Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis.

Though mental health and substance use concerns often co-occur, few studies have characterized patterns of co-occurrence among adolescents in clinical settings. The current investigation identifies and characterizes these patterns among adolescents presenting to an outpatient mental health service in Ontario, Canada. Data come from cross-sectional standardized patient intake assessments from 916 adolescents attending an outpatient mental health program (January 2019-March 2021). Latent profile analysis identified patterns of substance use (alcohol, cannabis, (e-) cigarettes) and emotional and behavioral disorder symptoms. Sociodemographic and clinical correlates of these patterns were examined using multinomial regression. Three profiles were identified including: 1) low substance use and lower frequency and/or severity (relative to other patients in the sample) emotional and behavioral disorder symptoms (26.2%), 2) low substance use with higher emotional and behavioral disorder symptoms (48.2%), and 3) high in both (25.6%). Profiles differed in sociodemographic and clinical indicators related to age, gender, trauma, harm to self, harm to others, and service use. Experiences of trauma, suicide attempts, and thoughts of hurting others increased the odds of adolescents being in the profile high in both substance use and symptoms compared to other profiles. These findings further document the high rates of substance use in adolescents in mental health treatment and the profiles generally map onto three out of four quadrants in the adapted four-quadrant model of concurrent disorders, indicating the importance of assessing and addressing substance use in these settings.

Continuity of mental disorders in children with chronic physical illness.

Data on the chronicity of mental disorder in children with chronic physical illness (CPI) are limited. We examined the prevalence and predictors of homotypic and heterotypic continuity of mental disorder in children with CPI. A sample of 263 children aged 2-16 years with physician-diagnosed CPI were recruited from outpatient clinics (e.g., dermatology, respiratory) at a Canadian pediatric academic hospital and followed for 24 months. Parent and child-reported mental disorders (mood, anxiety, behavioral, attention-deficit hyperactivity disorder [ADHD]) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline, 6, 12, and 24 months. Marginal regression models were computed to identify clinical, parent, and demographic factors associated with mental comorbidity over time. Mental disorder was observed in 24-27% of children with CPI based on child reports and 35-39% based on parent reports. Parent-reported models revealed significant homotypic continuity for all mental disorders (ORs = 4.2-9.5), and heterotypic continuity between mood and anxiety disorders (OR = 2.2), ADHD and behavioral disorders (OR = 5.1), and behavioral and each mental disorder (ORs = 6.7-8.4). Child-reported models revealed significant homotypic continuity for mood (OR = 8.8) and anxiety disorder (OR = 6.0), and heterotypic continuity between anxiety and mood disorders (OR = 12.4). Child disability (ORs = 1.3-1.5) and parent psychopathology (ORs = 1.2-1.8) were the most consistent predictors of both child- and parent-reported mental disorder over time. Mental comorbidity was prevalent and persistent in children with CPI with homotypic and heterotypic continuity common across informants. Child disability and parent psychopathology may be priority targets within integrated family-centered models of care to prevent mental comorbidity in children with CPI.

Young mothers' use of and experiences with mental health care services in Ontario, Canada: a qualitative descriptive study.

BACKGROUND: Despite the high prevalence of mental health issues among young mothers, their subsequent needs for mental health care support does not correlate with their access and use of services. The purpose of this study, grounded in the experiences of young mothers living in Ontario, Canada, was to describe their experiences of using mental health services during the perinatal period, and to identify the attributes of services and professionals that influenced their decision to engage with mental health services. METHODS: As the qualitative component of a sequential explanatory mixed methods study, the principles of qualitative description informed sampling, data collection, and analysis decisions. In-depth, semi-structured interviews were conducted with a purposeful sample of 29 young mothers (≤ 21 years) who met diagnostic criteria for at least one psychiatric disorder, and who were ≥ 2 months postpartum. Interview data were triangulated with data from ecomaps and a sub-set of demographic data for this purposeful sample from the survey conducted in the quantitative study component. Qualitative data were analyzed using both conventional content analysis and reflexive thematic analysis; the subset of survey data extracted for these 29 participants were analyzed using descriptive statistics. RESULTS: Young mothers identified the need to have at least one individual, either an informal social support or formal service provider who they could talk to about their mental health. Among participants deciding to seek professional mental health support, their hesitancy to access services was grounded in past negative experiences or fears of being judged, being medicated, not being seen as an active partner in care decisions or experiencing increased child protection involvement. Participants identified organizational and provider attributes of those delivering mental health care that they perceived influenced their use of or engagement with services. CONCLUSION: Organizations or health/social care professionals providing mental health services to young pregnant or parenting mothers are recommended to implement trauma-and violence-informed care. This approach prioritizes the emotional and physical safety of individuals within the care environment. Applying this lens in service delivery also aligns with the needs of young mothers, including that they are actively listened to, treated with respect, and genuinely engaged as active partners in making decisions about their care and treatment.

Prevalence and Correlates of Physical-mental Multimorbidity in Outpatient Children From a Pediatric Hospital in Canada.

OBJECTIVE: The aim of this study was to estimate the six-month prevalence of mental illness in children with chronic physical illness (multimorbidity), examine agreement between parent and child reports of multimorbidity, and identify factors associated with child multimorbidity. METHOD: The sample included 263 children aged 2-16 years with a physician-diagnosed chronic physical illness recruited from the outpatient clinics at a pediatric hospital. Children were categorized by physical illness according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10. Parent and child-reported six-month mental illness was based on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). RESULTS: Overall, 101 (38%) of children had a parent-reported mental illness; 29 (25%) children self-reported mental illness. There were no differences in prevalence across ICD-10 classifications. Parent-child agreement on the MINI-KID was low (κ = 0.18), ranging from κ = 0.24 for specific phobia to κ = 0.03 for attention-deficit hyperactivity. From logistic regression modeling (odds ratio [OR] and 95% confidence interval), factors associated with multimorbidity were: child age (OR = 1.16 [1.04, 1.31]), male (OR = 3.76 [1.54, 9.22]), ≥$90,000 household income (OR = 2.57 [1.08, 6.22]), parental symptoms of depression (OR = 1.09 [1.03, 1.14]), and child disability (OR = 1.21 [1.13, 1.30]). Similar results were obtained when modeling number of mental illnesses. CONCLUSIONS: Findings suggest that six-month multimorbidity is common and similar across different physical illnesses. Level of disability is a robust, potentially modifiable correlate of multimorbidity that can be assessed routinely by health professionals in the pediatric setting to initiate early mental health intervention to reduce the incidence of multimorbidity in children.

Predictors of mentoring relationship quality: Investigation from the perspectives of youth and parent participants in Big Brothers Big Sisters of Canada one-to-one mentoring programs.

AIMS: This study examined predictors of mentoring relationship quality (MRQ) as reported by youth and parents participating in Big Brothers Big Sisters (BBBS) of Canada one-to-one mentoring programs. METHODS: Mentoring program capacity and other external supports, youth personal and environmental risk, youth and parent attitudes and motives, and mentoring relationship processes and attributes were examined as predictors of MRQ at 18 months following youth referral to the program using data from a longitudinal study of the Canadian BBBS mentoring programs. RESULTS: For youth (n = 335), significant predictors of MRQ included: minimal difficulties pairing youth and mentors, perceptions of shared attributes with their mentor, mentor emotional engagement and support, and longer relationships. For parents (n = 356) higher MRQ was correlated with parent report of minimal difficulties pairing youth and mentors, a high-quality relationship with the youth's mentor, and longer relationships. CONCLUSION: Implications for program and policy development are discussed.

The 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) Part II: Psychometric Adequacy for Categorical Measurement of Selected DSM-5 Disorders.

OBJECTIVES: To compare the reliability and convergent validity of parent assessments from the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID-a structured diagnostic interview) and the Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) symptom checklist for classifying conduct disorder (CD), conduct disorder or oppositional defiant disorder (CD-ODD), attention-deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and separation anxiety disorder (SAD) based on DSM-5 criteria. METHODS: Data came from 283 parent-youth dyads aged 9 to 18 years. Parents and youth completed the assessments separately on 2 different occasions 7 to 14 days apart. After converting the OCHS-EBS scale scores to binary disorder classifications, we compare test-retest reliability estimates and use structural equation modelling (SEM) to compare estimates of convergent validity for the same disorders assessed by each instrument. RESULTS: Average test-retest reliabilities based on κ were 0.71 (MINI-KID) and 0.67 (OCHS-EBS). The average ß coefficients for 3 latent measures comprising the following indicators-parent perceptions of youth mental health need and impairment, diagnosis of specific disorders based on health professional communications and youth taking prescribed medication, and youth classifications of disorder based on the MINI-KID-were 0.67 (MINI-KID) and 0.69 (OCHS-EBS). CONCLUSION: The OCHS-EBS and MINI-KID achieve comparable levels of reliability and convergent validity for classifying child psychiatric disorder. The flexibility, low cost, and minimal respondent burden of checklists for classifying disorder make them well suited for studying disorder in the general population and screening in clinical settings.

The 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) Part I: A Checklist for Dimensional Measurement of Selected DSM-5 Disorders.

OBJECTIVES: To describe the development and psychometric properties of the 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) for dimensional measurement of 7 disorders based on criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS: Scale items were selected by agreement among 19 child psychologists and psychiatrists rating the correspondence between item descriptions and DSM-5 symptoms. Psychometric evaluation of the item properties and parent/caregiver and youth scales came from a general population study of 10,802 children and youth aged 4 to 17 years in 6537 families. Test-retest reliability data were collected from a subsample of 280 children and their caregivers who independently completed the OCHS-EBS checklist on 2 occasions 7 to 14 days apart. Structural equation modelling was used to assess internal and external convergent and discriminant validity-the latter tested against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). RESULTS: Confirmatory factor analyses exhibited adequate item fit to all scales. Except for conduct disorder and youth-assessed separation anxiety disorder, internal (Cronbach's α) and test-retest reliability (Pearson's r) for scale scores were 0.70 or above. Except for youth-assessed conduct disorder, the OCHS-EBS met criteria for internal and convergent and discriminant validity. Compared with the MINI-KID, the OCHS-EBS met criteria for external convergent and discriminant validity. CONCLUSIONS: The OCHS-EBS provide reliable and valid dimensional measurement of 7 DSM-5 disorders assessed by caregivers and youth in the general population. Part II describes use of the OCHS-EBS as a categorical (present/absent) measure of disorder.

Youth with chronic health problems: how do they fare in main-stream mentoring programs?

BACKGROUND: Youth with chronic physical health problems often experience social and emotional problems. We investigate the relationship between participation in the Big Brothers Big Sisters of Canada community-based mentoring programs (BBBS) and youth social and mood outcomes by youth health status. METHODS: Youth newly enrolled in BBBS were classified by health status (one or more chronic physical health problems without activity limitation, n = 191; one or more chronic physical health problems with activity limitation, n = 94; no chronic health problem or activity limitation, n = 536) and mentoring status (yes/no) at 18 month follow-up. Youth outcomes measured at follow-up were social anxiety, depressed mood, and peer self-esteem. RESULTS: Youth with chronic health problems and activity limitation were more likely to live with two biological parents, use mental health or social services, and have parents who reported difficulties with depressed mood, social anxiety, family functioning and neighbourhood problems. At 18 month follow-up, mentored youth in this health status group experienced fewer symptoms of social anxiety and higher peer self-esteem compared to non-mentored youth. Mentored youth with chronic health problems without activity limitation and mentored youth with no health problems or limitations did not show significant improvements in social anxiety and peer self-esteem. Regardless of their health status, mentored youth reported fewer symptoms of depressed mood than non-mentored youth. CONCLUSIONS: Youth with chronic health problems, particularly those with activity limitation as well, demonstrate a capacity to experience social and mood benefits associated with mentoring.

How Mentor Support Interacts With Mother and Teacher Support in Predicting Youth Academic Adjustment: An Investigation Among Youth Exposed to Big Brothers Big Sisters of Canada Programs.

This study examines three potential contributions (i.e., additive only, hierarchical compensatory, and hierarchical conditional) of mentor support to youth academic adjustment, taking into account interactions with support from mothers and teachers. We derived data from a larger study of the Big Brothers Big Sisters (BBBS) of Canada community mentoring program. The sample included 427 youth (average age 9.8 years; 64% girls, 56% White) who received one-to-one community-based mentoring for at least three months. We assessed perceptions of support from mothers and teachers before the match and assessed perceptions of support from mentors five times throughout the mentoring experience. Hierarchical linear regression analyses showed that mentor support predicted positive changes in youth academic adjustment (i.e., school attitude, academic self-efficacy, assistance seeking, and problem solving) mainly when mentees already reported high support from their mother. This finding clearly supports the conditional model and invites researchers to question the assumption that mentoring constitutes a corrective experience for young people (i.e., the compensatory model). BBBS agencies are strongly encouraged to involve parents in the mentoring process and to view them as experts, assets, and allies in their effort to meet the youth's needs.

The Role of Program-Supported Mentoring Relationships in Promoting Youth Mental Health, Behavioral and Developmental Outcomes.

This study examined the relationship between youth mentoring status and behavioral, developmental, and emotional outcomes for 859 youths aged 6-17 participating in a national survey of Big Brothers Big Sisters community mentoring relationships (MRs). Youth self-reported behaviors and mental health occurred at the baseline assessment (before being paired to a mentor) and at 18 months follow-up. Youth mentoring status was categorized as follows: (1) continuous MR less than 12 months (n = 131); (2) continuous MR 12 or more months (n = 253); (3) dissolved MR less than 12 months (n = 110); (4) dissolved MR 12 or more months (n = 70); 5) MR with a second mentor (re-matched; n = 83); and (6); never mentored (n = 212). Structural equation model results at 18 months revealed that mentored youths, especially those in MR lasting 12 or more months (continuous or dissolved), reported significantly fewer behavioral problems and fewer symptoms of depression and social anxiety than did non-mentored youths. They also reported stronger coping skills and emotional support from parents. Mentored girls and boys in long-term relationships experienced positive outcomes. Re-matched girls displayed better outcomes than did never-mentored girls while there was some evidence of harmful outcomes for re-matched boys. Threats to internal validity are examined including the possibility of pre-existing baseline differences between mentored and non-mentored youths. Implications for mentoring programs are discussed.

Mentoring Relationship Closures in Big Brothers Big Sisters Community Mentoring Programs: Patterns and Associated Risk Factors.

Previous research suggests that early mentoring relationship (MR) closures may have harmful consequences for the health and well-being of youth participating in community-based mentoring programs. However, knowledge of the factors that lead some MRs to close early has been slow to emerge. This study examined patterns and correlates of early versus on-time MR closures among 569 youth participating in Big Brothers Big Sisters community mentoring programs. Thirty-four percent of youth experienced an early MR closure prior to the end of the program's 12 month period of commitment. The probability of closure was highest at 12 months into the MR. Early closures were positively associated with youth gender (girls), behavioral difficulties, and match determination difficulties. Early and on-time closures were associated with youth extrinsic motives for joining the program. Early MR closures were negatively associated with youth perceptions of parent emotional support, parent social support, high quality MR, weekly contact in MR, and parent support of the MR. Implications for programming are discussed.

A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews.

OBJECTIVE: We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. METHODS: Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. RESULTS: No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. CONCLUSIONS: Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.

Modeling Parenting Programs as an Interim Service for Families Waiting for Children's Mental Health Treatment.

Using a discrete choice conjoint experiment, we explored the design of parenting programs as an interim strategy for families waiting for children's mental health treatment. Latent class analysis yielded 4 segments with different design preferences. Simulations predicted the Fast-Paced Personal Contact segment, 22.1% of the sample, would prefer weekly therapist-led parenting groups. The Moderate-Paced Personal Contact segment (24.7%) preferred twice-monthly therapist-led parenting groups with twice-monthly lessons. The Moderate-Paced E-Contact segment (36.3%), preferred weekly to twice-monthly contacts, e-mail networking, and a program combining therapist-led sessions with the support of a computerized telephone e-coach. The Slow-Paced E-Contact segment (16.9%) preferred an approach combining monthly therapist-led sessions, e-coaching, and e-mail networking with other parents. Simulations predicted 45.3% of parents would utilize an option combining 5 therapist coaching calls with 5 e-coaching calls, a model that could reduce costs and extend the availability of interim services. Although 41.0% preferred weekly pacing, 58% were predicted to choose an interim parenting service conducted at a twice-monthly to monthly pace. The results of this study suggest that developing interim services reflecting parental preferences requires a choice of formats that includes parenting groups, telephone-coached distance programs, and e-coaching options conducted at a flexible pace.

The measurement properties of mentoring relationship quality scales for mentoring programs.

The measurement properties of two new scales designed to measure global and engagement mentoring relationship quality (Global Mentoring Relationship Quality Scale and Quality of Mentoring Relationship Engagement Scale) were examined among 272 mentors, 491 children, and 554 parents participating in Big Brothers Big Sisters community mentoring programs across Canada. Results demonstrated their unidimensionality, moderate convergent validity, good external validity, and weak-to-moderate reporter concordance. Longitudinal analyses demonstrated good predictive validity of mentor and parent mentoring relationship quality scales with respect to predicting mentoring relationship status.

Are children and adolescents with psychiatric illness at risk for increased future body weight? A systematic review.

The aim of this paper was to review the longitudinal relationship between early-onset depression and disruptive behaviour and adult body weight. A systematic review of prospective longitudinal studies was conducted of articles in which (1) initial assessment occurred during childhood or adolescence (<18 y); and (2) the primary outcome reported as body mass index (BMI), overweight (BMI>25-<30 kg/m(2)), obesity (BMI ≥ 30 kg/m(2)), or depression; and (3) validated assessment measures for assessment of depressive symptoms or disruptive behaviour problems were employed. A total number of 16 articles were identified for review. Obese adolescent females are more likely to develop depressive illness in adulthood than their non-obese peers. Conversely, depressed adolescent females, and possibly males, are more likely to become overweight adults than non-depressed adolescents. There are insufficient data addressing future depression risk among overweight, non-obese, adolescents to evaluate the potentially interactive nature of this relationship. Studies to date are consistent in reporting that children with behaviour problems are at increased risk of future overweight, though whether this risk is conferred by conduct symptoms, ADHD symptoms, or both, is less clear. Care providers of children with disruptive behaviour problems and depressed adolescents should monitor weight gain. Among obese adolescent females, mood should be followed.

Mental and psychosocial health among youth after their first psychiatric hospitalization: a feasibility study.

OBJECTIVE: This pilot study investigated the feasibility of studying 12-month readmission of youth aged 10-16 years following their first psychiatric hospitalization and changes in youth mental and psychosocial health prospectively. RESULTS: Inpatient youth with a first psychiatric hospitalization and their parents were recruited from a regional hospital in Canada. Data were collected at recruitment, and at 3-, 6-, and 12-months post-discharge. Repeated measures ANOVA was performed to assess changes in health outcomes. Nineteen eligible youth were approached and 15 (78.9%) consented to participate (13.9 ± 2.0 years, 73.3% female). Eleven youth (73.3%) gave permission to contact their parents, all of whom participated (39.2 ± 7.6 years). Four youth dropped out of the study (26.7%) and six youth-parent dyads completed all four follow-ups. The readmission rate was 20.0% (n = 3) over 12 months. Significant changes in youth-reported symptoms of conduct disorder (F = 3.0, p = 0.06) and adverse childhood experiences (F = 3.4, p = 0.05) were found. Changes in parent-reported youth mental health symptoms (F = 3.1, p = 0.06), particularly among internalizing disorders, youth health-related quality of life (F = 11.3, p < 0.01), and youth disability (F = 2.7, p = 0.08) were significant. This preliminary work demonstrates the feasibility of, and need to, engage youth and their families to understand their mental and psychosocial health during this vulnerable period of time.

Cognitive and Mental Health of Young Mothers' Offspring: A Meta-analysis.

BACKGROUND AND OBJECTIVES: The nature and magnitude of the cognitive and mental health risks among the offspring of young mothers is not fully understood. Our objective is to examine the risk of mental disorders in these offspring. METHODS: Five databases (Medline, Embase, Web of Science, PsycINFO, and CINAHL) were searched from their inceptions until February 2022. Studies were eligible if they assessed offspring of young mothers (<21 years), contained a control group, and assessed any cognitive and/or mental health outcomes. Random-effects meta-analysis was used to generate standardized mean differences (SMDs) in infants (0-3 years), children (4-9), adolescents (10-19), and adults (20+). Methodological bias was assessed using the Newcastle-Ottawa Scale. RESULTS: 51 outcomes were meta-analyzed. Levels of cognitive and learning problems were higher among the infants (SMD = 0.30 [95% confidence interval 0.0-0.55]) and adolescents (SMD = 0.43 [0.24 to 0.62]) of young mothers. Adolescents had more symptoms of delinquency (SMD = 0.24 [0.12 to 0.36]). As adults, they are more often convicted of violent crimes (SMD = 0.36 [0.22 to 0.50]). Internalizing symptoms were higher in these offspring in childhood (SMD = 0.29 [0.14 to 0.45]) and adulthood (SMD = 0.35 [0.34 to 0.36]). This review uses unadjusted data and is thus unequipped to infer causality. Studies have high attrition and rely heavily on self-report. CONCLUSIONS: Young mothers' offspring have more cognitive, externalizing, and internalizing problems across the lifespan than individuals born to mothers ≥21 years of age. They may benefit from early detection and support.

Evaluation of parent and youth experiences in advisory groups as part of a mental healthcare clinical trial: protocol for a mixed-method study.

INTRODUCTION: Patient engagement in healthcare research is a necessity to ensure that research objectives align with priorities, outcomes and needs of the population under study, and to facilitate ease of implementation and adoption of findings. In clinical trials, there is an increasing focus on patient engagement during the planning and conduct of clinical trials due to the potential for ethical and methodological benefits. As patient engagement in clinical trials increases, there is a need to evaluate the approaches of these activities to contribute evidence on what is most appropriate and successful. The purpose of this study is to evaluate patient engagement processes and the activities of patient partners during and after a paediatric mental healthcare trial. METHODS AND ANALYSIS: Using a mixed-methods study design, we will evaluate patient partners' engagement activities across set time-points during the trial and after trial completion. In this study, the term 'patient partner' is inclusive of two groups of people with lived experience: (1) caregivers (parents, formal/informal caregivers and family), and (2) youth (aged 15-24 years). Engagement will be evaluated using the participant and project questionnaires of the Public and Patient Engagement Evaluation Tool (PPEET), followed sequentially by semi-structured interviews. Quantitative data from the PPEET questionnaire will be analysed and reported using descriptive statistics. Data from open-ended questions from the PPEET questionnaires and semi-structured interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION: Approval from Athabasca University Research Ethics Board will be obtained for this project. Findings will be disseminated at both academic and public venues whether in-person or online, and using platforms that are caregiver and youth friendly. TRIAL REGISTRATION NUMBER: NCT04902391.

An Innovative Model of Pediatric Emergency Department Mental Health Care: Protocol for a Multicenter Type 1 Effectiveness-Implementation Cluster Randomized Trial.

Over the past decade, visits to American and Canadian emergency departments (EDs) for child and youth mental health care have increased substantially.1,2 Acute mental health crises can occur as a result of a variety of concerns, including those that are life threatening (eg, suicide attempts), pose safety concerns (eg, suicidal intentions, aggressive behaviors, alcohol and other drug use), and are physically distressing to the child or youth (eg, panic attacks). ED health care providers play a vital role in assessing the safety and well-being of the child or youth and referring them to services for ongoing care.3,4 During the ED visit, assessment and care should pinpoint risks, inform treatment, and consider family needs and preferences as part of a patient-centered approach. Yet, this approach to care is not widely adopted in EDs. Most EDs do not require the use of pediatric-specific mental health tools to guide assessments or have patient-centered procedures in place to guide the care of patients with mental health emergencies.5-7 Our team believes these limitations have led to the provision of acute mental health care that can lack sufficient quality and efficiency. This study protocol describes a trial designed to evaluate if a novel mental health care bundle that was co-designed with parents and youth results in greater improvements in the well-being of children and youth 30 days after seeking ED care for mental health and/or substance misuse concerns compared with existing care protocols. We hypothesize that the bundle will positively impact child and youth well-being, while also providing cost-effective health care system benefits.

Providing web-based mental health services to at-risk women.

BACKGROUND: We examined the feasibility of providing web-based mental health services, including synchronous internet video conferencing of an evidence-based support/education group, to at-risk women, specifically poor lone mothers. The objectives of this study were to: (i) adapt a face-to-face support/education group intervention to a web-based format for lone mothers, and (ii) evaluate lone mothers' response to web-based services, including an online video conferencing group intervention program. METHODS: Participating mothers were recruited through advertisements. To adapt the face-to-face intervention to a web-based format, we evaluated participant motivation through focus group/key informant interviews (n = 7), adapted the intervention training manual for a web-based environment and provided a computer training manual. To evaluate response to web-based services, we provided the intervention to two groups of lone mothers (n = 15). Pre-post quantitative evaluation of mood, self-esteem, social support and parenting was done. Post intervention follow up interviews explored responses to the group and to using technology to access a health service. Participants received $20 per occasion of data collection. Interviews were taped, transcribed and content analysis was used to code and interpret the data. Adherence to the intervention protocol was evaluated. RESULTS: Mothers participating in this project experienced multiple difficulties, including financial and mood problems. We adapted the intervention training manual for use in a web-based group environment and ensured adherence to the intervention protocol based on viewing videoconferencing group sessions and discussion with the leaders. Participant responses to the group intervention included decreased isolation, and increased knowledge and confidence in themselves and their parenting; the responses closely matched those of mothers who obtained same service in face-to-face groups. Pre-and post-group quantitative evaluations did not show significant improvements on measures, although the study was not powered to detect these. CONCLUSIONS: We demonstrated that an evidence-based group intervention program for lone mothers developed and evaluated in face-to-face context transferred well to an online video conferencing format both in terms of group process and outcomes.