP, an electronic self-administered screening tool. The tool is adapted from HEARTSMAP, a previously validated computerized assessment and management tool used by ED clinicians. MyHEARTSMAP has previously been evaluated for face validity and inter-rater reliability. Here, we measured the sensitivity and specificity of MyHEARTSMAP in identifying mental health concerns in youth. Design/Methods A prospective cohort study was conducted at two tertiary care pediatric EDs. Eligible youth aged 10-17 years presenting for a non-mental health complaint were invited to self-screen using MyHEARTSMAP. An accompanying parent/guardian could also complete an assessment of their child. The sensitivity and specificity was measured as the proportion of screened youth with mental health concerns identified through self-assessment by MyHEARTSMAP compared to assessment performed by a clinician (criteron standard). Results 760 youth and/or parents completed the study intervention. The sensitivity at identifying any psychiatric concerns was comparable between youth and guardian assessments: 92.7% (95%CI: 89.1, 95.4%) and 93.1% (95%CI: 89.5, 95.8%) respectively. The specificity at identifying youth without any psychiatric issues was also comparable between youth and their guardians: 42.2% (95%CI: 37.3, 47.3) and 37.0% (95%CI: 32.2,42.1), respectively. Conclusion MyHEARTSMAP is sensitive for identifying youth with mental health concerns. While it showed only modest specificity, false positives were almost entirely (98%) mild issues identified by youth and deemed to be normal by clinicians. This would not place a burdensome demand on mental health services and could be effectively assessed without specialized psychiatric training. Thus, MyHEARTSMAP may be an effective tool for early identification and management of mental health concerns.
Objective: To explore parental perceptions of psychosocial screening in the paediatric emergency department and identify post-screening barriers to accessing mental health care. Methods: We conducted a qualitative study during the 30-day follow-up period of a larger prospective cohort study. Eligible youth and their accompanying parent/guardian first completed psychosocial self/proxy-screening using the MyHEARTSMAP tool and then received a standardized clinical mental health assessment. If the MyHEARTSMAP assessment provided youth with mental health resources recommendations, their parents were invited to a follow-up session. Thirty days (±5 days) after their ED visit, parents participated in a virtual interview to reflect and share their attitudes, perceptions and thoughts around the screening and mental health care-seeking process. Results: Of the 171 participants who received resource recommendations during their ED visit, 124 parents (72.5%; 95% CI 65.2–79.1%) completed the follow-up interview. Most parents endorsed positive perceptions of the screening process, describing it as an ‘eye-opening’ process that ‘sparked conversation’. Most participants (74.2%; 95% CI 65.6–81.6) agreed with the resource recommendations they received. In terms of resources-seeking, only 41 participants (33.1%; 95% CI 24.9–42.1) attempted to access recommended supports. Families generally felt identified concerns were mild and ‘not serious enough’ to warrant resource-seeking, though many expressed an intention to seek care if concerns escalated. Conclusion: Perceptions of psychosocial screening in the ED were favourable and encouraging among participating parents of youth screened positive for psychosocial issues. Despite positive attitudes, only a fraction of the families invited to follow-up attempted to access care. Mental health may be perceived as low priority for many families, signifying the need for improved education and awareness building on the importance of early intervention.
ABSTRACT:Background: Advances in multiple sclerosis (MS) disease modifying therapy (DMT) have increased laboratory monitoring requirements. Our goal was to survey existing practices and perceptions of risk in laboratory monitoring throughout Canada and assess whether opportunities to improve patient care and safety exist. Methods: A web-based survey assessing prescriber demographics, current infrastructure, and concerns for lab monitoring was sent to the Canadian Network of MS Clinics (CNMSC) listserv, inviting MS clinicians across the country to participate. Results: Respondents included 32/65 CNMSC-affiliated neurologists (49%), 6 registered nurses (RN), 2 nurse practitioners (NP), and 2 non-neurologist physicians from 8/10 provinces. For some questions, analysis was limited to 34 DMT-prescribing clinicians only. Despite broad implementation of electronic medical records (25/34, 74%), many prescribers (15/34, 44%) still receive laboratory results in paper form. In terms of lab monitoring infrastructure, we noted regional variability in the employment of nursing to monitor patient compliance with required laboratory monitoring. There is also a gap in laboratory surveillance, as less than 5% of respondents reported regularly reviewing results on weekends. Providers’ length of practice and volume of MS patients were not associated with different perception of DMT laboratory monitoring risk. Conclusions: This nation-wide survey showed variability in infrastructure used in laboratory monitoring and regional variation in nursing involvement. Providers’ level of concern for laboratory monitoring for DMTs did not vary by years of experience or volume of MS patients followed, suggesting that improved systems, rather than education, could ameliorate perceptions of risk.
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