Background: Youth suicide is a public health crisis. In addition to suicide mortality, many youth experience and live with suicidal thoughts and behaviors (STBs). STBs have serious consequences for youth mental health and are associated with suicide. Despite recognition of the incidence and severity of STBs, barriers to accessing support are prevalent. Digital mental health (DMH) and digitally delivered measurement-based care (MBC) may improve access to treatment among youth and enhance clinical response to suicide risk and crises. Objective: This study aimed to explore clinician perceptions of the barriers and facilitators to using DMH and MBC with youth experiencing STBs. Methods: As part of a larger implementation science project, a DMH and MBC platform was implemented in youth-serving mental health service settings in communities across Alberta, Canada. The platform included a multidimensional assessment package and embedded an automated suicide escalation protocol that notified clinicians when youth reported STBs. In participating service settings, 32 interviews were conducted with clinicians using DMH and MBC. We used the Consolidated Framework for Implementation Research and theoretical thematic analysis to identify barriers, facilitators, and relevant themes. Results: Four overarching themes were identified that described barriers and facilitators to using DMH and MBC with youth experiencing STBs: (1) service setting and professional practice barriers, (2) DMH platform barriers, (3) service setting and professional practice facilitators, and (4) DMH platform facilitators. Clinicians' recommendations were presented in alignment with the identified barrier themes. Conclusions: Given the association between STBs and suicide, attending to STBs is a critical component of suicide prevention. Our findings suggest that the assessment of STBs using DMH may address the youth suicide crisis by facilitating disclosure and rapid clinical action. Moreover, multidimensional assessment may reveal important information about STBs and risk factors, with advantages for personalized care and system-level improvement. Clinicians delivering DMH and MBC must be supported by applying their recommendations and continuously strategizing to mitigate barriers and leverage facilitators for sustained implementation.

Background: The increasing prevalence of mental health disorders among youth underscores the need for accessible and effective interventions. Digital mental health (dMH) platforms like Innowell offer promising solutions by increasing access to mental health care for young people. Innowell is a web-based platform that supports youth mental health by providing personalized measurement-based care in collaboration with a youth's health care providers. However, understanding youth perspectives on these platforms is crucial for ensuring successful implementation and sustained engagement. Objective: This study aimed to explore youth perspectives on the implementation of the Innowell platform, identifying key factors influencing uptake, engagement, and long-term retention. Methods: A qualitative descriptive approach was used to examine youth perspectives. Data were collected through 9 focus groups and 1 interview, involving 39 participants aged 15-24 years from urban (23/39, 59%) and rural (16/39, 41%) communities in Alberta, Canada. Participants were recruited through mental health clinics and community organizations. Thematic analysis was conducted on the transcripts to identify factors that support or hinder engagement with the platform. Results: Participants emphasized the importance of privacy, security, and personalization in building trust in the platform, with 72% (28/39) reporting that clear communication about data protection would increase their likelihood of use. Progress tracking features, such as symptom trend visualizations and diaries, were identified by 65% (25/39) of participants as critical for sustaining engagement. Ease of use was highlighted, with 58% (23/39) preferring mobile app functionality over web-based interfaces. Dynamic content and personalized notifications were suggested as strategies to maintain long-term use, with 64% (25/39) of participants valuing customizable reminders to encourage daily interactions. Rural participants (16/39, 41%) noted the need for offline functionality due to inconsistent internet access. In addition, participants recommended features such as crisis support, professional communication channels, and access to local mental health resources. Conclusions: Youth-centered design is essential for enhancing the usability and engagement of dMH platforms like Innowell. Key features prioritized by participants included privacy, security, progress tracking, and personalization. Dynamic and user-friendly interfaces, along with the ability to customize notifications and access professional support, were critical for fostering long-term engagement. Insights from this study provide actionable recommendations for optimizing dMH platforms to meet the mental health needs of young people, particularly in diverse urban and rural settings. Future research should explore implementation strategies tailored to specific user demographics to enhance the scalability and impact of dMH interventions.

With mental health concerns on the rise among youth and young adults (age 12–24), increased mental health options include virtual care, apps and online tools, self-management and tracking tools, and digitally-enabled coordination of care. These tools may function as alternatives or adjuncts to face-to-face models of care. Innovative solutions in the form of digital mental health (dMH) services not only provide support, resources and care, but also decrease wait times and waitlists, increase access, and empower youth. However, organizational factors may impact the extent of dMH interventions are that accepted, used, and sustained in clinical settings. This qualitative study explores organizational barriers and facilitators surrounding the implementation of a digital platform (Innowell), which uses measurement-based care (MBC) to track youth progress and outcomes. Data was collected from 154 mental health care providers participating in 23 focus groups across Alberta, drawing on school and community settings, specialized mental health services, and primary care networks. A thematic analysis revealed the following: barriers included incompatibility with current systems and workflows, lack of inter-organizational collaboration, time commitment, perceived sustainability and lack of digital literacy. Facilitators included positive attitudes towards using dMH to optimize clinical practices by empowering youth and improving continuity of care, transitions in care, and quality of care, as well as workplace culture and leadership. The study highlights a critical need for decision makers and clinical leaders to address organizational factors by integrating training and support, establishing interoperability between digitized and in-person healthcare systems, and leveraging support for MBC and youth-centred care.

OBJECTIVES To estimate associations between clinical and socioeconomic variables and hospital days and emergency department (ED) visits for children with medical complexity (CMCs) for 5 years after index admission. METHODS Retrospective, longitudinal, population-based cohort study of CMCs in Alberta (n = 12 621) diagnosed between 2010 and 2013 using administrative data linked to socioeconomic data. The primary outcomes were annual cumulative numbers of hospital days and ED visits for 5 years after index admission. Data were analyzed using mixed-effect hurdle regression. RESULTS Among CMCs utilizing resources, those with more chronic medications had more hospital days (relative difference [RD] 3.331 for ≥5 vs 0 medications in year 1, SE 0.347, P value < .001) and ED visits (RD 1.836 for 0 vs ≥5 medications in year 1, SE 0.133, P value < .001). Among these CMCs, initial length of stay had significant, positive associations with hospital days (RD 1.960–5.097, SE 0.161–0.610, P value < .001 outside of the gastrointestinal and hematology and immunodeficiency groups). Those residing in rural or remote areas had more ED visits than those in urban or metropolitan locations (RD 1.727 for rural versus urban, SE 0.075, P < .001). Material and social deprivation had significant, positive associations with number of ED visits. CONCLUSIONS Clinical factors are more strongly associated with hospitalizations and socioeconomic factors with ED visits. Policy administrators and researchers aiming to optimize resource use and improve outcomes for CMCs should consider interventions that include both clinical care and socioeconomic support.

BackgroundYouth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person’s life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. ObjectiveThe objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. MethodsGuided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. ResultsThemes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. ConclusionsOur findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase.

Objectives The primary objective of this study was to identify clinical and socioeconomic predictors of hospital and ED use among children with medical complexity within 1 and 5 years of an initial discharge between 2010 and 2013. A secondary objective was to estimate marginal associations between important predictors and resource use. Methods This retrospective, population-cohort study of children with medical complexity in Alberta linked administrative health data with Canadian census data and used tree-based, gradient-boosted regression models to identify clinical and socioeconomic predictors of resource use. Separate analyses of cumulative numbers of hospital days and ED visits modeled the probability of any resource use and, when present, the amount of resource use. We used relative importance in each analysis to identify important predictors. Results The analytic sample included 11 105 children with medical complexity. The best short- and long-term predictors of having a hospital stay and number of hospital days were initial length of stay and clinical classification. Initial length of stay, residence rurality, and other socioeconomic factors were top predictors of short-term ED use. The top predictors of ED use in the long term were almost exclusively socioeconomic, with rurality a top predictor of number of ED visits. Estimates of marginal associations between initial length of stay and resource use showed that average number of hospital days increases as initial length of stay increases up to approximately 90 days. Children with medical complexity living in rural areas had more ED visits on average than those living in urban or metropolitan areas. Conclusions Clinical factors are generally better predictors of hospital use whereas socioeconomic factors are more predictive of ED use among children with medical complexity in Alberta. The results confirm existing literature on the importance of socioeconomic factors with respect to health care use by children with medical complexity.

BACKGROUND:We described longitudinal trends in the incidence of episodes of care (EOC) and follow-up care for pediatric concussion in relation to age, sex, rurality of patient residence, point of care, and area-based socioeconomic status (SES) in Alberta, Canada.METHODS:A retrospective population-based cohort study was conducted using linked, province-wide administrative health data for all patients <18 years of age who received a diagnosis of concussion, other specified injuries of head, unspecified injury of head, or post-concussion syndrome between April 1, 2004 and March 31, 2018. Data were geospatially mapped.RESULTS:Concussion EOCs increased 2.2-fold over the study period, follow-up visits 5.1-fold. Care was increasingly received in physician office (PO) settings. Concussion diagnoses in rural and remote areas occurred in emergency department (ED) settings more often than in metro centres or urban areas (76%/75% vs. 52%/60%). Proportion of concussion diagnoses was positively related to SES and age. Diagnosis and point of care varied geographically.CONCLUSIONS:The shift in care to PO settings, increased incidence of all diagnoses, and the higher use of the ED by some segments of the population all have important implications for appropriate clinical management and the efficient provision of health care for pediatric concussion.IMPACT:This is the first study to use EOC to describe longitudinal trends in incidence and follow-up care for pediatric concussion in relation to age, sex, rurality, point of care, and area-based SES. We report increased incidence of concussion in both emergency and outpatient settings and the proportion of diagnoses was positively related to SES and age. Patients increasingly received care for concussion in PO over time. Geospatial mapping indicated that the incidence of concussion and unspecified injury of head varied geographically and temporally. Results have important implications for appropriate clinical management and efficient provision of health care following pediatric concussion.

BACKGROUND: Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS: We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS: A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and < 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06). INTERPRETATION: Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick.