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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
247
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.
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.
North York General Hospital
Toronto, Ontario, Canada
Michael Garron Hospital
Toronto, Ontario, Canada
Sunnybrook Hospital
Toronto, Ontario, Canada
The Hospital for Sick Children
Toronto, Ontario, Canada
Centre for Addiction and Mental Health (CAMH)
Toronto, Ontario, Canada
Youth functioning
Measured using the Columbia Impairment Scale (CIS)
Time frame: One year
Clinical improvement
Measured using Strengths and Difficulties Questionnaire
Time frame: One year
Problematic substance use
Assessed using the GAIN Short Screener and the substance use table of the Adolescent Alcohol and Drug Involvement Scale
Time frame: One year
Satisfaction with the service models
Assessed using the Ontario Perception of Care Tool for Mental Health and Addictions
Time frame: One year
Continuity of care
Measured using the Continuity of Care in Children's Mental Health questionnaire
Time frame: One year
Goal attainment
Measured using a custom form indicating goals established by the youth and caregiver at intake, followed by a rating of goal attainment
Time frame: One year
Client empowerment and engagement
Measured using the Family Empowerment Scale for caregivers, and the Youth Efficacy/Empowerment Scale for youth
Time frame: One year
Caregiver burden
Measured using the Burden Assessment Scale
Time frame: One year
Quality-adjusted life years (QALYs)
Measured using the Assessment of Quality of Life-6D (AQOL-6D)
Time frame: One year
Cost-effective analysis (CEA) and a cost-utility analysis (CUA)
Incremental costs of ICCT compared to TAU (treatment as usual) in improving health outcomes
Time frame: One year
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