Meeting the service needs of youth with and without a self-reported mental health diagnosis during COVID-19

Background: The COVID-19 pandemic catalyzed major changes in how youth mental health (MH) services are delivered. Understanding youth's MH, awareness and use of services since the pandemic, and differences between youth with and without a MH diagnosis, can help us optimize MH services during the pandemic and beyond. Objective(s): We investigated youth's MH and service use one year into the pandemic and explored differences between those with and without a self-reported MH diagnosis. Method(s): In February 2021, we administered a web-based survey to youth, 12-25 years, in Ontario. Data from 1373 out of 1497 (91.72%) participants were analyzed. We assessed differences in MH and service use between those with (N=623, 45.38%) and without (N=750, 54.62%) a self-reported MH diagnosis. Logistic regressions were used to explore MH diagnosis as a predictor of service use while controlling for confounders. Result(s): 86.73% of participants reported worse MH since COVID-19, with no between-group differences. Participants with a MH diagnosis had higher rates of MH problems, service awareness and use, compared to those without a diagnosis. MH diagnosis was the strongest predictor of service use. Gender and affordability of basic needs also independently predicted use of distinct services. Conclusion(s): Various services are required to mitigate the negative effects of the pandemic on youth MH and meet their service needs. Whether youth have a MH diagnosis may be important to understanding what services they are aware of and use. Sustaining pandemic-related service changes require increasing youth's awareness of digital interventions and overcoming other barriers to care.Copyright © 2023, Canadian Academy of Child and Adolescent Psychiatry. All rights reserved.

Pediatric emergency department physicians' perceptions of virtual mental health assessments for urgent needs.

PURPOSE: Pressures related to the COVID-19 pandemic have created the need to develop innovative ways to deliver mental health care, especially for urgent needs. After the launch of a pediatric Emergency Department (ED) Virtual Care service, we aimed to evaluate pediatric ED physicians' experiences with the use of ED virtual care for mental health assessments. METHODS: This mixed-methods study was conducted at a pediatric academic health center in Ontario, Canada. Pediatric ED physicians who conducted ED virtual mental health assessments from May to December 2020 were eligible. Participants completed a 22-question novel survey and were invited to participate in a focus group. Descriptive and thematic analyses were used to analyze the data. RESULTS: Twenty-nine physicians provided mental health services through the ED virtual care platform. Twenty-five physicians (86% response rate) completed the survey and 3 (10%) participated in a focus group. While many agreed that virtual care benefits patients (67%), key barriers identified included time constraints, lack of mental health clinician support, and uncertainty around the pediatric ED physicians' role in these types of assessments. Despite these barriers, physicians recognized the potential benefit of the ED virtual care service for mental health assessments and were largely amenable to improving this process should mental health support be available. CONCLUSIONS: While many physicians agreed that there is a potential benefit of the ED virtual care platform for urgent mental health assessments, time constraints and lack of confidence in providing satisfactory virtual mental health care with minimal mental health support limited its acceptability. These findings can inform the future implementation of mental health services using an innovative virtual ED platform.

RéSUMé: OBJECTIF: Les pressions liées à la pandémie de COVID-19 ont créé le besoin de développer des moyens innovants pour fournir des soins de santé mentale, en particulier pour les besoins urgents. Après le lancement d'un service de soins virtuels aux urgences pédiatriques, nous avons cherché à évaluer les expériences des médecins des urgences pédiatriques avec l'utilisation des soins virtuels aux urgences pour les évaluations de la santé mentale. MéTHODOLOGIE: Cette étude à méthodes mixtes a été menée dans un centre universitaire de santé pédiatrique en Ontario, au Canada. Les médecins pédiatriques qui ont effectué des évaluations virtuelles de la santé mentale aux urgences de mai à décembre 2020 étaient admissibles. Les participants ont rempli une enquête inédite de 22 questions et ont été invités à participer à un groupe de discussion. Des analyses descriptives et thématiques ont été utilisées pour analyser les données. RéSULTATS: Vingt-neuf médecins ont fourni des services de santé mentale par le biais de la plateforme de soins virtuels des urgences. Vingt-cinq médecins (taux de réponse de 86 %) ont répondu au sondage et trois (10 %) ont participé à un groupe de discussion. Si beaucoup s'accordent à dire que les soins virtuels sont bénéfiques pour les patients (67 %), les principaux obstacles identifiés sont les contraintes de temps, le manque de soutien des cliniciens en santé mentale et l'incertitude quant au rôle des urgentistes pédiatriques dans ces types d'évaluations. Malgré ces obstacles, les médecins ont reconnu l'avantage potentiel du service de soins virtuels de l'urgence pour les évaluations de la santé mentale et étaient largement disposés à améliorer ce processus si un soutien en santé mentale était disponible. CONCLUSIONS: Bien que de nombreux médecins s'accordent à dire que la plateforme de soins virtuels des urgences présente un avantage potentiel pour les évaluations urgentes de la santé mentale, les contraintes de temps et le manque de confiance dans la prestation de soins de santé mentale virtuels satisfaisants avec un soutien minimal en matière de santé mentale ont limité son acceptabilité. Ces résultats peuvent éclairer la mise en œuvre future des services de santé mentale à l'aide d'une plateforme virtuelle d'urgence innovante.

Building Resilience and Attachment in Vulnerable Adolescents (BRAVA): Piloting a Virtual Adaptation of a Brief Group Intervention for Adolescents With Mild-to-Moderate Suicidal Ideation and Their Caregivers

Objectives: Suicidal ideation (SI) is common in adolescents and increases the risk of completed suicide. Due to the COVID-19 pandemic, healthcare providers rapidly shifted to providing telehealth and virtual options for clients. Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a group intervention designed for adolescents and their caregivers to reduce adolescent SI. The objective of this study was to adapt BRAVA for virtual delivery and evaluate the feasibility of this adaptation. Methods: We conducted an 8-week open trial between October and December 2020. Twelve participants (6 adolescents and 6 primary caregivers) were recruited from a pediatric hospital in Eastern Ontario. Through Zoom, adolescents and caregivers completed an intake assessment together, 6 weekly BRAVA group sessions separately, and an exit assessment together 1-week post-BRAVA. The primary adolescent outcome variable was the Suicidal Ideation Questionnaire Junior (SIQ-JR). Data were analyzed in IBM SPSS v.27. Pre-post comparisons on the SIQ-JR were done with a 2-tailed t test for matched pairs. Results: The study uptake rate was 42.9% of the eligible participants. There were no study dropouts. Adolescent (Mean [M] age = 15.3 years;SD age = 1.0;66.7% female) and caregiver attendance rates for BRAVA group sessions were high (median = 6). Overall group satisfaction scores were high for adolescents (M = 4.2;SD = 0.8) and their caregivers (M = 4.2;SD = 0.7). Most youth (83.4%) and caregivers (66.7%) reported that the virtual process worked well. Whereas all caregivers (100%) agreed they would participate in a virtual group session again, youth responses were more variable (50% agree, 33.3% neutral, 16.7% disagree). Adolescent SI decreased after completing the intervention (M pretreatment [tx] = 50.7, SD pretreatment [tx] = 16.7;M post-tx = 29.7, SD post-tx = 20.4;t = 5.7;95% CI, 11.52-30.5;p = 0.002). Conclusions: Study results indicate that the virtual delivery of BRAVA is feasible. Study uptake was good, retention was complete, and satisfaction was high for adolescents and their caregivers. Importantly, initial results suggest that this adaptation of BRAVA may help reduce SI in adolescents. Feedback from participants will inform further changes to improve the adaptation of BRAVA for use in a planned RCT. S, ADOL, FT