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

Stephen Freedman, Jennifer Thull-Freedman, Teresa Lightbody, Kassi Prisnie, Bruce Wright, Angela Coulombe, Linda M Anderson, Antonia S Stang, Angelo Mikrogianakis, Lindy VanRiper, Michael Stubbs, Amanda Newton, Pediatric Emergency Research Canada (PERC), Stephen Freedman, Jennifer Thull-Freedman, Teresa Lightbody, Kassi Prisnie, Bruce Wright, Angela Coulombe, Linda M Anderson, Antonia S Stang, Angelo Mikrogianakis, Lindy VanRiper, Michael Stubbs, Amanda Newton, Pediatric Emergency Research Canada (PERC)

Abstract

Introduction: Children 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 analysis: Two 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 dissemination: The 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 number: NCT04292379.

Keywords: clinical decision-making; emergency department; health services research; interrupted time series analysis; mental health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Study timeline for key milestones.
Figure 2
Figure 2
Acute mental healthcare bundle. ASQ, Ask Suicide-Screening Question; ED, emergency department.

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