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Mental HealthNCT04902391

A Patient-Partnered, Pan-Canadian, Comparative Effectiveness Evaluation of an Acute Pediatric Mental Health and Addiction Care Bundle

A study testing Health Services in people with Mental Health and Mental Disorders, run by University of Calgary at 8 sites in Canada.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The investigators will determine, in an 8-site, hybrid Type 1 cluster randomized effectiveness implementation trial, if an acute mental health care bundle, compared to standard care, improves wellbeing at 30 days in children and youth seeking emergency department care for mental health and substance use concerns. Read more about this study

Who is it for?
Ages 8 to 17 years
Conditions the study is for
Mental Health, Mental Disorders, Pediatrics
What is being tested?
Health Services
Could I receive a placebo?
No, everyone receives an active treatment
How many people
6,800 participants
Where
8 sitesCanada
Study dates
9 Feb 2022to 31 Dec 2025
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 8 to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Age 8 to 17.99 years
  • Chief triage concern of at least one of the following (or comparable) mental health CEDIS triage categories:
  • Anxiety/situational crisis and/or hyperventilation
  • Bizarre/paranoid behaviour
  • Concern for patient's welfare
  • Depression/suicidal/deliberate self-harm
Show all 10Show fewer
  • Hallucinations/delusions
  • Violent/homicidal behaviour
  • Insomnia
  • Pediatric disruptive behaviour

Who cannot join

  • Brought to the ED under provincial mental health legislation
  • Exhibiting features of schizophrenia, schizotypal, delusional disorders, or psychosis (e.g., hallucinations/delusions complaint should be reviewed carefully for this exclusion criterion)
  • Significant self-harm act (i.e., suicide attempt requiring medical clearance, excluding ideation or minor superficial wounds; e.g., laceration/puncture, overdose ingestion, etc.)
  • Other co-morbid medical concerns requiring oversight and/or medical clearance from an emergency physician (e.g., confusion/disorientation, substance withdrawal, other medical complaints, etc.)
  • Substance misuse/intoxication or altered level of consciousness
  • Exhibiting a behavioural syndrome associated with physiologic disturbances (e.g., anorexia)
  • Children/youth will also be excluded based on language barriers:
  • Language barrier (i.e., patient and parent/legal guardian must be fluent in either English or French)

Trial locations and contacts

8 sites in 1 country.

8 sites in 1 country

Canada8 sites
  • IWK Health Centre

    Halifax, Nova Scotia, B3K 6R8

  • McMaster Children's Hospital

    Hamilton, Ontario, L8N 3Z5

  • London Health Sciences Centre

    London, Ontario, N6A 5W9

  • Montreal Children's Hospital

    Montreal, Quebec, H4A 3J1

  • Jim Pattison Children's Hospital

    Saskatoon, Saskatchewan, S7N 0W8

  • Janeway Children's Hospital

    St. John's, Newfoundland and Labrador, A1B 3V6

  • The Hospital for Sick Children

    Toronto, Ontario, M5G 1X8

  • The Children's Hospital of Winnipeg

    Winnipeg, Manitoba, R3E 0Z3

Other trials in Canada

About this study

Official title: A Multi-Disciplinary, Patient-Partnered, Pan-Canadian, Comparative Effectiveness Evaluation of an Innovative Acute Pediatric Mental Health and Addiction Care Bundle

The investigators will determine, in an 8-site, hybrid Type 1 cluster randomized effectiveness implementation trial, if an acute mental health care bundle, compared to standard care, improves wellbeing at 30 days in children and youth seeking emergency department care for mental health and substance use concerns.

Read the detailed description

The investigators we co-designed, with parents and youth, an acute mental health care bundle-a set of evidence informed practices collectively used to improve the quality of care. The bundle of care includes:

  1. Triage-based evaluation of risk for suicide [Ask Suicide-Screening Questions (ASQ) and HEADS-ED, an assessment mnemonic (Home; Education \& Employment; Activities \& Peers; Drugs \& Alcohol; Suicidality; Emotions \& Behaviours; Discharge or Current Resources]
  2. Focused mental health team psychosocial evaluation to guide decision-making
  3. Choice And Partnership Approach (CAPA) to care

This bundle of care also strives to remove the ED physician as the gatekeeper to mental health care and will facilitate, ideally, 24-48 hour urgent mental health follow-up (booked before the child/family leave the ED), with up to 96 hours to coordinate follow-up for patients attending the ED on weekends.

Primary Research Objective: To determine, in an 8-site, hybrid Type I cluster randomized effectiveness-implementation trial, if an acute mental health care bundle, compared to standard care, improves wellbeing at 30 days in children and youth seeking ED care for mental health and substance use concerns.

Secondary Research Objectives: (1) To determine if the bundle improves wellbeing, satisfaction with care, family functioning, and health care delivery; (2) To identify modifiable barriers, constraints, and enablers of bundle implementation fidelity and effectiveness; (3) To test if trial intervention effects are moderated by sociodemographic characteristics (sex, gender, ethnicity, culture, education, and socioeconomic status); and (4) To assess the cost-effectiveness of the approach.

Being tested
Health Services
Keywords
Emergency Psychiatric Services, Healthcare Delivery
Medical subject headings
Psychological Well-Being, Mental Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Health ServicesOther

    The Acute Mental Health Care Bundle consists of 3 core elements, including: (1) ED triage, (2) ED assessment and care, and (3) follow-up care.

Study groups in NCT04902391
Study groupRoleWhat they receive
Acute Mental Health Care BundleExperimentalWe developed an evidence-based bundle of care to address current gaps in care. The bundle: 1) brings together multiple evidence-based assessment tools (ASQ, HEADS-ED) to ensure efficient, high-value ED-based care; 2) removes barriers to assessment and builds connections to care: Assessments are conducted by a mental health care provider and families have access to urgent follow-up care; and 3) prioritizes family engagement: A shared decision-making framework (Choice and Partnership) is used to promote children and youth as stewards of their care and support partnership between EDs and follow-up services with the duration of care determined collaboratively by the patient and their provider.
Receives: Other: Health Services
Usual ED-Based Mental Health CareNo interventionLocal standards of ED-based mental health care will be delivered at control sites. Site leads have determined that this care does not involve the 3 specific core innovations in the bundle. Local care standards are similar across study sites and include use of CTAS score at triage (but no mental health risk assessment tool), ED physician medical clearance and assessment of consultation need, and no consistent mental health follow-up plan. Sites that are randomized to the control arm will not adopt core bundle elements.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Warwick-Edinburgh Mental Wellbeing Scale 30 days after the index ED visit

    Measured in survey completed by the participant using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) for patients ≥13 years

    Each item is scored on a range from 1 to 5. The total score will be between 14 and 70, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 45. A substantial decrease in wellbeing is a decrease by 5 or more points.

    Measured: 30 days after the index emergency department (ED) visit

  2. Stirling Children's Wellbeing Scale 30 days after the index ED visit

    Measured in survey completed by the participant using the Stirling Children's Wellbeing Scale (SCWBS) for patients <13 years.

    Each item is scored on a range from 1 to 5. The total score will be between 12 and 60, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 30. A substantial decrease in wellbeing is a decrease by 5 or more points.

    As these scales used for the primary outcomes measure the same construct, data will be standardized and combined across age groups to derive a single measure of wellbeing.

    Measured: 30 days after the index emergency department (ED) visit

Secondary outcomes (9)
  1. Satisfaction with acute mental health care services as measured by the Service Satisfaction Scale 10

    Measured in survey completed by the participant using the Service Satisfaction Scale 10 (SSS-10). The scale consists of 12 items (parent version) or 10 items (youth version). Items are scored on a 5-point response scale with a total possible score of 60 (parent) or 50 (youth). Higher scores indicate higher satisfaction.

    Measured: 72 hours after the index ED visit

  2. Quality of life as measured by the Beach Center Family Quality of Life Scale

    Measured in survey completed by the participant using the Beach Center Family Quality of Life Scale (FQOL). The 25-item scale uses a 5-point rating with a maximum score of 125 indicating highest quality of life.

    Measured: 30 days after the index ED visit

  3. Warwick-Edinburgh Mental Wellbeing Scale at 90 days after the index ED visit

    Measured in survey completed by the participant using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) for patients ≥13 years.

    Each item is scored on a range from 1 to 5. The total score will be between 14 and 70, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 45. A substantial decrease in wellbeing is a decrease by 5 or more points.

    Measured: 90 after the index ED visit

  4. Stirling Children's Wellbeing Scale at 90 days after the index ED visit

    Measured in survey completed by the participant using the Stirling Children's Wellbeing Scale (SCWBS) for patients <13 years.

    Each item is scored on a range from 1 to 5. The total score will be between 12 and 60, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 30. A substantial decrease in wellbeing is a decrease by 5 or more points.

    As the WEMWBS and SCWBS measure the same construct, data will be standardized and combined across age groups to derive a single measure of wellbeing.

    Measured: 90 after the index ED visit

  5. Warwick-Edinburgh Mental Wellbeing Scale at 180 days after the index ED visit

    Measured in survey completed by the participant using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) for patients ≥13 years.

    Each item is scored on a range from 1 to 5. The total score will be between 14 and 70, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 45. A substantial decrease in wellbeing is a decrease by 5 or more points.

    Measured: 180 days after the index ED visit

  6. Stirling Children's Wellbeing Scale at 180 days after the index ED visit

    Measured in survey completed by the participant using the Stirling Children's Wellbeing Scale (SCWBS) for patients <13 years.

    Each item is scored on a range from 1 to 5. The total score will be between 12 and 60, with lower scores indicating poor wellbeing, and higher scores indicating greater wellbeing. Very low wellbeing is defined as a score of ≤ 30. A substantial decrease in wellbeing is a decrease by 5 or more points.

    As the WEMWBS and SCWBS measure the same construct, data will be standardized and combined across age groups to derive a single measure of wellbeing.

    Measured: 180 days after the index ED visit

  7. Median duration of the index ED visits

    Measured using data collected in the patient electronic medical record. ED Length of stay is defined as the time interval between triage and discharge

    Measured: Hours spent in the ED, measured at the index ED visit (Day 0)

  8. Proportion of children and youth that revisited the emergency department for a mental health complaint related to their index emergency department visit within 7 and 30 days of the index visit

    Measured using data collected in the patient electronic medical record.

    Measured: 7 and 30 days after the index ED visit

  9. Proportion of emergency department visits for mental healthcare that concluded in hospital admission

    Measured using data collected in the patient electronic medical record.

    Measured: Measured based on admissions following the index ED visit (Day 0)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 May 2021
  2. Study start9 Feb 2022
  3. Primary completion30 Jun 2025
  4. Study completion31 Dec 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
Pragmatic, parallel arm cluster randomized trial
Masking
None (open label)
Enrolment
6,800 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04902391
Sponsor's protocol ID
REB20-1825
Status last verified
Dec 2024
First submitted
7 Apr 2021
Last updated
17 Jul 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: IPD will not be shared with other researchers.

Publications

  • Rasiah J, Freedman S, Macdonald L, Prisnie K, Eltorki M, Finkelstein Y, Hopkin G, Santana MJ, Thull-Freedman J, Stang A, Prebeg M, Gagnon IJ, Steele M, Mater A, Katz L, Greenfield B, Plotnick L, Monga S, Lipman EL, Wright B, Dimitropoulos G, Porter R, Hurley K, Al Hamarneh YN, Newton A. Evaluation of parent and youth experiences in advisory groups as part of a mental healthcare clinical trial: protocol for a mixed-method study. BMJ Open. 2022 Jun 17;12(6):e059689. doi: 10.1136/bmjopen-2021-059689.

    PubMed 35715176

Questions about this trial

What is this clinical trial studying?

A study testing Health Services in people with Mental Health and Mental Disorders, run by University of Calgary at 8 sites in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 17 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Warwick-Edinburgh Mental Wellbeing Scale 30 days after the index ED visit (time frame: 30 days after the index emergency department (ED) visit). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04902391, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Jul 2025.

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