277 - A Novel Mental Health Screening and Referral Program for Parents of Children with Medical Complexity: A Feasibility Study

Publication Number: 3266.277

Kayla Esser, The Hospital for Sick Children, Toronto, ON, Canada; Nichelle Benny Gerard, University of toronto, Oshawa, ON, Canada; Natasha Bruno, The Hospital for Sick Children, Toronto, ON, Canada; Elisabeth Wright, Women’s College Hospital, Toronto, ON, Canada; Julia Orkin, The Hospital for Sick Children, Toronto, ON, Canada

Background: Parents of children with medical complexity report suboptimal mental health compared to other parents, and face barriers to accessing external mental health supports due to high caregiving requirements. Identification and treatment of parental mental illness is critical to improve parent and child wellbeing.

Objective: Our objective was to describe the feasibility of a novel mental health screening and integrated referral program for parents of children with medical complexity.

Design/Methods: This is an observational feasibility study conducted in 2022-2024 in the complex care program of a tertiary care paediatric hospital in Toronto. We developed a stepped care model wherein parents were screened for depression (Patient Health Questionnaire 9) and anxiety symptoms (Generalized Anxiety Disorder 7) at six-week intervals over 24 weeks, and those who scored positive (≥ 10) were referred to social work. Parents who did not screen positive could request support. The social worker could refer parents to an adult psychiatric service that partnered with the complex care program, if diagnostic assessment and psychiatric treatment were needed. We recruited parents new to the complex care program, and existing parents not actively seen by social work. We used questionnaires and descriptive statistics to report demographic characteristics, positive screens, referrals, and screening acceptability.

Results: The sample (n=116) was 89% female with a mean age of 39 years. Most parents were married (77%) and had two or more children (66%). Nearly half of parents belonged to a visible minority (46%). Most (81%) completed three or more screening time points. Across 24 weeks, 54% of parents screened positive for depression symptoms at one or more time points, and 47% for anxiety symptoms. All of the 63% of parents who screened positive on either measure, and the 3% who requested support, were contacted by a social worker to schedule an appointment for assessment, psychotherapy where appropriate, or resource navigation. Of those, 8% were referred to psychiatry. Of the 75 parents who completed the acceptability questionnaire, 89% felt screening was helpful for identifying needs, and 88% reported comfort with future screening.

Conclusion(s): We found it feasible and acceptable to screen parents for mental health symptoms, and refer them to an integrated service for support. Paediatricians and general practitioners caring for CMC may consider screening parents for psychiatric symptoms, and complex care teams may consider partnering with psychiatry services for integrated referrals.