Janet A. Curran

Background: The COVID-19 pandemic shaped childhood globally. The experiences of vulnerable children in Canada’s Maritime provinces reveal important lessons about equity, resilience, and the unintended consequences of public health directives. Public health restrictions were enacted in the early days of COVID-19. At-risk populations such as children with complex care needs (CCN) were among those most impacted by health system changes due to COVID-19. To better understand how COVID-19 public health measures impacted children with CCN who were highly susceptible to the virus and associated disruptions, we conducted an environmental scan to map changes in COVID-19 public health directives and services impacting children with CCN. Methods: We systematically retrieved government news releases communicating new or changing COVID-19 public health directives published March 1, 2020-March 31, 2022. All directives and service changes in the health and education sectors were included. Directives were divided into 13 categories co-developed with parent and decision-maker partners, and we identified whether directives included support measures relevant to children with CCN. Results: The environmental scan revealed that children with CCN were largely overlooked in COVID-19 directives across the Maritime provinces. We identified 699 public health directives and services changes. Fewer than 2.2% of COVID-19 directives explicitly referenced children with CCN, with most guidance focusing on general social restrictions, vaccinations, and education/daycare. Mental health and well-being were also rarely addressed (13 directives). Conclusion: The Maritimes’ predominately rural and geographically dispersed population exacerbates the inequities experienced by children with CCN, offering insights relevant to other regions about the unintended consequences of broad public health policies delivered to heterogeneous populations. Examining this data through the lens of children with CCN and their families can inform recommendations to better support this vulnerable population in future public health emergencies.

Objective: This scoping review will identify and synthesize evidence regarding implemented and evaluated innovations aimed at improving communication between patients, caregivers, health care providers, and trainees in inpatient pediatric setting. Introduction: Communication has an important role in promoting safe, effective, and equitable patient care. Medical interactions in the inpatient pediatric setting require unique communication strategies. While family-centered rounds are beneficial, additional adaptations and innovations are needed to meet patient and family communication needs and reduce disparities in communication. There is currently no synthesis of innovations to improve communication between patients, caregivers, health care providers, and trainees in inpatient pediatric settings. Eligibility criteria: Participants in this review will include hospitalized pediatric patients or their caregivers, and health care providers or medical trainees. The review will explore implemented and evaluated innovations aimed at improving communication of patients and/or caregivers with health care providers and/or medical trainees. Inpatient pediatric medical units will be investigated in any geographic location, but only English studies with an evaluative component in their design will be included. Methods: This review will follow JBI methodology for scoping reviews. Databases to be searched include MEDLINE, Embase, and CINAHL. Study selection and data extraction will be conducted in duplicate, with data extracted using a tool created by the authors. The Implementation Outcomes Framework, Consolidated Framework for Implementation Research, and Health Equity Implementation Framework will be used to develop a conceptual map and support analysis. The results will be narratively described and presented visually using tables and figures. Review registration: OSF https://osf.io/3zs59/overview

Background: The transition from child to adult mental health services is a vulnerable period marked by service disengagement, care gaps, and worsening mental health outcomes. Although planned, developmentally appropriate transition processes can improve functioning, youths report insufficient preparation, limited continuity of care, and unmet expectations for support. Existing transition supports remain underevaluated and require further adaptation for mental health contexts. Youth consistently report needing clearer information, concrete support, and sustained connection. Digital tools, particularly SMS text messaging, which is widely used, accessible, and acceptable to youth, offer a promising way to deliver timely transition supports. Yet most digital mental health tools are developed without meaningful youth involvement, highlighting the need for participatory approaches to ensure relevance, usability, and uptake. Objective: This study aimed to co-design and refine prototypes for a transition-focused SMS text messaging intervention by engaging youth with lived experience in a participatory co-design activity (design jam) to identify priority content, key functionality, and implementation enablers to support the transition from child to adult mental health services. Methods: We conducted a 3-hour mixed methods, participatory design jam to co-design transition-focused SMS text messaging prototypes, recruiting youth aged 16-26 years in Canada who had recently transitioned to, or were approaching transitioning to, adult mental health services. Data sources included workshop artifacts, observational field notes, and audio recordings from structured activities involving evidence review, brainstorming, rapid prototyping, brief team pitches, and evaluation. Rapid qualitative analysis, integrating open coding, content analysis of visual prototypes, and the rapid identification of themes from audio recordings, was used to identify priority content, key functionality, and implementation enablers. Findings were refined through a member-checking debrief with youth participants. Results: Seven youths aged 19-24 years participated in the design jam. Across two teams, participants generated 54 content ideas and 50 feature ideas. Two distinct prototypes were developed: one emphasizing long-term affirmation, self-advocacy, self-care, and profile-based customization, and the other prioritizing shorter-term informational support, navigation resources, and flexible message frequency. Youth across both groups highlighted the importance of interactive and visually engaging elements. Analysis revealed 3 thematic tensions shaping youth design preferences: balancing autonomy with ongoing support (roaming/reconnecting), balancing personalization with the need for simplicity (customization/convention), and balancing knowledge delivery with motivation for action (learning/living). Participants rated the design jam positively. Conclusions: Youth meaningfully contributed to co-designing an SMS text messaging intervention to support transition from child to adult mental health services, generating concrete content, functionality, and implementation priorities. Their prototypes highlighted the need to balance autonomy with support, personalization with simplicity, and information with motivational guidance. These findings demonstrate the value of participatory co-design in developing youth-centered digital transition supports and underscore the importance of evaluating such prototypes in real-world settings to determine feasibility and impact.

Background: Discharge communication is a key component of high-quality care. This practice is important in the pediatric emergency department (PED), where patients and families often leave without fully understanding important information shared during their visit. Co-designed discharge communication interventions may enhance information exchange in PEDs. The aim of this study was to assess the usability of two discharge communication tools, co-designed with youth, parents, and PED clinicians, for asthma or concussion presentations. Methods: This was a mixed methods study with a concurrent validating quantitative triangulation design. Youth, parents, and clinicians recruited from two Canadian PEDs completed usability tests for either an asthma or concussion co-designed discharge communication intervention. Usability Testing Round 1 was remote, where participants provided quantitative and qualitative feedback on tool functionality. Feedback from Round 1 informed the revised tools for Round 2 testing. Remote Usability Testing Round 2 was self-administered by a new group of participants who provided feedback on user experience and satisfaction with the tool by completing 5-point Likert scale questions and open-text fields. Round 1 data were analyzed using the severity of usability problems (SUP) scoring. Quantitative data from Rounds 1 and 2 were analyzed descriptively. Deductive content analysis was applied to qualitative data from Rounds 1 and 2. One reviewer coded participant feedback and a second reviewer verified categories. Results: Round 1 ( n = 14) revealed primarily cosmetic and minor usability issues for each tool. Revised tools were used in Usability Testing Round 2 ( n = 40), which identified additional, minor revisions to each tool. A key suggestion was offering the tools in multiple languages and formats to ensure they met the diverse needs of patients and families presenting to the PED. Site 1 participants consistently scored the tools more helpful or useful compared to Site 2. Conclusions: Through two rounds of comprehensive usability testing, we refined each tool to meet the needs of youth, parents and PED clinicians. Enhanced recruitment strategies are needed to reach youth and diverse populations to ensure future tools meet a range of information needs during PED discharge.

Objective: The objective of this scoping review is to identify how school-based nursing programs that support children with special health care needs (CSHCN) are structured and implemented globally. Introduction: The number of CSHCN living and participating in the community is increasing due to medical and technological advances. To participate fully in school, CSHCN may require support for a wide range of health conditions. There is minimal research that synthesizes the development and implementation of school-based nursing programs and interventions, particularly in Canada. Eligibility criteria: Academic and gray literature will be considered for inclusion. Included sources must refer to school-aged children (pre-primary through 12) and discuss a school-based nursing program or intervention that targets medical or health needs. Literature reviews will be excluded from this review; however, their reference lists will be scanned for relevant studies. There are no restrictions on geographical location or date of publication, but only studies published in English will be considered for inclusion. Methods: This scoping review will be conducted using the JBI methodology for scoping reviews. A search strategy has been developed using the Population, Concept, Context (PCC) mnemonic. The search has been developed in MEDLINE (Ovid) and will be translated to Embase, CINAHL, and Scopus, and reported in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (RE-AIM) will be used to categorize the range of implementation strategies across included studies. Findings related to determinants (facilitators and barriers) will be organized according to the Consolidated Framework for Implementation Research. Review registration: OSF https://osf.io/fgbxm/overview

BACKGROUND The transition from child to adult mental health services is a vulnerable period marked by service disengagement, care gaps, and worsening mental health outcomes. Although planned, developmentally appropriate transition processes can improve functioning, youths report insufficient preparation, limited continuity of care, and unmet expectations for support. Existing transition supports remain underevaluated and require further adaptation for mental health contexts. Youth consistently report needing clearer information, concrete support, and sustained connection. Digital tools, particularly SMS text messaging, which is widely used, accessible, and acceptable to youth, offer a promising way to deliver timely transition supports. Yet most digital mental health tools are developed without meaningful youth involvement, highlighting the need for participatory approaches to ensure relevance, usability, and uptake. OBJECTIVE This study aimed to co-design and refine prototypes for a transition-focused SMS text messaging intervention by engaging youth with lived experience in a participatory co-design activity (design jam) to identify priority content, key functionality, and implementation enablers to support the transition from child to adult mental health services. METHODS We conducted a 3-hour mixed methods, participatory design jam to co-design transition-focused SMS text messaging prototypes, recruiting youth aged 16-26 years in Canada who had recently transitioned to, or were approaching transitioning to, adult mental health services. Data sources included workshop artifacts, observational field notes, and audio recordings from structured activities involving evidence review, brainstorming, rapid prototyping, brief team pitches, and evaluation. Rapid qualitative analysis, integrating open coding, content analysis of visual prototypes, and the rapid identification of themes from audio recordings, was used to identify priority content, key functionality, and implementation enablers. Findings were refined through a member-checking debrief with youth participants. RESULTS Seven youths aged 19-24 years participated in the design jam. Across two teams, participants generated 54 content ideas and 50 feature ideas. Two distinct prototypes were developed: one emphasizing long-term affirmation, self-advocacy, self-care, and profile-based customization, and the other prioritizing shorter-term informational support, navigation resources, and flexible message frequency. Youth across both groups highlighted the importance of interactive and visually engaging elements. Analysis revealed 3 thematic tensions shaping youth design preferences: balancing autonomy with ongoing support (roaming/reconnecting), balancing personalization with the need for simplicity (customization/convention), and balancing knowledge delivery with motivation for action (learning/living). Participants rated the design jam positively. CONCLUSIONS Youth meaningfully contributed to co-designing an SMS text messaging intervention to support transition from child to adult mental health services, generating concrete content, functionality, and implementation priorities. Their prototypes highlighted the need to balance autonomy with support, personalization with simplicity, and information with motivational guidance. These findings demonstrate the value of participatory co-design in developing youth-centered digital transition supports and underscore the importance of evaluating such prototypes in real-world settings to determine feasibility and impact.

Background: Transitions from pediatric to adult care can be a complex process for youth and their caregivers. Exploring barriers and facilitators to transitions from pediatric to adult care is critical to inform the design and implementation of evidence-based interventions to improve transition processes. Previous literature has focused on describing experiences with transition; however, determinants influencing transitions need further exploration. Objective: This study explored barriers and facilitators to the transition from pediatric to adult care from youth and caregiver perspectives to inform future intervention design, implementation, and evaluation to support transitions in care. Methods: This study used a qualitative descriptive design guided by the COM-B Model of Behaviour. Youth and caregivers of youth in Nova Scotia, Canada, were recruited for semi-structured interviews. Data analysis consisted of directed content analysis, followed by inductive thematic analysis to identify barriers and facilitators of transitioning from pediatric to adult care. Results: A total of nine youth and nine caregivers participated in the semi-structured interviews. We identified barriers and facilitators related to the COM-B Model of Behaviour’s components of capability, opportunity, and motivation. Main themes from both the youth and caregiver participants relate to developing health literacy for transition processes, shifting roles to increase youth independence, and the importance of health system coordination. Conclusion: This project identified intersecting behavioural and contextual determinants related to youth and caregivers’ capability, opportunity, and motivation that influence the transition of care process. These findings will be instrumental for designing and adapting interventions and policies to improve youth transitions from pediatric to adult care.

Introduction: The COVID-19 pandemic resulted in rapid change across all sectors, including healthcare and education, as necessary public health measures (PHM) were implemented to protect the public. Children with complex care needs (CCCN) use health and specialised education services at a higher rate than the general paediatric population and were disproportionately affected by these changes. The current study aimed to explore the wider impacts of COVID-19 PHM on CCCN and their families in the Maritime provinces of Canada. Methods: Semi-structured interviews were conducted from March to September 2023, with CCCN aged 15–17 years old and caregivers of CCCN. Interviews were coded by two independent reviewers using the Ten Domains of Health Framework and interpreted using a phenomenological approach. Results: 21 parents and 3 youth from across the three Maritime provinces participated in the interviews. Key themes that emerged from the interviews included families carrying the burden of stress and fear, creating and protecting safe spaces, living through uncertainty, accumulating consequences of PHM and feeling disconnected. Within these themes, families mostly described negative impacts, although some positive experiences were also described. Conclusion: The findings of the current study will assist in the co-development of recommendations for healthcare and education decision-makers to reduce the negative impacts of future public health emergencies.