Young Bryan, Mughal Sarah, Churchill AnnMarie, Rash Joshua, Tee Karen, Salmon Amy, Shah Jai
Douglas Mental Health University Institute, Verdun, Quebec, Canada.
Department of Psychiatry, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada.
BMJ Open. 2024 Dec 26;14(12):e096453. doi: 10.1136/bmjopen-2024-096453.
Canadian youth mental health (YMH) systems have the potential to urgently tackle the mental health treatment gap currently impacting young people, and stepped care (SC) is one model that can address this need. The adoption of SC models can guide the development of better-connected YMH systems by simplifying transitions and care pathways. To do so requires robust standards that are co-created across stakeholder groups, including with lived experience experts, to ensure the effective implementation of SC models.
This study aims to establish standards for implementing SC in Canadian child and YMH service settings by convening and developing a learning alliance (LA) of 65 individuals, translating guiding principles to standards via consensus methods (Delphi study), and operationalising and applying draft standards to three test ecosystems. Members of the LA will be recruited via snowball and purposive recruitment techniques to complete an e-Delphi study over three to four rounds until consensus is achieved. Participants will rank their agreement with including specific clause items in the final standard, and will be given opportunities to provide feedback and suggest revisions during each round. Comments will be analysed, scored and coded accordingly. Once consensus has been achieved, members of the LA will consider the application of these implementation standards in three settings that could benefit from SC. The protocol for this study was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/J5UNW).
The protocol has been approved by the Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal-Mental Health and Neuroscience subcommittee. As part of the ethics approval, informed consent forms for all Delphi participants were created and distributed to participants ahead of the Delphi. This includes parental consent forms for all LA members participating in the study who are under the age of 18. On completion, the project will ultimately support the implementation of SC in diverse service systems and guide the development of a robust and connected mental health delivery system in Canada. The final standard will be shared with relevant government bodies and health planners and disseminated via academic and other platforms.
加拿大青年心理健康（YMH）系统有潜力紧急应对当前影响年轻人的心理健康治疗缺口，而阶梯式护理（SC）是一种能够满足这一需求的模式。采用SC模式可以通过简化过渡和护理途径来指导联系更为紧密的YMH系统的发展。要做到这一点，需要在包括有实际经验的专家在内的各利益相关者群体之间共同制定强有力的标准，以确保SC模式的有效实施。
本研究旨在通过召集并组建一个由65人组成的学习联盟（LA），在加拿大儿童和YMH服务环境中建立实施SC的标准，通过共识方法（德尔菲研究）将指导原则转化为标准，并将标准草案应用于三个测试生态系统。LA成员将通过滚雪球和目的抽样招募技术进行招募，以完成一项为期三到四轮的电子德尔菲研究，直至达成共识。参与者将对他们是否同意在最终标准中纳入特定条款项目进行排名，并将有机会在每一轮中提供反馈并提出修订建议。评论将相应地进行分析、评分和编码。一旦达成共识，LA成员将考虑在三个可从SC中受益的环境中应用这些实施标准。本研究方案已在开放科学框架（https://doi.org/10.17605/OSF.IO/J5UNW）上注册。
该方案已获得蒙特利尔岛西部综合大学健康与社会服务中心（CIUSSS）心理健康和神经科学小组委员会的批准。作为伦理批准的一部分，为所有德尔菲参与者创建了知情同意书，并在德尔菲之前分发给参与者。这包括为所有参与研究的18岁以下LA成员提供的家长同意书。项目完成后，最终将支持SC在不同服务系统中的实施，并指导加拿大强大且相互联系的心理健康服务系统的发展。最终标准将与相关政府机构和卫生规划者分享，并通过学术和其他平台进行传播。
