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

Center for Addiction and Mental Health (CAMH)

Status: Active, not recruiting

Conditions: Mental Disorders; Addiction

Treatments: Behavioral: Integrated Collaborative Care Team (ICCT); Other: Treatment as Usual (TAU)

Study type: Interventional

Funder types: Other

Identifiers

NCT02836080

#012/2016

Details and patient eligibility

About

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.

Full 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.

Enrollment: 247 patients

Sex: All

Ages: 14 to 18 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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247 participants in 2 patient groups

Integrated Collaborative Care Team

Experimental group

Description:

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.

Treatment:

Behavioral: Integrated Collaborative Care Team (ICCT)

Treatment as Usual (TAU)

Active Comparator group

Description:

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.

Treatment:

Other: Treatment as Usual (TAU)