Clinical trial NCT04292379: An Innovative Model of Pediatric Acute Mental Health and Addictions Care
Official title: An Innovative Model of Pediatric Acute Mental Health and Addictions Care to Increase Value to Children,Youth, and the Healthcare System
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Mental Health
Mental Disorders
Pediatrics
Emergency Psychiatric
Keywords: Emergency Psychiatric Services
Healthcare Delivery
Lead sponsor: University of Alberta
Sponsor class: OTHER
Collaborators: name: University of Calgary
First posted: 2020-03-03
Enrollment: 1992
Sex: ALL
Minimum age (years): 0
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Intervention model description: This is a quasi-experimental study design conducted in three phases. Phase 1 involves standard care. Phase 2 involves introducing a new care bundle to clinical practice using quality improvement and change management strategies. Phase 3 involves delivery of the care bundle.
Primary purpose: HEALTH_SERVICES_RESEARCH

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

Detailed 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.

Eligibility criteria: 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

Primary outcomes:
measure: Patient wellbeing at 30 days
timeFrame: 30 days after the index emergency department (ED) visit
Secondary outcomes:
measure: Patient wellbeing at 90 and 180 days
timeFrame: 90 days, and 180 days after the index ED visit
measure: Family functioning
timeFrame: 30 days after the index ED visit
measure: Satisfaction with acute mental health and addictions ED care
timeFrame: 72 hours after the index ED visit
measure: Proportion of children/youth admitted to child mental health service (child and adolescent psychiatry, mental health team, etc.)
timeFrame: Index ED visit (Day 0)
measure: Length of ED stay for discharged patients with any mental health presenting complaint
timeFrame: Hours spent in the ED, measured at the index ED visit (Day 0)
measure: Proportion of ED revisits within 72 hours and 30 days for mental health and substance use disorders
timeFrame: 72 hours and 30 days after the index ED visit (Day 0)
Other outcomes:
measure: Death by suicide within 30 days of the index ED visit
timeFrame: 30 days after the index ED visit
Locations:
city: Calgary
country: Canada
facility: Alberta Children's Hospital
state: Alberta
city: Edmonton
country: Canada
facility: Stollery Children's Hospital
state: Alberta
Study officials:
affiliation: University of Alberta
name: Amanda Newton, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Freedman S, Thull-Freedman J, Lightbody T, Prisnie K, Wright B, Coulombe A, Anderson LM, Stang AS, Mikrogianakis A, VanRiper L, Stubbs M, Newton A; Pediatric Emergency Research Canada (PERC). Introducing an innovative model of acute paediatric mental health and addictions care to paediatric emergency departments: a protocol for a multicentre prospective cohort study. BMJ Open Qual. 2020 Dec;9(4):e001106. doi: 10.1136/bmjoq-2020-001106.