Exploring how to enhance care and pathways between the emergency department and integrated youth services for young people with mental health and substance use concerns

Abstract

Background Integrated youth services (IYS) provide multidisciplinary care (including mental, physical, and social) prioritizing the needs of young people and their families. Despite a significant rise in emergency department (ED) visits by young Canadians with mental health and substance use (MHSU) concerns over the last decade, there remains a profound disconnect between EDs and MHSU integrated youth services. The first objective of this study was to better understand the assessment, treatment, and referral of young people (ages 12–24 years) presenting to the ED with MHSU concerns. The second objective was to explore how to improve the transition from the ED to IYS for young people with MHSU concerns. Methods We conducted semi-structured one-on-one video and phone interviews with stakeholders in British Columbia, Canada in the summer of 2020. Snowball sampling was utilized, and participants (n = 26) were reached, including ED physicians (n = 6), social workers (n = 4), nurses (n = 2), an occupational therapist (n = 1); a counselor (n = 1); staff/leadership in IYS organizations (n = 4); mental health/family workers (n = 3); peer support workers (n = 2), and parents (n = 3). A thematic analysis (TA) was conducted using a deductive and inductive approach conceptually guided by the Social Ecological Model. Results We identified three overarching themes, and factors to consider at all levels of the Social Ecological Model. At the interpersonal level inadequate communication between ED staff and young people affected overall care and contributed to negative experiences. At the organizational level, we identified considerations for assessments and the ED and the hospital (wait times, staffing issues, and the physical space). At the community level, the environment of IYS and other community services were important including wait times and hours of operation. Policy level factors identified include inadequate communication between services (e.g., different charting systems and documentation). Conclusions This study provides insight into important long-term systemic issues and more immediate factors that need to be addressed to improve the delivery of care for young people with MHSU challenges. This research supports intervention development and implementation in the ED for young people with MHSU concerns.

Association between continuity of care and attendance of post-discharge follow-up after psychiatric emergency presentation

“…This impedes motivation to engage in mental health aftercare. Repeating the same stories to multiple clinicians may also be another source of frustration 51 . Young people may be less inclined to attend the follow-up appointment if they expect themselves to be repeating the difficult and negative experiences that resulted in their A&E presentation.…”

Association between continuity of care and attendance of post-discharge follow-up after psychiatric emergency presentation

“…Repeating the same stories to multiple clinicians may also be another source of frustration. 51 Young people may be less inclined to attend the follow-up appointment if they expect themselves to be repeating the di cult and negative experiences that resulted in their A&E presentation.…”

Informing youth‐centred opioid agonist treatment: Findings from a retrospective chart review of youths' characteristics and patterns of opioid agonist treatment engagement in a novel integrated youth services program

“…Chart records for these data exposed substantial challenges and gaps in the continuity of care between our community‐based IYS setting and those acute care settings. Such challenges have been described in a recent qualitative study that sought to understand how youth with mental health and substance use concerns are assessed and treated in emergency departments (Glowacki et al, 2022). In this study, Glowacki et al (2022) identified several gaps in the quality of care for youth in the emergency department setting, such as inappropriate assessments, long waiting times in a stressful environment, and inadequate discharge and referral pathways (Glowacki et al, 2022).…”

“…Such challenges have been described in a recent qualitative study that sought to understand how youth with mental health and substance use concerns are assessed and treated in emergency departments (Glowacki et al, 2022). In this study, Glowacki et al (2022) identified several gaps in the quality of care for youth in the emergency department setting, such as inappropriate assessments, long waiting times in a stressful environment, and inadequate discharge and referral pathways (Glowacki et al, 2022). Given these findings and the ongoing overdose crisis, it is critical that policy makers develop interventions or programs for the acute care setting that are tailored to the needs of youth using substances, including those from racialized or sexual and gender minority populations, and promote continuity between healthcare settings through addressing the above gaps in care quality.…”