Exploring parental perceptions of psychosocial screening in paediatric emergency departments.

Objective: To explore parental perceptions of psychosocial screening in the paediatric emergency department and identify post-screening barriers to accessing mental health care. Methods: We conducted a qualitative study during the 30-day follow-up period of a larger prospective cohort study. Eligible youth and their accompanying parent/guardian first completed psychosocial self/proxy-screening using the MyHEARTSMAP tool and then received a standardized clinical mental health assessment. If the MyHEARTSMAP assessment provided youth with mental health resources recommendations, their parents were invited to a follow-up session. Thirty  days (±5 days) after their ED visit, parents participated in a virtual interview to reflect and share their attitudes, perceptions and thoughts around the screening and mental health care-seeking process. Results: Of the 171 participants who received resource recommendations during their ED visit, 124 parents (72.5%; 95% CI 65.2-79.1%) completed the follow-up interview. Most parents endorsed positive perceptions of the screening process, describing it as an 'eye-opening' process that 'sparked conversation'. Most participants (74.2%; 95% CI 65.6-81.6) agreed with the resource recommendations they received. In terms of resources-seeking, only 41 participants (33.1%; 95% CI 24.9-42.1) attempted to access recommended supports. Families generally felt identified concerns were mild and 'not serious enough' to warrant resource-seeking, though many expressed an intention to seek care if concerns escalated. Conclusion: Perceptions of psychosocial screening in the ED were favourable and encouraging among participating parents of youth screened positive for psychosocial issues. Despite positive attitudes, only a fraction of the families invited to follow-up attempted to access care. Mental health may be perceived as low priority for many families, signifying the need for improved education and awareness building on the importance of early intervention.

Utility of MyHEARTSMAP for Universal Psychosocial Screening in the Emergency Department.

OBJECTIVES: To evaluate the utility of universal psychosocial screening in the emergency department (ED) using MyHEARTSMAP, a digital self-assessment and management guiding tool. STUDY DESIGN: We conducted a cohort study of youth 10-17 years of age with nonmental health related presentations at 2 pediatric EDs. On randomly selected shifts (December 2017-February 2019), participants completed their psychosocial self-assessments using MyHEARTSMAP on a mobile device, then underwent a standardized clinical mental health assessment (criterion standard). We reported the sensitivity and specificity of respondents' self-assessment, against a clinician's standard emergency psychosocial assessment, and the frequency of psychosocial issues and recommended mental health resources identified by screening. RESULTS: We approached 1432 eligible youth, among which 795 youth consented to participate (55.5%). Youth and guardians' sensitivity at self-identifying psychiatric concerns was 92.7% (95% CI 89.1, 95.4%) and 93.1% (95% CI 89.5, 95.8%), respectively. In cases where clinicians had determined to be no psychiatric issues, 98.5% (95% CI 96.7, 99.4%) of youth and 98.9% (95% CI 97.3, 99.7%) of guardians identified the youth as having no or only mild issues. Screening identified 36.4% of youth as having issues in at least 1 psychosocial domain which warranted further follow-up. CONCLUSIONS: Psychosocial screening in EDs using MyHEARTSMAP can reliably be conducted using the MyHEARTSMAP self-assessment tool and over one-third of screened youth identified issues which can be directed to further care.

Laboratory Monitoring Practices Among Canadian Multiple Sclerosis Clinicians.

BACKGROUND: Advances in multiple sclerosis (MS) disease modifying therapy (DMT) have increased laboratory monitoring requirements. Our goal was to survey existing practices and perceptions of risk in laboratory monitoring throughout Canada and assess whether opportunities to improve patient care and safety exist. METHODS: A web-based survey assessing prescriber demographics, current infrastructure, and concerns for lab monitoring was sent to the Canadian Network of MS Clinics (CNMSC) listserv, inviting MS clinicians across the country to participate. RESULTS: Respondents included 32/65 CNMSC-affiliated neurologists (49%), 6 registered nurses (RN), 2 nurse practitioners (NP), and 2 non-neurologist physicians from 8/10 provinces. For some questions, analysis was limited to 34 DMT-prescribing clinicians only. Despite broad implementation of electronic medical records (25/34, 74%), many prescribers (15/34, 44%) still receive laboratory results in paper form. In terms of lab monitoring infrastructure, we noted regional variability in the employment of nursing to monitor patient compliance with required laboratory monitoring. There is also a gap in laboratory surveillance, as less than 5% of respondents reported regularly reviewing results on weekends. Providers' length of practice and volume of MS patients were not associated with different perception of DMT laboratory monitoring risk. CONCLUSIONS: This nation-wide survey showed variability in infrastructure used in laboratory monitoring and regional variation in nursing involvement. Providers' level of concern for laboratory monitoring for DMTs did not vary by years of experience or volume of MS patients followed, suggesting that improved systems, rather than education, could ameliorate perceptions of risk.

Les pratiques de monitorage en laboratoire parmi les professionnels cliniciens canadiens traitant la sclérose en plaques. Contexte: Dans le cas de la sclérose en plaques (SP), les avancées offertes par les médicaments modificateurs de l'évolution de cette maladie ont augmenté les exigences de monitorage des pratiques en laboratoire. Dans cet article, notre objectif a été d'examiner ces pratiques ainsi que les perceptions du risque entourant leur monitorage partout au Canada. Nous avons aussi voulu évaluer dans quelle mesure des possibilités d'améliorer les soins offerts aux patients et leur sécurité existent. Méthodes: Nous avons invité des professionnels cliniciens spécialisés dans le domaine de la SP et issus de tout le pays à participer à un sondage en ligne cherchant à déterminer leur profil et à évaluer l'état actuel des infrastructures et leurs préoccupations en ce qui regarde le monitorage de leur travail effectué en laboratoire. Pour ce faire, nous avons fait appel à la liste de diffusion du Réseau canadien des cliniques de SP. Résultats: Au total, 65 professionnels cliniciens ont répondu à notre sondage. De ce nombre, 32, soit 49 %, étaient des neurologues affiliés au réseau cité précédemment ; 6 étaient des infirmières autorisées ; 2 étaient des infirmières praticiennes ; et 2 des médecins non spécialisés en neurologie. Ces répondants étaient issus de 8 provinces canadiennes sur 10. Dans le cas de certaines questions, nous avons limité notre analyse à seulement 34 professionnels cliniciens ayant prescrit des médicaments modificateurs de l'évolution de la SP. En dépit d'une vaste implantation des dossiers médicaux électroniques (25 cliniciens sur 34, soit 74 %), nombre d'entre eux (15 sur 34, soit 44 %) continuent à recevoir des résultats de laboratoire en format papier. En ce qui regarde les infrastructures de monitorage en laboratoire, nous avons aussi noté une grande variété régionale dans l'utilisation de personnel infirmier pour veiller à ce que les patients suivent leur traitement. Il existe de surcroît des lacunes en matière de contrôle en laboratoire, moins de 5 % des répondants ayant affirmé réviser de façon régulière les résultats de leurs patients au cours des fins de semaine. Les années d'expérience de ces professionnels cliniciens, de même que le nombre de patients atteints de SP qu'ils traitent, n'ont pas été associés à des perceptions du risque différentes en ce qui regarde le monitorage en laboratoire des médicaments modificateurs de l'évolution de la SP. Conclusions: Ce sondage mené à l'échelle pancanadienne a montré une variabilité dans les infrastructures de monitorage utilisées en laboratoire ainsi que des variations régionales par rapport à l'implication du personnel infirmier. Le niveau de préoccupation des professionnels cliniciens quant au monitorage en laboratoire des médicaments modificateurs de l'évolution de la SP n'a pas varié en fonction de leurs années d'expérience ou du nombre de patients traités, ce qui suggère que des systèmes de fonctionnement améliorés, plutôt que l'enseignement, pourraient améliorer les perceptions du risque.