Health Services

The Family Navigation Project (FNP), a youth and family mental health and addictions (MHA) navigation service that currently operates in the Greater Toronto Area (GTA), is expanding to northern Ontario by setting up a new site in the Sudbury and Manitoulin districts. This work is being done in partnership with Compass/Boussole/Akii-Izhinoogan, the lead child and youth mental health agency for Sudbury-Manitoulin. An innovative clinical trial will be conducted following the setup of FNP in Sudbury-Manitoulin, which will test how well the model works for the community in this area. The team will collect information about the experiences and outcomes of the youth and families who use the service. The goal is to see whether FNP leads to better outcomes for youth and families, such as getting help sooner, feeling more supported, and being able to use the healthcare system more efficiently. The trial will use a mixed methods approach, meaning it gathers both numbers (e.g., wait times and service use) and personal experiences (e.g., whether families feel supported). This will provide a rich, in-depth picture of how navigation services work in a northern community and how they impact the lives of young people and their families living there.

Although cataract remains the leading cause of avoidable blindness in Nepal, completion of referral from peripheral Eye Care Centers (ECCs) to Bharatpur Eye Hospital (BEH) for cataract surgery remains very low, with only about 3% of referred patients attending the hospital. Poor referral completion is influenced by barriers such as long travel distances, transportation costs, inadequate counselling, fear of surgery, and limited communication between peripheral eye care providers and ophthalmologists. This study aims to evaluate whether an enhanced tele-ophthalmology model improves cataract referral completion compared with the existing referral system. A stratified matched-cluster quasi-experimental study will be conducted in 12 satellite ECCs of Bharatpur Eye Hospital, comprising six intervention ECCs and six matched control ECCs. Adults aged 40 years or older diagnosed with visually significant cataract or other conditions requiring ophthalmological consultation will be enrolled. Participants in intervention ECCs will receive real-time tele-ophthalmology consultation using slit lamp-mounted anterior segment cameras, allowing ophthalmologists to remotely examine patients, confirm the diagnosis, provide counselling, and support referral planning. Control ECCs will continue the existing standard referral process without real-time ophthalmologist-patient interaction. The primary outcome is referral completion, defined as attendance at Bharatpur Eye Hospital or a designated secondary hospital within 12 weeks of referral. Secondary outcomes include patient-reported barriers to referral completion, time to hospital attendance, acceptance of tele-ophthalmology, and diagnostic confidence among ECC staff. A total of 396 participants (198 per group) will be enrolled. Referral completion rates between groups will be compared to determine whether enhanced tele-ophthalmology improves access to cataract surgical services and strengthens referral systems in rural Nepal.

The goal of this study is to learn how telephone-based screening and care coordination impacts children experiencing adverse childhood events (ACEs). The main questions are: 1. Does telephone-based screening and care coordination for children experiencing ACEs increase child receipt of ACEs-related services? 2. Does telephone-based screening and care coordination for children experiencing ACEs improve parent health and wellbeing? 3. Does telephone-based screening and care coordination for children experiencing ACEs improve child social and emotional health? Researchers will compare families who have been randomly selected to receive telephone-based screening and care coordination with those who will receive usual care at their clinic. Participants will: * Be randomly assigned to receive usual care or usual care plus telephone-based screening and care coordination (the intervention) * If selected for the intervention, be connected to 211 Los Angeles to receive screening and care coordination for up to 6 months * Complete four surveys via interview; surveys will be done at enrollment and 1 month, 6 months, and 12 months following enrollment * Agree to allow researchers to review their child's medical records to collect information about their child's health, screenings, diagnoses, and referrals.

The objective of the BASIS R34 pilot study is to test the impact of eBASIS in a randomized controlled trial (RCT). Consistent with IMPACT's IQM, the study tests effects of eBASIS on treatment fidelity and youth outcomes, compared to a digitally delivered control (N=32 clinicians; 96 clients). A well-established EBP (Cognitive Behavioral Therapy Plus), will be a focus of the investigation, which eligible participants will already be signed up to receive.

This study aims to evaluate the integration of a standalone eye centre into the Provincial Government Hospital in Kalaiya, Bara District, Nepal. The integration model seeks to improve access to comprehensive eye care services by combining the specialized expertise of an eye care facility with the infrastructure and patient flow of a provincial hospital. As the burden of avoidable visual impairment remains high in Nepal, strengthening service delivery at the district level has the potential to improve early detection, timely treatment, and continuity of care. 1 A mixed-method approach will be used to assess changes in service utilization patterns for example patient volume, follow ups and referrals following the integration. Additional focus will be placed on the acceptability of the integration model among patients, eye care professionals, and the hospital staff. This study will help to generate evidence-based recommendations to guide district-level planning for integrated eye care models by 2027. Data will be collected from patient records, hospital statistics, patient and staff interviews. The findings are expected to provide evidence on the feasibility, challenges, and benefits of integrating specialized eye care units into provincial hospital systems in low-resource settings. Ultimately, the study aims to inform policy decisions, support scalable models of eye care integration, and contribute to improved eye health outcomes for underserved populations.

Red blood cell (RBC) transfusions are selected based upon matching donor and recipient blood group: donor and recipient sex are not considered when selecting blood for transfusion. Hence, transfused patients can currently receive sex-matched and/or unmatched RBCs when transfusions are given. Sex-matched stem cell transplants, and some solid organ transplants, have shown that sex-matching donor to recipient improves patient outcomes. Recent exploratory studies have also suggested that patient outcomes could be improved by sex-matching for RBC transfusion. There is emerging evidence of underlying biologic mechanism(s) to support these observations. This study is designed as a randomized controlled trial and will explore the impact on patients who receive RBC transfusions from donors of the same sex ("sex-matched") compared with donors of the opposite sex ("sex-mismatched"). The trial will study adult patients admitted to the Intensive Care Unit who require an RBC transfusion. Patients will be assigned (through a process called randomization) to receive sex-matched RBCs or sex-mismatched RBCs to determine if there is a difference in mortality between those receiving matched versus mismatched RBCs. The results of this trial could have direct implications on resources, blood inventory, and RBC transfusion ordering practices.