Grant: Operating Grant: SPOR Innovative Clinical Trial Multi-Year Grant

For people suffering from an acute mental health or addictions crisis, emergency departments (EDs) serve as a vital settings for assessment, treatment and referral. The number of ED visits for such conditions is increasing rapidly. These crises are stressful and overwhelming, leaving the family vulnerable. In response, acute care must be evidence-based, family-centred, multidisciplinary, and lead to diagnosis and therapy while being integrated with community-based services. Current ED care is fragmented, system-centred and limits access to mental health services. Most families repeat their stories multiple times, and do not receive diagnostic assessments, therapy or clear follow-up instructions. Instead they find the 'door' they seek is closed and are left to navigate on their own. We will evaluate a patient and family-centred model of acute mental health care that is evidence-based. We will enroll 6,800 children and youth (<18 years of age) with visits to 8 pediatric EDs for mental health and substance use concerns. Using a cluster randomized trial design that integrates both comparative effectiveness and implementation science techniques, we will evaluate interventions that we believe will improve the care delivered leading to improved outcomes. These include: 1) Triage based evaluation of self-harm risk 2) Focused mental health team psychosocial evaluation to guide decision making 3) Choice And Partnership Approach (CAPA) to care These tools will be embedded into a model that removes the ED physician as the gatekeeper to mental health care and assures 24-48 hour community-based follow-up (booked before the child/family leave the ED). We believe this approach will provide the greatest value to children, youth and their families by matching resources and services to need while eliminating healthcare inefficiencies and closing care gaps. The model builds on existing services and committed investments, making it appropriate, feasible and highly likely to succeed.