Development of a Clinical Pathway for the Assessment and Management of Suicidality on a Pediatric Psychiatric Inpatient Unit.

PURPOSE: This article describes steps taken by a mental health inpatient multidisciplinary team to develop a clinical pathway for the assessment and management of suicidality in a pediatric psychiatric inpatient unit. PATIENTS AND METHODS: The setting for this project is a 19-bed inpatient psychiatry unit providing care for children and adolescents (6-17 years of age) in a tertiary care pediatric hospital in Ontario, Canada. Three Lean methodologies were used: 1) The A3 process was used to articulate a problem statement and help clarify expectations, determine goals, and uncover, address and encourage discussion of potential issues; 2) Process mapping was used to show how work process activities are sequenced from the time of the patient's admission to discharge; and 3) Standard work, where consideration was given to the breakdown of the work into categories which are sequenced, organized and repeatedly followed. Generally accepted methodologies for developing clinical pathways were used to create a framework and algorithm for the assessment and management of suicidality in psychiatrically hospitalized children and adolescents. RESULTS: The clinical pathway development resulted in six steps from admission to discharge: intake process, inclusion/exclusion criteria, data integration and treatment formulation, interventions, determination of readiness for discharge, and the discharge process. CONCLUSION: This framework, developed with the aim to standardize care for psychiatrically admitted suicidal children and adolescents, may serve as a flexible template for use in similar settings and could be adapted according to local realities and resources.

Using Rapid Prototyping to Design a Smoking Cessation Website with End-Users.

Rapid prototyping is an iterative approach to design involving cycles of prototype building, review by end-users and refinement, and can be a valuable tool in user-centered website design. Informed by various user-centered approaches, we used rapid prototyping as a tool to collaborate with users in building a peer-support focused smoking-cessation website for gay men living with HIV. Rapid prototyping was effective in eliciting feedback on the needs of this group of potential end-users from a smoking cessation website.

Personas to Guide Understanding Traditions of Gay Men Living With HIV Who Smoke.

Gay men living with HIV (GMLWH) who smoke are less responsive to generalized smoking reduction and cessation (SRC) programs than heterosexual persons. This study explored perspectives of GMLWH during the design of a web-based SRC intervention. Participatory design techniques were used to guide the creation of personas that are composite representations of a person who would use the web-based SRC intervention. Researcher-participants (n = 13) created all data. Data analysis involved thematic coding drawing from an ethnographic perspective. Thematic analysis revealed seven intersecting themes related to SRC among participants, and an overarching theme navigating life. Concepts drawn from our ethnographic approach highlight cultural differences between GMLWH and mainstream society. Personas offer a mechanism for interpreting experiences and traditions of GMLWH. SRC interventions with GMLWH must address their social realities that include tools for navigating life, disease, and social identity.