Like many of us, I recently returned from our annual conference in Quebec City, where I connected with fabulous colleagues and learned of the amazing work they are doing. I would argue that it was our best conference to date because of the high level research symposia and workshops, the pre conference institute and quality of the keynotes. Cut some words here
From the conference and others I have attended this fall, I have been given many reasons to think about the possibility, and necessity of stepped care for adolescents – particularly those with suicidal thoughts and behaviours. These youth constitute the majority of general CAP adolescent patients. They require intensive services based on data from randomized trials. We are at risk of losing funding for such services. It is imperative that we identify which youth require less intensive treatments so that waiting lists are shorter and care can be better tailored to their needs. Some of these early interventions are, of necessity, psycho-educational and could be delivered digitally, and some of these may not require CAP involvement. Two articles in this issue contribute to actualizing stepped care.
Courtney and colleagues (2019, this issue) share their protocol for a trial examining the feasibility of a Depression Care Pathway in the outpatient service context. Our outpatient services are full of youth and families with complex needs, many of which we cannot possibly address during the time we have with them. Knowing what interventions can at least address their basic needs are absolutely critical building blocks when setting up pathways. I applaud them for this work at trying to sort this out. Boydell and colleagues (2019, this issue) presents very practical information for colleagues starting and modifying their existing telepsychiatry services. Doing telepsychiatry care well is a truly valuable contribution to mental health care outside of tertiary centers, which is the majority of Canada. I heard many times at our conference, that the impact of our work as CAPs must be expanded outside of cities, and telepsychiatry care can directly meet this need.
Dr McLennan describes what is a typical highly complex patient seen by CAPs in consultation. While not shocking to us, the scenario of the youth emphasizes both the critical importance of extended consultation in our most vulnerable youth with comorbid developmental and psychiatric disabilities. Without access to this level of expertise, these youth do not improve.
Casiano and colleagues (2019) describe their study of several thousand detained youth in Manitoba where they validated the Inmate Security Assessment – Suicide tool which has been in use for decades. This study is important because detained youth are less commonly studied in the area of suicide risk of which they are at significantly elevated risk. We congratulate them on this work and expect the paper to be regularly cited.
Dr Couturier and colleagues describe common triggers for disordered eating behaviour in their mixed in and outpatient sample. Many of these triggers are socially mediated and they caution there is a need for prospective research exploring the perception of “healthy behaviour” messaging from teachers, coaches and peers and extreme interpretations as risk factors for disordered eating behaviour. There may be a clinic or population health based intervention waiting to be created!
This will be my final editorial as Editor of our Journal. I have thoroughly enjoyed my role over the past 5 because I regularly interacted with our membership, encouraged new researchers to publish work and had the most incredible support from our talented and dedicated team of Associate Editors and editorial assistant, Vicki Simmons. I am also grateful to the Board of the Directors of CACAP, as they have continually supported the work of our Journal team with gusto and gratitude. I am very excited to announce that our next Editor of JCACAP will be Dr John McLennan, MD, PhD, FRCPC. Our Academy can look forward to strategic leadership under John’s direction. I will remain involved as an Editorial Board member until someone takes me off the masthead.