Henderson Joanna L, Cheung Amy, Cleverley Kristin, Chaim Gloria, Moretti Myla E, de Oliveira Claire, Hawke Lisa D, Willan Andrew R, O'Brien David, Heffernan Olivia, Herzog Tyson, Courey Lynn, McDonald Heather, Grant Enid, Szatmari Peter
Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
BMJ Open. 2017 Feb 6;7(2):e014080. doi: 10.1136/bmjopen-2016-014080.
Among youth, the prevalence of mental health and addiction (MHA) disorders is roughly 20%, yet youth are challenged to access evidence-based services in a timely fashion. To address MHA system gaps, this study tests the benefits of an Integrated Collaborative Care Team (ICCT) model for youth with MHA challenges. A rapid, stepped-care approach geared to need in a youth-friendly environment is expected to result in better youth MHA outcomes. Moreover, the ICCT approach is expected to decrease service wait-times, be more youth-friendly and family-friendly, and be more cost-effective, providing substantial public health benefits.
In partnership with four community agencies, four adolescent psychiatry hospital departments, youth and family members with lived experience of MHA service use, and other stakeholders, we have developed an innovative model of collaborative, community-based service provision involving rapid access to needs-based MHA services. A total of 500 youth presenting for hospital-based, outpatient psychiatric service will be randomised to ICCT services or hospital-based treatment as usual, following a pragmatic randomised controlled trial design. The primary outcome variable will be the youth's functioning, assessed at intake, 6 months and 12 months. Secondary outcomes will include clinical change, youth/family satisfaction and perception of care, empowerment, engagement and the incremental cost-effectiveness ratio (ICER). Intent-to-treat analyses will be used on repeated-measures data, along with cost-effectiveness and cost-utility analyses, to determine intervention effectiveness.
Research Ethics Board approval has been received from the Centre for Addiction and Mental Health, as well as institutional ethical approval from participating community sites. This study will be conducted according to Good Clinical Practice guidelines. Participants will provide informed consent prior to study participation and data confidentiality will be ensured. A data safety monitoring panel will monitor the study. Results will be disseminated through community and peer-reviewed academic channels.
Clinicaltrials.gov NCT02836080.
在青少年中，心理健康与成瘾（MHA）障碍的患病率约为20%，然而青少年在及时获得循证服务方面面临挑战。为解决MHA系统存在的差距，本研究测试了综合协作护理团队（ICCT）模式对有MHA挑战的青少年的益处。一种针对需求、在青少年友好型环境中采用的快速、分阶段护理方法预计会带来更好的青少年MHA结果。此外，ICCT方法预计会减少服务等待时间，对青少年和家庭更友好，且更具成本效益，带来重大的公共卫生效益。
我们与四个社区机构、四个青少年精神病医院科室、有MHA服务使用经历的青少年及其家庭成员以及其他利益相关者合作，开发了一种创新的基于社区的协作服务提供模式，包括快速获得基于需求的MHA服务。按照实用随机对照试验设计，共有500名前来接受医院门诊精神科服务的青少年将被随机分配接受ICCT服务或常规的医院治疗。主要结局变量将是青少年的功能，在入组时、6个月和12个月时进行评估。次要结局将包括临床变化、青少年/家庭满意度以及对护理的认知、赋权、参与度和增量成本效益比（ICER）。意向性分析将用于重复测量数据，同时进行成本效益和成本效用分析，以确定干预效果。
已获得成瘾与心理健康中心的研究伦理委员会批准，以及参与社区场所的机构伦理批准。本研究将按照良好临床实践指南进行。参与者在参与研究前将提供知情同意，并将确保数据保密。一个数据安全监测小组将对研究进行监测。结果将通过社区和同行评审的学术渠道进行传播。
Clinicaltrials.gov NCT02836080
