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Background To determine: (a) the feasibility and acceptability of administering a standardized electronic assessment of substance use and other mental health concerns to youth admitted to an inpatient psychiatric unit, and (b) the prevalence and clinical correlates of substance use in this sample. Methods The sample included 100 youth between the ages of 13 to 17 years admitted to an inpatient psychiatric unit in Ontario, Canada between September and November 2019 (78% response rate). Youth data were comprised of electronic self-reported assessments (during hospitalization and 6-months following) and chart reviews (99% consented; historical and prospective). Frontline staff completed a self-report survey assessing their perceptions of the need for standardized substance use assessments, training, and interventions on the unit (n = 38 Registered Nurses and Child and Youth Workers; 86% response rate). Analyses included descriptive statistics, correlations, regression, and qualitative content analysis. Results Feasibility of standardized youth self-reported mental health and substance use assessments was evident by high response rates, little missing data, and variability in responses. 79% of youth had used at least one substance in their lifetime; 69% reported use in the last 3 months. Substance use was positively correlated with severity of psychiatric symptoms (τb 0.17 to 0.45) and number of psychiatric diagnoses (τb 0.17 to 0.54) at index. Based on prospective and retrospective data, substance use was also positively related to mental health symptom severity at follow-up and repeat mental health related hospital visits. Frontline staff reported a need for standardized assessment, training, and interventions on the unit, indicative of acceptability. Conclusions This study demonstrated the feasibility, acceptability and clinical importance of administering a standardized mental health and substance use assessment among youth experiencing psychiatric hospitalization.

The objective of this paper is to explore ethical issues in the provision of transitional care. Using five case studies a number of ethical issues in transition and transition care are discussed. These issues include: 1) preserving, promoting and ensuring dignity and respect for patients; 2) fostering and supporting the trusting relationships that young people and their parents have for pediatric providers to their new adult providers by using a graduated system of transfer; 3) recognizing graduated capacity; 4) promoting autonomy and self-management; 5) duties of beneficence and non-maleficence; 6) truthtelling; 7) duty to provide developmental^ appropriate care; and 8) duty of pediatric providers to advocate for transitioning patients in the adult system. Attention to the ethical issues surrounding these complex cases has the potential to positively influence a successful transition to adult-oriented health care.

Objective: This pilot study investigated the feasibility of studying 12-month readmission of youth aged 10-16 years following their first psychiatric hospitalization and changes in youth mental and psychosocial health prospectively. Results: Inpatient youth with a first psychiatric hospitalization and their parents were recruited from a regional hospital in Canada. Data were collected at recruitment, and at 3-, 6-, and 12-months post-discharge. Repeated measures ANOVA was performed to assess changes in health outcomes. Nineteen eligible youth were approached and 15 (78.9%) consented to participate (13.9±2.0 years, 73.3% female). Eleven youth (73.3%) gave permission to contact their parents, all of whom participated (39.2±7.6 years). Four youth dropped out of the study (26.7%) and six youth-parent dyads completed all four follow-ups. The readmission rate was 20.0% (n=3) over 12 months. Significant changes in youth-reported symptoms of conduct disorder (F=3.0, p=0.06) and adverse childhood experiences (F=3.4, p=0.05) were found. Changes in parent-reported youth mental health symptoms (F=3.1, p=0.06), particularly among internalizing disorders, youth health-related quality of life (F=11.3, p<0.01), and youth disability (F=2.7, p=0.08) were significant. This preliminary work demonstrates the feasibility of, and need to, engage youth and their families to understand their mental and psychosocial health during this vulnerable time in their lives.