Health Services: The Acute Mental Health Care Bundle consists of 3 core elements, including: (1) ED triage, (2) ED assessment and care, and (3) follow-up care.
Study summary
The investigators will determine, in an 8-site, hybrid Type 1 cluster randomized effectiveness implementation trial, if an acute mental health care bundle, compared to standard care, improves wellbeing at 30 days in children and youth seeking emergency department care for mental health and substance use concerns.
Eligibility
Sex
ALL
Min age
8 Years
Max age
17 Years
Healthy volunteers
No
Inclusion Criteria:
1. Age 8 to 17.99 years
2. Chief triage concern of at least one of the following (or comparable) mental health CEDIS triage categories:
1. Anxiety/situational crisis and/or hyperventilation
2. Bizarre/paranoid behaviour
3. Concern for patient's welfare
4. Depression/suicidal/deliberate self-harm
5. Hallucinations/delusions
6. Violent/homicidal behaviour
7. Insomnia
8. Pediatric disruptive behaviour
Exclusion Criteria:
1. Brought to the ED under provincial mental health legislation
2. Exhibiting features of schizophrenia, schizotypal, delusional disorders, or psychosis (e.g., hallucinations/delusions complaint should be reviewed carefully for this exclusion criterion)
3. Significant self-harm act (i.e., suicide attempt requiring medical clearance, excluding ideation or minor superficial wounds; e.g., laceration/puncture, overdose ingestion, etc.)
4. Other co-morbid medical concerns requiring oversight and/or medical clearance from an emergency physician (e.g., confusion/disorientation, substance withdrawal, other medical complaints, etc.)
5. Substance misuse/intoxication or altered level of consciousness
6. Exhibiting a behavioural syndrome associated with physiologic disturbances (e.g., anorexia)
Children/youth will also be excluded based on language barriers:
7. Language barrier (i.e., patient and parent/legal guardian must be fluent in either English or French)
Primary outcome measure(s)
Warwick-Edinburgh Mental Wellbeing Scale 30 days after the index ED visit — 30 days after the index emergency department (ED) visit Measured in survey completed by the participant using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) for patients ≥13 years
Each item is scored on a range from 1 to 5. The total score will be between 14 and 70, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 45. A substantial decrease in wellbeing is a decrease by 5 or more points.
Stirling Children's Wellbeing Scale 30 days after the index ED visit — 30 days after the index emergency department (ED) visit Measured in survey completed by the participant using the Stirling Children's Wellbeing Scale (SCWBS) for patients \<13 years.
Each item is scored on a range from 1 to 5. The total score will be between 12 and 60, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 30. A substantial decrease in wellbeing is a decrease by 5 or more points.
As these scales used for the primary outcomes measure the same construct, data will be standardized and combined across age groups to derive a single measure of wellbeing.
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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