Lived Experience-Led Research Agenda to Address Early Death in People With a Diagnosis of a Serious Mental Illness: A Consensus Statement.

Importance: People with serious mental illness (SMI), defined as a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or disabling major depressive disorder) die approximately 10 to 25 years earlier than the general population. Objective: To develop the first-ever lived experience-led research agenda to address early mortality in people with SMI. Evidence Review: A virtual 2-day roundtable comprising 40 individuals convened on May 24 and May 26, 2022, and used a virtual Delphi method to arrive at expert group consensus. Participants responded to 6 rounds of virtual Delphi discussion via email that prioritized research topics and agreement on recommendations. The roundtable was composed of individuals with lived experience of mental health and/or substance misuse, peer support specialists, recovery coaches, parents and caregivers of people with SMI, researchers and clinician-scientists with and without lived experience, policy makers, and patient-led organizations. Twenty-two of 28 (78.6%) of the authors who provided data represented people with lived experiences. Roundtable members were selected by reviewing the peer-reviewed and gray literature on early mortality and SMI, direct email, and snowball sampling. Findings: The following recommendations are presented in order of priority as identified by the roundtable participants: (1) improve the empirical understanding of the direct and indirect social and biological contributions of trauma on morbidity and early mortality; (2) advance the role of family, extended families, and informal supporters; (3) recognize the importance of co-occurring disorders and early mortality; (4) redefine clinical education to reduce stigma and support clinicians through technological advancements to improve diagnostic accuracy; (5) examine outcomes meaningful to people with an SMI diagnosis, such as loneliness and sense of belonging, and stigma and their complex relationship with early mortality; (6) advance the science of pharmaceuticals, drug discovery, and choice in medication use; (7) use precision medicine to inform treatment; and (8) redefine the terms system literacy and health literacy. Conclusions and Relevance: The recommendations of this roundtable are a starting point for changing practice and highlighting lived experience-led research priorities as an option to move the field forward.

Pathways from parenting practices to adolescent suicidality: Evidence on the role of emotional and behavioral symptoms from a prospective cohort of Canadian children.

OBJECTIVE: To investigate longitudinal relationships between parenting practices in childhood and adolescent suicidality, and assess the mediating role of emotional and behavioral symptoms. METHODS: Data were drawn from the National Longitudinal Survey of Children and Youth, a Canadian population-based longitudinal cohort study. The sample included 9,490 children aged 10-11 who were followed up biennially to ages 14-15. Parents reported their positive and punitive parenting practices when children were 10-11. Adolescents self-reported symptoms of depression/anxiety, hyperactivity, conduct disorder, and social aggression at 12-13, and past-year suicidal ideation and suicide attempts at 14-15. RESULTS: The inverse associations between positive parenting at 10-11 and suicidal behaviors at 14-15 were significantly mediated by symptoms of hyperactivity, conduct disorder, and social aggression at 12-13. Direct relationships between punitive parenting and suicidal behaviors were observed. These associations were significantly mediated by hyperactivity and, among boys only, by conduct disorder and social aggression. The association between punitive parenting and suicide attempt was additionally mediated by depression/anxiety. CONCLUSIONS: Parenting in childhood may be associated with adolescent suicidality both directly and indirectly through emotional and behavioral symptoms. Interventions aimed at reducing the use of harsh disciplinary strategies and promoting positive parent-child interactions may reduce the burden of adolescent suicidality.

Teacher-student relationships and mental health help seeking behaviors among elementary and secondary students in Ontario Canada.

This study examined associations between teacher-student relationship quality at school and teachers' responsiveness to students' emotional concerns in a classroom and (a) students' intention to seek help at school for mental health concerns and (b) mental health-related service use. Data for analyses came from the School Mental Health Survey, a cross-sectional survey of 31,120 grade 6-12 students, in 1968 classrooms, attending 248 schools in Ontario, Canada. Three-level (student, classroom, school) binary logistic regression was used to address the study objectives. Student ratings of the quality of teacher-student relationships and teachers' responsiveness were included as predictors, both at the individual student level and aggregated to represent a contextual level characteristic at the school and classroom level, respectively. At the student level, both teacher-student relationship quality and teacher responsiveness were positively associated with intentions to seek help at school among both elementary and secondary students (ORs ranged from 1.14-1.19 for relationships and 1.06-1.08 for responsiveness). Aggregated to the school level, teacher-student relationship quality was positively associated with mental health service use for secondary students (OR = 1.36, 95% CI [1.10, 1.69]). Positive and responsive teacher-student relationships were associated with help-seeking behaviors among students. Longitudinal studies are warranted to disentangle the temporality of these associations.

Global research priorities for youth mental health.

AIM: Over the past two decades, the youth mental health field has expanded and advanced considerably. Yet, mental disorders continue to disproportionately affect adolescents and young adults. Their prevalence and associated morbidity and mortality in young people have not substantially reduced, with high levels of unmet need and poor access to evidence-based treatments even in high-income countries. Despite the potential return on investment, youth mental disorders receive insufficient funding. Motivated by these continual disparities, we propose a strategic agenda for youth mental health research. METHOD: Youth mental health experts and funders convened to develop youth mental health research priorities, via thematic roundtable discussions, that address critical evidence-based gaps. RESULTS: Twenty-one global youth mental health research priorities were developed, including population health, neuroscience, clinical staging, novel interventions, technology, socio-cultural factors, service delivery, translation and implementation. CONCLUSIONS: These priorities will focus attention on, and provide a basis for, a systematic and collaborative strategy to globally improve youth mental health outcomes.

Frayme: Building the structure to support the international spread of integrated youth services.

AIM: Frayme is a Canadian-based international network designed to accelerate the adoption and scaling up of integrated youth services (IYS). This is done through the synthesis of evidence from a variety of sources and a commitment to integrated knowledge mobilization (KMb) to inform research policy and practice. Frayme is utilizing innovative approaches to stakeholder engagement (youth, families, policy makers, funders, researchers and practitioners) and KMb in order to co-design system change. The purpose of this article describes the overall Frayme strategy and presents findings from a participatory needs assessment implemented to inform policy-related priorities. METHODS: The Frayme leadership team facilitated a participatory needs assessment with major stakeholder groups that applied a modified problem-solving activity. The needs assessment was on a designed to support diverse stakeholder perspectives on ways to improve knowledge mobilization of IYS. Qualitative data were analysed using a thematic analysis. RESULTS: The four themes identified through the needs assessment were: (a) traditional scientific practices, (b) organizational obstacles, (c) change aversion, and (d) pre-established stakeholder hierarchies. CONCLUSIONS: Through the recognition of these challenges, Frayme has developed a set of major objectives to inform projects, opportunities for knowledge sharing, implementation of evidence and scaling up of efforts. The Frayme integrated KMb model represents a unique applied example of an evidence-informed approach to practice collaboration in KMb to promote system change. The findings from this research also contribute to the expanding knowledge base with regard to complex evaluation and system transformation.

Adolescent Mental Health Following Exposure to Positive and Harsh Parenting in Childhood.

OBJECTIVES: The purpose of the present study was to assess longitudinal associations between positive and harsh parenting in childhood and adolescent mental and behavioral difficulties. METHODS: Data were drawn from Canada's population-based National Longitudinal Survey of Children and Youth (data collected from 1994 to 2009, analyzed 2018). The sample included 9,882 adolescents aged 12/13 years old. Parents self-reported positive and harsh parenting when children were 6/7, 8/9, and 10/11 years old. Symptoms of depression/anxiety, hyperactivity, physical aggression, social aggression, and suicidal ideation were self-reported by adolescents at age 12/13. Linear regression was used to examine the associations between parenting behaviors at each age and adolescent psychiatric symptoms, adjusted for children's baseline symptoms. RESULTS: Harsh parenting at 10/11 was associated with elevated symptoms of early-adolescent physical aggression, social aggression, and suicidal ideation for boys only, and for all children at earlier ages. Beginning at age 8/9, harsh discipline was associated with elevated symptoms of depression/anxiety for boys only. Overall, positive parenting at age 6/7 was protective against depression/anxiety, physical aggression, and social aggression. Significant sex differences emerged beginning at age 8/9, with positive parenting associated with higher symptoms of depression/anxiety for boys only. Positive parenting at age 10/11 was associated with increased depression/anxiety, physical aggression, social aggression, and suicidal ideation among boys, but decreased symptoms of physical aggression, social aggression, and suicidal ideation among girls. CONCLUSIONS: Results suggest that the impact of positive and harsh parenting may depend on age and sex, with harsh parenting being more detrimental to boys as they approach adolescence.

Prevalence and Correlates of Youth Suicidal Ideation and Attempts: Evidence from the 2014 Ontario Child Health Study.

OBJECTIVES: To present the 12-month prevalence and correlates of suicidal ideation and attempts in a sample of youth in Ontario. METHODS: Data come from the 2014 Ontario Child Health Study, a provincially representative survey of families with children in Ontario. Youth aged 14 to 17 y ( n = 2,396) completed a computer-assisted, self-administered questionnaire in their home to assess the occurrence of suicidal ideation, suicidal attempts, and associated correlates, including non-suicidal self-injury, mental disorders, substance use, peer victimization and exposure to child maltreatment. Socio-demographic information was collected from the parent. Logistic regression models were used to identify correlates that distinguished between youth reporting: 1) no suicidal ideation or attempts, 2) suicidal ideation but no attempts, and 3) suicidal ideation and attempts. RESULTS: The 12-month prevalence of suicidal ideation and attempts was 8.1% and 4.3%, respectively. All clinical and behavioural correlates were significantly higher among youth reporting suicidal ideation or attempts, as compared with non-suicidal youth. In adjusted models, depression and non-suicidal self-injury were each independently associated with elevated odds of suicidal ideation (OR = 4.84 and 4.19, respectively) and suicidal attempt (OR = 7.84 and 22.72, respectively). Among youth who reported suicidal ideation, the only variable that differentiated youth who attempted suicide v. those who did not, in adjusted models, was non-suicidal self-injury (OR = 3.89). CONCLUSIONS: Suicidal ideation and attempts are common among youth in Ontario, often co-occurring with mental disorders and high-risk behaviours. These findings underscore the need for effective prevention and intervention strategies, particularly for youth depression and non-suicidal self-injury.

Understanding the mental health and recovery needs of Canadian youth with mental health disorders: a Strategy for Patient-Oriented Research (SPOR) collaboration protocol.

BACKGROUND: While considerable progress is being made to understand the health and self-management needs of youth with mental health disorders, little attention has focused on the mental health and recovery needs that the youth themselves identify-this despite a national priority to incorporate patient-oriented research into the development and assessment of mental health services. To address this gap, estimates of the extent to which existing patient-reported outcome measures (PROMs)-originally developed for use amongst adult populations-are clinically meaningful and psychometrically fit for use among youth are needed. In tandem, a recovery profile for youth can be constructed incorporating the youth perspective of the services provided within a community mental health setting. METHODS/DESIGN: This study will utilize a mixed methods design incorporating qualitative focus group interviews and cross-sectional survey. Our process will begin with the hiring of a youth peer research partner who will provide lived experience expertise through all phases of the study. We will advertise, recruit, and conduct four focus groups with youth who receive services from the Foundry Vancouver Granville located in British Columbia, Canada. In the first two focus groups, we will recruit youth aged 15-18 years (n = 10). In the second two focus groups, we will recruit young adults aged 19-24 years (n = 10). In parallel, we will conduct a cross-sectional survey of the recovery and mental health needs of youth, informed by ten widely used and validated PROM. Thematic analysis techniques will guide the identification of predominant thematic trends in the qualitative focus group data. We will use Classical and Rasch measurement methods to test and analyze the reliability and validity of selected PROM measures for youth populations. DISCUSSION: The proposed study has the potential to produce a preliminary conceptual and measurement model for understanding the mental health and recovery needs of youth with mental health disorders. This evidence will inform how youth mental health services can grow, support, and sustain the capacity for a collaborative, interdisciplinary and innovative patient-oriented research environment. Findings will also contribute much needed evidence to improve the standard of care for youth who experience mental health disorders in Canada and beyond.

Trends in mental health system transformation: Integrating youth services within the Canadian context.

The current mental health services system in Canada is fragmented and transitions between the youth and adult mental health systems have been identified as needing significant improvement. Integrated Youth Services (IYS) are designed to be adaptable and developmentally appropriate as well as to promote seamless transitions, including during emerging adulthood. This article provides an overview of recent developments in Canadian mental health system transformation to promote the integration of services and the holistic promotion of youth well-being. We offer an overview of the current state of knowledge related to best practices in IYS in Canada and highlight areas for future development. We also introduce Frayme, a Canadian-based international knowledge translation platform designed to connect organizations working in the youth services system to accelerate the implementation of IYS.

Examining Integrated Youth Services Using the Bioecological Model: Alignments and Opportunities.

Integrated youth service (IYS) is a collaborative approach that brings practitioners together from across disciplines to provide comprehensive services including mental health care for youth and their families. IYS models serve as an advancement in practice as they go beyond the capacity of individual programs and services to reduce the fragmentation of care. Yet, there continue to be opportunities to expand on this perspective and promote health beyond the scope of formalized services. The bioecological model is a theoretical model that examines individual development within multiple systems of influence as well as through interactional processes between the individual and their environment. This paper provides an overview of the bioecological model and the major components of the IYS model, describing alignment and complementarity. The bioecological model provides some explanations for why IYS models may be effective and helps to provide direction to expand applied practice toward a more holistic perspective.

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.

Sex differences in suicides among children and youth: the potential impact of help-seeking behaviour.

OBJECTIVE: To describe sex differences in health service use among children and youth who died by suicide. METHOD: This is a retrospective study of children and youth (aged 10 to 25 years) living in Ontario who died by suicide between April 1, 2003, and December 31, 2007. Coroner records were individually linked to outpatient physician visit, emergency department (ED) presentation, and inpatient stay administrative health care records for 724 people (192 girls and 532 boys). Only 77 (10.6%) were aged 10 to 15 years. The health services types used, number of contacts made, and the last contact were compared in boys and girls. RESULTS: About 80% of subjects had contact with the health care system in the year before their death, typically to an outpatient physician and (or) the ED. However, not all were seen for mental health reasons. Girls had more outpatient physician and ED contact than boys and closer in time to their death. Further, girls were more likely than boys to have contact in more than one setting. Still, boys and girls did not differ in their use of an outpatient psychiatrist, some ED presentations, and in the nature and number of inpatient stays. CONCLUSIONS: While most people were seen by an outpatient physician and (or) in the ED in the year before their death, not all received mental health care. Further research is needed to determine whether boys and girls who died by suicide differ from their peers in their health service use to guide preventive interventions.

Objectif : Décrire les différences entre les sexes dans l'utilisation des services de santé chez des enfants et des adolescents qui sont décédés par suicide. Méthode : Il s'agit d'une étude rétrospective d'enfants et de jeunes (de 10 à 25 ans) habitant en Ontario qui sont décédés par suicide entre le 1er avril 2003 et le 31 décembre 2007. Les dossiers du coroner ont été individuellement liés à des visites chez le médecin en externe, à des présentations au service d'urgence (SU), et aux dossiers de santé administratifs des hospitalisations pour 724 personnes (192 filles et 532 garçons). Seulement 77 (10,6 %) d'entre eux avaient de 10 à 15 ans. Les types de services de santé utilisés, le nombre de contacts établis, et le dernier contact ont été comparés entre les garçons et les filles. Résultats : Quelque 80 % des sujets avaient eu un contact avec le système de santé dans l'année précédant leur mort, habituellement avec un médecin en externe et (ou) le SU. Toutefois, ils n'ont pas tous été vus pour des raisons de santé mentale. Les filles avaient plus de contacts avec les médecins en externe et le SU que les garçons, et de façon plus rapprochée du moment de leur mort. En outre, les filles étaient plus susceptibles que les garçons d'avoir un contact dans plus d'un contexte. Néanmoins, l'utilisation d'un psychiatre en externe, certaines présentations au SU, et la nature et le nombre d'hospitalisations ne différaient pas entre les garçons et les filles. Conclusions : Bien que la plupart de ces personnes aient été vues par un médecin en externe et (ou) au SU dans l'année précédant leur mort, elles n'ont pas toutes reçu des soins de santé mentale. Il faut plus de recherche pour déterminer si les garçons et les filles qui sont décédés par suicide sont différents de leurs pairs en ce qui concerne leur utilisation des services de santé, afin d'orienter les interventions préventives.

Stigma in school-based mental health: perceptions of young people and service providers.

BACKGROUND: Mental health affects one in five young people, with the majority avoiding help due to stigma. In this study, young people's (n = 49) perception of stigma as a barrier to accessing school-based mental health services was compared with that of service providers (n = 63), along with the perceived extent of mental health problems and availability of school-based mental health resources. METHOD: Participants completed a survey or interview. EBSCO and PubMed databases were used for the duration of this study, from August 2010 to September 2011. RESULTS: A greater proportion of young people versus providers reported stigma as the largest barrier to accessing mental health services. In addition, most young people reported that school-based mental health resources were scarce. CONCLUSIONS: These results emphasize the need for young people's involvement in mental health initiatives.

Child maltreatment and repeat presentations to the emergency department for suicide-related behaviors.

OBJECTIVES: To identify factors associated with repeat emergency department (ED) presentations for suicide-related behaviors (SRB) - hereafter referred to as repetition - among children/youth to aid secondary prevention initiatives. To compare rates of repetition in children/youth with substantiated maltreatment requiring removal from their parental home with their peers in the general population. METHODS: A population-based (retrospective) cohort study was established for children/youth with a first ED SRB presentation at risk for repetition in the Province of Ontario, Canada between 1 January 2004 and 31 December 2008. Children/youth legally removed from their parental home because of substantiated maltreatment (n=179) and their population-based peers (n=6,305) were individually linked to administrative health care records over time to ascertain social, demographic, and clinical information and subsequent ED presentations for SRB during follow-up. These children/youth were described and their repetition-free probabilities over time compared. To identify factors associated with repetition we fit multivariable, recurrent event survival analysis models stratified by repetition and present unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Children/youth with substantiated maltreatment (as noted) were two times more likely to have repetition than their peers after adjustments for social, demographic, and clinical factors (conditional on prior ED SRB presentations). A number of these factors were independently associated with repetition. No one factor distinguished between having a first and second repetition nor was more strongly associated with repetition than another. CONCLUSIONS: The risk of repetition is higher in children with substantiated maltreatment (as noted) than their peers. No one factor stood out as predictive of repetition. Implications for secondary prevention initiatives include a non-selective approach, sensitive to family difficulties and the need to better contextualize repetition and harness data linkages.

Sex differences in suicides among children and youth: the potential impact of misclassification.

OBJECTIVES: We examined whether established sex differences in suicide rates persist when adjustments are made for potential misclassification of deaths in children and youth. METHODS: This is a retrospective, descriptive study of 1294 suicides, 961 accidental and 254 undetermined deaths occurring between January 1, 2000 and December 31, 2007, among persons aged 10 to 25 years in Ontario, Canada. Using data from Coroner's records, causes of death were reclassified based on two different misclassification criteria. Actual and reclassified suicide rates were calculated by sex and age group (with 95% confidence intervals) and by year of death. RESULTS: Males aged 16-25 years accounted for the majority of suicides (68.9%). Asphyxia was the most common cause of suicide in both sexes. While suicides by shooting were almost exclusive to males, suicides due to alcohol/drug toxicity were significantly higher in females. Both before and after reclassification of suicide deaths, sex differences in suicide rates emerged in the 16-25 years age group. In each study year, both actual and reclassified suicide rates were higher in males than females. CONCLUSIONS: Sex differences in suicide rates emerging in adolescence are unlikely to be due to misclassification. Other proposed explanations for sex differences in youth suicide rates should be investigated further.

Child maltreatment and onset of emergency department presentations for suicide-related behaviors.

OBJECTIVES: To determine whether the rates of a first presentation to the emergency department (ED) for suicide-related behavior (SRB) are higher among children/youth permanently removed from their parental home because of substantiated maltreatment than their peers. To describe the health care settings accessed by these children/youth before a first SRB presentation to help design preventive interventions. METHODS: A population-based (retrospective) cohort of 12-17-year-olds in Ontario, Canada was established. Children/youth removed from their parental home because of the above noted maltreatment (n=4683) and their population-based peers (n=1,034,546) were individually linked to administrative health care records over time to ascertain health service use and subsequent ED presentations for SRB during follow-up. Person-time incidence rates were calculated and Cox regression models used to estimate adjusted hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS: After controlling for demographic characteristics and prior health service use, maltreated children/youth were about five times more likely to have a first ED presentation for SRB compared to their peers, in both boys (HR: 5.13, 95% CI: 3.94, 6.68) and girls (HR: 5.36, 95% CI: 4.40, 6.54). CONCLUSIONS: Children/youth permanently removed from their parental home because of substantiated child maltreatment are at an increased risk of a first presentation to the ED for SRB. The prevention of child maltreatment and its recurrence and the promotion of resilience after maltreatment has occurred are important avenues to study toward preventing ED SRB presentations in children/youth. Provider and system level linkages between care sectors may prevent the need for such presentations by providing ongoing environmental support.

Knowledge translation efforts in child and youth mental health: a systematic review.

The availability of knowledge translation strategies that have been empirically studied and proven useful is a critical prerequisite to narrowing the research-to-practice gap in child and youth mental health. Through this review the authors sought to determine the current state of scientific knowledge of the effectiveness of knowledge translation approaches in child and youth mental health by conducting a systematic review of the research evidence. The findings and quality of the 12 included studies are discussed. Future work of high methodological quality that explores a broader range of knowledge translation strategies and practitioners to which they are applied and that also attends to implementation process is recommended.

Tying together research and practice: using ROPE for successful partnerships in school mental health.

There is solid evidence for strategies and programs that, if implemented with fidelity in schools, will enhance the mental health of children and youth. These practices are, however, inconsistently applied and rarely evaluated programmatically in every day practice. In recent years, implementation variables that influence uptake have received attention. An emerging area of interest is the role that research partnerships might play in narrowing the gap between science and practice. Drawing on the literature and practice examples, collaborators from the United States and Canada explore the role of partnerships in bringing the worlds of research and practice closer into alignment.

Sex differences in childhood sexual abuse and suicide-related behaviors.

Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.

Collaborating with youth to inform and develop tools for psychotropic decision making.

INTRODUCTION: Youth oriented and informed resources designed to support psychopharmacotherapeutic decision-making are essentially unavailable. This article outlines the approach taken to design such resources, the product that resulted from the approach taken, and the lessons learned from the process. METHODS: A project team with psychopharmacology expertise was assembled. The project team reviewed best practices regarding medication educational materials and related tools to support decisions. Collaboration with key stakeholders who were thought of as primary end-users and target groups occurred. A graphic designer and a plain language consultant were also retained. RESULTS: Through an iterative and collaborative process over approximately 6 months, Med Ed and Med Ed Passport were developed. Literature and input from key stakeholders, in particular youth, was instrumental to the development of the tools and materials within Med Ed. A training program utilizing a train-the-trainer model was developed to facilitate the implementation of Med Ed in Ontario, which is currently ongoing. CONCLUSION: An evidence-informed process that includes youth and key stakeholder engagement is required for developing tools to support in psychopharmacotherapeutic decision-making. The development process fostered an environment of reciprocity between the project team and key stakeholders.