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

Not Applicable

Active, not recruiting

• Conditions: Mental Disorders; Addiction
• Interventions: Other: Treatment as Usual (TAU); Behavioral: Integrated Collaborative Care Team (ICCT)

• Registration Number: NCT02836080
• Lead Sponsor: Centre for Addiction and Mental Health

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.

Study Timeline

• Study First Submitted: 2016-07-14
• Study First Submitted QC: 2016-07-14
• Study First Posted: 2016-07-18
• Study Start: 2016-09
• Primary Completion: 2021-04
• Status Verified: 2023-08
• Last Update Submitted: 2023-08-29
• Last Update Posted: 2023-08-30
• Study Completion: 2025-04

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 247

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Treatment as Usual (TAU)	Treatment as Usual (TAU)	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.
Integrated Collaborative Care Team	Integrated Collaborative Care Team (ICCT)	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.

Primary Outcome Measures

Name	Time	Method
Youth functioning	One year	Measured using the Columbia Impairment Scale (CIS)

Secondary Outcome Measures

Name	Time	Method
Satisfaction with the service models	One year	Assessed using the Ontario Perception of Care Tool for Mental Health and Addictions
Client empowerment and engagement	One year	Measured using the Family Empowerment Scale for caregivers, and the Youth Efficacy/Empowerment Scale for youth
Quality-adjusted life years (QALYs)	One year	Measured using the Assessment of Quality of Life-6D (AQOL-6D)
Caregiver burden	One year	Measured using the Burden Assessment Scale
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
Continuity of care	One year	Measured using the Continuity of Care in Children's Mental Health questionnaire
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
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

Trial Locations

Locations (5)

North York General Hospital; 🇨🇦 Toronto, Ontario, Canada

Michael Garron Hospital; 🇨🇦 Toronto, Ontario, Canada

Centre for Addiction and Mental Health (CAMH); 🇨🇦 Toronto, Ontario, Canada

Sunnybrook Hospital; 🇨🇦 Toronto, Ontario, Canada

The Hospital for Sick Children; 🇨🇦 Toronto, Ontario, Canada