Grant: Partnerships for Health System Improvement (PHSI)

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

<html> <body>The overarching goal of this proposal is to improve timely access to appropriate mental health(MH) care for children and youth. Ontario&rsquo;s current MH system for children and youth in Ontario is fragmented among multiple ministries, organizations, and care providers. Communication between these groups is often poor, resulting in gaps in transitions of care for this vulnerable population. 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. We propose to 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.<br> <strong> <br>This project is important because it directly addresses identified MH service delivery needs for children, youth and families.</strong> We will address the goals of Ontario&rsquo;s comprehensive MH and Addictions Strategy<em>⁹</em>: 1) early identification and intervention of child and youth MH issues, 2) fast access to high quality services and 3) reduced service gaps for vulnerable children and youth.<br> <br>With our strengths in research, collaboration and clinical expertise, our team has great capacity to achieve our program goals. These capacities include emergency medicine, community and hospital-based pediatric MH, emergency outreach, implementation, statistics, mixed methods research and knowledge translation. Our team also includes members of multiple ministries, parent and youth advocates, and the local health region and administrative leads from the CMHA and hospital sites. These members will optimize success by providing leadership commitment for this implementation and ensuring input from all relevant stakeholders.<br> <br>We will conduct a 3-year mixed methods health services research project with three components: 1) local implementations using a theory-driven, evidence-based approach, 2) quantitative and qualitative evaluation of CP effectiveness through measurement of process and clinical outcomes, and 3) a robust process evaluation to document and assess the implementation strategy against the outcomes achieved.<br> <br>To ensure our findings directly impact relevant service delivery areas, we 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. Our 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, we plan to disseminate our findings through presentation at scientific and healthcare conferences, and publication in relevant peer-reviewed journals.</body> </html>