Prioritizing core components of successful transitions from child to adult mental health care: a national Delphi survey with youth, caregivers, and health professionals.

Youth accessing mental health care often experience a disruption in care as they attempt to transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). Few studies have evaluated interventions seeking to improve the experience and outcomes of CAMHS-AMHS transitions, in part due to lack of consensus on what constitutes best practices in intervention success. As such, the aim of this study was to engage patients, caregivers, and clinicians to prioritize core components of successful CAMHS-AMHS transitions which can be used in the design or evaluation of transition interventions. As such, a Delphi study was conducted to determine core components of successful CAMHS-AMHS transitions. Guided by the principles of patient-oriented research, three balanced expert panels consisting of youth, caregivers, and clinicians ranked and provided feedback on the importance and feasibility of core components of CAMHS-AMHS transitions. Components endorsed as feasible or important with ≥ 70% agreement from any panel moved to the next round. As a result, a list of 26 core components of CAMHS-AMHS transitions has been refined which can be used in the design, implementation, or evaluation of interventions intended to improve transition experiences and outcomes for youth in mental health care. Youth and families were engaged in an expert advisory role throughout the research process, contributing their important perspectives to the design and implementation of this study, as well as interpretation of the findings.

Cardiovascular Disease Risk Factors Among Children and Adolescents With Depression.

Aim: To examine CVD risk factors among children and adolescents with Major Depressive Disorder (MDD). Methods: A cross-sectional study of 77 children and adolescents (mean age 14.1 years, 74% female) referred to a pediatric depression program. MDD was assessed using a semi-structured diagnostic interview. Cardiovascular assessments included family cardiovascular disease (CVD) history, cigarette smoking, body mass index (BMI), blood pressure, lipid and glucose concentrations. CVD risk factors among healthy weight and overweight/obese participants were compared. Results: Forty-six percent of participants had a family history of early CVD. On examination, 25% of participants had a BMI in overweight/obese range, and 25% of children had pre-hypertension (14%) or hypertension (11%). Total cholesterol levels were elevated among 28% of participants. Overweight/obese participants had increased non-HDL cholesterol concentrations compared with healthy-weight participants (36 vs. 10%, p = 0.01). There were no significant differences between healthy and overweight/obese groups for other CVD risk factors, including HDL cholesterol concentration, plasma glucose concentration, hypertension, cigarette smoking, and family history of early CVD. More than half (52%) of participants had at least two CVD risk factors. Conclusion: CVD risk factors are prevalent among children and adolescents with MDD. Routine CVD risk factor screening may be warranted among MDD youth, regardless of BMI, and may provide a valuable opportunity for prevention of future CVD.

From Pandemic to Progression: An Educational Framework for the Implementation of Virtual Mental Healthcare for Children and Youth as a Response to COVID-19.

COVID-19 restrictions have necessitated child/youth mental health providers to shift towards virtually delivering services to patients' homes rather than hospitals and community mental health clinics. There is scant guidance available for clinicians on how to address unique considerations for the virtual mental healthcare of children and youth as clinicians rapidly shift their practices away from in-person care in the context of the COVID-19 pandemic. Therefore, we bridge this gap by discussing a six-pillar framework developed at Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, for delivering direct to patient virtual mental healthcare to children, youth and their families. We also offer a discussion of the advantages, disadvantages, and future implications of such services.