Introducing an innovative model of acute paediatric mental health and addictions care to paediatric emergency departments: a protocol for a multicentre prospective cohort study

Abstract

IntroductionChildren and youth with mental health and addiction crises are a vulnerable patient group that often are brought to the hospital for emergency department care. We propose to evaluate the effect of a novel, acute care bundle that standardises a patient-centred approach to care.Methods and analysisTwo paediatric emergency departments in Alberta, Canada are involved in this prospective, pragmatic, 29-month interventional quasi-experimental study. The acute care bundle comprises three components, applied when appropriate: (1) assessing self-harm risk at triage using the Ask Suicide-Screening Questionnaire (ASQ) to standardise the questions administered, enabling risk stratification; (2) use of the HEADS-ED (Home, Education, Activities/peers, Drug/alcohol, Suicidality, Emotions and behaviour, Discharge Resources) to focus mental health evaluations for those who screen high risk on the ASQ; and (3) implementation of a Choice And Partnership Approach to enable shared decision making in care following the emergency department visit. The overarching goal is to deliver the right care at the right place and time for the patients. The study design involves a longitudinal collection of data 12 months before and after the introduction of the bundle and the use of quality improvement strategies such as Plan-Do-Study-Act cycles during a 5-month run-in period to test and implement changes. The primary study end-point is child/youth well-being 1 month after the emergency department visit. Secondary outcomes include family functioning, child/youth well-being at 3 and 6 months, satisfaction with emergency department care, and health system outcomes (hospital admissions, length of emergency department stays, emergency department revisits).Ethics and disseminationThe study is registered at www.ClinicalTrials.gov and has received ethics and operational approvals from study sites. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be shared broadly with key policy and decision makers and disseminated in peer-reviewed academic journals and presentations at conferences.Trial registration numberNCT04292379.

Evaluation of parent and youth experiences in advisory groups as part of a mental healthcare clinical trial: protocol for a mixed-method study

“…In response to this position, a novel ‘bundle’ of mental healthcare was created with feedback from patient partners (comprised separate groups of youth and parent/caregivers). The bundle components were discussed and prioritised through several in-person meetings and teleconferences that took place between 2017 and 2019 22. Patient partners also prioritised study outcomes and selected outcome measures that were most relevant for self-reporting in mental health, satisfaction with care and family functioning.…”

“…Patient partners also prioritised study outcomes and selected outcome measures that were most relevant for self-reporting in mental health, satisfaction with care and family functioning. The results of this engagement were applied to both the trial as well as quasi-experimental study that provided pilot data to inform the trial 22. The bundle combines three evidence-based approaches to ED care, as follows:…”

“…The bundle components were discussed and prioritised through several in-person meetings and teleconferences that took place between 2017 and 2019. 22 Patient partners also prioritised study outcomes and selected outcome measures that were most relevant for self-reporting in mental health, satisfaction with care and family functioning. The results of this engagement were applied to both the trial as well as quasi-experimental study that provided pilot data to inform the trial.…”

“…The results of this engagement were applied to both the trial as well as quasi-experimental study that provided pilot data to inform the trial. 22 The bundle combines three evidence-based approaches to ED care, as follows:…”

Mental health triage tools: A narrative review

“…MHT tools assist clinicians to guide treatment response in other population groups and care settings, including prioritization of victims and care providers in disaster situations (Brannen et al 2013;Dyer et al 2008;Schreiber et al 2014;Sylwanowicz et al 2018). Other tools have been developed and implemented in special population groups including pregnant women (Yu et al 2015), children, and adolescents (Ayliffe et al 2005;Downey et al 2015;Freedman et al 2020;Jackson et al 2021;Naviaux 2018;Schreiber et al 2014;Smith & Hadorn 2002), elderly people (Dyer et al 2008), military personnel (Jones & Greenberg 2015), and forensic populations (Freestone et al 2015). Recently, Frasquilho et al (2021) proposed a four stream, stepped care MHT tool for use in people receiving treatment for cancer.…”