Nov 1, 2024

Partnering with psychiatry to support caregiver mental health

Kayla and Eyal
Kayla Esser with Eyal Cohen, Co-Director of the Edwin S.H. Leong Centre for Healthy Children, at the Children’s Healthcare Canada Annual Conference (Oct. 18-22, St. John’s, Newfoundland)

Kayla Esser is a 2024 graduate of the Master of Public Health program (Epidemiology) in the Dalla Lana School of Public Health at the University of Toronto, and former Leong Centre Studentship Award recipient. She provides a summary of her graduate project, which examines the psychiatrist's role in supporting caregivers of children with medical complexity through partnership. Her research demonstrates the feasibility of virtual mental health care for caregivers, revealing a high prevalence of psychiatric conditions among caregivers.

My project, “Understanding the Psychiatrist Role in Caring for Caregivers of Children with Medical Complexity: A Retrospective Chart Review,” focused on a new partnership between the SickKids Complex Care program and Women’s College Hospital’s psychiatric service. This partnership allows parents of children with medical complexities to be referred to an adult psychiatrist for diagnostic assessment and treatment of mental illness. Caregivers in this population have many risk factors for mental illness, yet little is known about their psychiatric conditions and treatment needs, and caregivers face many barriers to care. Our goal was to demonstrate the feasibility of the partnership between pediatric complex care and adult psychiatry, and to describe parent characteristics and clinical outcomes.

Over three years, 57 caregivers were seen by the psychiatry service, with wait times lower than the provincial average. All appointments were virtual, chosen by the parents. We found a high prevalence of psychiatric illnesses requiring intervention among the referred parents, most commonly depression, anxiety, and post-traumatic stress disorder. Many parents received new diagnoses, with common treatment recommendations including psychotherapy and medications. Most parents reported a history of psychiatric illness, adverse childhood experiences, and sleep difficulties or insomnia.

The partnership proved feasible, and the virtual delivery of care made it accessible for caregivers who could not attend in-person appointments. Other paediatric populations may consider similar partnership with adult psychiatric services to increase caregiver access to treatment.

We have presented our findings at Women’s College Hospital’s Psychiatry Rounds and SickKids’ Complex Care Rounds. Last month, I presented a poster at the Children’s Healthcare Canada conference in Newfoundland and engaged with clinicians and caregivers from across Canada (see poster here). We are also preparing a manuscript for submission to a peer-reviewed journal.

This study is part of a larger initiative where we designed a comprehensive, stepped care model of mental health support for caregivers of children with medical complexity within the SickKids Complex Care program. This model involves treatments of varying intensity (including social work and psychiatry) to match the intensity of the caregiver’s mental health needs and their preference for treatment. The most broadly effective, yet least resource intensive treatment, is delivered first, with caregivers only “stepping” to more intensive services depending on the level of distress. We are now analyzing outcomes from the model, which will be disseminated in the next year (read the paper here).

The partnership is ongoing, and caregivers continue to receive integrated support. We are applying for funding to expand our work to include siblings in our mental health model, aiming to make family-centred care more comprehensive.

Funding from the Edwin S.H. Leong Centre for Healthy Children has given me the opportunity to demonstrate the utility and feasibility of partnership between paediatric and psychiatric services, and share our findings with Complex Care teams across Canada. I have learned so much from Leong Centre Trainee Hub events, community engagement and rounds over the last year, and plan to continue engaging with training and education opportunities provided by the Centre as I continue my research at SickKids.