Improving mental health care transitions for children and youth: a protocol to implement and evaluate an emergency department clinical pathway

Mona Jabbour, S Reid, C Polihronis, P Cloutier, W Gardner, A Kennedy, C Gray, R Zemek, K Pajer, N Barrowman, M Cappelli, Mona Jabbour, S Reid, C Polihronis, P Cloutier, W Gardner, A Kennedy, C Gray, R Zemek, K Pajer, N Barrowman, M Cappelli

Abstract

Background: While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication among these groups is often poor, resulting in gaps, particularly in transitions of care, for this vulnerable population. The evidence-based Emergency Department Mental Health Clinical Pathway (EDMHCP) was created with two main goals: (1) to guide risk assessment and disposition decision-making for children and youth presenting to the ED with MH concerns and (2) to provide a streamlined transition to follow-up services with community MH agencies (CMHAs) and other providers. The purpose of this paper is to describe our study protocol to implement and evaluate the EDMHCP.

Methods/design: This mixed methods health services research project will involve implementation and evaluation of the EDMHCP in four exemplar ED-CMHA dyads. The Theoretical Domains Framework will be used to develop a tailored intervention strategy to implement the EDMHCP. A multiple baseline study design and interrupted time-series analysis will be used to determine if the EDMHCP has improved health care utilization, medical management of the MH problems, and health sector coordination. The primary process outcome will be the proportion of patients with MH-specific recommendations documented in the health record. The primary service outcome will be the proportion of patients receiving the EDMHCP-recommended follow-up at 24-h or at 7 days. Data sources will include qualitative interviews, health record audits, administrative databases, and patient surveys. A concurrent process evaluation will be conducted to assess the degree of variability and fidelity in implementation across the sites.

Discussion: This paper presents a novel model for measuring the effects of the EDMHCP. Our development process will identify how the EDMHCP is best implemented among partner organizations to deliver evidence-based risk management of children and youth presenting with MH concerns. More broadly, it will contribute to the body of evidence supporting clinical pathway implementation within novel partnerships.

Trial registration: ClinicalTrials.gov ( NCT02590302 ).

Keywords: Care transitions; Clinical pathway; Emergency department; Implementation; Mental health; Pediatric; Risk assessment; Scoring tools; Service integration.

Figures

Fig. 1
Fig. 1
Emergency Department Mental Health Clinical Pathway algorithm
Fig. 2
Fig. 2
Intervention strategy

References

    1. Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiat. 2002;159(9):1548–55. doi: 10.1176/appi.ajp.159.9.1548.
    1. Hacker K, Arsenault L, Franco I, et al. Referral and follow-up after mental health screening in commercially insured adolescents. J Adolesc Health. 2014;55:17–23. doi: 10.1016/j.jadohealth.2013.12.012.
    1. Kirby MJL, Keon WJ. Out of the shadows at last: transforming mental health, mental illness and addiction services in Canada. The Standing Senate Committee on Social Affairs, Science and Technology; 2006.
    1. MHASEF Research Team . The mental health of children and youth in Ontario: a baseline scorecard. Toronto: Institute for Clinical Evaluative Sciences; 2015.
    1. Children’s Hospital of Eastern Ontario. Advocacy Mental Health. Ottawa, Canada: . Accessed 4 July 2016.
    1. Richman B, Grossman D, Sloan F. Fragmentation in mental health benefits and services: a preliminary examination into consumption and outcomes. In: Elhauge ER, editor. The fragmentation of US healthcare: causes and solutions. Toronto: Oxford University Press; 2010. pp. 279–300.
    1. MacWilliams K, Curran J, Racek J, et al. Barriers and facilitators to implementing the HEADS ED: a rapid screening tool for pediatric patients in emergency departments. Pediatr Emerg Care. 2016
    1. Provincial Council for Maternal and Child Health. Implementation toolkit: emergency department clinical pathway for children and youth with mental health conditions. Prov Counc Matern Child Heal. Available at: . Accessed 4 July 2016.
    1. Cappelli M, Gray C, Zemek R, et al. The HEADS-ED: a rapid mental health screening tool for pediatric patients in the emergency department. Pediatric. 2012;130(2):e321–7. doi: 10.1542/peds.2011-3798.
    1. Jabbour M, Curran J, Scott SD, et al. Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial. Implement Sci. 2013;8(1):55. doi: 10.1186/1748-5908-8-55.
    1. Schulz KF, Altman DG, Moher D, et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Int Med. 2010;152(11):726–32. doi: 10.7326/0003-4819-152-11-201006010-00232.
    1. Scott SD, Grimshaw J, Klassen TP, et al. Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol. Implement Sci. 2011;6:133. doi: 10.1186/1748-5908-6-133.
    1. Jabbour M, Reid S, Irwin D, et al. Clinical pathway-based pediatric emergency outreach program: implementation and preliminary evaluation. Can J Hosp Pharm. 2014;67(3):240–5.
    1. Lougheed MD, Olajos-Clow J, Szpiro K, et al. Multicentre evaluation of an emergency department asthma care pathway for adults. CJEM. 2009;11(3):215–29.
    1. Bhogal S, Bourbeau J, McGillivray D, et al. Adherence to pediatric asthma guidelines in the emergency department: a survey of knowledge, attitudes and behaviour among health care professionals. Can Respir J. 2010;17:175–82. doi: 10.1155/2010/274865.
    1. HEADS-ED, From screening to services. . Accessed 4 July 2016.
    1. Michie S, Johnston M, Abraham C, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Healthc. 2005;14(1):26–33. doi: 10.1136/qshc.2004.011155.
    1. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7(37):1–17.
    1. Michie S, Johnston M, Francis J, et al. From theory to intervention: mapping theoretically derived behavioral determinants to behaviour change techniques. Appl Psychol. 2008;57(4):660–80. doi: 10.1111/j.1464-0597.2008.00341.x.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterizing and designing behaviour change interventions. Implement Sci. 2011;6(42):1–11.
    1. Waltz TJ, Powell BJ, Matthieu MM, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implement Sci. 2015;10(109):1–8.
    1. Jensen PS, Eaton Hoagwood K, Roper M, et al. The services for children and adolescents-parent interview: development and performance characteristics. J Am Acad Child Adolesc Psychiat. 2004;43(11):1334–44. doi: 10.1097/01.chi.0000139557.16830.4e.
    1. Attkisson CC, Zwick RJ. The client satisfaction questionnaire: psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Prog Plann. 1982;5(3):233–7. doi: 10.1016/0149-7189(82)90074-X.
    1. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. doi: 10.1016/j.jbi.2008.08.010.
    1. Hartmann DP, Gottman JM, Jones RR, et al. Interrupted time-series analysis and its application to behavioural data. J Appl Behav Anal. 1980;13(4):543–59. doi: 10.1901/jaba.1980.13-543.
    1. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299–309. doi: 10.1046/j.1365-2710.2002.00430.x.
    1. Zhang F, Wagner AK, Soumerai SB, Ross-Degnan D. Methods for estimating confidence intervals in interrupted time series analysis of health interventions. J Clin Epidemiol. 2009;62(2):143–8. doi: 10.1016/j.jclinepi.2008.08.007.
    1. Morse J, Field P. Qualitative research methods for health professionals. 2. Thousand Oaks: Sage; 1995.

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