Health System Integration and Sustainability Improving youth access to mental health and addiction services

Peter Szatmari, Centre for Addiction and Mental Health (CAMH)
Peter Szatmari, Centre for Addiction and Mental Health (CAMH)
Joanna Henderson, Centre for Addiction and Mental Health (CAMH)
Joanna Henderson, Centre for Addiction and Mental Health (CAMH)

A Pragmatic RCT of Integrated Collaborative Care Team (ICCT) Model for Youth with MHA Challenges

Issue

  • Among youth, the prevalence of mental health and addiction disorders is roughly 20%. Three-quarters of all adult disorders begin in adolescence. Yet as few as 1 in 6 affected individuals will access specialized treatment services. This vulnerable population is poorly served by existing mental health and addiction services, which are often characterized by long wait lists, lack of integration, limited use of evidence-based treatments, lack of attention to social determinants of health, poor discharge planning, and by appearing “unwelcoming” to youth.
  • Youth are challenged to access services in a timely fashion and to follow through with treatment planning. This lack of appropriate care often leads to long-term impairment and reduced quality of life, resulting in serious personal, familial, and societal impacts.

Project

  • To address these system gaps, this project will work with youth, families, and stakeholders to test the benefits of an Integrated Collaborative Care Team (ICCT) model for at-risk youth with mental health and addiction challenges. In partnership with three community agencies, four adolescent psychiatry hospital departments, and two family health teams, an innovative model of service provision involving rapid access to mental health and addiction services, health system navigation, evidence-based interventions matched to level of need, and peer support will be implemented. This model will be compared to the usual treatment youth receive in hospital-based, outpatient, mental health clinics in Toronto.
  • It is anticipated that a rapid, systematic approach to mental health and addiction services geared to need in a youth-friendly environment will result in better outcomes for youth, including improved functioning, decreased symptoms, and improved client satisfaction. Moreover, the ICCT approach is expected to decrease service wait-times, be more youth- and family-centred, and be more cost-effective by better aligning appropriate resources for youth requiring assessment, treatment and ongoing support. In this way, the mental health of this vulnerable population can be substantially improved and make Ontario a leader in innovative systems of care.

Patient engagement

  • The research lead was involved in 38 focus groups and 15 interviews with diverse youth, family members and service providers regarding the mental health and addictions system. Two youth with lived experience were integrated throughout these activities and developed a National Youth Advisory Committee. Perspectives gathered from these sessions informed the ICCT model intervention.
  • Youth and families with lived experience were involved in the design of the intervention, implementation process, randomization-related ethics issues, determining primary and secondary outcomes, staff training and policy-issue identification.
  • A variety of patient engagement activities continue during the project. To support these activities, individuals with lived experience were hired to co-lead patient engagement activities designed to facilitate ongoing interaction among research, implementation and patient engagement leads to ensure that project activities are informed by patient priorities.
  • In addition, Youth and Family Member Advisory Groups meet every 4 months to review project performance and provide guidance to the research team. These advisory groups help guide: recruitment strategies; assessment and treatment protocols; outcome measures; interpretations of findings; knowledge translation goals and strategies to reach youth, families and other stakeholders; and dissemination of the trial learnings to knowledge users.

Publications

Youth engagement in the YouthCan IMPACT trial, CMAJ, November 07, 2018