Addiction, Mental Disorders
Conditions
Keywords
Mental Health, Randomized, Pragmatic, Integrated Collaborative Care, Addiction, Youth
Brief summary
Among youth, the prevalence of mental health and addiction (MHA) disorders is roughly 20%, yet youth are challenged to access services in a timely fashion. To address MHA system gaps, this study will test the benefits of an Integrated Collaborative Care Team (ICCT) model for at-risk youth with MHA challenges. In partnership with community agencies, adolescent psychiatry hospital departments, and family health teams, investigators have developed an innovative model of service provision involving rapid access to MHA services. This model will be implemented and compared to the usual treatment youth receive in hospital-based, outpatient, mental health clinics in Toronto. A rapid, systematic, approach to MHA services geared to need in a youth-friendly environment is expected to result in better MHA outcomes for youth. Moreover, the ICCT approach is expected to decrease service wait-times, be more youth- and family-centred, and be more cost-effective.
Detailed description
This study is a pragmatic randomized control trial (RCT) with random allocation occurring within each hospital site to either treatment as usual (TAU) (4 out-patient hospital sites) or treatment at one of 3 community-based Integrated Collaborative Care Teams (ICCTs). A total of 500 youth aged 14-18 with mental health and/or addictions (MHA) concerns, referred for out-patient services at one of four local hospitals, will be randomized to receive ICCT care versus TAU. For each youth, a primary caregiver will also be recruited into the study, if available. With wide inclusion criteria and a design meant to emulate a "real world" setting, this study will rigorously evaluate a service delivery model composed of multiple interventions for youth presenting with a broad range of MHA problems. The ICCT is expected to result in better MHA outcomes, show better performance indicators, and be more cost-effective than TAU.
Interventions
BEHAVIORALIntegrated Collaborative Care Team (ICCT)
An integrated, collaborative pathway of needs-based services. ICCTs will offer a wide variety of services, including Solution-Focused Brief Therapy (SFBT) on a scheduled and walk-in basis, care navigators, various clinician-guided interventions, psychiatry, nurse practitioner services, access to primary care, and peer support, all co-located in youth-friendly, community-based clinics. For each intervention, standardized intervention protocols will be used.
OTHERTreatment as Usual (TAU)
Standard out-patient treatment provided at each participating hospital site. This typically entails referral to a psychiatrist at the participating hospital, who will provide assessment and treatment, with referral to appropriate services, guided by local treatment protocols.
Sponsors
Centre for Addiction and Mental Health
East Metro Youth Services
Delisle Youth Services
LOFT Community Services
The Sashbear Foundation
The Anne Johnston Health Station
South East Toronto Family Health Team
Institute for Clinical Evaluative Sciences
Medical Psychiatry Alliance
Graham Boeckh Foundation
The Ontario Spor Support Unit
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
14 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
1. Provision of informed consent 2. Aged 14 - 17 years 11 months 3. New referrals to one of the four participating hospitals for out-patient MHA services 4. Among the population regularly accepted for out-patient services at that hospital
Exclusion criteria
1. Referral for specialty forensic or firesetting treatment 2. Moderate to severe intellectual disability or autism without MHA problems 3. Primary diagnosis of an eating disorder 4. Active psychosis or imminent risk of self-harm requiring immediate intervention 5. Inability to read and write English or to consent to the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Youth functioning | One year | Measured using the Columbia Impairment Scale (CIS) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical improvement | One year | Measured using Strengths and Difficulties Questionnaire |
| Problematic substance use | One year | Assessed using the GAIN Short Screener and the substance use table of the Adolescent Alcohol and Drug Involvement Scale |
| Satisfaction with the service models | One year | Assessed using the Ontario Perception of Care Tool for Mental Health and Addictions |
| Goal attainment | One year | Measured using a custom form indicating goals established by the youth and caregiver at intake, followed by a rating of goal attainment |
| Client empowerment and engagement | One year | Measured using the Family Empowerment Scale for caregivers, and the Youth Efficacy/Empowerment Scale for youth |
| Caregiver burden | One year | Measured using the Burden Assessment Scale |
| Quality-adjusted life years (QALYs) | One year | Measured using the Assessment of Quality of Life-6D (AQOL-6D) |
| Continuity of care | One year | Measured using the Continuity of Care in Children's Mental Health questionnaire |
| Cost-effective analysis (CEA) and a cost-utility analysis (CUA) | One year | Incremental costs of ICCT compared to TAU (treatment as usual) in improving health outcomes |
Countries
Canada
Contacts
PRINCIPAL_INVESTIGATORJoanna Henderson, Ph.D., C.Psych
Director, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health; Clinician Scientist, Centre for Addiction and Mental Health; Associate Professor, Dept. of Psychiatry, University of Toronto
PRINCIPAL_INVESTIGATORPeter Szatmari, MD, FRCPC
Chief, Child and Youth Mental Health Collaborative, The Hospital for Sick Children and Centre for Addiction and Mental Health; Professor and Head of the Division of Child and Youth Mental Health, University of Toronto
PRINCIPAL_INVESTIGATORAmy Cheung, MD, FRCPC
Associate Scientist, Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; Associate Professor, Department of Psychiatry, University of Toronto
PRINCIPAL_INVESTIGATORKristin Cleverley, RN, Ph.D.
CAMH Chair in Mental Health Nursing Research; Assistant Professor, University of Toronto; Clinician-Scientist, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health
PRINCIPAL_INVESTIGATORGloria Chaim, M.S.W.
Associate Director, Child Youth and Family Services; Head, Community Engagement and Partnership, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, CAMH; Assistant Professor, Dept. of Psychiatry, University of Toronto
Outcome results
None listed