Not provided
| ID | Type | Description | Link |
|---|---|---|---|
| REB19-0357 | Other Identifier | University of Calgary |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| University of Calgary | OTHER |
Not provided
Not provided
Not provided
Not provided
The investigators will implement and evaluate an integrated, evidence-based bundle of family-centred, pediatric emergency mental health and addictions care.
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.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard care | Active Comparator | 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. |
|
| Care Bundle | Experimental | 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard care | Other | Standard procedures and assessments |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Patient wellbeing at 30 days | Measured in survey completed by the participant using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) for patients ≥14 years of age, and the Stirling Children's Wellbeing Scale (SCWBS) for patients <14 years of age. For the WEMWBS, each item is scored on a range from 1 to 5. The resulting total score will be between 14 and 70, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 45. A substantial decrease in wellbeing is defined as a decrease by 5 or more points. For the SCWBS, each item is scored on a range from 1 to 5. The resulting total score will be between 12 and 60, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 30. A substantial decrease in wellbeing is defined as a decrease by 5 or more points. | 30 days after the index emergency department (ED) visit |
| Measure | Description | Time Frame |
|---|---|---|
| Patient wellbeing at 90 and 180 days | Measured in survey completed by the participant using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) for patients ≥14 years of age, and the Stirling Children's Wellbeing Scale (SCWBS) for patients <14 years of age. For the WEMWBS, each item is scored on a range from 1 to 5. The resulting total score will be between 14 and 70, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 45. A substantial decrease in wellbeing is defined as a decrease by 5 or more points. For the SCWBS, each item is scored on a range from 1 to 5. The resulting total score will be between 12 and 60, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 30. A substantial decrease in wellbeing is defined as a decrease by 5 or more points. |
| Measure | Description | Time Frame |
|---|---|---|
| Death by suicide within 30 days of the index ED visit | Measured using coroner's data | 30 days after the index ED visit |
Inclusion Criteria:
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:
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Amanda Newton, PhD | University of Alberta | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Alberta Children's Hospital | Calgary | Alberta | T3B 6A8 | Canada | ||
| Stollery Children's Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40009377 | Derived | Newton AS, Thull-Freedman J, Xie J, Lightbody T, Woods J, Stang A, Winston K, Larson J, Wright B, Stubbs M, Morrissette M, Freedman SB; Pediatric Emergency Research Canada (PERC). Outcomes Following a Mental Health Care Intervention for Children in the Emergency Department: A Nonrandomized Clinical Trial. JAMA Netw Open. 2025 Feb 3;8(2):e2461972. doi: 10.1001/jamanetworkopen.2024.61972. | |
| 33318032 |
Not provided
Not provided
IPD will not be shared with other researchers.
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D000092862 | Psychological Well-Being |
| D001523 | Mental Disorders |
| ID | Term |
|---|---|
| D010549 | Personal Satisfaction |
| D001519 | Behavior |
Not provided
Not provided
| ID | Term |
|---|---|
| D059039 | Standard of Care |
| D064872 | Patient Care Bundles |
| ID | Term |
|---|---|
| D019984 | Quality Indicators, Health Care |
| D011787 | Quality of Health Care |
| D006298 | Health Services Administration |
| D017530 | Health Care Quality, Access, and Evaluation |
Not provided
Not provided
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.
Not provided
Not provided
Not provided
Not provided
| Care Bundle |
| Other |
Suicide risk screening tool, mental health assessment tool, follow-up appointment |
|
| 90 days, and 180 days after the index ED visit |
| Family functioning | Measured in survey completed by the participant using the Family Quality of Life Scale (FQOL). The 25-item scale uses a 5-point rating with a maximum score of 125 indicating highest quality of life. | 30 days after the index ED visit |
| Satisfaction with acute mental health and addictions ED care | Measured in survey completed by the participant using the Service Satisfaction Scale 10 (SSS-10). The scale consists of 12 items (parent version) or 10 items (youth version). Items are scored on a 5-point response scale with a total possible score of 60 (parent) or 50 (youth). Higher scores indicate higher satisfaction. | 72 hours after the index ED visit |
| Proportion of children/youth admitted to child mental health service (child and adolescent psychiatry, mental health team, etc.) | Measured using data collected in the patient electronic medical record | Index ED visit (Day 0) |
| Length of ED stay for discharged patients with any mental health presenting complaint | Measured using data collected in the patient electronic medical record. ED Length of stay is defined as the time between patient triage and discharge from the emergency department | Hours spent in the ED, measured at the index ED visit (Day 0) |
| Proportion of ED revisits within 72 hours and 30 days for mental health and substance use disorders | Measured using data collected in the patient electronic medical record | 72 hours and 30 days after the index ED visit (Day 0) |
| Edmonton |
| Alberta |
| T6G 2B7 |
| Canada |
| Derived |
| 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. |
| D013812 | Therapeutics |