Improving Transitions in Care for Children and Youth With Mental Health Concerns

NCT02590302 | Unknown

• 1 other identifier: ChildrensHEO
• Study Type: interventional
• Target: 3,095
• Locations: 1 country
• Sites: 2

Brief Summary

The overarching goal of this project is to improve timely access to appropriate mental health (MH) care for children and youth. The investigators will conduct and rigorously evaluate implementations of this pathway in four exemplar hospitals and associated CMHA dyads within a local health region. Outcomes-based validation of this pathway is important for effective adoption in other communities. A multiple baseline study design and conduct interrupted time-series analysis will be used to evaluate whether the EDMHCP has resulted in improved health care utilization, medical management, and health sector coordination. To ensure EDMHCP feasibility in various settings, implementation will occur in four exemplar hospital-community dyads with different workflows and patient populations.

Conditions

Mental Health

Keywords

Clinical pathway; Mental Health; Emergency Department; Paediatric; Risk assessment; Service integration; Transitions in care; Implementation; Scoring tools; Clinical Pathway Evaluation

Outcome Measures

Primary Outcomes (2)

• Proportion of patients receiving post-ED follow-up on the Services for Children and Adolescents Parent Interview questionnaire

  The primary clinical outcome is the proportion of patients that receive the post ED follow-up as per the clinical pathway recommendations as measured by the Services for Children and Adolescents Parent Interview questionnaire

  24 hours or 7 days

• Proportion of patients with documented mental health recommendations in the medical chart

  The primary process outcome is the proportion of patients with documented MH-specific recommendations (as defined by the project team) in the medical chart.

  24 hours or 7 days

Secondary Outcomes (7)

• Proportion of completed CP assessment forms filed in the health record to determine clinical pathway uptake in the Emergency Department

  9 months

• Patient perspectives of post-ED mental health service using The Services for Children and Adolescents-Parent Interview

  7-10 days

• Alignment of HEADS-ED assessment and mental health services

  7-10 days

• Decreased length of stay

  26 months

• Patient satisfaction with ED visit measured by the Client Satisfaction Questionnaire

  7-10 days

Study Arms (1)

Dyads receiving the Implementation Phase

OTHER

Dyad 1 (CHEO-YSB) Dyad 2 (CGH-CCH) Dyad 3 (WDMH-CCH) Dyad 4 (QCH-YSB)

Other: Implementation Phase

Interventions

Implementation Phase OTHER

Core Components of the implementation intervention include: * Hospital and CMHA project commitment * Site champion teams (from hospital and CMHA) * Memorandum of Agreement between Hospital and CMHA * Pre-intervention site visits * Education sessions * Posters/reminders * Instructional videos (HEADS ED video) Completed pathway implementation includes EDMHCP site-customization and committee approvals, consequent planning and agreements among ED-CMHA partners, delivery of at least two educational workshops, and EDMHCP availability in the ED. An 8-month period for EDMHCP implementation, with negotiated interim target dates was set for each site.

Dyads receiving the Implementation Phase

Eligibility Criteria

• Age: 6 Years - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Ages \> 5.99 and \< 18 years
• Presented to the ED of the four chosen hospitals within a selected 8 month time frame (between January, 2016 to May 2017)
• Mental health issue as their primary complaint (all complaints identified at triage as involving MH \[psychosocial, emotional, behavioural\])
• Proficient in English.

You may not qualify if:

• CTAS of 1 (Resuscitation)
• Patient is not medically stable
• Intubation/PICU care required
• Direct admission to hospital for ongoing medical management and observation
• Patients presenting with head injury or post-concussional syndrome

Sponsors & Collaborators

• Children's Hospital of Eastern Ontario: lead
• Canadian Institutes of Health Research (CIHR): collaborator
• Ontario Ministry of Health and Long Term Care: collaborator
• Winchester District Memorial Hospital: collaborator
• Queensway Carleton Hospital: collaborator
• Youth Services Bureau: collaborator
• Cornwall Community Hospital: collaborator

Study Sites (2)

Children's Hopsital of Eastern Ontario

Ottawa, Ontario, K1H 8L1, Canada

RECRUITING

Winchester District Memorial Hospital

Winchester, Ontario, Canada

RECRUITING

Related Publications (31)

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  PMID: 22826567 BACKGROUND

• Children's Hospital of Eastern Ontario. Advocacy Mental Health. Ottawa, Canada: http://www.cheo.on.ca/en/mentalhealth. Accessed August 22, 2014.

  BACKGROUND

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  BACKGROUND

• Provincial Council for Maternal and Child Health. Implementation Toolkit: Emergency Department Clinical Pathway for Children & Youth with Mental Health Conditions. Prov Counc Matern Child Heal. Available at: http://pcmch.on.ca/sites/default/files/Toolkit- ED_Clinical_Pathway-Tookit_ Sept_ 30_2013-FINAL_0.pdf. Accessed January 14, 2014.

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• Tucci A, Cloutier P, Polihronis C, Kennedy A, Zemek R, Gray C, Reid S, Pajer K, Gardner W, Barrowman N, Cappelli M, Jabbour M. Improving transitions in care for children and youth with mental health concerns: implementation and evaluation of an emergency department mental health clinical pathway. BMC Health Serv Res. 2025 Mar 31;25(1):475. doi: 10.1186/s12913-025-12524-z.

  PMID: 40165260 DERIVED

• Jabbour M, Reid S, Polihronis C, Cloutier P, Gardner W, Kennedy A, Gray C, Zemek R, Pajer K, Barrowman N, Cappelli M. Improving mental health care transitions for children and youth: a protocol to implement and evaluate an emergency department clinical pathway. Implement Sci. 2016 Jul 7;11(1):90. doi: 10.1186/s13012-016-0456-9.

  PMID: 27389410 DERIVED

MeSH Terms

Conditions

Psychological Well-Being; Emergencies

Condition Hierarchy (Ancestors)

Personal Satisfaction; Behavior; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Mona Jabbour, MD

  Children's Hospital of Eastern Ontario

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Mona Jabbour, MD

CONTACT

613-737-7600; jabbour@cheo.on.ca

Cappelli Mario, PhD

CONTACT

613-737-7600; cappelli@cheo.on.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Vice-Chief/Chair, Department of Pediatrics

Study Record Dates

• First Submitted: October 20, 2015
• First Posted: October 29, 2015
• Study Start: December 1, 2017
• Primary Completion: September 1, 2018
• Study Completion: December 1, 2019
• Last Updated: July 19, 2018

Record last verified: 2018-07

Locations

CA (2)