As mentioned in the previous PREDICT newsletter, we have been successful in obtaining funding to conduct a series of projects addressing child and adolescent ED mental health presentations.
We are hoping to better understand, and to improve, care for this vulnerable group of patients.
Our initial projects involve determining
– What are research priorities for patients, families, carers, and healthcare providers?
– What outcome measures are most important?
– What factors influence the care which is delivered?
– What care do we currently provide?
Recently, we have sent out an “Expression of Interest” for the initial three projects, which are outlined further below.
We will be presenting detailed plans for these (and additional projects around the management of acute behavioural disturbance and safety planning for suicidal ideation/self-harm) at the PREDICT member’s meeting in October.
We are hoping that this work will be truly representative of the experience across Australia and New Zealand. Therefore, we are planning to involve up to 30 sites, and are particularly interested to hear from rural, regional, and non-tertiary metropolitan EDs, as well as the larger tertiary EDs.
Funding will be made available to support project set up and data collection.
If you are interested in participating, or have any questions, please contact simon.craig@monash.edu.
Project 1: Delphi Survey
Priorities for research, outcome measures, and discharge communication
Specific aims:
(1) To identify consensus research priorities in ED mental health presentations by children and young people
(2) To identify core outcome measures which should be reported in future studies in specific planned subgroups (suicidality/self-harm; behavioural disturbance; drug and alcohol presentations; eating disorders; and neurodevelopmental disorders such as autism spectrum disorder)
(3) To identify priorities for communication at the point of ED discharge.
Research Design:
An online three-round Delphi process for prioritisation will be conducted with health professionals and health consumers recruited from a range of tertiary paediatric hospitals, metropolitan and rural hospitals across Australia / NZ.
Project 2: Interviews with staff
Factors influencing care and information needs
Specific aims:
(1) To assess information and training needs facing ED clinicians in caring for children and adolescents with acute mental health problems
(2) To understand the factors influencing ED mental health care (e.g. individual beliefs, organisational culture, resources).
Research design:
Qualitative semi-structured interviews. We will conduct qualitative interviews with up to 5 health care providers at participating hospitals.
Project 3: Epidemiology.
Multicentre retrospective study
Specific aims:
(1) To understand the epidemiology of children and young people presenting to the ED with mental health concerns, including their risk profile
(2) To understand in detail the mental health issues of key subgroups (autism and other neurodevelopmental issues, suicidality, drug & alcohol, Indigenous, out-of-home care)
Research design:
Structured retrospective chart review (30 hospitals including tertiary, metropolitan and regional, n=6000, up to 200 mental health ED presentations at each site from 2019). Data will be collected regarding mode of presentation, ED and hospital diagnosis, ED and hospital management, including use of restrictive practices (physical or chemical restraint), healthcare costs, documented risk profiles, co-morbid mental and physical health conditions, and protective factors.