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Virk P, Arora R, Burt H, Finnamore C, Gadermann A, Barbic S, Doan Q. Evaluating the Psychometric Properties and Clinical Utility of a Digital Psychosocial Self-Screening Tool (HEARTSMAP-U) for Postsecondary Students: Prospective Cohort Study. JMIR Ment Health 2023; 10:e48709. [PMID: 37556180 PMCID: PMC10448294 DOI: 10.2196/48709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Existing screening tools for mental health issues among postsecondary students have several challenges, including a lack of standardization and codevelopment by students. HEARTSMAP-U was adapted to address these issues. OBJECTIVE This study aimed to evaluate the suitability of HEARTSMAP-U as a self-screening tool for psychosocial issues among postsecondary students by evaluating its validity evidence and clinical utility. METHODS A prospective cohort study was conducted with University of British Columbia Vancouver students to evaluate HEARTSMAP-U's predictive validity and convergent validity. Participating students completed baseline and 3-month follow-up assessments via HEARTSMAP-U and a clinician-administered interview. RESULTS In a diverse student sample (n=100), HEARTSMAP-U demonstrated high sensitivity (95%-100%) in identifying any psychiatric concerns that were flagged by a research clinician, with lower specificity (21%-25%). Strong convergent validity (r=0.54-0.68) was demonstrated when relevant domains and sections of HEARTSMAP-U were compared with those of other conceptually similar instruments. CONCLUSIONS This preliminary evaluation suggests that HEARTSMAP-U may be suitable for screening in the postsecondary educational setting. However, a larger-scale evaluation is necessary to confirm and expand on these findings.
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Affiliation(s)
- Punit Virk
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ravia Arora
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Heather Burt
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Anne Gadermann
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health, Vancouver, BC, Canada
| | - Skye Barbic
- Centre for Health Evaluation and Outcome Sciences, Providence Health, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Quynh Doan
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Paediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Lightbody T, Thull-Freedman J, Freedman SB, Wright B, Finseth N, Coulombe A, Morrissette M, DeGuerre A, McConnell S, Bozocea K, Groves-Johnston S, Woods J, Newton A. Use of quality improvement methods to enhance implementation of a mental health care bundle in a pediatric emergency department. CAN J EMERG MED 2023; 25:326-334. [PMID: 36964857 PMCID: PMC10039676 DOI: 10.1007/s43678-023-00476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/24/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES We used quality improvement methods to implement a care bundle for children presenting to a pediatric emergency department (ED) with mental health concerns. A bundle novelty was that it included an option for assessment in a partnered clinic, not in the ED, to families of children assessed as having no medical or safety concerns. The primary aim of this study was to establish successful implementation of the bundle prior to studying its impact. METHODS The bundle included the Ask Suicide-Screening Questions to standardize risk assessment at triage, the HEADS-ED (Home, Education, Activities/Peers, Drug/Alcohol, Suicidality, Emotions/Behavior, Discharge Resources) tool for brief, scored mental health assessments, and offering an urgent appointment within 96 h for low-risk children as an alternative to ED-based assessment or as a follow-up option for patients assessed in the ED. We developed aims, driver diagrams, and outcome measures for each bundle element. Each element was introduced with small tests of change using iterative plan-do-study-act cycles. Run charts were used to determine successful completion of aims. RESULTS Rules for special cause were met through detection of shifts in performance 5 months after bundle implementation for the Ask Suicide-Screening Questions and HEADS-ED. These bundle elements were consistently used with ≥ 80% of eligible patients, representing aim achievement. During the 6 months of providing urgent appointments, 89.3% of 159 referred families received an appointment within 96 h. CONCLUSIONS Using quality improvement methods, we were able to successfully ensure reliable implementation of a new care bundle for pediatric patients presenting to the ED with mental health concerns and allow eligible low-risk patients to receive full assessments in a partnered clinic instead of the ED.
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Affiliation(s)
- Teresa Lightbody
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada.
- Northgate Health Centre, Alberta Health Services-Edmonton Zone, Edmonton, AB, Canada.
| | - Jennifer Thull-Freedman
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Stephen B Freedman
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Bruce Wright
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Faculty of Medicine and Dentistry, Stollery Children's Hospital University of Alberta, Women and Children's Research Institute, Edmonton, AB, Canada
| | - Nicole Finseth
- University of Alberta Hospital and Stollery Emergency Department, Edmonton, AB, Canada
| | - Angela Coulombe
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada
| | - Matthew Morrissette
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amanda DeGuerre
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada
| | - Stephanie McConnell
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada
| | - Karen Bozocea
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada
| | | | - Jennifer Woods
- University of Alberta Hospital and Stollery Emergency Department, Edmonton, AB, Canada
| | - Amanda Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Hoge MA, Vanderploeg J, Paris M, Lang JM, Olezeski C. Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda. Community Ment Health J 2022; 58:1225-1239. [PMID: 35038073 PMCID: PMC8762987 DOI: 10.1007/s10597-022-00937-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
Abstract
There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.
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Affiliation(s)
- Michael A. Hoge
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jeffrey Vanderploeg
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- grid.475976.eChild Health and Development Institute, Farmington, CT USA
- grid.208078.50000000419370394Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Manuel Paris
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jason M. Lang
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- grid.475976.eChild Health and Development Institute, Farmington, CT USA
- grid.208078.50000000419370394Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Christy Olezeski
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Glowacki K, Whyte M, Weinstein J, Marchand K, Barbic D, Scheuermeyer F, Mathias S, Barbic S. Exploring how to enhance care and pathways between the emergency department and integrated youth services for young people with mental health and substance use concerns. BMC Health Serv Res 2022; 22:615. [PMID: 35525965 PMCID: PMC9077976 DOI: 10.1186/s12913-022-07990-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Integrated youth services (IYS) provide multidisciplinary care (including mental, physical, and social) prioritizing the needs of young people and their families. Despite a significant rise in emergency department (ED) visits by young Canadians with mental health and substance use (MHSU) concerns over the last decade, there remains a profound disconnect between EDs and MHSU integrated youth services. The first objective of this study was to better understand the assessment, treatment, and referral of young people (ages 12–24 years) presenting to the ED with MHSU concerns. The second objective was to explore how to improve the transition from the ED to IYS for young people with MHSU concerns. Methods We conducted semi-structured one-on-one video and phone interviews with stakeholders in British Columbia, Canada in the summer of 2020. Snowball sampling was utilized, and participants (n = 26) were reached, including ED physicians (n = 6), social workers (n = 4), nurses (n = 2), an occupational therapist (n = 1); a counselor (n = 1); staff/leadership in IYS organizations (n = 4); mental health/family workers (n = 3); peer support workers (n = 2), and parents (n = 3). A thematic analysis (TA) was conducted using a deductive and inductive approach conceptually guided by the Social Ecological Model. Results We identified three overarching themes, and factors to consider at all levels of the Social Ecological Model. At the interpersonal level inadequate communication between ED staff and young people affected overall care and contributed to negative experiences. At the organizational level, we identified considerations for assessments and the ED and the hospital (wait times, staffing issues, and the physical space). At the community level, the environment of IYS and other community services were important including wait times and hours of operation. Policy level factors identified include inadequate communication between services (e.g., different charting systems and documentation). Conclusions This study provides insight into important long-term systemic issues and more immediate factors that need to be addressed to improve the delivery of care for young people with MHSU challenges. This research supports intervention development and implementation in the ED for young people with MHSU concerns.
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Affiliation(s)
- Krista Glowacki
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. .,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada. .,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Madelyn Whyte
- Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada
| | - Jade Weinstein
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Kirsten Marchand
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - David Barbic
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Y 1Z6, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Y 1Z6, Canada
| | - Steve Mathias
- Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Lee A, Davidson J, Black T, Kim GG, Doan Q. Youth mental health-related presentations at a quaternary centre: Who comes, What are their needs, and Can we meet their needs. Paediatr Child Health 2022; 27:147-153. [PMID: 35712040 PMCID: PMC9191912 DOI: 10.1093/pch/pxab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Mental health issues are increasingly prevalent across Canada, reflected in rising presentations to emergency departments. To effectively address the needs of children and youth seeking mental health-related care in the emergency department and to judiciously use scarce mental health-related resources, we need to better identify the specific areas of psychosocial needs and accessibility of associated services. Objective To describe the types and severity of paediatric mental health-related presentations evaluated at a quaternary paediatric emergency department, and to explore the accessibility of community mental health-related resources. Methods We conducted a retrospective cohort study of children and youth presenting to a quaternary paediatric emergency department who were assessed using HEARTSMAP, a validated mental health assessment and management tool. We reported the proportion who sought care for a psychiatric, social, or youth health-related mental health complaint. We contacted community mental health-related resources for their estimated wait times to determine accessibility. Results Of 1,530 paediatric emergency presentations, 98.8% of patients had psychiatric issues (40.1% were severe), 78.0% of patients had social issues (17.1% were severe), and 71.5% had youth health issues (18.1% were severe). We contacted 123 community mental health-related resources. Community youth health and social services were somewhat accessible, with 50.0% and 38.7%, respectively, able to intake youth within a week of referral. Community psychiatric programs were least accessible, with 59.3% having wait times greater than 1 month. Conclusions Many psychiatric concerns presenting in paediatric emergency departments have complex psychosocial challenges requiring non-psychiatric support. A need exists for improved accessibility to community psychiatric programs.
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Affiliation(s)
- Alison Lee
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jana Davidson
- Department of Psychiatry., BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Black
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Grace G Kim
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Correspondence: Quynh Doan, Division of Pediatric Emergency Medicine, Department of Pediatrics, UBC, BC Children’s Hospital Research Institute., Emergency Department, 4480 Oak Street office B429, Vancouver, British Columbia, V6H 3N1, Canada. Telephone (778)-984-9914, fax (604)-875-2366, e-mail
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Virk P, Arora R, Burt H, Gadermann A, Barbic S, Nelson M, Davidson J, Cornish P, Doan Q. HEARTSMAP-U: Adapting a Psychosocial Self-Screening and Resource Navigation Support Tool for Use by Post-secondary Students. Front Psychiatry 2022; 13:812965. [PMID: 35280181 PMCID: PMC8908908 DOI: 10.3389/fpsyt.2022.812965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mental health challenges are highly prevalent in the post-secondary educational setting. Screening instruments have been shown to improve early detection and intervention. However, these tools often focus on specific diagnosable conditions, are not always designed with students in mind, and lack resource navigational support. OBJECTIVE The aim of this study was to describe the adaptation of existing psychosocial assessment (HEARTSMAP) tools into a version that is fit-for-purpose for post-secondary students, called HEARTSMAP-U. METHODS We underwent a three-phase, multi-method tool adaptation process. First, a diverse study team proposed a preliminary version of HEARTSMAP-U and its conceptual framework. Second, we conducted a cross-sectional expert review study with Canadian mental health professionals (N = 28), to evaluate the clinical validity of tool content. Third, we conducted an iterative series of six focus groups with diverse post-secondary students (N = 54), to refine tool content and language, and ensure comprehensibility and relevance to end-users. RESULTS The adaptation process resulted in the HEARTSMAP-U self-assessment and resource navigational support tool, which evaluates psychosocial challenges across 10 sections. In Phase two, clinician experts expressed that HEARTSMAP-U's content aligned with their own professional experiences working with students. In Phase three, students identified multiple opportunities to improve the tool's end-user relevance by calling for more "common language," such as including examples, definitions, and avoiding technical jargon. CONCLUSIONS The HEARTSMAP-U tool is well-positioned for further studies of its quantitative psychometric properties and clinical utility in the post-secondary educational setting.
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Affiliation(s)
- Punit Virk
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ravia Arora
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Heather Burt
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Anne Gadermann
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health, Vancouver, BC, Canada
| | - Skye Barbic
- Centre for Health Evaluation and Outcome Sciences, Providence Health, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marna Nelson
- Student Health Service, University of British Columbia, Vancouver, BC, Canada
| | - Jana Davidson
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Cornish
- Student Counselling Services, University of California, Berkeley, Berkeley, CA, United States
| | - Quynh Doan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Li BCM, Wright B, Black T, Newton AS, Doan Q. Utility of MyHEARTSMAP in Youth Presenting to the Emergency Department with Mental Health Concerns. J Pediatr 2021; 235:124-129. [PMID: 33819465 DOI: 10.1016/j.jpeds.2021.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the utility of a digital psychological self-assessment tool, MyHEARTSMAP (scores on 10 sections: home, education and activities, alcohol and drugs, relationships and bullying, thoughts and anxiety, safety, sexual health, mood, abuse, and professional resources), in youth presenting to the pediatric emergency department (ED) with a mental health concern. STUDY DESIGN We conducted a prospective cohort study in 2 tertiary care pediatric EDs from December 2017 to October 2019. Youth 10-17 years old triaged for a mental health concern were screened and enrolled to complete MyHEARTSMAP on a mobile device. A clinician blinded to the MyHEARTSMAP assessment conducted their own assessment which was used as the reference standard. Utility was quantified as the sensitivity and specificity of MyHEARTSMAP in detecting psychiatric, social, youth health, and functional concerns. RESULTS Among 379 eligible youth, 351 were approached and 233 (66.4%) families were enrolled. Sensitivity for youth MyHEARTSMAP self-assessments ranged from 87.4% in the youth health domain to 99.5% in the psychiatric domain for identifying any concern, and 33.3% in the social domain to 74.6% in the psychiatric domain for severe concerns. Specificity ranged from 66.7% in the psychiatric domain to 98.2% in the youth health domain for no or only mild concerns. CONCLUSIONS Youth and guardian MyHEARTSMAP assessments are sensitive for detecting psychosocial concerns requiring follow-up beyond pediatric ED evaluation. Specificity for no or only mild concerns was high in the nonpsychiatric domains.
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Affiliation(s)
- Brian C M Li
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tyler Black
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda S Newton
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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Pediatric somatization in the emergency department: assessing missed opportunities for early management. CAN J EMERG MED 2021; 22:331-337. [PMID: 32037998 DOI: 10.1017/cem.2019.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Somatization is a common phenomenon that can severely complicate youths' functioning and health. The burden of somatization on pediatric acute care settings is currently unclear; better understanding it may address challenges clinicians experience in effectively caring for somatizing patients. In this study, we estimate the prevalence of somatization in a pediatric emergency department (ED). METHODS We conducted a retrospective cross-sectional study of visits for non-critical, non-mental health-related concerns (n = 150) to a quaternary-level pediatric ED between July 2016 and August 2017. Demographic and clinical visit details were collected through chart review and used by two reviewing clinicians to classify whether each visit had a "probable," "unclear" (possible), or "unlikely" somatizing component. RESULTS Approximately 3.33% (n = 5) of youth displayed probable somatization, and an additional 13.33% (n = 20) possibly experienced a somatizing component but require additional psychosocial and visit documentation to be certain. Longer symptom duration and multiple negative diagnostic tests were associated with a higher likelihood of either probable or possible somatization. CONCLUSIONS A considerable proportion of non-mental health-related visits may involve a somatizing component, indicating the burden of mental health concerns on the ED may be underestimated. A higher index of suspicion for the possibility of somatization may support clinicians in managing somatizing patients.
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Reducing length of stay and return visits for emergency department pediatric mental health presentations. CAN J EMERG MED 2021; 23:103-110. [PMID: 33683603 DOI: 10.1007/s43678-020-00005-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Variability in expertise and risk tolerance among emergency departments (ED) clinicians, when assessing and managing pediatric mental health presentations, leads to increased resource utilization. HEARTSMAP is a validated electronic tool that supports ED clinicians in psychosocial assessments and disposition decision making. METHODS We used interrupted time series analysis (September 2016-December 2019) and multivariable regressions to measure the impact of integrating HEARTSMAP into ED practice on pediatric mental health presentations length of stay and return visits, at two pediatric EDs. The intervention site used HEARTSMAP trained ED clinicians to assess and manage mental health presentations, and reported bi-weekly ED median length of stay and 30 days-return visits for 15 months and a year, during passive and active implementation of HEARTSMAP, respectively. The control site used psychiatric nurses to assess and manage patients and was only exposed to passive implementation. RESULTS HEARTSMAP average uptake was on average 47.4% (range 23.8-74.6%) during active implementation at the intervention site, while the control site showed no uptake throughout the study period. Incremental HEARSTMAP (each percent increase) use was associated with a reduction of 1.8 min (95% CI 0.8-2.9 in ED length of stay and 0.3% (95% CI 0.2-0.5 in 30-day return visit rate. This translates to an adjusted average reduction of 85.3 min in ED length of stay and 15.2% in 30-day return visits for youth with mental health presentations. CONCLUSION Use of HEARTSMAP in the ED can decrease length of stay and return visits for emergency pediatric mental health visits, in a fixed-resource setting.
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Gill C, Arnold B, Nugent S, Rajwani A, Xu M, Black T, Doan Q. In Reply. Acad Emerg Med 2018; 25:1473-1474. [PMID: 30010223 DOI: 10.1111/acem.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carson Gill
- Faculty of Medicine, University of British Columbia
| | | | - Sean Nugent
- Faculty of Medicine, University of British Columbia
| | | | - Michael Xu
- Faculty of Medicine, University of British Columbia
| | - Tyler Black
- Division of Child and Adolescent Psychiatry, Department of Psychiatry
| | - Quynh Doan
- Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
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11
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Naderi M, Karimi S, Salehi F. Reliability of HEARTSMAP as a Tool for Evaluating Psychosocial Assessment Documentation Practices in Emergency Departments: A Methodologic Issue. Acad Emerg Med 2018; 25:1471-1472. [PMID: 30010230 DOI: 10.1111/acem.13516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mehdi Naderi
- Department of Operating Room School of Paramedical
| | - Shiva Karimi
- Department of Health Information Management School of Paramedical
| | - Farkhonde Salehi
- Clinical Research Development Center\Taleghani and Imam Ali Hospital Kermanshah University of Medical Sciences Kermanshah Iran
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