William Gardner

• PhD
• Chair at Children's Hospital of Eastern Ontario

Background Emergency departments (EDs) are often the first access point for children and youth seeking mental health (MH) and addiction care. However, many EDs are unprepared to manage large volumes of pediatric MH patients. In addition, the fragmented Canadian MH system is challenged in connecting youth seen in the ED for follow-up community servi...

Background The prescribing of antidepressants and antipsychotics to children has increased worldwide, but little is known about how changes in drug funding policy influence the practice. In 2018, Ontario introduced a universal pharmacare program (OHIP+) for children and youth, amending it in April 2019 to cover only those without private insurance....

Primary care providers (PCPs) report insufficient capacity for child and youth mental health care (CYMH). The telementoring program Project ECHO (Extension for Community Healthcare Outcomes) can build capacity, but 75- to 120-minute sessions are a participation barrier. Using a Lean health care paradigm, we designed a 60-minute session, and compare...

COVID-19 associated public health measures and school closures exacerbated symptoms in some children and youth with attention-deficit hyperactivity disorder (ADHD). Less well understood is how the pandemic influenced patterns of prescription stimulant use. We conducted a population-based study of stimulant dispensing to children and youth ≤ 24 year...

Background and Methods We conducted a population‐based, retrospective cohort study of first‐time emergency department (ED) visits in adolescents and young adults (AYA) due to alcohol and compared mortality to AYA with non‐alcohol ED visits between 2009 and 2015 using standardized all‐cause mortality ratios (age, sex, income, and rurality). We descr...

Background The COVID-19 pandemic was associated with increases in the prevalence of depression, anxiety and behavioural problems among children and youth. Less well understood is the influence of the pandemic on antidepressant and antipsychotic use among children. This is important, as it is possible that antidepressants and antipsychotics were use...

Objective To assess physician-based mental health care utilization during the COVID-19 pandemic among children and adolescents new to care and those already engaged with mental health services, and to evaluate differences by sociodemographic factors. Study design We performed a population-based repeated cross-sectional study using linked health an...

Background In January 2018, the Government of Ontario, Canada, initiated a universal pharmacare program (OHIP+) for all individuals aged 24 years and younger. In April 2019, the program was amended to cover only children and youth without private insurance. Because benzodiazepines are commonly prescribed to children and youth despite their potentia...

Background and objectives: Anxiety disorder diagnoses in office-based settings increased for children through the mid-2010s, but recent changes in diagnosis and treatment are not well understood. The objectives of the current study were to evaluate recent trends in anxiety disorder diagnosis and treatment among children, adolescents, and young adu...

Background In 2011, the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) published guidelines for the metabolic monitoring of antipsychotic-treated children and youth. Population-based studies examining adherence to these guidelines are needed to ensure the safe use of antipsychotics in children and y...

Objective: Stimulants are first-line pharmacotherapy for individuals with attention-deficit hyperactivity disorder. However, disparities in drug coverage may contribute to inequitable treatment access. In January 2018, the government of Ontario, Canada, implemented a publicly-funded program (OHIP+) providing universal access to medications at no c...

Objective: We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. Methods: This population-based repeated cross-sectional study of children and adolescents (3-17 years; N =...

Background Population-based research examining geographic variability in psychotropic medication dispensing to children and youth and the sociodemographic correlates of such variation is lacking. Variation in psychotropic use could reflect disparities in access to non-pharmacologic interventions and identify potentially concerning use patterns. Me...

Severe antisocial behavior in girls, best exemplified by conduct disorder (CD), is a serious clinical and public health problem. Treatment is difficult, particularly in girls with comorbid internalizing disorders. Identifying biological correlates may help to develop new treatments or diagnostic, prognostic, or treatment response biomarkers. Based...

This paper describes a solution approach for stochastic multi‐resource multi‐patient staff scheduling problems in inpatient units. Our solution approach has four steps. First, we classify patients into a number of groups with similar care‐provider requirements. Second, a predictive Markov model captures patients' flow in the inpatient unit and prov...

Many factors influence the health and well-being of children and the adults they will become. Yet there are significant gaps in how trajectories of healthy development are measured, how the potential for leading a healthy life is evaluated, and how that information can guide upstream policies and investments. The Gross Developmental Potential (GDP2...

Background Self-harm in children and adolescents is difficult to treat. Peripheral and neural correlates of self-harm could lead to biomarkers to guide precision care. We therefore conducted a scoping review of research on peripheral and neural correlates of self-harm in this age group. Methods PubMed and Embase databases were searched from Januar...

Child and adolescent mental health (CAMH) problems are prevalent and inefficient mental health (MH) care systems can contribute to poor outcomes. The Choice and Partnership Approach (CAPA) is a MH care delivery model aiming to provide efficient, high-quality care. Although widely used, no CAPA research review exists. We conducted a scoping review t...

Importance: Concussion may exacerbate existing mental health issues. Little evidence exists on whether concussion is associated with the onset of new psychopathologies or long-term mental health problems. Objective: To investigate associations between concussion and risk of subsequent mental health issues, psychiatric hospitalizations, self-harm...

Background Spinal pain and major depression are prevalent conditions in adult populations and are particularly impactful in the military. However, the temporal relationship between these two conditions remains poorly understood.Methods Using data extracted from electronic medical records, we assessed the association between incident diagnoses of sp...

Introduction: The COVID-19 pandemic has introduced new stressors for parents ("caregivers") that may affect their own and their child's mental health (MH). We explored self-reported levels of caregiver strain (parents' perceived ability to meet parenting demands), and the MH and sociodemographic factors of caregivers to identify predictors of stra...

Background: Cannabis-related emergency department visits can be an entry point for youths to mental health and substance use care systems. We aimed to examine trends in cannabis-related emergency department visits as a function of youths' age and sex. Methods: Using administrative data, we examined all visits to emergency departments in Ontario,...

Importance: Public health measures to reduce the spread of COVID-19 have heightened distress among children and adolescents and contributed to a shift in delivery of mental health care services. Objectives: To measure and compare physician-based outpatient mental health care utilization before and during the COVID-19 pandemic and quantify the ex...

Many factors influence health and well-being of children and the adults they will become. Yet there are significant gaps in how trajectories of healthy development are measured, and the potential for leading a healthy life is evaluated. The Gross Developmental Potential (GDP2) is proposed as a new capabilities-based framework for assessing threats...

We investigated young people’s mental health (MH) and preferences for future MH services early in the Covid-19 pandemic to support user-centered service planning and delivery. We administered a webbased survey to young people living in Ontario. Logistic regressions identified predictors of worsening MH and service preferences among a sample of 1341...

Background Self-harm in children and adolescents is difficult to treat. Peripheral and neural correlates of self-harm could lead to biomarkers to guide precision care. We therefore conducted a scoping review of research on peripheral and neural correlates of self-harm in this age group. Methods PubMed and Embase databases were searched from Januar...

Background and objectives: Screening interventions in pediatric primary care often have limited effects on patients' health. Using simulation, we examined what conditions must hold for screening to improve population health outcomes, using screening for depression in adolescence as an example. Methods: Through simulation, we varied parameters de...

The COVID-19 pandemic exacerbates the mental, emotional, and behavioral (MEB) health problems of children and adolescents in the United States (U.S.). A collective and coordinated national economic and social reconstruction effort aimed at shoring up services to promote children's MEB, like the Marshall Plan that helped rebuild Europe post-World Wa...

Background: Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)—including, but not limited to, problems in inaccessibility and quality of services—are widespread. Characterizing the nature of equity in CYMHS is an ongoing...

Objective: This study compared practitioner self-report of ADHD quality of care measures with actual performance, as documented by chart review. Method: In total, 188 practitioners from 50 pediatric practices completed questionnaires in which they self-reported estimates of ADHD quality of care indicators. A total of 1,599 charts were reviewed. Res...

Although exposure to ambient air pollution has been linked to mental health problems, little is known about its potential effects on youth. This study investigates the association between short-term exposure to air pollutants and emergency department (ED) visits for mental health disorders. The National Ambulatory Care Reporting System database was...

Purpose Major depression is a leading cause of morbidity in military populations. However, due to a lack of longitudinal data, little is known about the rate at which military personnel experience the onset of new episodes of major depression. We used a new source of clinical and administrative data to estimate the incidence of major depression dia...

The elderly in long-term care (LTC) and their caregiving staff are at elevated risk from COVID-19. Outbreaks in LTC facilities can threaten the health care system. COVID-19 suppression should focus on testing and infection control at LTC facilities. Policies should also be developed to ensure that LTC facilities remain adequately staffed and that i...

Introduction Major depression is a leading cause of morbidity in military personnel and an important impediment to operational readiness in military organizations. Although treatment options are available, a large proportion of individuals with depression do not access mental health services. Quantifying and closing this treatment gap is a public h...

This collection offers an evidence-based approach to evaluating children for ADHD. https://shop.aap.org/pediatric-collections-adhd-evaluation-and-care-paperback/

This collection offers an evidence-based approach to evaluating children for ADHD. https://shop.aap.org/pediatric-collections-adhd-evaluation-and-care-paperback/

Background: Self-harm is increasing among adolescents, and because of changing behaviours, current data are needed on the consequences of self-harm. We sought to investigate the trends related to hospital presentation, readmission, patient outcome and medical costs in adolescents who presented with self-harm to the emergency department. Methods:...

There is a need to bring specialized medical expertise to rural and remote areas. Project ECHO offers a method to move knowledge from specialists in academic centres using videoconference, case-base learning, and best-practices knowledge sharing. Ontario has implemented ECHO since 2014 and has demonstrated favourable outcomes among primary care cli...

Objectives: To examine patient- and provider-level factors associated with receiving attention-deficit/hyperactivity disorder (ADHD) medication treatment in a community care setting. We hypothesized that the likelihood of ADHD medication receipt would be lower in groups with specific patient sociodemographic (eg, female sex, race other than white)...

Objective: To document the rates of intentional self-harm and mental disorders among youths aged 13 to 17 years visiting Ontario emergency departments (EDs) from 2003-2017. Methods: This was a repeated cross-sectional observational design. Outcomes were rates of adolescents with (1) at least 1 self-harm ED visit and (2) a visit with a mental dis...

Background: Major depression is prevalent, impactful, and treatable in military populations, but not all depressed personnel seek professional care in a given year. Care-seeking patterns (including the use of primary vs. specialty care) and factors associated with the likelihood of mental health service utilization in depressed military personnel...

en The New Public Governance (NPG) paradigm addresses problems of complex and fragmented policy‐making. Health care is an increasingly complex policy area, and Canada has one of the most fragmented health care systems in the world. The theoretical articulation of NPG is compelling, and seems well suited to Canadian health care. However, it is not c...

Objective: To provide psychometric evaluation of the PROMIS® Pediatric Psychological and Physical Stress Experiences measures. Methods: Across two studies, Psychological and Physical Stress Experiences items were administered to 2,875 children aged 8-17 years and 2,212 parents of children aged 5-17 years. Analyses included descriptive statistics...

In Reply We thank Webbe et al for their thoughtful comments on our brief article.¹ We are glad they concur with the primary points, in particular, the need for a global set of concise pediatric measures, a focus on outcomes, and the early and frequent inclusion of child, family, and other stakeholder perspectives.

Objective: The Choice and Partnership Approach (CAPA) is designed to improve access and quality of pediatric mental health care. We tested whether CAPA improved access in an academic pediatric hospital. Method: We used de-identified administrative data to compare access pre- (2011) and post-CAPA (2013). Results: Wait time to first appointment...

We call for a national effort to develop a parsimonious set of quality and outcome measures for children. The target users are health care organizations that are accountable for large pediatric populations. These organizations need an efficient set of measures that will direct them toward meaningful health improvement efforts and that capture the h...

Antisocial behaviour disorders (ABDs) are among the most costly and treatment resistant of all psychiatric syndromes. Select neurodevelopmental abnormalities have been labelled a risk factor for ABDs, but it is unknown if maternal ABDs are associated with early neurodevelopmental abnormalities. This study tested whether infants of ABD mothers had m...

Objective: The goal of this trial was to present a case study of care coordination for children and youth with special health care needs from an exclusively pediatric accountable care organization, and compare precare and postcare data on their use of inpatient and emergency department services. Methods: This pre-post comparison of the health ca...

Background It has been suggested that offspring of parents with bipolar disorder are at increased risk for disruptive mood dysregulation disorder (DMDD), but the specificity of this association has not been established.AimsWe examined the specificity of DMDD to family history by comparing offspring of parents with (a) bipolar disorder, (b) major de...

Objective The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of AD...

Background: Comprehensive picture of population health status can be captured by the incorporation of patient reported outcome measures into population health monitoring. Objective: To identify current state, opportunities, and future research related to the utilization of patient reported outcome measures for population health monitoring in Can...

Background: Given that the goal of healthcare systems is to improve and maintain the health of the populations they serve, the indicators of performance must include outcomes that are meaningful to patients. The growth of health technologies provides an unprecedented opportunity to integrate the patient voice into clinical care by linking electron...

Rural children from small communities in the United States are more likely than those living in cities and suburbs to have a mental, behavioral, or developmental disorder. What might cause this disparity? And how do we care for these children and their families?

Background: Obtaining the patient's view about the outcome of care is an essential component of patient-centred care. Many patient-reported outcome (PRO) instruments for different purposes have been developed since the 1960s. Measurement validation is fundamental in the development, evaluation, and use of PRO instruments. Objective: This paper p...

The goal of this study is to evaluate feasibility and estimate effect sizes of omega-3 fatty acids (Ω3), individual-family psychoeducational psychotherapy (PEP), their combination, and moderating effects of maternal depression and psychosocial stressors in youth with depression. In a pilot 2 × 2 randomized controlled trial, 72 youth (ages 7–14; 57%...

Objective: Children with attention deficit hyperactivity disorder (ADHD) often exhibit psychiatric comorbidities, which may impact illness presentation, diagnosis, and treatment outcomes. Guidelines exist for dealing with these complex cases but little is known about how comorbidities are being handled in community pediatric settings. The purpose...

Background: The quality of care for children with attention-deficit/hyperactivity disorder (ADHD) delivered in community-based pediatric settings is often poor. Interventions have been developed to improve community-based ADHD care but have not demonstrated that better care results in improved patient outcomes. The objective of this study was to d...

Written from the perspective of hospitals, this article examines, in theory and in practice, challenges associated with hospitals’ efforts to engage in neighborhood development more fully with the communities that neighbor them. Increasingly, these efforts include significant investments in housing, safety, and educational initiatives. These invest...

Background While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication among these groups is often poor,...

Objective: The aim of this analysis was to determine changes in patterns of depression screening and diagnosis over three years in primary and specialty mental health care in a large health maintenance organization (HMO) as part of a project to develop quality measures for adolescent depression treatment. Methods: Two series of aggregate data (2...

Importance Published guidelines describing effective adolescent depression care in primary care settings include screening, assessment, treatment initiation, and symptom monitoring. It is unclear the extent to which these steps are documented in patient health records.Objective To determine rates of appropriate follow-up care for adolescents with...

Objective: To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use. Method: A retrospective cohort from a random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started ADHD medication, was studied. Independent variable...

Importance Pay for performance (P4P) is a mechanism by which purchasers of health care offer greater financial rewards to physicians for improving processes or outcomes of care. To our knowledge, P4P has not been studied within the context of a pediatric accountable care organization (ACO).Objective To determine whether P4P promotes pediatric per...

Objective: This pilot study evaluates efficacy of omega-3 fatty acid supplementation (Ω3), individual family psychoeducational psychotherapy (IF-PEP), and their combination in youth with subsyndromal bipolar disorders (bipolar disorder not otherwise specified [BP-NOS], cyclothymic disorder [CYC]). Methods: This study was a 12 week, randomized tr...

Pierre-Gerlier Forest and his colleagues make a strong argument for the need to expand policy capacity among healthcare actors. In this commentary, I develop an additional argument in support of Forest et al view. Forest et al rightly point to the need to have embedded policy experts to successfully translate healthcare reform policy into healthcar...

Canadians are, at best, only "marginally confident" in the future of Canada's healthcare system (Nanos and Jenkins 2014). They are skeptical that simply spending more money can address the issues underlying Canadian healthcare, yet they also doubt the country's capacity to harness innovative strategies to improve healthcare (ibid). These issues are...

To define risk factors associated with gastrostomy in premature infants receiving protracted mechanical ventilation (≥ 30 days). Retrospective data collected on 170 preterm neonates (birth weight < 1500 g) who received uninterrupted mechanical ventilation for ≥30 days was analyzed with logistic regression methods to predict the association of gastr...

To determine the extent to which it is feasible to implement quality measures on electronic health records (EHRs) as currently implemented in pediatric health centers. A survey of information technology professionals at 10 institutions that provide primary care services to adolescents. The survey asked whether data about care was being captured ele...

Endothelial dysfunction predicts adult cardiovascular disorder and may be associated with negative emotions in adolescents. This study was conducted to determine if hopelessness, hostility, and depressive, anxiety, or conduct disorders were associated with compromised endothelial function and whether those associations were mediated by health risk...

Accountable care organizations (ACOs) are responsible for costs and quality across a defined population. To succeed, the ACO must improve value by reducing costs while either maintaining or improving the quality of care. We examined changes from 2008 through 2013 in the cost and quality of care for Partners for Kids (PFK), a pediatric ACO serving a...

Background Severe mental illness (SMI), including schizophrenia, bipolar disorder and severe depression, is responsible for a substantial proportion of disability in the population. This article describes the aims and design of a research study that takes a novel approach to targeted prevention of SMI. It is based on the rationale that early develo...

Background: Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder (ADHD) in community-based pediatric settings, little is known about typical ADHD care in these settings other than rates garnered through pediatrician self-report. Methods: Rates of evidence-based AD...

Background Monitoring quality is an important way of understanding how the health care system is serving children and families. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Pediatric Quality Measures Program (PQMP) funded efforts to develop and enhance measures to assess care for children and adolescents. We describe...

Objective We tested the hypothesis that Respiratory Severity Score (RSS) on day of life 30 is predictive of mortality and length of mechanical ventilation in premature infants on prolonged mechanical ventilation. MethodsA retrospective chart review was performed using the Nationwide Children's Hospital medical record and Vermont-Oxford Network data...

A learning health care system (LHCS) continuously gathers data, evaluates them, and implements change to improve quality, health outcomes, and save costs.1 LHCSs have been discussed for adult health care but could also be important in the improvement of pediatrics. However, the mission of a pediatric LHCS should be driven by the distinctive goals o...

Objective: Adolescent mothers are at increased risk of mistreating their children. Intervening before they become pregnant would be an ideal primary prevention strategy. Our goal was to determine whether psychopathology, exposure to maltreatment, preparedness for child-bearing, substance use disorders (SUDs), IQ, race, and socioeconomic status wer...

To determine whether quality measures based on computer-extracted EHR data can reproduce findings based on data manually extracted by reviewers. We studied 12 measures of care indicated for adolescent well-care visits for 597 patients in three pediatric health systems. Observational study. Manual reviewers collected quality data from the EHR. Site...

To determine the practice variance, prevalence, and economic burden of clinically diagnosed gastroesophageal reflux disease (GERD) in preterm infants. Applying a retrospective cohort study design, we analyzed data from 18 567 preterm infants of 22 to 36 weeks' gestation and >400 g birth weight from the NICUs of 33 freestanding children's hospitals...

Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and sp...

In this book, we provide a thorough review of the literature concerning the origins, interpretation, and developmental significance of individual differences in early infant-parent attachment. The orientation we adopt borrows heavily from the ethological framework presented by Mary Ainsworth and John Bowlby. As progenitors of this powerful theoreti...

Background: Quality measurement is central in efforts to improve health care delivery and financing. The Interdisciplinary Nursing Quality Research Initiative supported interdisciplinary research teams to address gaps in measuring the contributions of nursing to quality care. Objective: To summarize the research of 4 interdisciplinary teams funded...

Optimizing the timing and safety for the placement of a tracheostomy in infants with bronchopulmonary dysplasia (BPD) has not been determined. The purpose of the present study was to describe the data from a single institution about the efficacy and safety of tracheostomy placement in infants with BPD needing long-term respiratory support. We estab...

Objective: To describe the qualitative development of the Patient-Reported Outcome Measurement Information System (PROMIS®) Pediatric Stress Response item banks. Methods: Stress response concepts were specified through a literature review and interviews with content experts, children, and parents. A library comprising 2,677 items derived from 71...

The practice of maintaining large Institutional Review Boards (IRBs) raises the question whether membership that extends much beyond the minimal regulatory requirements is necessary. Anecdotal data suggest that chairs and reviewers assigned for each protocol may make the greatest contributions to discussions, but to date there have been no systemat...

Lifetime health disparity between African-American and white females begins with lower birthweight and higher rates of childhood overweight. In adolescence, African-American girls experience earlier menarche. Understanding the origins of these health disparities is a national priority. There is growing literature suggesting that the life course hea...