Improving Transitions in Care for Children and Youth With Mental Health Concerns
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|ClinicalTrials.gov Identifier: NCT02590302|
Recruitment Status : Recruiting
First Posted : October 29, 2015
Last Update Posted : July 19, 2018
|Condition or disease||Intervention/treatment||Phase|
|Mental Health||Other: Implementation Phase||Not Applicable|
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 (Clinical Trial)|
|Estimated Enrollment :||3095 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Health Services Research|
|Official Title:||Improving Transitions in Care for Children and Youth With Mental Health Concerns: Implementation and Evaluation of an Emergency Department Mental Health Clinical Pathway|
|Actual Study Start Date :||December 1, 2017|
|Estimated Primary Completion Date :||September 2018|
|Estimated Study Completion Date :||December 2019|
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:
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.
- 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
- 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.
- 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
- 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
- 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
- Decreased length of stay [ Time Frame: 26 months ]ED length of stay will be obtained from health record and NACRS administrative database
- 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
- 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
- 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
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02590302
|Contact: Mona Jabbour, MD||613-737-7600 ext firstname.lastname@example.org|
|Contact: Cappelli Mario, PhD||613-737-7600 ext email@example.com|
|Children's Hopsital of Eastern Ontario||Recruiting|
|Ottawa, Ontario, Canada, K1H 8L1|
|Contact: Sheila Ledoux 613-737-7600 ext 4110 firstname.lastname@example.org|
|Contact: Andy Ng 613-737-7600 email@example.com|
|Principal Investigator: Mona Jabbour, MD|
|Principal Investigator: Mario Cappelli, PhD|
|Winchester District Memorial Hospital||Recruiting|
|Winchester, Ontario, Canada|
|Contact: Crystal Doyle, MD|
|Principal Investigator:||Mona Jabbour, MD||Children's Hospital of Eastern Ontario|