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

July 17, 2018 updated by: Mona Jabbour, Children's Hospital of Eastern Ontario

Improving Transitions in Care for Children and Youth With Mental Health Concerns: Implementation and Evaluation of an Emergency Department Mental Health Clinical Pathway

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.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

Commissioned by the Ontario Ministries of Health and Long Term Care(MOHLTC) and Child and Youth Services(MCYS), an expert-developed clinical pathway(CP) has been created with two main goals: 1) to guide risk assessment and disposition decision-making for children and youth presenting to the emergency department(ED) with MH concerns, and 2) to ensure seamless transition to follow-up services with community MH agencies(CMHAs) and providers. This pathway, referred to as the EDMHCP, is unique in undertaking to provide a seamless transition of care for children/youth and caregivers between hospital EDs and CMHAs.

Working with 4 exemplary hospital EDs and 2 Community Mental Health Agencies across Eastern Ontario, the investigators will conduct a 3-year mixed methods health services research project with three components to i) implement the EDMHCP using a theory driven, evidence-based approach, ii) evaluate EDMHCP effectiveness through measurement of relevant outcomes, and iii) conduct a process evaluation to document and assess the EDMHCP implementation strategy against the outcomes achieved.

This 3 year study will take place in five different phases, which include:

  • Preparation: Qualitative interviews with ED team members and strategy development
  • Implementation: Working with each ED team to implement the clinical pathway (including standardized assessments) within 8 months
  • Post-implementation: Qualitative interviews with ED team members
  • Data collection: 9-month pre/post chart audits of patients with mental health and caregiver satisfaction surveys
  • Follow up: to discuss findings, database creation, and dissemination strategy.

To ensure the findings directly impact relevant service delivery areas, the investigators have specifically recruited study team members with decision-making authority and/or influence on delivery of care for children and youth with MH concerns. This project will provide an implementation model for the EDMHCP to be used in any ED and CMHA setting, and will demonstrate decreased wait times and increased access with EDMHCP adoption. The findings will guide policy decision-making on access to timely and appropriate MH care and add to current knowledge of implementation science. In addition to knowledge translation via team member dissemination within their areas of influence, the investigators plan to disseminate the findings through presentation at scientific and healthcare conferences, and publication in relevant peer-reviewed journals.

Study Type

Interventional

Enrollment (Anticipated)

3095

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontario
      • Ottawa, Ontario, Canada, K1H 8L1
        • Recruiting
        • Children's Hopsital of Eastern Ontario
        • Contact:
        • Contact:
        • Principal Investigator:
          • Mona Jabbour, MD
        • Principal Investigator:
          • Mario Cappelli, PhD
      • Winchester, Ontario, Canada
        • Recruiting
        • Winchester District Memorial Hospital
        • Contact:
          • Crystal Doyle, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

6 years to 18 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • 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.

Exclusion Criteria:

  • 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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Dyads receiving the Implementation Phase
Dyad 1 (CHEO-YSB) Dyad 2 (CGH-CCH) Dyad 3 (WDMH-CCH) Dyad 4 (QCH-YSB)
Other: Implementation Phase

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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of patients receiving post-ED follow-up on the Services for Children and Adolescents Parent Interview questionnaire
Time Frame: 24 hours or 7 days
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
Time Frame: 24 hours or 7 days
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 Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of completed CP assessment forms filed in the health record to determine clinical pathway uptake in the Emergency Department
Time Frame: 9 months
CP uptake in the ED will be measured through audits as the proportion of completed clinical pathway assessment forms filed in the health record
9 months
Patient perspectives of post-ED mental health service using The Services for Children and Adolescents-Parent Interview
Time Frame: 7-10 days
Post ED uptake of recommended community MH services will be measured by The Services for Children and Adolescents-Parent Interview
7-10 days
Alignment of HEADS-ED assessment and mental health services
Time Frame: 7-10 days
Alignment of recommended services documented in the patients health record (audit) to the HEADS-ED mental health screening tool assessment
7-10 days
Decreased length of stay
Time Frame: 26 months
ED length of stay will be obtained from health record and NACRS administrative database
26 months
Patient satisfaction with ED visit measured by the Client Satisfaction Questionnaire
Time Frame: 7-10 days
Patient/caregiver satisfaction with the ED visit will be measured by the Client Satisfaction Questionnaire
7-10 days
Decreased number of hospital admissions obtained from health record and NACRS administrative database
Time Frame: 26 months
Hospital Admission will be obtained from health record and NACRS administrative database
26 months
Decreased number of ED Revisits from the health record and NACRS administrative database
Time Frame: 10 day and 3 months
ED revisits will be obtained from the health record and NACRS administrative database
10 day and 3 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Children's Hospital of Eastern Ontario

Collaborators

Canadian Institutes of Health Research (CIHR)
Ontario Ministry of Health and Long Term Care
Queensway Carleton Hospital
Winchester District Memorial Hospital
Youth Services Bureau
Cornwall Community Hospital

Investigators

  • Principal Investigator: Mona Jabbour, MD, Children's Hospital of Eastern Ontario

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 1, 2017

Primary Completion (Anticipated)

September 1, 2018

Study Completion (Anticipated)

December 1, 2019

Study Registration Dates

First Submitted

October 20, 2015

First Submitted That Met QC Criteria

October 27, 2015

First Posted (Estimate)

October 29, 2015

Study Record Updates

Last Update Posted (Actual)

July 19, 2018

Last Update Submitted That Met QC Criteria

July 17, 2018

Last Verified

July 1, 2018

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • ChildrensHEO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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