Improving mental health outcomes for children and youth in Nova Scotia.

L.A. Campbell leads a program of health services research in close collaboration with the IWK Mental Health & Addictions Program to inform evidence-based decision-making that ensures that each child, adolescent, and family receives optimal mental health care. Working together with clients, families, clinicians, and decision makers, her research aims to guide policy and planning, while providing insight into making care more accessible, effective, and client- and family-centered. 

Current Research Projects

Our Virtual Reality: Supporting Shared Decision-Making for Virtual Care in Child and Adolescent Mental Health Services

At IWK Health, mental health care by Zoom (“virtual care”) was important for helping children, youth, and families get the mental health care they need during the physical distancing restrictions of the pandemic. As those restrictions ease, continuing to offer virtual care in addition to in-person care could also be a way to help more children and youth to access mental health care from the IWK. Decisions about whether to use virtual or in-person care while ensuring safety are best shared by young people, their families or caregivers, and clinicians. However, making these decisions can cause challenges when young people and clinicians have different needs or preferences for care. There are currently no tools to help young people, families, and clinicians to make decisions about when to use virtual mental health care. Together with young people, families, and clinicians, we aim to develop a tool to guide shared decisions between youth and clinicians about virtual or in-person care that places the needs of young clients and families at the centre of care.

(Funding generously provided by the Dalhousie Medical Research Foundation’s Molly Appeal and Stefan Isner Fund)

Our Virtual Reality: Rapidly Responding to Changing Mental Health Needs among Children and Adolescents

COVID-19 affected child and youth mental health and the ability to access to mental health services. IWK Mental Health and Addictions services changed quickly from in-person to virtual (video or teleconference) services in response to the pandemic and need for physical distancing. While for some youth and families virtual care has improved access to services, some may not have internet access or the privacy or safety in their homes needed to speak to their clinician. Despite some challenges in providing virtual care, there are also opportunities to better meet the mental health needs of youth. In this research, we aim to:

1. Describe the mental health care needs of children, adolescents, and families in Nova Scotia during the COVID-19 pandemic;

2. Evaluate the barriers and facilitators of the delivery of virtual mental health care, including the views of children, adolescents, families, and service providers.

(Funding generously provided by the Canadian Institutes for Health Research)

Transforming Care in Nova Scotia: Implementation of Health System Change in Child and Adolescent Mental Health and Addictions

The creation of an accountable mental health care system centred on recovery for patients and families is a leading priority for health system transformation in Nova Scotia. This requires a major shift in the philosophy and organization of health care to replace a traditional system that is largely “clinician as the expert, patient as the help seeker”, with little ability to measure patient-centred outcomes, tailor care, or actively engage patients and families in the care process. Selected to guide transformation of IWK child and adolescent mental health and addictions services, the Choice and Partnership Approach (CAPA) is a service transformation model that combines collaborative and participatory practice to enhance effectiveness, leadership, skills modelling, and demand and capacity management. While CAPA has been implemented to varying degrees across child and adolescent mental health and addictions services in Nova Scotia, progress has been slower than desired, and achieving ‘scale-up’ has proven problematic. Together with clients and families, clinicians, administrators, and decision makers, we are rigorously studying the scale-up of CAPA across variably resourced jurisdictions while maintaining fidelity to the care model, describing “To what degree does CAPA work in Nova Scotia, for whom, and under what circumstances?”. This knowledge, together with the methods and relationships cultivated through this study, will serve as the foundation for a broader program of research aimed at understanding the conditions and processes needed to achieve transformational systemic change in other jurisdictions and for other areas of health care in Nova Scotia, including primary care and home care.

(Funding generously provided by Research Nova Scotia)

Factors related to Engagement with Nova Scotia Early Psychosis Program Treatment

Managing psychotic symptoms early in the course of psychosis has been shown to be the most successful treatment approach for improving long-term outcomes. The Nova Scotia Early Psychosis Program (NSEPP) is an early intervention program that follows this approach to provide early detection and optimal and timely health care to individuals experiencing their first episode of psychosis. However, not everyone may be able to benefit fully from this program. Barriers to access to the NSEPP due to specific factors such as sex, socioeconomic status, ethnicity, and rural residence can result in inequitable access to treatment and treatment disengagement. In this study, we aim to understand the differences in sociodemographic, clinical, and health service use factors among engaged, intermittently engaged, and disengaged patients of the Nova Scotia Early Psychosis Program using routinely collected health administrative data. This study will support the NSEPP in advocating for equitable access to their program for vulnerable individuals with various sociodemographic backgrounds, who may be in greater need of care but cannot adequately access the program. Beyond the immediate benefits to NSEPP, this knowledge will aid in minimizing accessibility barriers to specialized early intervention programs and improve access for at-risk populations.

Previous Research Projects

Opening the Door

Child and adolescent use of the emergency department (ED) for mental health concerns has been steadily increasing compared to other illnesses. The objectives of Opening the Door we are 1) Inform our research questions (i.e. Why are young patients and their families increasingly using the ED for mental and behavioural disorders?) for our program of research 2) Develop and evaluate interventions to improve outcomes following ED visits and 3) Develop and evaluate quality indicators for ongoing monitoring and improvement of ED mental health care across several domains. A main goal of the project is to achieve these objectives through engaging patients and families who have used the IWK ED to better understand the increased use of the ED for mental health concerns. In doing this, patient and families perspectives can be used to guide future research projects and contextualize findings. 

(Funding generously provided by the Canadian Institutes for Health Research)

“In Through the Out Door”: Do Increasing Pediatric Emergency Mental Health Presentations Reflect Poorer Access to Primary and Outpatient Mental Health Care?

As many as one in five Canadian children and youth experience mental illness. Unfortunately, many do not receive the care they require to treat their mental illness, perhaps because they can’t get timely care from a family doctor or from community mental health services. Lack of proper treatment can have long-lasting harmful effects on their mental and physical health, education, and employment. It can also leave children and young people at risk of mental health crises. Recent reports show that many Canadian children and young people are increasingly turning to hospital Emergency Departments for help with mental illnesses. However, Emergency Departments are designed for very quick assessments and care of trauma or other emergencies and are not well-suited for the kind of wide-ranging, ongoing care necessary for the proper assessment and treatment of mental illnesses. In this study, we will measure how many children and youth in Nova Scotia are going to the IWK Emergency Department for mental and behavioural disorders. We will also study whether these visits are related to not having a regular family doctor, or are the result of long wait times to be seen in outpatient mental health clinics. This will help us to identify opportunities to support family doctors and mental health services to reduce the need for use of Emergency Departments for mental health care. We will compare the use of the IWK Emergency Department in different communities to help us identify areas of higher and lower than average use in which we should focus our attention, both to see what is not working in mental health care, and what is working well.

(Funding generously provided by the Canadian Institutes for Health Research)

Electronic Routine Outcome Measurement in Child and Adolescent Community Mental Health Clinics: Implementing Outcome-Informed Care

When patients and families are seen by the IWK's Mental Health and Addictions Program, they complete a paper and pencil questionnaire that asks about their emotions, behaviours, hyperactivity or inattention, peer relationships, and prosocial behaviours. They are also asked what (if any) impact these have had on their home life, friendships, classroom learning, leisure activities and the family as a whole. This questionnaire, the Strengths and Difficulties Questionnaire or “SDQ”, is brief (25 questions) but gives patients, families and clinical staff (such as Psychologists and Social Workers) a reliable picture of how well the child or young person is functioning in important areas in their life. This information is particularly useful in a clinical setting, as it provides valuable insight into how well (or not well) treatment is working. However, when the questionnaire is filled out on paper, the patient has long left the clinic before it can be scored or made available to their clinician. Therefore, we would like to introduce an iPad version of the questionnaire into the Community Mental Health Clinics. As the patient and their family fill out the SDQ on an iPad it is automatically entered into a database, scored, and made available for their clinician to use during their appointment. This is known as Routine Outcome Measurement (“ROM”). It will also offer the opportunity to monitor patients’ personal treatment goals. Research indicates that ROM improves patients’ outcomes, reduces unnecessary treatments, shorten length of treatment, and improves satisfaction with mental health services.

(Funding generously provided by IWK Health)

Maternal Obesity and Offspring Mental Health 

Pre-pregnancy obesity has been shown to have negative consequences on various infant health outcomes. Recent studies have reported that pre-pregnancy obesity increases the risk of impaired cognitive performance, autism spectrum disorder, negative emotionality, and symptoms of attention-deficit hyperactivity disorder (ADHD) in school-aged children. Understanding the association between maternal obesity and developmental and mental disorders among offspring is important given that as many as one in five children are affected by these disorders by the age of 15. A better ability to understand this association is also key to informing effective interventions. We recently conducted an analysis using data from the Nova Scotia Atlee Perinatal Database (NSAPD) between 2005 and 2016, in which we demonstrated that children of mothers who are obese have more visits to a physician for common childhood mental disorders. However, our conclusions were limited by the inability to adequately assess the contribution of a key confounder - maternal mental illness. The NSAPD contains minimal information on maternal mental health; data capture is limited to current psychiatric medication use and identification of psychiatric illness in the perinatal health record. We are unsure with how this information aligns with other measures of maternal mental health, such as health care utilization information for mental health conditions. The NSAPD has other limitations, such as the lack of detailed sociodemographic information on the mothers.There are individual databases spanning a wealth of clinical, social, economic, and health service use information already existing in Nova Scotia. Alone, they are not able to address the complex questions faced in understanding this relationship. Therefore, we propose to link several existing databases to create an anonymous database (a “cohort”) of all children born in Nova Scotia between 2005 and 2016 that will have rich information about mothers’ BMI, mental health, and social and economic factors (such as income, education, rural residence). The cohort will allow us to pose research questions that will improve our understanding of the effects of mothers’ characteristics on children’s health outcomes. We will demonstrate the ability of the cohort to answer such questions by means of a test case analysis of maternal obesity and offspring mental health, while assessing the contribution of a key potential confounder, maternal mental illness.

(Funding generously provided by Research Nova Scotia)