TOPLINE: 

The implementation of a mental health care bundle for children who presented to emergency departments (EDs) with mental and behavioral health concerns was not associated with improved family quality of life (FQOL) at 1 month, though disability-related support increased by 1.21 points.

METHODOLOGY:

• Researchers conducted a nonblinded, nonrandomized clinical trial including 1412 children (median age, 13.0 years; 52.9% girls; 71.7% White individuals) who visited two pediatric EDs in Canada over two periods for non-life-threatening mental and/or behavioral health concerns that did not require medical treatment or stabilization and did not involve communication barriers.
• During the first period (January 2020-January 2021), children received standard ED care. In the second period (July 2021-June 2022), the EDs delivered a mental health care bundle designed to assess patient needs and facilitate follow‑up care. All care was delivered by healthcare professionals.
• The objective was to evaluate the association of the care bundle with changes in FQOL from the baseline ED visit to the 1-month follow-up assessment, comparing outcomes before and after implementation.
• Caregivers reported FQOL for 71.2% of children using a validated 25‑item Beach Center FQOL scale, which includes five subdomains: parenting, emotional well-being, family interaction, physical or material well-being, and disability-related support.

TAKEAWAY:

• The implementation of the mental health care bundle was not associated with a significant improvement in overall FQOL at 1 month (level change, 3.34; P = .06) or in the monthly trend of FQOL (slope change, -0.15 points per month; P = .41), whereas disability-related support improved significantly post-implementation (mean difference, 1.21; P = .007).
• Higher FQOL scores at baseline were associated with smaller improvements in FQOL at the 1-month follow-up assessment after an ED visit (adjusted change in FQOL, -0.29 points; P < .001).
• Children from Black or Latin American backgrounds experienced greater improvements in FQOL at 1 month (adjusted increase in FQOL score, 4.10 points; P = .01), with significant gains in emotional well-being (adjusted increase in FQOL score, 1.01 points; P = .01) and family interaction (adjusted increase in FQOL score, 1.24 points; P = .02).
• A nonbinary gender identity (adjusted change, -0.90 points; P = .01) and a diagnosis of a behavioral or emotional disorder (adjusted change, -0.74 points; P = .02) were associated with smaller improvements in emotional well‑being.

IN PRACTICE:

"In this study, a care bundle designed to improve mental health care was not associated with improved caregiver satisfaction with family life 1 month after an ED visit," the authors wrote. 

"While the study took place during the COVID-19 pandemic, a time of worsened family functioning, that higher baseline FQOL was not even maintained after the ED visit suggests the bundle should be refined to include care components designed to immediately improve FQOL," they added.

SOURCE:

The study was led by Amanda S. Newton, PhD, MSc, University of Alberta, Edmonton, Canada. It was published online on December 9, 2025, as a research letter in JAMA Network Open.

LIMITATIONS:

The study was conducted in a limited number of pediatric EDs; future studies in multicenter general emergency care settings may be needed to better evaluate care bundle delivery and its effects. Additionally, incomplete data collection was identified as a limitation.

DISCLOSURES:

The study received funding from Alberta Innovates and Alberta Health Services through the Grant Partnership for Research and Innovation in the Health System Program. One author reported receiving grants from the Canadian Institutes of Health Research outside the submitted work, and another author was supported by the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.