Integrated Collaborative Care Teams for Youth With Mental Health and/or Addiction Challenges (YouthCan IMPACT)

Study Overview
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Brief Summary
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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
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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.

Official Title
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Integrated Collaborative Care Teams to Enhance Service Delivery to Youth With Mental Health and Substance Use Challenges: Protocol for a Pragmatic Randomized-controlled Trial

Conditions
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Mental Disorders, Addiction

Intervention / Treatment
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* Behavioral: Integrated Collaborative Care Team (ICCT)
* Other: Treatment as Usual (TAU)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Provision of informed consent Aged 14 - 17 years 11 months New referrals to one of the four participating hospitals for out-patient MHA services Among the population regularly accepted for out-patient services at that hospital Exclusion Criteria: Referral for specialty forensic or firesetting treatment Moderate to severe intellectual disability or autism without MHA problems Primary diagnosis of an eating disorder Active psychosis or imminent risk of self-harm requiring immediate intervention Inability to read and write English or to consent to the study

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Integrated Collaborative Care Team<br>Integrated Collaborative Care Team (ICCTs) are housed in the local community to improve youth access, in three neighborhoods across Toronto (East Metro Youth Services [EMYS]-Scarborough, EMYS-Southeast Toronto, and Delisle Youth Services-Central Toronto). Each ICCT will include a variety of service providers and coordinated patient care delivering evidence-informed interventions in a stepped-care model. | Behavioral: Integrated Collaborative Care Team (ICCT)<br>* 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.<br>|
| Active Comparator: Treatment as Usual (TAU)<br>The comparator arm consists of out-patient TAU in a hospital setting and will occur at one of four outpatient hospital sites across Toronto. Partners include the following four hospitals: Hospital for Sick Children (SickKids), the Centre for Addiction and Mental Health (CAMH), Michael Garron Hospital (formerly the Toronto East General Hospital), and Sunnybrook Hospital. | Other: Treatment as Usual (TAU)<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Youth functioning | Measured using the Columbia Impairment Scale (CIS) | One year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical improvement | Measured using Strengths and Difficulties Questionnaire | One year | 
| Problematic substance use | Assessed using the GAIN Short Screener and the substance use table of the Adolescent Alcohol and Drug Involvement Scale | One year | 
| Satisfaction with the service models | Assessed using the Ontario Perception of Care Tool for Mental Health and Addictions | One year | 
| Continuity of care | Measured using the Continuity of Care in Children's Mental Health questionnaire | 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 | One year | 
| Client empowerment and engagement | Measured using the Family Empowerment Scale for caregivers, and the Youth Efficacy/Empowerment Scale for youth | One year | 
| Caregiver burden | Measured using the Burden Assessment Scale | One year | 
| Quality-adjusted life years (QALYs) | Measured using the Assessment of Quality of Life-6D (AQOL-6D) | 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 | One year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mental Health, Randomized, Pragmatic, Integrated Collaborative Care, Addiction, Youth