Stepped care solutions to reduce impact of the COVID-19 pandemic on youth living with chronic pain, their families, and health care providers: A pan-Canadian study.

The COVID-19 pandemic is one of the greatest threats to youth mental health in generations. Similar to past disasters, youth today report increased pain complaints. Without treatment, this pain will become chronic (CP; pain lasting >3 months), which already affects 1 in 5 youth and has devastating impacts on whole families. CP in childhood can trigger a wave of mental health and substance misuse issues that carry forward into adulthood. In 2019, our team revealed that "access to pain care" is a priority for youth with CP and families. Unfortunately, COVID-19 has only made access more difficult. CP clinics cannot see patients in person and only some can offer virtual care. Meanwhile, youth have lost access to school counselors, and physical distancing has likely worsened their mental health. The pandemic offers a once-in-a-lifetime chance to improve access to CP care moving foward. "Stepped care" is a promising way to do this. A good thing about stepped care is that it tailors care based on how bad a person's symptoms are. Like a ladder, a person may start with one type of care and then "step up" or "step down" to more or less intense care depending on need. We want to hear from youth, families, and healthcare professionals (HCPs) in the CP community about COVID-19 impacts. We will then create a "stepped care" program called Kids Pain Portal. This online Portal will increase access to CP care and ensure youth get the right treatment at the right time. Our study has four phases. In Phase 1, youth, families, and HCPs from across Canada will complete online surveys. In Phase 2, we will interview some patients, families, and HCPs from Phase 1. These surveys and interviews will tell us about COVID-19 impacts on CP care. In Phase 3, we will meet with HCPs, researchers, and family partners. There, we will create best practice recommendations for virtual "stepped care" in Canada. In Phase 4, we will co-design the Kids Pain Portal and ensure it is easy and satisfying to use.