Stepping up to COVID-19: Examining a virtual mental health stepped care approach to addressing needs of at-risk children and families
PI: Dr. Tricia Williams & Dr. Evdokia Anagnostou
Funded by the Canadian Institutes of Health Research (CIHR)
This study will evaluate a stepped-care model of an evidenced-based virtual mental health parent intervention (I-InTERACT-North; PI: Williams) with a strong record of success in virtual service delivery predating COVID-19. Stepped care models offer effective treatment and tailor treatment intensity and level of therapist involvement to families’ needs. For this study, I-InTERACT-North is partnering with the Province of Ontario Neurodevelopmental Disorders (POND) Network (Co-PI: Anagnostou), a large, well-characterized diverse cohort of children and youth across Ontario with neurodevelopmental conditions.
Families will be asked to complete a set of online questionnaires and listen to a podcast about COVID-19. Based on parent preference and need, families may be invited to participate in a short or full version of the I-InTERACT-North program (https://i-interact.aboutkidshealth.ca/)
We are looking for participants!
Families can participate in this study if they:
Have a child between 3-9 years old
Have concerns regarding your child’s externalizing behaviour, and/or your child has a clinical diagnosis of ADHD or ASD
Associated with the Province of Ontario Neurodevelopmental Disorders (POND) Network or The Hospital for Sick Children (SickKids)
We are currently completing a pre-post pilot feasibility trial of the 7-session I-InTERACT parenting program at The Hospital for Sick Children (SickKids) among families following medical illness/brain injury and most recently were awarded COVID-19 specific funding to extend the study to include other families in Neurology, Psychology and Psychiatry at SickKids and Holland Bloorview Kids Rehabilitation hospital.
Families will be asked to complete 5 online questionnaires at the beginning and end of the study. Families will complete the I-InTERACT-North program (7 sessions and 7 online modules) which combines online psychoeducational modules and 1:1 online meetings with a therapist to review skills and gain feedback.
Parenting Experiences following Different Types of Neonatal Brain Injury: A pilot descriptive study
PI: Dr. Tricia Williams
In the Parent Experience (PE) study, we used a patient-oriented research framework to examine parenting stress, coping, and mental health following their child’s diagnosis of neonatal brain injury or associated medical condition. Within the same study, we also conducted a mental health service needs assessment for these families. In the initial stages of this work, clinicians, researchers and parents created the primary study measures (the Parent Experiences Questionnaire).1 Parents of children diagnosed with a neonatal stroke, hypoxic ischemic encephalopathy (HIE) and congenital heart disease (CHD) participated in the study.
There were several key scholarly outcomes from this work, including 7 publications1-7, and several symposium talks and poster presentations advocating to reduce barriers to mental health services for families and to improve access to services that promote resilience in neonatal brain injury. Findings from the PE study emphasized the many parent-reported barriers to traditional mental health services, their strong interest in understanding how their child’s medical condition affects behaviour, and a pressing need to develop skills to better support their children’s socio-emotional development. Parents voiced a clear preference for individual, easily accessible eHealth initiatives over in-person and group therapies. Further, 100% of parents wanted a program to help them understand their child’s medical condition, with this need not met in existing general parent support programs. We also identified the relationship among parent mental health, child neurodevelopment, and coping strategies from this study.
The Parent Experiences Study has set the foundation for new initiatives that prioritize 1:1 eHealth initiatives that empower parent skill development and help parents understand the impact of their child’s medical history.
Williams, T.S., McDonald, K.P., Roberts, S.D., Westmacott, R., Ahola Kohut, S., & Miller, S. (2018). In their own words: Building the parent experience questionnaire (PEQ) through participatory design. Brain Injury, 32(11), 1386-1396. DOI: 10.1080/02699052.2018.1495844
Williams, T. S., McDonald, K. P., Roberts, S. D., Westmacott, R., Dlamini, N., & Tam, E. W. Y. (2019). Understanding early childhood resilience following neonatal brain injury from parents’ perspectives using a mixed-method design. JINS, 25(4), 390-402. DOI: 10.1017/S1355617719000079
Williams, T. S., McDonald, K. P., Roberts, S. D., Chau, V., Seed, M., Miller, S. P., & Sananes, R. (2019). From diagnoses to ongoing journey: Parent experiences following congenital heart disease diagnoses. Journal of Pediatric Psychology, 44(8), 924-936. DOI: 10.1093/jpepsy/jsz055
McDonald, K.P., Connolly, J., Roberts, S.D., Ford, M., Westmacott, R., Dlamini, N., Tam, E., & Williams, T.S. (2020). The response to stress questionnaire for parents following neonatal brain injury. Journal of Pediatric Psychology, 45(9), 1005-1015. DOI: 10.1093/jpepsy/jsaa059
Peterson, R.K., Williams, T.S., Dlamini, N., & Westmacott, R. (2020). Parent experiences and developmental outcomes following neonatal stroke. The Clinical Neuropsychologist, published online. DOI: 10.1080/13854046.2020.1815855
Danguecan, A., El Shahed, A.I., Somerset, E., Chun-Po, S.F., Ly, L.G., & Williams, T. (2020). Towards a biopsychosocial understanding of neurodevelopmental outcomes in children with hypoxic-ischemic encephalopathy: A mixed-methods study. The Clinical Neuropsychologist, published online. DOI: 10.1080/13854046.2020.1833987
Shruti S. Vyas, Meghan K. Ford, Emily W. Y. Tam, Robyn Westmacott, Renee Sananes, Ranit Beck & Tricia S. Williams (2021). Intervention experiences among children with congenital and neonatal conditions impacting brain development: patterns of service utilization, barriers and future directions. The Clinical Neuropsychologist, published online. DOI: 10.1080/13854046.2020.1871516
Roberts, S.D., Kazazian, V., Ford, M.K., Marini, D., Miller, S.P., Chau, V., Seed, M., Ly, L.G., Williams, T.S., & Sananes, R. (revise & resubmit). The association between parent stress, coping and mental health, and neurodevelopmental outcomes of infants with congenital heart disease. The Clinical Neuropsychologist (TCN), Special Edition.
Establishing a Retrospective Clinical Research Database for Patients with Congenital Heart Disease Undergoing Routine Clinical Neuropsychological Evaluation
PI: Dr. Renee Sananes
Disruptions in Adolescent Brain Maturation Following Neonatal Stroke and the Impact of Intellectual Ability and Executive Function
PI: Dr. Robyn Westmacott
Comprehensive Characterization of Social-Behavioural Phenotypes of NFT1
PI: Dr. Katia Sinopoli
Examining the Feasibility and Client Satisfaction of a Tiered Approach to Delivering Videoconference-Based Screening Assessments to Youth and Families During COVID-19 and Beyond
PI: Dr. Naddley Désiré
The current pandemic calls for consideration of innovative teleneuropsychological practices in providing complementary service delivery options to traditional in-person assessments. In response to this crisis, we examined the feasibility and client satisfaction of a novel tiered teleneuropsychological approach to provide informed and time-conscious direction to patients and families based on needs identified in the screening assessment. This novel approach consisted of a three-part assessment process which included:
completion of online psychosocial questionnaires;
an intake interview with a neuropsychologist via the hospital’s integrated secured Zoom platform; and
completion of remote neuropsychological testing when eligible.
Preliminary findings of implementing this approach to meet families’ neuropsychological needs during COVID at SickKids Neonatal Neurology program are described and suggest that 62% of patients and families’ needs were completely met by virtual means. Results also indicate that this tiered approach to providing clinical care is feasible, facilitates efficient screening and triaging, and meets families’ needs while providing appropriate parent consultation. Globally, this novel tiered approach has the potential to increase service delivery to families, particularly in contexts where physical distancing regulations persist or where access to specialized tertiary pediatric hospital services is limited.