Capstone research projects database
The Capstone research project is where students work on real-world issues.
See the Capstone projects TRP students have worked on over the years.
Roadmap to Bridging: Developing a Unified Discharge Process
A quality improvement project at CAMH’s Bridging Clinic examines barriers to care coordination, addressing a growing backlog of post-discharge mental health clients, particularly worsened during COVID-19.
Background
According to the Survey on COVID-19 and Mental Health, one in four (25%) Canadian adults (18 and older) self-reported symptoms of a mental health disorder, an increase from the one in five (21%) reported in Fall 2020 (Government of Canada, 2021a). One in five individuals (18.1%) aged 12 and older reported the need for help for their mental health in the Fall of 2020; and (45.0%) felt that their needs were either unmet or only partially met (Government of Canada, 2021b). Out of those with unmet needs, 20.9% reported features of the health care system, such as accessibility, as a barrier to meet their care needs (Government of Canada, 2021). The lack of coordination and fragmentation of Ontario's mental health care system generates confusion, hinders clear navigation of the system, and results in unnecessary emergency visits (Roadmap to Wellness, 2020).
The World Health Organization (WHO) defines care coordination as “a proactive approach to bring together care professionals and providers to meet the needs of service users to ensure that they receive integrated, person-focused care across various settings” (World Health Organization, 2018). Coordination of care or continuity of care (COC) has also been described as “the degree to which a series of discrete health care events is experienced by people as coherent and interconnected over time and consistent with their health needs and preferences” (World Health Organization, 2018). The lack of coordinated and continuous care in the mental healthcare space remains a significant challenge that greatly impacts costs and the patient experience. It has been shown, that without effective and timely follow-up and COC post-discharge from inpatient psychiatric care, clients are vulnerable to relapse within 30 days of discharge and are found to be at greater risk for suicide within six months (Rudoler et al., 2017).
To better understand this problem space, the Capstone team met with different stakeholders of the mental health system, including people working at the Centre for Addiction and Mental Health (CAMH) and in government. One of these meetings uncovered an opportunity at CAMH's Bridging Clinic (BRDG) for a quality improvement project regarding the navigation of the system. Dr. Andrea Waddell was leading this initiative and after several meetings to discuss goals and the project, working together was a good fit due to our shared interest in quality improvement in mental health care. Established in 2017 in Toronto, Ontario, CAMH’s BRDG aims to provide low barrier and rapid access for acute care post-discharge from mental health and addiction services. The clinic is intended as a mechanism to provide continuity of care while clients are connected with longer-term solutions. This service is provided to individuals who identify as needing support as they transition from hospital to the community. Individuals can access the service for a maximum period of three months. BRDG staff is composed of a leadership team (clinical directors and managers), administrative team, clinicians (social workers and nurses) and the physician team (psychiatrists). BRDG plays a role on the continuum of care stemming from the following client sources: the CAMH Emergency Department (ED) triage; post-assessment or post-discharge by the ED; and post-discharge from the CAMH inpatient unit. Clients are unable to schedule appointments and access the clinic on a drop-in basis. The services included in BRDG are designed to ensure that clients a re bridged to other CAMH services, community or primary care providers and not lost to follow-up. When we analyzed the BRDG monthly reports, we learned that there is an increase in the total number of clients served yearly from 2017 to 2020 (Figure. 1, p < 0.05, except between 2020 and 2021; p >0.05). However, the difference between the number of new clients and total discharges has not followed the same upward trend as clients served each year (ANOVA p=0.04, but Tukey p>0.05 in all comparisons).
If we accept the increase of clients served yearly as a surrogate of the number of open episodes, the backlog in discharges was a natural outcome given the absence of a growth in discharge. During COVID, the backlog of clients worsened, further disrupting the flow of BRDG. The data, however, does not pinpoint the reason for the backlog. It should be clarified from Figure 1 that the discharge number for 2021 reflects a one-time focused effort put on discharge in the last three months of the year.
Project team
- Andres Kohan
- Dorottya Harangi
- Mona Irannejad
- Stephannie Jeanneret Manning
TRP supervisors
Project advisory committee
- Andrea Waddell
- Melissa Hiebert
- Olivier St-Cyr
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SPOT Concussion:Systems to Prevent Overlooking Teen Concussion
This study identifies barriers and facilitators to the use of paediatric concussion clinical practice guidelines among primary care providers in Toronto.
Background
Background: Evidence-based Clinical Practice Guidelines (CPGs) help improve the quality and consistency of care provided by healthcare professionals. However, despite the existence of multiple concussion-related CPGs, published studies suggest that CPG awareness and adherence is low for the management of paediatric concussion. Not using CPGs could contribute to missed diagnoses or the mismanagement of children at risk for persisting post-concussion symptoms (PPCS), such as anxiety and learning disabilities, which can last for years following injury. There is a need to increase the utilization of paediatric concussion CPGs by primary care providers (PCPs).
Objective: We aimed to improve the use of CPG guidelines among community-based PCPs in Toronto by first identifying the facilitators and barriers to the uptake of CPGs.
Methods: A qualitative descriptive study design was used. Family physicians, paediatricians, and nurse practitioners were recruited via purposive and snowball sampling. Semi-structured interviews were conducted online. A combination of deductive and inductive coding was used, and a reflexive thematic analysis process followed for data analysis.
Results: Eight participants met our eligibility criteria and were interviewed. Four overarching themes were identified:
- Diverse conceptualizations of concussion CPGs and their relevance
- Limited opportunities to learn about paediatric concussion
- The important role of intermediaries
- End-user needs remain unmet
Conclusion: Participants shared their perspectives, insights into their decision-making process, and helped identify the barriers and facilitators to the use of concussion CPGs. With this knowledge, custom strategies for community-based PCPs in Toronto could be created to improve concussion CPG uptake.
Project team
- Amelia Di Meo
- Bethany Tong
- Maryam Fereig
- Sarah Diaz
TRP supervisors
Project advisory committee
- Heather Boon
- Gabrielle Freire
- Charlene Welsh
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STAMPS: Strategies to Access Mental-health Perinatal Services
The STAMPS study explores the mental health care pathways of birthing parents and providers in Toronto, identifying structural, process, and contextual barriers to support for perinatal depression and anxiety using the Donabedian framework.
Background
The STAMPS study investigated the mental health care experiences of birthing parents and healthcare providers within Toronto, with a specific focus on perinatal depression and anxiety. We aimed to understand the barriers and facilitators to mental health support and uncover the resources available for birthing parents who are experiencing perinatal depression or anxiety.
Perinatal mood and anxiety disorders are a spectrum of mental health conditions affecting individuals during the perinatal period, spanning the entire pregnancy and up to one year after childbirth. Perinatal depression, one of these conditions, is the most common complication of childbirth. In addition, perinatal anxiety is another common condition and is a strong predictor of postpartum depression.
In Canada, perinatal depression and anxiety symptoms are estimated to affect around 23% of women, yet not everyone who experiences these conditions talks to someone about their mental health. In fact, only around 50% of those who do reach out for help talk to a professional!
Even with the high number of people affected, there are no formal screening guidelines for perinatal depression or anxiety in Canada. However, as other countries have shown, the problem may not be with screening but with referral networks, available resources, or follow-up.
Before creating solutions to improve perinatal mental health in Toronto, we need to understand the mental health care pathways of birthing parents who experience perinatal depression or anxiety and of healthcare providers who offer perinatal services. This is the gap we aimed to fill. Birthing parents in Toronto are currently experiencing the burdens of untreated perinatal depression and anxiety.
Our objective was to discover the mental health care pathways of birthing parents and the current perinatal mental healthcare support systems in Toronto. By understanding the mental health care journey of birthing parents, we aimed to identify gaps in perinatal mental health care in Toronto. To ensure inclusivity of sex and gender diversity, this study was open to any individual who had given birth or was pregnant, and who self-identified as a woman or mother, including those who identify as transgender, transsexual, two-spirited, androgynous, agender, intersex, bigender, gender questioning, gender fluid, non-binary, genderqueer, or gender-non-conforming.
In terms of healthcare providers, we included professions that are part of the perinatal circle of care, including nurses, psychiatrists, family doctors, neonatologists, midwives, obstetricians, social workers, and doulas. The study relied on one-on-one semi-structured interviews with birthing parents and healthcare providers to gather their lived experiences with perinatal mental health care. We collected information about symptom awareness and diagnosis, as well as how they found support services for perinatal mental health, what services they found, the treatments or services offered for perinatal mental health, and whether these services were beneficial for the treatment of their mood disorders.
Common themes between care pathways were highlighted and analyzed. Given the complexity of the Canadian healthcare system, we needed a conceptual framework to categorize our exploration including barriers and facilitators to perinatal mental health service and care delivery.
We decided to use the Donabedian Model, which we combined with context of care to organize these themes into the following main categories:
- Structure - represents the attributes of the settings in which care occurs like resource access and wait times
- Process - denotes the exchange between patients and providers, such as perinatal mood disorder diagnosis and care management https://sydneytaylor58.wixsite.com/stamps
- Outcome - represents the effects of care on the health status of patients, such as mental health awareness and patient satisfaction
- Context of care - individual influences on perinatal mental health care, such as social determinants of health and mental health stigma
Project team
- Dr. Nancy Mingo
- Dr. Ayeshah Mohiuddin
- Sydney Taylor
- Susan Elizabeth Zelko
TRP supervisors
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The 1 in 5 Perinatal Mental Health Project; Understanding Clinician awareness in Ontario (Kanadario) of a Treatment Pathway devised to assist patients and clients suffering from Perinatal or Postpartum Mood and Anxiety Disorders (PMAD)
This mixed-methods study evaluates Ontario clinicians’ awareness and uptake of the PCMCH Care Pathway to improve treatment of perinatal mood and anxiety disorders.
Background
Mental health resources and clinicians available to provide timely and cost-effective treatment have diminished as the number of individuals requiring care has steadfastly risen in the province of Ontario. (1,) Individuals in the perinatal period, which spans from conception to the first year following childbirth, are no exception. In 2019 the Maternal Mental Health Survey conducted by Statistics Canada showed 23% of respondents, or circa 1 in 5, reported symptoms in line with the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) definition of mood disorders depression and anxiety (1, 2) Research from all provinces and territories across Canada is definitive that perinatal mood and anxiety disorders (PMAD) are neither uncommon nor insignificant and that the repercussions that follow are far-reaching and profound to both birthing person and their infant.(3,4,5,6,7)
The 1 in 5 Perinatal Mental Health Project is a mixed-method cross-sectional study in survey format which aims to evaluate clinician awareness and uptake of the Provincial Council for Maternal and Child Health (PCMCH) Care Pathway for the Management of Perinatal Mental Health published in July 2021(8). The 1in 5 Perinatal Mental Health Project assumes an iterative process analyzing the PCMCH treatment pathway usage and how this may influence perinatal care providers in Ontario and impact their patient’s health and well-being. Data collected can be used to inform further development of treatment options that are accessible, timely and beneficial to clinicians and birthing persons suffering from PMAD.
Project team
- Suzan Lorenz
TRP supervisors
Project advisory committee
- Sabrina Kolker
- Rohan D'Souza
- Kristin Horsley
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The ADAPTS Project: Advancing Diabetes Care for Adolescents preparing for healthcare transition in Saskatchewan
This study explores the transition needs of adolescents with type 1 diabetes in Saskatchewan, highlighting key support gaps and priorities to inform the development of a formal transition care program.
Background
The transition from pediatric to adult care for adolescents with type 1 diabetes mellitus is a particularly challenging and vulnerable period, leaving adolescents at high risk for deterioration of their physical and mental health. Transition programs have been shown to support adolescents, improve their quality of care, and minimize negative health consequences related to transition. Currently, however, no formal transition support program exists in Saskatchewan for adolescents with diabetes. This survey-based exploratory study examined perspectives, anticipated challenges, and needs for transition of adolescents with type 1 diabetes followed in the LiveWell Pediatric Diabetes Program in Saskatoon, Saskatchewan and their caregivers. Respondents identified the need for supports to facilitate increasing adolescent independence and negotiation of responsibility for diabetes-related tasks between adolescents and their caregivers. Education regarding smoking, substance use, and sexual health needs to be improved. Adolescents and their caregivers also conveyed the need for information about their future adult diabetes care provider, wanting to meet them in advance, and their preference of in-person individual meetings to facilitate transition readiness. These findings, which better our understanding of transition challenges and needs, will be instrumental in guiding further transition care initiatives to minimize gaps in care, reduce patient and family anxiety related to transition, and improve adolescent health and independence.
Project team
- Katherine Backman
TRP supervisors
Project advisory committee
- Mark Inman, MD
- Ryzel Shulman, MD
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The Effects of the Recent COVID-19 Pandemic on Solid Organ Transplantation: An Essential Medical Service
This qualitative study explores how stakeholders at the Multi-Organ Transplant Program (MOTP) at Toronto General Hospital adapted to disruptions in care during the COVID-19 pandemic.
Background
The saturation of healthcare services during the COVID-19 pandemic has imposed multiple challenges on healthcare delivery, with disruption across all essential medical services. One such service that has been impacted at-large is organ transplantation.[1] The COVID-19 pandemic has affected not only processes related to donors or recipients, but also the administration of resources in the healthcare systems, mental health of different stakeholders, safety of healthcare professionals (HCPs), ways of communicating, and research activities, amongst others.[2] This project aimed to understand how various stakeholders at the MOTP at TGH in Toronto, Canada, were affected by and responded to the COVID-19 pandemic. These findings may be used to inform and contribute to improved healthcare delivery responses and strategies during times of systemic strain on the healthcare system. This project employed a qualitative approach to understand and compare organ transplantation processes at the MOTP before and during the COVID-19 pandemic. A modified Journey Mapping Method – Organ Mapping – was employed to describe and visualize regulatory, institutional, and individual tasks and responsibilities along the organ transplant pathway, from donor to recipient. An initial draft of the Organ Map was designed using publicly available MOTP data, and then complemented after discussions with key stakeholders.
To further investigate the institutional, professional, and individual experiences of healthcare delivery among MOTP stakeholders, 1-hour-long semi-structured interviews were conducted. This project recruited a sample size of 16 participants from three cohorts: healthcare professionals (HCPs); administrative staff; and patients and families. Interviews were transcribed and analyzed by the TRP Capstone Team using thematic content analysis[3] to uncover key barriers and facilitators to organ transplantation during COVID-19. The interviews focused on changes to practices during the COVID-19 pandemic, including workflow, protocols, methods of communication, education and training, decision-making processes and priorities, and the use of clinical and administrative resources. The TRP Capstone Team synthesized and analyzed these data to learn from the experiences of participants in healthcare delivery during systemic strain, such as in a pandemic. We expect that our findings will help to identify areas (systemic, professional, and personal) that can be improved while enhancing best-practices and future optimization for the MOTP and healthcare delivery. The next steps of this project include the dissemination of the results through a publication in a peer-reviewed journal, report for all stakeholders, Capstone defense presentation, and presentation at an upcoming transplant conference.
Project team
- Fabricio Batistella Zasso
- Atina Boonchit
- Katherine Puerto Nino
- Sabrin Salim
TRP supervisors
Project advisory committee
- Alex Jadad
- Heather Boon
- Gary Levy
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The MEND (Meaningfully Empowering the Neurodiverse) Initiative: Helping Autistic Adults in the GTA Express their Mental Health Needs
The MEND Initiative is a student-led Capstone project within the TRP. Our goal is to collaborate with autistic adults (18 years of age and older) in the Greater Toronto Area (GTA) to develop an intervention that empowers them to express their mental health needs to their chosen healthcare provider(s).
Project team
- Katie Boddison
- Alena Moya
- Abitha Suthakaran
- Mouzhan Varshoueitabrizi
TRP supervisors
TransCoRe: Translational Success in Corneal Regenerative Medicine
Globally, 12.7 million people await corneal transplantation. Since only 1 in 70 are treated due donor tissue shortage, researchers have turned to regenerative cell-, tissue-engineering-, gene- and drug-based alternatives. However, despite decades of research, few have crossed the “valley of death” of translation to assume a well-defined role in the corneal blindness treatment paradigm. Today, corneal transplantation remains the gold standard therapy. The need to accelerate the translation of emerging regenerative therapies to overcome the burden of corneal blindness is clear. The problems is that there is no objective way to determine the translational potential of emerging therapies.
Background
Determining the translational potential of emerging therapies is essential both for deciding whether their development is worth pursuing and for building customized strategies to accelerate their translational progress. Our aim is therefore to develop a translational potential assessment tool for emerging cornea regenerative therapies. In this project, we will:
- Map the current rate of translation of corneal regenerative therapies, process bottlenecks, and factors predictive of translational success.
- Design a low-fidelity prototype of a translational potential assessment tool.
- And test the prototype to collect feedback from cornea researchers on concept, content, design and utility.
This tool would be the first of its kind and would directly impact cornea researchers, funding entities, and industry who must make resource allocation and directional decisions early in technology development. The ambition is to make safe and effective alternatives available to cornea-blind patients faster.
Project video
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Watch Christina's video on YouTube
Project team
- Cristina Bostan
TRP supervisors
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Transforming mental health in anesthesia education
Anesthesia residents have been reported to be at very high risk for developing mental health problems. There is a need to address mental health concerns in anesthesia residents.
Background
Anesthesia trainees are unique in that they work with a faculty member intimately one-to-one on a daily basis and this makes faculty key persons that can recognize those trainees in trouble. With the implementation of the new competency-based curriculum in 2017, this will entail a greater number of one-to-one assessments placing even more emphasis on the importance of faculty in maintaining resident wellness.
Project team
- Fahad Alam
- Clyde Matava
TRP supervisors
Project advisory committee
- Dr. Lisa Bahrey, Education Director, Department of Anesthesiology UHN-SHS
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Transitioning Cancer Follow-Up Care from Specialized Oncology Teams to Primary Care Providers
Oncology units at Princess Margaret are overburdened, and the integration of PCPs could ease the burden on the hospital. There is a need to test the validity and usability of an End-of-Treatment letter prototype, which aims to improve the communication barriers faced by oncology teams and PCPs. This project involves the iterative refinement of a tool for clinics at PM by embedding specific PCP feedback. In doing so, this project builds on existing literature to gather first-hand experiences, translated into a refined communication tool for use by PM to effectively optimize the communication between providers during this transition.
Background
Integrating cancer survivorship care with primary care providers (PCPs), specifically family physicians, may ease the burden on hospitals and allow cancer care specialists to focus on patients receiving primary treatment. This project aimed to examine the overall views of PCPs regarding their role in cancer survivorship care and identify the resources they require to effectively manage this responsibility.
The Toronto Translational Framework was used to guide the approach, identify the problem and need, verify the need, and test a prototype. This project employed a multi-method approach, including a survey distributed to family physicians for general perspectives on providing cancer survivorship care and semi-structured interviews to gather feedback on the end-of-treatment letter. Overall, 28 surveys and 9 interviews were conducted with family physicians. Findings from the surveys and interviews indicated a clear disparity in the communications between family physicians and oncology teams, with a need for a better definition of roles and improved information formatting of the end-of-treatment letter. A primary barrier towards optimizing the transition of patients is the lack of clinician buy-in and clinical support (e.g. human resources) to facilitate projects that address the communication barriers. To better understand the specific communication barriers, updating and validating a tool that could facilitate better communication, such as the end-of-treatment letter, could help optimize the transition of patients from specialized care teams back to their primary care providers and support better coordination of care.
Project team
TRP supervisors
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