The Emergency Department (ED) in busy BC Children's Hospital (BCCH) is well-equipped to treat children in physical crisis – but challenged when treating children with mental health issues. In fact, pediatric emergency physician Dr Quynh Doan said, “It was our biggest emerging problem.” ED doctors and clinicians are trained to assess physical conditions and make recommendations, but are not trained in psychiatry.
Dr Doan knew “We were scrambling. Everyone was doing something different. We all had varying degrees of risk tolerance – some could do a mental health assessment and correctly use the community resources and others just checked the pulse and called for a psychiatric consult.”
Dr Doan decided she was going to be part of a solution to fix this. As a medical investigator, Dr. Doan started seeking a solution by meeting with Dr. Tyler Black, Head of Pediatrics at BCCH and consulting with the hospital's mental health specialists.
After researching and consulting, she concluded the best approach was to adapt an existing online screening tool created for ED physicians to assess youth with mental health issues and use it with children.
Dr Doan approached and received funding from the Specialist Services Committee (SSC). SSC is one of four joint collaborative committees that represents a partnership of Doctors of BC and the BC government. The adapted online assessment tool is called HEARTSMAP. It is included in the five-step ED Protocols developed by the Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative under Shared Care, also a joint collaborative committee of Doctors of BC and the BC government.
The tool helps assess a patient through many lenses from: home environment, moods, anxiety, etc. and contains recommended actions, including using appropriate out-patient resources. Dr Doan worked with the CYMHSU Collaborative to identify and integrate the appropriate resources. Often, these resources are local or regional, but if all else fails there are always the provincial resources attached to the BCCH.
HEARTSMAP uses data to flag areas of concern and recommends action plans for ED clinicians. Dr Doan notes, “As a clinician using the tool I feel so much more confident in my assessment, in my decisions and recommendations. Families are a lot more receptive to the recommendations because they feel I’ve asked everything I needed to ask.”
Implemented in nearly 50 emergency departments in BC and used by over 300 ED clinicians, including physicians, nurses, social workers and mental health specialist working in the ED – it has become a valued resource for both clinicians and families. Plans continue to implement it in all EDs across the province.
Created for the emergency department, the tool will soon find new places to be used. Dr Doan recently received funding from the Canadian Institutes of Health Research to make this a self-assessment tool that can be used by children and families, and with primary care physicians and school counsellors. In addition, a young adult version of the tool is being discussed with UBC. As Dr. Doan says, “You know it’s good when you are asked to also develop it for other people in need.”
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