Emergency Department to Community Services Youth Transition Protocol
LONDON
A coordinated community response to improving care for youth with mental health and addiction needs by transitioning them from using emergency departments to community-based care.
What is the system challenge?
Many Canadian communities have seen a dramatic increase in the number of youth seeking care for mental health and addiction challenges. This increasing demand for care has placed a strain on affected youth and their families, stretched resources, and lengthened wait times for treatment. At the same time, youth and families are not always aware of the services and supports that are available in their community, or may not know which services would be most helpful for them. For example, when seeking assistance, youth who may benefit most from community-based care may go to the closest hospital’s emergency department because they are unaware of appropriate community services or community services are unavailable in their area (Canadian Institute for Health Information, 2015).
What are we doing about it?
Recognizing an opportunity for hospital and community services to work together to improve care for youth with mental health and/or addictions needs, the London Service Collaborative, supported by the Provincial System Support Program at the Centre for Addiction and Mental Health, established an Emergency Department to Community Services Youth Transition Protocol.
This intervention ensures that youth with mental health and/or addiction needs who seek help at the emergency department but are best suited for community-based care are supported to quickly access the services they need. Connecting youth with the right kind of community supports can, in turn, help reduce unnecessary use of the emergency department in the future.
Evidence:
The London Service Collaborative used the Transitional Discharge Model (Forchuk et. al. 2007, Forchuk et al. 2007) and the Emergency Department Clinical Pathways for Children and Youth with Mental Health Conditions/Addictions (Provincial Council for Maternal and Child Health, 2012) to inform the design of the intervention. In addition, the lived experience of youth was integrated into the project with the support of clinical expertise in the youth mental health field and drawing from research on meaningful youth engagement.
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In this stage, the London Service Collaborative identified a need and action plan to improve support and continuity of care for youth with mental health and addiction needs as they transition from the emergency department to the community. Youth members of the Service Collaborative suggested that a mobile app would be a valuable and youth-friendly crisis planning resource.
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The London Health Sciences Centre (LHSC) and the Crisis Intake Team (CIT, a community-based crisis response and intake service) developed a partnership to facilitate a pathway from the hospital to community services for youth with mental health and addiction needs. Partners from the LHSC and CIT collaborated with other members of the Service Collaborative and PSSP to develop a draft Emergency Department to Community Services Youth Transitions Protocol that could then be tested and refined.
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Following its development, the Emergency Department to Community Services Youth Transitions Protocol was tested by the Pediatric Emergency Department at LHSC and CIT. Continuous improvement cycles were applied to refine the protocol by finalizing process details and establishing agreement on roles and responsibilities. In addition, the Be Safe mobile app was launched.
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The Emergency Department to Community Services Youth Transitions Protocol was successfully implemented, and the intervention is now self-sustaining under the guidance of an Oversight Committee comprised of former members of the Service Collaborative.
The Be Safe app has been replicated at multiple sites around the Province with information about local resources.
217
number of youth referred to community services from the LHSC Pediatric ER between April 2015 and September 2016
10.5K
Be Safe user interaction sessions from 2014 through 2016
“In order to be relevent we need (youth) at all of our tables . . . planning, development, implementation, and evaluation.”
— Adult Service Collaborative member
As a member of the London Service Collaborative, I learned a lot about making change at the system level.
— Youth Service Collaborative member
The Be Safe resource was so successful in the London-Middlesex community that it has since expanded to multiple communities across the province. The youth-adult partnership model used in the development of Be Safe was also viewed as a successful engagement model, with value for both youth and adult participants.
Who is involved?
The Service Collaborative brought together over 50 members including youth, children’s mental health and addiction workers and physicians.
Next Steps
The Oversight Committee continues to monitor the Youth Transitions Protocol, identifying where action is needed to support sustainability.
Resources
For more information, please contact:
Beth Powell, Implementation Specialist
London, Ontario
519-858-5158, ext. 20082