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T he E volution of the HE ADS- E D A jour ne y fr om c onc e ption thr ough de ve lopme nt, e valuation and imple me ntation Ma rio Ca ppe lli, Ph.D.,C.Psyc h. Dire c tor, Me nta l He a lth Re se a rc h, CHE O, Cha ir Re se a rc h Ac

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SLIDE 1

Ma rio Ca ppe lli, Ph.D.,C.Psyc h. Dire c tor, Me nta l He a lth Re se a rc h, CHE O, Cha ir Re se a rc h Ac tion Are a – Community Suic ide Pre ve ntion Ne twork Clinic a l & Adjunc t Profe ssor of Psyc holog y & Psyc hia try, Unive rsity of Otta wa & Me mbe r of the F a c ulty Gra dua te Post- Doc tora l Studie s

T he E volution of the HE ADS- E D

A jour ne y fr

  • m c onc e ption

thr

  • ugh de ve lopme nt, e valuation

and imple me ntation

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SLIDE 2

Co nflic ts o f I nte re st: No ne F unding So urc e s: RBC F

  • unda tio n

CHE O F

  • unda tio n

CHE O Re se a rc h I nstitute Rya n Willia ms F und

Ac knowle dg e me nts:

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SLIDE 3

Past and Cur r e nt Me mbe r s of the Re se ar c h Gr

  • up:

Roge r Ze me k Sar ah Re id Paula Cloutie r Jane t Cur r an Clar e Gr ay Me lissa Mac Williams Allison Ke nne y Mona Jabbour Guy Douc e t John L yons L iz Gle nnie Nathalie Gille n

Ac knowle dg e me nts:

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SLIDE 4
  • Ba c kg ro und
  • HE

ADS-E D: T he T

  • o l
  • www.he a ds-e d.c o m: T

he Site

  • E

vide nc e

  • Sc a la b ility

Ove rvie w

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SLIDE 5
  • T

he re is no sta nda rd o f pra c tic e o r to o l use d to g uide the a sse ssme nt a nd dispo sitio n o f me nta l he a lth c o nc e rns within the E D

  • Only 9% o f E

D physic ia ns indic a te d using e vide nc e -b a se d sc re e ning me tho ds to a sse ss me nta l he a lth c o nc e rns1

  • 62% ide ntifie d la c k o f a n a va ila b le to o l a s a sig nific a nt

b a rrie r

1

  • T

he AAP c a lle d fo r a c tio n suppo rting impro ve d sc re e ning

  • f me nta l he a lth issue s in the E

D

  • Re c o mme nda tio ns we re ma de fo r the use o f spe c ific a nd

va lida te d pe dia tric sc re e ning me a sure s pa rt o f the a sse ssme nt a nd dispo sitio n pla nning fo r E D pa tie nts with me nta l he a lth e me rg e nc ie s.

Ba c kg round

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SLIDE 6

An E D Me ntal He alth T

  • ol must be :
  • Ve ry Brie f
  • Ve ry E

a sy to c o mple te

  • Ve ry E

a sy to sc o re

  • Clinic a lly intuitive
  • He lp g uide c linic a l de c isio ns in the a sse ssme nt a nd fo r

tre a tme nt re c o mme nda tio ns

Ba c kg round

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SLIDE 7
  • E

na b le s E D physic ia ns to ta ke a psyc ho so c ia l histo ry whic h a ids in de c isio ns re g a rding pa tie nt dispo sitio n

  • Ra te d o n a 3 po int sc a le b a se d o n ne e d fo r a c tio n
  • Only 7 va ria b le s a re inc o rpo ra te d into the HE

ADS-E D to o l:

H o me E duc a tio n A c tivitie s a nd pe e rs D rug s a nd a lc o ho l S uic ida lity E mo tio ns a nd b e ha vio urs D isc ha rg e re so urc e s HE ADS- E D: T he T

  • ol
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SLIDE 8

HE ADS- E D: T he Vide o

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SLIDE 9
  • I

nitia l Va lida tio n & Re lia b ility Study

  • T

he o re tic a l Do ma ins F ra me wo rk Study fo r I mple me nta tio n

  • L
  • c a l E

D I mple me nta tio n Study

E vide nc e : 3 Studie s to Da te

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SLIDE 10

T he HE ADS-E D: A ra pid me nta l he a lth sc re e ning to o l fo r pe dia tric pa tie nts in the E me rg e nc y De pa rtme nt. Pe dia tric s, 130 (2) 130:e 321-e 327 (2012)

  • 313 c hildre n a nd yo uth pre se nting to the E

D b e twe e n Ma rc h 1 to Ma y 30 a nd se e n b y a Crisis Wo rke r

  • Crisis Wo rke rs c o mple te d the HE

ADS-E D, CANS-MH 3.0

  • Yo uth c o mple te d the Childre n’ s De pre ssio n I

nve nto ry (CDI )

E vide nc e : Re lia bility a nd Va lidity

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SLIDE 11
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SLIDE 12
  • HE

ADS-E D c o rre la te d with a ll sub sc a le s o f the CDI a nd the CANS-MH 3.0 (r = 0.17 to r = 0.89)

  • Pre dic te d re q ue st fo r c o nsulta tio n & ho spita l a dmissio ns
  • Se nsitivity = 82%
  • Spe c ific ity = 87%
  • De mo nstra te d inte r-ra te r re lia b ility (I

CC=.78)

E vide nc e : Re lia bility a nd Va lidity

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SLIDE 13
  • Co nduc te d 6 fo c us g ro ups (1.5 ho urs) c o nsisting o f 6 to 8 E

D physic ia ns to e va lua te fa c ilita to rs a nd b a rrie rs to HE ADS-E D use in pe dia tric , g e ne ra l a nd rura l ho spita ls

  • 3 in Onta rio (pe dia tric c e ntre , g e ne ra l ho spita l, rura l ho spita l
  • 3 in No va Sc o tia (pe dia tric c e ntre , g e ne ra l ho spita l, rura l

ho spita l)

  • “I

think I c an spe ak fo r mo st E me rg do c s whe n I say we ’ re no t re ally all that aware o f what’ s o ut the re in the c o mmunity”

  • “I

think the b ig g e st part o f the to o l is…the dispo sitio n and all

  • f the re so urc e s linking that to this pie c e , like just this in and
  • f itse lf is use ful”

E vide nc e : T he ore tic a l Doma ins F ra me work E D F

  • c us Groups
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SLIDE 14
  • 374 Yo uths (M = 14.98 ye a rs; 72.6% fe ma le ) pre se nting to CHE

O E D b e twe e n Ma y 7, 2013 to De c e mb e r 16, 2013 a nd se e n b y a physic ia n

  • 38.5% o f pa tie nts re c e ive d a psyc hia tric o r c risis c o nsulta tio n

during the ir sta y

  • 14.9% o f pa tie nts we re a dmitte d (Ψ in-pa tie nt)

E vide nc e : Imple me nta tion Study

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SLIDE 15

Se nsitivity = 79.5% Spe c ific ity = 66.7%

Crisis and/or Psych Consult No Consult Patients with a HEADS-ED Score > 7 and Suicidality = 2 (N = 44) 35 (79.5%) 9 (20.5%) Patient with a HEADS-ED Score ≤ 7 or HEADS-ED Score >7 without Suicidality (N = 330) 110 (33.3%) 220 (66.7%)

E vide nc e : Imple me nta tion

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SLIDE 16

Pa tie nts with a HE ADS-E D Sc o re > 7 a nd Suic ida lity = 2 tha t did no t re c e ive a c o nsult (N = 9)

  • 2 pa tie nts we re a dmitte d to CHE

O I npa tie nt Psyc ho lo g y

  • 2 pa tie nt ha d a n urg e nt f/ u re c o mme nda tio n (ne xt da y a ppt.)
  • 3 pa tie nts we re we ll-c o nne c te d with disc ha rg e re so urc e s
  • 2 pa tie nts we re sc o re d inc o rre c tly o n Suic ida lity (NSSI

)

E vide nc e : Imple me nta tion

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SLIDE 17
  • Nine ty-two pa tie nts we re se e n b y b o th a n E

DP a nd a CI W

  • E

DP a nd CI W inde pe nde ntly c o mple te d HE ADS-E D fo r the ir pa tie nt * p < .05; ** p < .001

E vide nc e : Imple me nta tion

ICC Home (n=89) .569** Education (n=82) .815** Activities & Peers (n=83) .392* Drugs & Alcohol (n=83) .838** Suicidality (n=90) .699** Emotions & Behaviours (n=86) .263 Discharge Resources (n=83) .518**

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SLIDE 18
  • Curre ntly pla nning multi-site e le c tro nic HE

ADS-E D e va lua tio n a nd imple me nta tio n study: Ja ne wa y Ho spita l (NL ), I WK He a lth Sc ie nc e s Ce ntre (NS), CHU Sa inte -Justine (PQ), Childre n’ s Ho spita l o f E a ste rn Onta rio (ON), T he Ho spita l fo r Sic k Childre n (ON), Childre n’ s Ho spita l o f Winnipe g (MB), Ro ya l Unive rsity Ho spita l (SK), Sto lle ry Childre n’ s Ho spita l (AB), a nd British Co lumb ia Childre n’ s Ho spita l (BC)

  • Pro vinc ia l Co unc il fo r Ma te rna l a nd Child He a lth suppo rt

imple me nta tio n o f the HE ADS-E D in the E me rg e nc y De pa rtme nt Clinic a l Pa thwa y fo r Childre n a nd Yo uth with Me nta l He a lth Co nditio ns

  • De ve lo p a pps suita b le fo r ha nd he ld de vic e s
  • Pa rtne r with c o mmunity re g a rding HE

ADS-E D use in prima ry c a re &

  • De ve lo p a pps suita b le fo r ha nd he ld de vic e s

L

  • oking be yond our ba c k ya rd:
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SLIDE 19

T HANK YOU

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