Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, Canada.
University of Toronto Department of Psychiatry, 250 College Street, Toronto, Ontario, Canada.
BMC Health Serv Res. 2021 Oct 1;21(1):1035. doi: 10.1186/s12913-021-07038-3.
Given high rates of mental health and substance challenges among youth and substantial system access barriers, system innovation is required. Integrated youth services (IYS) models aim to transform youth mental health and substance use services by creating integrative, collaborative models of care in youth-friendly settings. This study examines service provider perspectives on the key service components to include in IYS models.
A discrete choice experiment modeled service provider preferences for the service components of IYSs. The sample includes 388 service provider/agency leader participants (age 18+) from youth-serving organizations in Ontario. Importance scores and utility values were calculated for 12 attributes represented by four levels each. Latent class analysis identified subgroups of participants with different preferences.
The majority of participants were direct service providers working in larger organizations in the mental health and/or substance use sectors in large urban centers. Participants strongly endorsed service models that provide rapid access to the widest variety of culturally sensitive service options, with supplementary e-health services, in youth-focused community settings with evening and weekend hours. They prefer caregiver involvement in youth services and treatment decisions and support youth and family engagement. Latent class analyses reveal three segments of service providers: a Youth-Focused Service Accessibility segment representing 62.1% (241/388) of participants, a Service Options segment representing 27.6% (107/388) of participants, and a Caregiver Integration segment representing 10.3% (40/388) of participants. Within these segments, the degree of prioritization of the various service components differ; however, the overall endorsement of the service components remains largely consistent across classes for most attributes. The segments did not differ based on demographic or agency characteristics.
The core characteristics of IYS settings for youth with mental health and substance use challenges, i.e., rapid access to a wide range of youth-oriented services, are strong priorities of service providers and youth-serving agency leaders. These findings confirm that youth-oriented service providers endorse the importance and relevance of IYS models as a whole; strong service provider buy-in to the model is expected to facilitate development, implementation and scaling of IYS models. Hearing stakeholder perspectives, including those of service providers, youth, and caregivers, is essential to developing, effectively implementing, and scaling effective youth services.
鉴于青少年心理健康和物质挑战的高发病率以及大量的系统准入障碍，需要进行系统创新。综合青年服务（IYS）模式旨在通过在青年友好的环境中创建综合的、协作的护理模式来改变青少年心理健康和物质使用服务。本研究探讨了服务提供者对 IYS 模型中包含的关键服务要素的看法。
采用离散选择实验模型研究了服务提供者对 IYS 服务要素的偏好。样本包括来自安大略省青年服务组织的 388 名服务提供者/机构负责人（年龄在 18 岁及以上）。为每个属性的四个级别代表的 12 个属性计算了重要性得分和效用值。潜在类别分析确定了具有不同偏好的参与者亚组。
大多数参与者是在大城市中心的心理健康和/或物质使用部门的大型组织中工作的直接服务提供者。参与者强烈支持提供快速获得最广泛的文化敏感服务选择的服务模式，这些服务模式辅以电子健康服务，在以青年为中心的社区环境中提供晚间和周末的服务时间。他们希望照顾者参与青年服务和治疗决策，并支持青年和家庭的参与。潜在类别分析揭示了服务提供者的三个群体：代表 62.1%（241/388）参与者的青年为中心的服务可及性群体，代表 27.6%（107/388）参与者的服务选择群体，以及代表 10.3%（40/388）参与者的照顾者整合群体。在这些群体中，各种服务要素的优先程度不同；然而，对于大多数属性，服务要素的总体认可在各个类别中基本保持一致。这些群体在人口统计学或机构特征方面没有差异。
青少年心理健康和物质使用挑战的 IYS 环境的核心特征，即快速获得广泛的面向青年的服务，是服务提供者和青年服务机构领导者的首要任务。这些发现证实，面向青年的服务提供者认可 IYS 模式的重要性和相关性；预计服务提供者对该模式的强烈认可将促进 IYS 模式的开发、实施和推广。听取利益相关者的意见，包括服务提供者、青年和照顾者的意见，对于开发、有效实施和扩大有效的青年服务至关重要。
