One in seven young people aged 10–19 suffers from a mental health condition that can change the course of their lives, yet only half respond to treatment. This “Global Crisis of Child and Adolescent Mental Health” demands new solutions. Imagine a world where early signs are recognized, treatments are tailored to each child, and diagnosing and treating mental disorders no longer takes years.

Over weeks of Zoom calls—Ottawa mornings, Barcelona evenings—I spent more than 80 hours collaborating with two remarkable leaders at the Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Dr. Kathleen Pajer and Christina Honeywell, who, together with their colleagues, are determined to make this vision a reality.

Our shared mission? To design a measurement and evaluation framework to guide the pioneering work of the Precision Child and Youth Mental Health (PCYMH) Collaboratory

This fascinating partnership began when Christina replied to my LinkedIn note about needing a practical project for my Health Data for Innovation Professional Certificate .

What follows are insights from our discussions, together with my reflections.

1. Why is focusing on mental health of children and youth so important?

75% of the lifetime burden from mental disorders emerges by age 24. Early intervention can be transformative. When mental health challenges are identified in childhood or adolescence, life trajectories can be altered in profound ways.

As of September 2025, mental health disorders currently account for 15% of the global disease burden among 10–19 year olds, and suicide is the third leading cause of death among adolescents aged 15–19.

Despite the scale of the problem, only less than 50% of children and adolescents with mental health disorders respond to treatment. Precision mental health has the potential to improve these odds.

2. What is precision mental health?

Precision mental health, also known as precision psychiatry, is an emerging field that applies an individualized approach to mental health care. Instead of relying on what works for the “average patient,” it tailors care based on the specific biological, psychological, environmental, and lifestyle characteristics of each individual.

3. Don't doctors already tailor the treatment for each patient? How is precision mental health any different?

Traditional mental health care relies on limited information—demographics and subjective symptom reports—unlike other medical fields that use laboratory tests to assess biological processes.

Diagnoses are based on broad categories that group people by symptom clusters. But broad diagnostic categories can combine individuals who may need very different treatments.
This often leads to a trial-and-error approach: try one therapy or medication and move to the next if it is ineffective. This process can be emotionally exhausting for patients and families and imposes significant costs on health systems.

This challenge has driven interest in more precise approaches to mental health care.

Advances in omics technologies (e.g., genomics, transcriptomics, proteomics, metabolomics), computing power, and AI now make it possible to access and integrate more extensive and diverse data about individuals—including genetics, brain function, imaging, demographics, wearable devices, and biomarkers such as saliva or baby teeth. This comprehensive view enables more precise diagnosis, treatment, and prognosis tailored to each child or youth.

Watch Dr. Pajer explain this difference:

4. What’s a Collaboratory?

In this context, the Precision Child and Youth Mental Health (PCYMH) Collaboratory at the CHEO Research Institute is a space where researchers, clinicians, data scientists, patients, and caregivers work together to find solutions to mental health challenges.

As a transdisciplinary approach to implementing precision mental health, the Collaboratory is itself an innovation and offers important lessons that can be shared with others.

5. What is an example of a projects that the Collaboratory is working on?

One recent project focused on predicting which children and youth are most likely to return to the emergency department for mental health reasons. These types of predictions are critical for improving patient outcomes and optimizing use of healthcare resources. The Collaboratory team aimed to develop a predictive algorithm incorporating machine learning with electronic health records and validated against a clinician-driven algorithm. They will be sharing what they learned through a forthcoming publication.

6. Why is measurement so critical in this emerging field?

Without measurement and evaluation, we lose the insights needed to guide decisions—both short-term and long-term. If we can’t show value, or understand what’s working and what isn’t, we can’t make the case for precision mental health, improve it, or share lessons with others.

I once wrote on a slide: “Evaluation is important because …” Dr. Pajer stopped me: “We should say critical. Not just important. Critical.”

Important Critical

7. What does a measurement framework help us do?

*Janus* *is the Roman god, with two faces, one looking forward and one looking backward.*
A good measurement and evaluation framework helps us look both into the future and backwards.

First, it guides us toward the future we imagine: children and youth whose mental health challenges are recognized early, whose treatments are tailored to their unique needs, whose long-term well-being improves. From that vision, we work backward: What steps get us there? Which short-term goals do we need to achieve first? What should we test, refine, or abandon? What do we measure along the way to know we’re on course?

As the program unfolds piece by piece, the evaluation helps us reflect back and analyze the data to see what’s working, for whom, how, and in what context.

“Our logic model—a visual map that shows how planned activities are linked to intended results—helps connect the dots between the Collaboratory's efforts and benefits for children and youth, keeping their needs at the heart of every effort,” Christina said.

This dots metaphor resonated perfectly. Of course that’s the role of a logic model: connecting the dots, literally and figuratively!

8. What makes this measurement framework stand out?

Precision mental health for youth is still in its infancy, and guidance on monitoring and evaluation is limited. Most existing studies focus on clinical evaluation of precision medicine solutions, rather than program- or Collaboratory-level evaluation. To our knowledge, this will be one of the first comprehensive measurement and evaluation frameworks for a precision mental health program targeting children and youth.

The framework is designed as a living document—flexible to adapt as new evidence, technologies, and lessons emerge. That adaptability reflects the Collaboratory’s spirit of experimentation: try, learn, refine, and move forward.

We hope that publishing this framework will provide a valuable reference for others.

9. What advice would you give to others trying similar innovations?

See evaluation as part of the innovation itself—not a burden. Yes, it requires extra work upfront, but the benefits far outweigh the effort. Here’s what you’ll gain by embedding evaluation into your innovation:

10. What's ahead?

Precision mental health holds enormous promise—but only if its benefits are shared widely, as UNICEF’s Office of Innovation cautions.

At present, precision health innovations, including precision mental health, are developed in resource-rich countries and remain largely unaffordable for most of the world’s populations. Equally concerning, some groups of children and youth are completely missing from the data used to build these solutions.

Trends in precision health research from 2010–2020, which included data on children and youth, show significant gaps in demographic representation, including women, First Nations people, minority groups, people with disabilities, and people from the LGBTQI+ community.

Within the Collaboratory, the team sees these challenges firsthand: AI models trained on unrepresentative data risk reinforcing biases, with potentially harmful consequences. Another critical challenge is bringing precision mental health into communities—reaching all children and youth, not just those who can access hospitals.

This is particularly relevant to CHEO, who serves children, youth and families in Eastern Ontario, Western Quebec, Nunavut and Northern Ontario. This is a vast geographic area and includes many remote communities who would need to travel hundreds of kilometers to obtain care.

These are complex challenges and no single organization or group can solve them alone. The Collaboratory, however, is making a meaningful contribution by raising awareness, forging strategic partnerships, and pursuing rigorous research and care.

We can’t predict exactly what the future will hold, but we know the right question to ask: as we create this new world for child and youth mental health, how do we ensure it is truly inclusive?
Acknowledgements

I would like to thank all CHEO RI/ PCYMH Collaboratory/CHEO staff who provided insights, participated in meetings, and assisted with coordination of activities related to this project, including:

Dr. Kathleen Pajer, Director, Precision Child and Youth Mental Health Collaboratory, CHEO Research Institute
Christina Honeywell, Co-Director, Precision Child and Youth Mental Health Collaboratory, CHEO Research Institute
Tammy DeGiovanni, Senior Vice President Clinical Services and Chief Nurse Executive at CHEO
Dr. Jason Berman, CEO and Scientific Director at CHEO Research Institute
Dr. Jeff Gilchrist, Senior AI Data Scientist at CHEO Research Institute
Ivan Terekhov, Director, Research Informatics, AI & Technology at CHEO Research Institute
Navjot Kaur Bians, AI Scientist, CHEO Research Institute
Himani Dhaundiyal, Administrative Assistant, PCYMH Collaboratory

I would also like to thank EIT-Health Health Data for Innovation Professional Certificate Faculty and staff, including:

Dr. Isabel Rocha (Lisbon School of Medicine, Universidade de Lisboa)
Sinead O’Connor (CEO, Ethomix; Adjunct Professor, School of Medicine, Trinity College Dublin)
Dr. Farhad Abtahi (Assistant Professor, Department of Clinical Science, Intervention, and Technology, Karolinska Institute)
Dr. Gema Ibáñez Sánchez (Associate Professor, Universitat Politècnica de València)
Dr. Vicente Traver (R\&D Director, SABIEN; Universitat Politècnica de València)
Fernando Seoane, Senior Lecturer at Karolinska institutet
Montse Delgado Llavina (Head of Entrepreneurship Education, EIT Health)

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Building a New World for Child and Youth Mental Health: A Conversation on the Critical Role of Measurement in Innovation