Background: Limitations of the traditional assessment for autism include the cost and length of the assessments and subsequent long waiting lists (often extending to two years) and reduced accessibility. Additionally, conventional assessment tools have questionable applicability to non-white, non-English speaking and non-male populations. There is a need for novel, efficient, equitable and culturally sensitive autism diagnostic assessments.
CHATA consists of two elements: first, a set of pre-assessment autism questionnaires delivered online (available in written and aural format).To increase accessibility we provided audio descriptions, translations into the two most commonly spoken languages of the population on our waiting list in East London(Bangla and Urdu) that caregivers can complete in their own time; second, a structured, short, online observational assessment of the child’s behavior and interaction with their caregiver. Information from these two procedures is combined to determine the likelihood for an autism diagnosis.
An important aspect of this research is to develop tools that are effective and acceptable for our target populations, we addressed this by using a variety of assessment methods that are not solely English-language-based and also developing our research with input from PPI in order to establish whether our ideas are suitable and acceptable to the target population. Project development was informed by PPI before and during the study. Alongside this we gained feedback from two focus group we conducted which allowed us to refine the study procedure. Two systematic reviews informed intervention development and concluded telehealth assessments for autism were comparable to in-person assessments (above 80%).
Objective: The aim of CHATA project is development and empirical examination of a new, autism diagnostic pathway for children up to five years old, which is offered via Telehealth, integrated within usual NHS digital systems and applicable to the target population in East London where– one of the most ethically and linguistically diverse populations in the UK.
Methods: This is an intervention development and pilot implementation evaluation study. We have completed a 6-month acceptability, feasibility and usability pilot study. We conducted a clinical validation study, comparing the predictions made by the CHATA pathway with the subsequent diagnosis made by independent clinicians from the Children with Autism in Newham Diagnostic service (CHAND).
Results: Preliminary data show excellent (100%) concordance between the predictions made by the CHATA assessment and the outcomes from the CHAND assessment pathway. The CHATA process has proved to have good acceptability and feasibility. We worked closely with families and clinicians to optimise the design of the CHATA, with iterative updates to the process over the period of development.
Conclusions: A rapid increase in the use of telehealth and the need to provide accurate and convenient services to diverse populations necessitate the development of novel assessments for autism.
The longer-term objective of the CHATA project is to embed the CHATA into ‘usual care’ for children with suspected autism. We aim to provide the assessment protocol for trialling in other clinical services and adapt it to other ethnic minority languages. Also aim to modify the procedure that suitable for school-age children.

Integrated youth services (IYS) have developed at a rapid rate in Canada and across the globe as an innovative way to organize and deliver mental health and substance use (MHSU) services to young people, centering youth co-development and engagement as core components of model development. Youth Wellness Hubs Ontario (YWHO) is Ontario’s commitment to improved service access and outcomes for youth aged 12-25 through the implementation of IYS hubs that provide rapid access to walk-in, low-barrier MHSU, physical health, and social services in a convenient, youth-friendly setting. There are 22 funded YWHO networks operating youth hubs in 31 communities (large urban, small urban, rural, Francophone, Indigenous) throughout Ontario. These hubs provide mental health, substance use, primary care, education, employment, housing, and other health and social services. YWHO teams, embedded within existing local services, provide a single point of entry for young people to access a range of services.

Aligned with flexible services and approaches to mental health service delivery that empower youth in their own service journey, YWHO has developed a virtual platform (YWHO Virtual) co-designed with youth, families, and service providers that provides for young people, safe, secure and timely access to mental health and substance use services, as well as other primary care, community and social support services. Platform development and features have been co-designed with several provincial and local youth and family groups: YWHO has established a Digital Action Advisory Group (DAAG) made up of youth and family members who have been involved in the development of the platform; a Provincial Youth Advisory Council, a Provincial Indigenous Youth and Family Advisory Circle, and local youth at YWHO sites.

The virtual hub offers an accessible solution for youth facing challenges in reaching in-person hubs, whether due to geographical constraints or personal circumstances. This youth-centric platform, co-designed by and for young people, provides a safe and welcoming space for them to receive the care they require. The virtual hub contributes to ensuring youth can access services from any location. This is especially advantageous for those residing in remote or underserved areas, those who are hesitant to access services due to stigma and those who experience physical and mental health challenges that make it challenging to access in-person services away from home.

Youth have the independence to request and schedule appointments at their own convenience, eliminating the necessity for travel or support from a family member who may be a barrier to accessing services due to stigma. The virtual hub ensures that youth can maintain uninterrupted access to the support they require. In situations where it is not feasible for youth to attend regular in-person appointments, they can request a virtual appointment to provide them with access to continuity of their care.

This presentation will share the web application platform and features, the co-designed elements and innovations, the integration of data collected on the platform with in-person service-level data, and the lessons learned in the pilot launch across five sites of this initiative. Next steps is implementation across all Networks.

Background
As health services shift towards more patient-centred care, the importance of patient-reported outcome measures (PROMs) is increasingly recognized. PROMs can effectively capture patients’ perspectives and enable meaningful engagement. This research program aims to improve health outcomes for pediatric patients by systematically implementing PROMs into clinical practice. We have targeted methodological and practical decisions needed to guide effective integration of PROMs into care settings with a phased approach, including a systematic review (Phase 1), key stakeholder interviews (Phase 2), and a consensus workshop (Phase 3). The preliminary evidence that informed this project addressed critical elements within implementation science, including assessing fit and readiness for change, establishing stakeholder buy-in and fostering a supportive environment. In this study, we designed (Phase 4) and tested the usability (Phase 5) of an electronic PROM (ePROM) platform called Voxe.

Methods
A user-centred approach, in which end-users (i.e., patients and healthcare providers (HCPs)) are central to the design process and usability testing, guided Voxe platform creation. Iterative testing sessions involved participants from The Hospital for Sick Children (SickKids) and Children’s Hospital of Eastern Ontario (CHEO) completing (1) tasks on design wireframes and prototypes to evaluate effectiveness and efficiency, (2) the Microsoft Desirability Toolkit, a system usability scale, and (3) a semi-structured interview to assess satisfaction and gather user feedback. This methodology was implemented to ʻtest, learn and improveʼ Voxe prior to full development and launch.

Results
Forty-nine patients aged 8-17 years (n=25 solid organ transplant patients receiving care at SickKids; n=24 hematology and oncology patients receiving care at CHEO) and 38 of their HCPs (n=22 HCPs from SickKids; n=16 HCPs from CHEO) participated. Iterative and sequential testing rounds demonstrated improved effectiveness as the proportion of successfully completed tasks increased from 74% to 85%. Efficiency improved as time-to-task decreased from 23.2 to 15.8 seconds. Patients described Voxe as “fun”, “friendly”, “helpful”, “easy”, “calm”, “clear” and “creative”. Patients shared “[Voxe] makes you feel like you’re welcome in the hospital” and “…it feels like you can get better with this app”. HCPs highlighted that Voxe is “intuitive” and enables “a more patient-centered model of care”. HCPs also remarked “it [Voxe] is very user friendly”, “it [Voxe] is pretty clear and easy to use”, and “I can see Voxe naturally fitting into what we do already”.

Conclusion
Findings will influence how Voxe looks and operates to drive successful and sustainable adoption and the meaningful use of digital solutions and shared data for information and care management. Although solid organ transplant patients, hematology and oncology patients, and their HCPs participated in the design and testing, Voxe could be implemented with any pediatric population as it was built to accommodate any ePROM. Voxe acknowledges and supports patients as partners in their health and healthcare and fosters meaningful patient engagement. Future research will assess the implementation effectiveness of the Voxe ePROM platform. Ultimately, Voxe leverages eHealth technology as an innovative approach to meaningfully capture and integrate patients’ voices and transform their care experiences.

Background
Digital solution is one of the major pillars of integrated care. However, as a form of digital health, current mobile health (mHealth) tools and interventions for youth mental health are highly unregulated and lack engagement in the design, development, and implementation stages. Evidence suggests that most mHealth tools and interventions are expensive to develop and have a short shelf life. To date, limited research exists to understand how youth, mHealth developers, and health providers design tools and interventions for application within an integrated health service. The objective of this study was to describe the value of meaningful engagement of diverse stakeholders in the development, implementation, and scaling of mHealth tools and interventions for youth mental health services through a case study at an integrated youth services (IYS) initiative.

Methods
To understand stakeholder perception on how can youth be meaningfully engaged within the different stages of mHealth service delivery in an integrated system, our team recruited three types of participants, mHealth developers, service providers, and youth users. Participants were recruited at Foundry, is an integrated youth services (IYS) initiative based in British Columbia which creates a single point of access to care for youth ages 12-24. In 2020, Foundry launched its provincial virtual service, along with the Foundry BC app, to support youth with health care access during the COVID-19 pandemic. App development is ongoing and requires input from multiple stakeholders. We conducted semi-structured interviews via Zoom. All interviews were recorded and we used thematic analysis to understand the common and unique themes amongst the three groups.

Results
Currently, data continue to be collected to achieve saturation within the three groups and gain the perspectives of more diverse participants. Preliminary results suggest that integrating mHealth services into an IYS system is value-added to in-person services, and a key component of success is systematic collaboration with diverse stakeholders. Three main themes have emerged: 1) utilizing co-design efforts to ensure first-time impressions of the service are intriguing to youth and continuously fresh; 2) clearly defining roles throughout the ongoing processes of development, refinement, and scaling; and 3) building ongoing processes to ensure meaningful and ongoing participation of new youth and families. Across all three groups, participants suggested the term “engagement” be constantly examined to ensure the values are applied and participants are not tokenized.

Conclusion
Preliminary results suggest the value of engagement in mHealth development, but also the extensive effort needed to ensure it is done well in a rapidly functioning team working to meet the needs of youth. The results of the study are fundamental to establishing a guideline for collaborative engagement when developing integrated mHealth products and interventions that are sustainable and fit for purpose for the evolving needs of youth. What we are learning from this study can serve as an example for international partners to consider mHealth integration to current systems of and methods to engage youth at different stages of co-designing, testing, and scaling new mHealth interventions that are designed to last and have an impact.

Background
The Response for Vulnerable People (RVP) team evolved to support new migrants to ROI initially in the National Transit Centre and subsequently across over 70 geographic locations in Ireland aside from homeless settings.
Supporting thousands of distributed migrants that are new to the country with limited access to primary care required a change of approach. Through remote working a small clinical workforce is supported by a larger social care team who act as the eye’s ears and hands of the clinicians. This clinical team delivers healthcare and support directly to clients on site via video and phone call and responds to clinical complexity, outbreaks and other escalations across three counties of Ireland including the populous south inner city of Dublin.
Methods
Training social care workers as community health workers (CHW) and embedding them as a support to a clinical team broadens the reach and capacity of that team in a context of clinical skills scarcity.
Using an electronic medical records in supported by secure threaded team electronic communications platforms allows dynamic and efficient utilisation of clinical time.
A single clinician can remotely consult using video calls and instant messaging across the entire region, support numerous CHW and advise as many as 45 different patients and interface with multiple agencies in one day. There would not be recourse to efficient and appropriate care without this system which is safe and highly effective.
Results
Using digital communications (Slack) and data recording technologies (KOBO toolbox) and an Electronic Health Record (Open EMR) across the Response for Vulnerable People service has both increased the accessibility of clinical expertise and support available to non-clinically qualified teams of health care support workers and allowed the limited clinical resources to be optimally directed.
We upscaled our utilisation of a combination of secure messaging technology (Slack) during the development of our Migrant Health teams. We utilise distinct live channels that allow text, phone and video communication across our team of over 45 staff for both care planning and assessment. This team is clinically led and supported by 5 nurses and one GP in total. We provides advice, signposting and in limited circumstances urgent care and health promotion as well as primary care to a fluctuating population of approximately ten thousand migrants new to Ireland and 150 Roma families and complex homeless clients needing support.
Discussion
This communications approach is much more flexible than telephone or traditional communications technologies and allows non-qualified health care support staff much greater support from a small core of highly skilled clinical resource across diverse settings. This provides improved patient outcomes and reduces acute presentations. It also allows a level of service that would not be deliverable using traditional communication methods.

Like many countries, Wales has a real challenge at the front door of the emergency department. However, where is the front door these days? Is it the hospital building, the parked ambulance or the patient’s residence? For many it has become a mix of all three and all the while, their condition may deteriorate, and catastrophic harm can occur. Finding the answer is not easy; health care professionals’ capacity is stretched, estate is bulging, and money is tight, so what can be done? The Welsh Ambulance Service, with the support of Welsh Government, have been developing a community-based model that uses digital technology and our expertise in remote clinical assessment to enhance our capabilities and offers a path to a national model for dealing with personal wearable technology in health and social care. We have partnered with Luscii, Apple, NHS Charities Together and SBRI and we have commenced deployment of remote POC diagnostics through a community volunteer who links to our clinical workforce in an emergency control centre. The volunteer, the patient, their family and the clinician work together to make a decision on the most appropriate next stage in their urgent care need. But this is only stage one... our ambition is to realise the potential of a national healthcare infrastructure with experienced clinicians and effective digital solutions to offer primary and secondary prevention opportunities for all. This journey has started, we are doing it, and we want to share it!