Developing a quality standard for youth experiencing mental health and/or substance use concerns in emergency department settings

Background: Mental health and substance use disorders affect more than 1 billion people globally and are the leading cause of disability in children and youth (under the age of 25). While mild to moderate mental health and/or substance use (MHSU) concerns are often best addressed in community, youth have increasingly relied on emergency departments (EDs) to address their MHSU needs, contributing to ED overcrowding. For instance, in Canada, there was a 66% rise in ED visits by youth (ages 5-24) presenting with mental health and/or substance use (MHSU) concerns between 2007 and 2017. Due to long wait times in the ED, youth often wait hours, sometimes days, before being seen and often do not receive outpatient care, thus often return to the ED for the same concerns. Despite this trend, no standard of care exists to ensure youth get connected to appropriate community MHSU services after presenting to the ED. Objective: This project aims to develop a pan-Canadian standard describing what high-quality care looks like for youth presenting at the ED with MHSU concerns, including transitions to appropriate MHSU services. This standard will help healthcare practitioners working in EDs and community MHSU services provide consistent, high-quality care to youth experiencing MHSU challenges. Methods: In the first phase of this project (September 2023 – January 2024) a technical committee will create a draft outline of the standard using existing evidence on the way MHSU support is provided in the ED and ten principles of integrated youth services. This includes an initial qualitative study conducted with service providers in British Columbia to understand how MHSU assessment, treatment, and transitions to care currently occur for youth, a broader scoping review summarizing global evidence, and their own experiences and expertise. The technical committee is comprised of youth, caregivers, ED staff, MHSU service providers, integrated youth service (IYS) leaders, and MHSU researchers from across Canada. In the second phase (February 2024 – March 2024) we will conduct a public review of the standard using a Delphi process and stakeholder-specific deliberative dialogues with three groups of experts: youth, service providers, and decision makers. We will lean on the Federation of IYS Networks, which is a pan-Canada network of IYS, to share the draft standard with their networks and ensure representation from diverse populations (e.g., geographically, cultural background). The feedback provided will be used to refine the standard by the technical committee. Results/Implications: The project will articulate a specific and actionable standard to improve timely access to care for youth accessing the ED for MHSU concerns. This will involve the type of care youth should receive, how to assess MHSU severity, transitions to community MHSU, and how to ensure continuity of care. This will also include specific indicators to measure progress in meeting each quality statement and will help inform interventions needed in EDs to meet the standard and ensure timely transitions to community youth MHSU services.