Browsing by Author "Wittevrongel, Krystle"

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    Patient-reported outcome measures used to improve youth mental health services: a systematic review
    (2023-02-14) Thapa Bajgain, Kalpana; Amarbayan, Mungunzul; Wittevrongel, Krystle; McCabe, Erin; Naqvi, Syeda F.; Tang, Karen; Aghajafari, Fariba; Zwicker, Jennifer D.; Santana, Maria
    Abstract Background Patient-reported outcome measures (PROMs) are standardized and validated self-administered questionnaires that assess whether healthcare interventions and practices improve patients’ health and quality of life. PROMs are commonly implemented in children and youth mental health services, as they increasingly emphasize patient-centered care. The objective of this study was to identify and describe the PROMs that are currently in use with children and youth living with mental health conditions (MHCs). Methods Three databases (MEDLINE, EMBASE, and PsycINFO) were systematically searched that used PROMs with children and youth < 18 years of age living with at least one diagnosed MHC. All methods were noted according to Preferred Reporting Items for Systematic reviews and Meta-Analysis. Four independent reviewers extracted data, which included study characteristics (country, year), setting, the type of MHC under investigation, how the PROMs were used, type of respondent, number of items, domain descriptors, and the psychometric properties. Results Of the 5004 articles returned by the electronic search, 34 full-texts were included in this review. This review identified both generic and disease-specific PROMs, and of the 28 measures identified, 13 were generic, two were generic preference-based, and 13 were disease-specific. Conclusion This review shows there is a diverse array of PROMs used in children and youth living with MHCs. Integrating PROMs into the routine clinical care of youth living with MHCs could improve the mental health of youth. Further research on how relevant these PROMs are children and youth with mental health conditions will help establish more uniformity in the use of PROMs for this population.
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    Pediatric Concussion Health Service Utilization and Follow-Up Care: A Population-Based Epidemiological Study Using Administrative Health Data
    (2021-08-19) Wittevrongel, Krystle; Zwicker, Jennifer; Yeates, Keith; Schneider, Kathryn; Hagel, Brent
    Concussion is a common injury among children and youth, although population-level incidence and trends related to service use are not well described in the literature. In addition, while treatment and management decisions are led by best practices and clinical guidelines, there is a paucity of studies exploring the individual and contextual factors that impact health service utilization following concussion in the pediatric patient. Thus, the objective of this thesis was to address these gaps and better understand how children and youth are interacting with the health care system following concussion in Alberta. In this thesis, 14-years of system-level linked administrative health data and a defined episode of care (EOC) were used to describe trends in health care utilization following pediatric concussion in Alberta. An increased incidence of concussion and other mild head injury diagnoses was observed across the province. In addition, a shift in care from emergency department (ED) to outpatient physician office (PO) settings and a higher use of the ED by some segments of the population was observed. Findings suggest some children and youth are more likely to receive care following a concussion. In addition, follow-up care increased over time, demonstrating accordance with clinical guidelines. However, rates remained low, indicating a lack of application by provider or adherence by patient. Findings indicate that the likelihood of receiving follow-up care in Alberta was influenced by both individual and contextual factors. Factors related to need (perceived and evaluated) were most strongly associated with health care utilization. The index visit occurring in PO had the strongest positive association with follow-up care, followed by a history of concussion-related EOC. At the same time, patient predisposing and enabling factors also affected utilization. Younger children and youth, females, and those from areas of lower socioeconomic status (SES) or residing in certain geographical areas were less likely to receive follow-up care. Findings suggest that to improve service delivery and targeted treatment in line with clinical guidelines for all children and youth, policies that focus on equitable access are needed.
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    Stakeholders’ engagement in co-producing policy-relevant knowledge to facilitate employment for persons with developmental disabilities
    (2020-04-17) Khayatzadeh-Mahani, Akram; Wittevrongel, Krystle; Petermann, Lisa; Graham, Ian D; Zwicker, Jennifer D
    Abstract Background Persons with developmental disabilities (PWDD) face a number of individual, environmental and societal barriers when seeking employment. Integrated knowledge translation (IKT) involves ongoing and dynamic interactions between researchers and stakeholders for the purpose of engaging in mutually beneficial research to address these types of multi-faceted barriers. There is a knowledge gap in the IKT literature on effective stakeholder engagement strategies outside of the dissemination stage to inform policy. In this paper, we report on a number of engagement strategies employed over a 2-year period to engage a wide range of stakeholders in different stages of an IKT project that aimed to investigate the ‘wicked’ problem of employment for PWDD. Method Our engagement plan included multiple linked strategies and was designed to ensure the meaningful engagement of, and knowledge co-production with, stakeholders. We held two participatory consensus-building stakeholder policy dialogue events to co-produce knowledge utilising the nominal group technique and the modified Delphi technique. A total of 31 and 49 stakeholders engaged in the first and second events, respectively, from six key stakeholder groups. Focused engagement strategies were employed to build on the stakeholder dialogues for knowledge mobilisation and included a focus group attended only by PWDD, a stakeholder workshop attended only by policy/decision-makers, a webinar attended by human resources professionals and employers, and a current affairs panel attended by the general public. Results Our findings suggest that the level of engagement for each stakeholder group varies depending on the goal and need of the project. Our stakeholder dialogue findings highlight the inherent challenges in co-framing and knowledge co-production through the meaningful engagement of multiple stakeholders who hold different ideas and interests. Focused outreach is needed to foster relationships and trust for meaningful engagement. Conclusions In addition to providing guidance on how to implement adaptable meaningful engagement strategies, these findings contribute to discussions on how IKT projects are planned and funded. More studies to explore effective mechanisms for engaging a wide range of stakeholders in IKT research are needed. More evidence of successful engagement strategies employed by researchers to achieve meaningful knowledge co-production is also key to advancing the discipline.
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    Understanding and Implementing Concussion Policy in Alberta
    (2017-08-21) Wittevrongel, Krystle; Zwicker, Jennifer
    Rates of concussion-related emergency room visits in Alberta have risen exponentially over the past decade, with visit rates highest among youth. Adolescents and youth suffering from concussions tend to have more complicated recovery than children or adults. Youth are at risk of prolonged recovery periods and other difficulties with premature Return-to-Play (RTP) or Return-to-Learn (RTL) should their physical and cognitive recovery not be adequately supported. This capstone analysis is the first study of its kind in Canada to explore the status of concussion policy and protocols in the education system in a province lacking ministry mandated policy. The current concussion policy landscape in Alberta can best be described as a patchwork of standards across individual agencies, sports organizations, and teams. There is no official policy in the education system, and policies and protocols appear to be at the discretion of individual schools. Staff survey in two different boards in the Calgary area allowed for analysis of current student and parent/guardian education, school management protocols, and staff training on concussions. The investigation indicated disparity and inconsistency within schools and boards across multiple tenets of concussion policy, with many respondents unaware of various components of their school's policy or even whether such protocols existed. 2 This study's assessment of current policy and protocols is supplemented with recommendations for inclusion for provincial policy in Alberta. As compared to legislation, policy appears to have been effective in Ontario, the only province in Canada with ministry mandated policy in addition to any semblance of concussion legislation. Alberta Education is urged to take heed from the implementation of Ontario's Policy/Program Memorandum on Concussions (PPM No. 158) and require development of, at minimum, strategies to raise awareness, prevent and identify concussions, institute management procedures for diagnosed concussions, and provide appropriate training for educators and other school staff. This assessment closes with a series of recommendations to supplement the overarching policy and its component parts.