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Objectives Youth face numerous challenges in receiving coordinated and continuous mental health services, particularly as they reach the age of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). The Longitudinal Youth in Transition Study (LYiTS) follows youth prospectively as they cross this transition boundary to better understand their transition pathways and resulting symptoms and health service use outcomes. The current paper presents the baseline profile description for the LYiTS cohort and additionally examines differences in symptoms and functioning and health service utilization between youth receiving services at hospital- versus community-based CAMHS. Methods A cross-sectional design was used. A sample of 237 16–18-year-old youth recruited from outpatient CAMHS at two hospitals and two community sites completed self-report measures at their first of four annual assessments. A latent profile analysis was conducted to identify symptomology profiles, and youth were compared on symptoms and health service use between hospital- and community-based sites. Results Four distinct symptomology profiles were identified (subclinical, moderate internalizing, moderate externalizing, and high symptomology). Symptom profiles and functioning levels reported by youth were no different across both types of organization, although there were differences detected in health service utilization, such as type of provider seen and use of medications. Conclusions These findings suggest that there is little difference in symptomology between youth accessing hospital versus community-based CAMHS. With growing interest in understanding the effectiveness and cost-effectiveness of different models of mental health care, these findings provide a new understanding of the clinical and service use profiles of transition-aged youth that will be explored further as this cohort is followed across the CAMHS to AMHS transition boundary.

Adolescents with cancer (AWC) in pediatrics may not have adequate opportunities for peer support. This mixed methods study aimed to characterize peer support needs of AWC during or shortly after treatment. Ten AWC with median age 16.5 (range 14-18) years completed a survey and semistructured interview. Three themes were apparent: cancer journey difficulties, current support system, and peer support perspectives. Participants felt incompletely understood by existing supports, lacked connection with other AWC, and craved experiential information. Peer support interventions should be flexible, facilitate various interactions, and include social media. The next step is to implement and evaluate an intervention.

Parents of adolescents with cancer (AWC) provide critical support throughout the cancer journey and could offer key insights into support needs. This prospective study aimed to obtain parent perspectives on peer support needs of AWC. Ten individual parents (9 mothers and 1 father) completed a survey and a semistructured interview. Four themes were identified: cancer journey challenges; emotions, reactions, and coping; personal support preferences; and AWC's support needs. Parents recognized that AWC require various support, but lacked insight into their specific peer support desires. Next step interventions should focus on peer support for AWC, while also incorporating peer support for parents.

Youth accessing mental health care often experience a disruption in care as they attempt to transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). Few studies have evaluated interventions seeking to improve the experience and outcomes of CAMHS–AMHS transitions, in part due to lack of consensus on what constitutes best practices in intervention success. As such, the aim of this study was to engage patients, caregivers, and clinicians to prioritize core components of successful CAMHS–AMHS transitions which can be used in the design or evaluation of transition interventions. As such, a Delphi study was conducted to determine core components of successful CAMHS–AMHS transitions. Guided by the principles of patient-oriented research, three balanced expert panels consisting of youth, caregivers, and clinicians ranked and provided feedback on the importance and feasibility of core components of CAMHS-AMHS transitions. Components endorsed as feasible or important with ≥ 70% agreement from any panel moved to the next round. As a result, a list of 26 core components of CAMHS–AMHS transitions has been refined which can be used in the design, implementation, or evaluation of interventions intended to improve transition experiences and outcomes for youth in mental health care. Youth and families were engaged in an expert advisory role throughout the research process, contributing their important perspectives to the design and implementation of this study, as well as interpretation of the findings.

Background Suicide and risk management protocols in mental health research aim to ensure patient safety, provide vital information on how to assess suicidal ideation, manage risk, and respond to unexpected and expected situations. However, there is a lack of literature that identifies specific components and strategies to include in suicide and risk management protocols (SRMPs) for mental health research. The goal of this scoping review was to review academic and grey literature to determine core components and associated strategies, which can be used to inform SRMPs in mental health research. Methods and analysis The methodological framework outlined by Arksey and O’Malley was used for this scoping review. The search strategy, conducted by a medical librarian, was multidisciplinary and included seven databases. Two reviewers independently assessed eligibility criteria in each document and used a standardized charting form to extract relevant data. The extracted data were then examined using qualitative content analysis. Specifically, summative content analysis was used to identify the core components and strategies used in SRMPs. The data synthesis process was iterative. Results This review included 36 documents, specifically 22 peer-reviewed articles and 14 documents from the grey literature. Five core components of SRMPs emerged from the reviewed literature including: training; educational resources for research staff; educational resources for research participants; risk assessment and management strategies; and clinical and research oversight. Potentials strategies for risk mitigation within each of the core components are outlined. Conclusions The five core components and associated strategies for inclusion in SRMPs will assist mental health researchers in conducting research safely and rigorously. Findings can inform the development of SRMPs and how to tailor them across various research contexts.

Youth accessing mental health care often experience a disruption in care as they attempt to transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). Few studies have evaluated interventions seeking to improve the experience and outcomes of CAMHS-AMHS transitions, in part due to lack of consensus on what constitutes best practices in intervention success. As such, the aim of this study was to engage patients, caregivers, and clinicians to prioritize core components of successful CAMHS-AMHS transitions which can be used in the design or evaluation of transition interventions. As such, a Delphi study was conducted to determine core components of successful CAMHS-AMHS transitions. Guided by the principles of patient-oriented research, three balanced expert panels consisting of youth, caregivers, and clinicians ranked and provided feedback on the importance and feasibility of core components of CAMHS-AMHS transitions. Components endorsed as feasible or important with ≥ 70% agreement from any panel moved to the next round. As a result, a list of 26 core components of CAMHS-AMHS transitions has been refined which can be used in the design, implementation, or evaluation of interventions intended to improve transition experiences and outcomes for youth in mental health care. Youth and families were engaged in an expert advisory role throughout the research process, contributing their important perspectives to the design and implementation of this study, as well as interpretation of the findings.

IntroductionTransition from child and adolescent mental health services (CAMHS) to community or adult mental health services (AMHS) is a highly problematic health systems hurdle, especially for transition-aged youth. A planned and purposeful transition process is often non-existent or experienced negatively by youth and their caregivers. Stakeholders, including youth and their caregivers, have demanded interventions to support more effective transitions, such a transition navigator. The transition navigator model uses a navigator to facilitate complex transitions from acute care CAMHS to community or AMHS. However, despite the widespread implementation of this model, there has been no evaluation of the programme, hindering its scalability. This paper describes the study protocol of the Navigator Evaluation Advancing Transitions study that aims to collaborate with patients, caregivers and clinicians in the evaluation of the navigator model.Methods and analysisA pre and post mixed-method study will be conducted, using the Triple Aim Framework, to evaluate the navigator model. We will recruit participants from one large tertiary and two community hospitals in Toronto, Canada. For the quantitative portion of the study, we will recruit a sample of 45 youth (15 at each site), aged 16–18, and their caregivers at baseline (referral to navigator) (T1) and 6 months (T2). Youth and caregiver participants will complete a set of standardised measures to assess mental health, service utilisation, and satisfaction outcomes. For the qualitative portion of the study, semistructured interviews will be conducted at 6 months (T2) with youth, their caregivers and clinicians to better understand their experience and satisfaction with the model.Ethics and disseminationResearch Ethics Board (REB) approval has been obtained from the lead research sites, the University of Toronto and the Hospital for Sick Children. The results of the study will be reported in peer-reviewed publications, webinars and conferences and to all relevant stakeholders.

A 10-year-old boy presented to the emergency department with an eight-week history of food refusal. The parents reported that he had been preoccupied and “afraid to eat” any solid foods following a choking episode while eating steak 18 months previously. He became progressively more restricted in the type of foods that he considered to be ‘safe’. His paediatrician sent him to the emergency department along with a copy of his growth charts, which showed a steady decline in weight and faltering growth in height. Before the choking episode, his physical growth and development were normal. His weight and height had always followed the 50th percentile. Over the past 18 months, he had fallen off his curve and his current weight was 23 kg (third percentile) and height 89 cm (between the 15th and 50th percentiles). Despite his parents’ best attempt to feed him soft and pureed food, he failed to gain any weight. He had a medical history of generalized anxiety disorder and, as a result, was homeschooled until grade 3. The child denied intentional weight loss, a fear of weight gain, or concerns about his body weight or shape. However, he did express a desire to “grow taller and not be so skinny”. The child’s restricted intake had made it difficult for him to spend time with friends. On physical examination, he appeared cachectic, with dry mucous membranes. Cardiovascular examination revealed a resting heart rate of 44 beats/min, delayed capillary refill, and mottled hands and feet. LEARNING POINTS Avoidant/restrictive food intake disorder (A5),D) is a new diagnostic category in the section on Feeding and Eating Disorders in the Diagnostic and Statistical Manual, 5th Edition.(1) ARFID takes the place of and extends Feeding Disorder of Infancy or Early Childhood in the Diagnostic and Statistical Manual, 4th Edition. The aim of this revision was to improve the clinical utility by adding more detail to the diagnostic criteria and widening the criteria to be applicable across the lifespan. Clinical features of ARFID include an eating or feeding disturbance that is manifested by persistent failure to meet appropriate nutritional and/or energy needs leading to one or more of the following:(1) ○ Significant weight loss (ie, crossing percentiles on the growth chart for weight and/or height or failure to achieve expected weight gain over time); ○ Significant nutritional deficiency (which warrants additional clinical attention); ○ Dependence on enteral feeding or oral nutritional supplements; ○ Marked interference with psychosocial functioning. ARFID is not: ○ The result of not having enough available food or the result of an associated culturally sanctioned practice; ○ Associated with any abnormalities in the way in which one perceives his/her own body weight or shape; ○ Attributable to a concurrent medical condition or not better explained by another mental disorder. In cases in which the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention. In a recent Canadian Paediatric Surveillance Program (CPSP) one-time survey,(2) paediatricians and paediatric subspecialists retrospectively reported having seen 339 cases of ARFID over the past year (unpublished data). Because this is a new diagnosis, many clinicians are unfamiliar with this new diagnostic category and the specific diagnostic criteria that define this disorder. ○ The CPSP one-time survey revealed that two-thirds (418 of 657 [63%]) of paediatricians and paediatric subspecialists were unfamiliar with ARFID (unpublished data). ○ Of the paediatricians and paediatric subspecialists who suspected a diagnosis of ARFID (239 of 657 [36%]), 30% inappropriately applied the exclusion criteria, resulting in a misdiagnosis (unpublished data). The presence of other psychological disorders, such as anxiety disorder, obsessive-compulsive disorder, attention deficit disorder or autism spectrum disorder, may be a risk factor for ARFID. When a child or adolescent presents with one of these illnesses and an eating problem, a diagnosis of ARFID should be given only when the feeding disturbance itself is causing significant clinical impairment that requires intervention beyond that usually required for the other condition. Little is known about effective treatments for children and adolescents with ARFID. Moving forward, it will be important for researchers to embark on studies that set out to inform how such patients are best treated. Currently, treatment is informed by the area most responsible for contributing to the avoidance or restriction of the food intake.(3) In most cases, treatment will include psychological interventions, nutritional involvement and medical monitoring.(3) Experience to date suggests that patients with ARFID often present with complex histories and require the expertise of clinicians (and multidisciplinary teams, when available) with experience in complex feeding and eating disorders.

Additional file 1.

Additional file 1.