6.2 VIRTUAL IN-HOME EMERGENCY DEPARTMENT MENTAL HEALTH CONSULTATIONS FOR CHILDREN AND YOUTH

Abstract Background This article describes the provincial dissemination of HEARTSMAP, an evidence-based emergency department (ED) psychosocial assessment and disposition decision tool for clinician use with children and youth. Methods HEARTSMAP was disseminated in partnership with local, child and youth mental health teams, as part of a quality improvement initiative implemented in British Columbia EDs. The target audience of education sessions were clinicians working in ED settings responsible for paediatric psychosocial assessments. We used the RE-AIM framework to evaluate the reach, effectiveness, adoption, implementation, and maintenance of HEARTSMAP dissemination, analyzing data from session evaluation forms and online tool data. Results Education sessions reached 475 attendees, in 52 of 95 British Columbia EDs. HEARTSMAP training was well received by clinicians with 96% describing effective content including increased comfort in conducting paediatric psychosocial assessments and confidence in disposition planning after training. Clinicians identified unclear processes and lack of local resources as the main barriers to implementation. One-third of the attendees expressed willingness to use the tool, and 27% of registered clinicians have used the tool postimplementation. Conclusions Our approach reached and effectively trained clinicians from over half of the province’s EDs to use HEARTSMAP for emergency paediatric psychosocial assessments. For some, this provided greater comfort and confidence for these assessments and the following disposition decisions. This evaluation provides valuable insights on training clinicians to use a paediatric mental health tool within diverse ED settings and emphasized the need for ongoing support and institutional engagement to facilitate local, infrastructural, and operational processes for adoption and maintenance, postdissemination.

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Evaluating mental health service use during and after emergency department visits in a multisite cohort of Canadian children and youth

CJEM ◽

10.1017/cem.2017.416 ◽

2017 ◽

Vol 21 (1) ◽

pp. 75-86 ◽

Cited By ~ 2

Author(s):

Mario Cappelli ◽

Paula Cloutier ◽

Amanda S. Newton ◽

Eleanor Fitzpatrick ◽

Samina Ali ◽

...

Keyword(s):

Mental Health ◽

Emergency Department ◽

Emergency Department Visits ◽

Health Needs ◽

Children And Youth ◽

Mental Health Service Use ◽

Mental Health Needs ◽

Health Crisis ◽

Follow Up Care

AbstractObjectivesThe goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed.MethodsA 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction. Data analysis included descriptive statistics and the Fisher’s exact test to compare sites.ResultsThe cohort consisted of 373 children and youth (61.1% female; mean age 15.1 years, 1.5 standard deviation). The main reason for ED presentations was a mental health crisis. The three most frequent areas of need requiring action were mood (43.8%), suicide risk (37.4%), and parent-child relational problems (34.6%). During the ED visit, 21.6% of patients received medical clearance, 40.9% received a psychiatric consult, and 19.4% were admitted to inpatient psychiatric care. At the 1-month post-ED visit, 84.3% of patients/caregivers received mental health follow-up. Ratings of service recommendations were generally positive, as 60.9% of patients obtained the recommended follow-up care and 13.9% were wait-listed.ConclusionsChildren and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.

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Implementing a Clinical Pathway for Paediatric Mental Health Care in the Emergency Department

Canadian Journal of Community Mental Health ◽

10.7870/cjcmh-2019-015 ◽

2020 ◽

pp. 1-18

Author(s):

Erin M. McCabe ◽

Teresa Katherine Lightbody ◽

Christine Mummery ◽

Angela Coloumbe ◽

Kathy GermAnn ◽

...

Keyword(s):

Mental Health ◽

Emergency Department ◽

Clinical Pathways ◽

Implementation Process ◽

Lessons Learned ◽

Children And Youth ◽

Unique Contribution ◽

Hospital Emergency ◽

Current State ◽

Service Strategies

Practitioners in emergency departments across Canada are challenged with providing quality mental health (MH) care for children and youth despite increased demand for services. Coordinated service strategies, such as clinical pathways, are needed to effectively manage paediatric MH disorders. Practitioners in a children’s hospital emergency department implemented a pathway to improve the care of children and youth with MH conditions. This paper describes an external evaluation of practitioner and stakeholder experiences of the initiative as well as the implementation process, then explores current state and lessons learned. The paper provides a unique contribution to the practitioner-led implementation literature.

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