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| Name | Class |
|---|---|
| East Metro Youth Services | OTHER |
| Delisle Youth Services | UNKNOWN |
| LOFT Community Services | OTHER |
| The Sashbear Foundation |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Integrated Collaborative Care Team | Experimental | 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 as Usual (TAU) | Active Comparator | 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Integrated Collaborative Care Team (ICCT) | Behavioral | An integrated, collaborative pathway of needs-based services. ICCTs will offer a wide variety of services, including Solution-Focused Brief Therapy (SFBT) on a scheduled and walk-in basis, care navigators, various clinician-guided interventions, psychiatry, nurse practitioner services, access to primary care, and peer support, all co-located in youth-friendly, community-based clinics. For each intervention, standardized intervention protocols will be used. |
| Measure | Description | Time Frame |
|---|---|---|
| Youth functioning | Measured using the Columbia Impairment Scale (CIS) | One year |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical improvement | Measured using Strengths and Difficulties Questionnaire | One year |
| Problematic substance use | Assessed using the GAIN Short Screener and the substance use table of the Adolescent Alcohol and Drug Involvement Scale |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Joanna Henderson, Ph.D., C.Psych | Director, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health; Clinician Scientist, Centre for Addiction and Mental Health; Associate Professor, Dept. of Psychiatry, University of Toronto | Principal Investigator |
| Peter Szatmari, MD, FRCPC | Chief, Child and Youth Mental Health Collaborative, The Hospital for Sick Children and Centre for Addiction and Mental Health; Professor and Head of the Division of Child and Youth Mental Health, University of Toronto | Principal Investigator |
| Amy Cheung, MD, FRCPC | Associate Scientist, Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; Associate Professor, Department of Psychiatry, University of Toronto | Principal Investigator |
| Kristin Cleverley, RN, Ph.D. | CAMH Chair in Mental Health Nursing Research; Assistant Professor, University of Toronto; Clinician-Scientist, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health | Principal Investigator |
| Gloria Chaim, M.S.W. | Associate Director, Child Youth and Family Services; Head, Community Engagement and Partnership, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, CAMH; Assistant Professor, Dept. of Psychiatry, University of Toronto | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| North York General Hospital | Toronto | Ontario | M2K 1E1 | Canada | ||
| Michael Garron Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41225406 | Derived | Quinlan-Davidson M, Henderson JL, Szatmari P, Cheung A, Dixon M, Relihan J, Singer D, Hawke LD, Cleverley K. A qualitative study exploring youth's experiences of hospital- and integrated community-based mental health services: the YouthCan IMPACT initiative. BMC Psychiatry. 2025 Nov 12;25(1):1084. doi: 10.1186/s12888-025-07523-7. | |
| 40358950 |
| Label | URL |
|---|---|
| Information about research at the Centre for Addiction and Mental Health, Canada's largest mental health and addiction teaching hospital | View source |
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| UNKNOWN |
| The Anne Johnston Health Station | UNKNOWN |
| South East Toronto Family Health Team | UNKNOWN |
| Institute for Clinical Evaluative Sciences | OTHER |
| Medical Psychiatry Alliance | OTHER |
| Graham Boeckh Foundation | OTHER |
| The Ontario Spor Support Unit | OTHER |
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|
| Treatment as Usual (TAU) | Other | Standard out-patient treatment provided at each participating hospital site. This typically entails referral to a psychiatrist at the participating hospital, who will provide assessment and treatment, with referral to appropriate services, guided by local treatment protocols. |
|
| One year |
| Satisfaction with the service models | Assessed using the Ontario Perception of Care Tool for Mental Health and Addictions | One year |
| Continuity of care | Measured using the Continuity of Care in Children's Mental Health questionnaire | One year |
| Goal attainment | Measured using a custom form indicating goals established by the youth and caregiver at intake, followed by a rating of goal attainment | One year |
| Client empowerment and engagement | Measured using the Family Empowerment Scale for caregivers, and the Youth Efficacy/Empowerment Scale for youth | One year |
| Caregiver burden | Measured using the Burden Assessment Scale | One year |
| Quality-adjusted life years (QALYs) | Measured using the Assessment of Quality of Life-6D (AQOL-6D) | One year |
| Cost-effective analysis (CEA) and a cost-utility analysis (CUA) | Incremental costs of ICCT compared to TAU (treatment as usual) in improving health outcomes | One year |
| Toronto |
| Ontario |
| M4C 3E7 |
| Canada |
| Sunnybrook Hospital | Toronto | Ontario | M4N 3M5 | Canada |
| The Hospital for Sick Children | Toronto | Ontario | M5G 1X8 | Canada |
| Centre for Addiction and Mental Health (CAMH) | Toronto | Ontario | M6J 1H4 | Canada |
| Henderson J, Szatmari P, Cleverley K, Ma C, Hawke LD, Cheung A, Relihan J, Dixon M, Quinlan-Davidson M, Moretti M, de Oliveira C, Lee A, Courtney DB, O'Brien D, McDonald H, Lemke K, Pignatiello T, Monga S, Kozloff N, Solomon L, Andrade BF, Barwick M, Charach A, Courey L, Darnay K, Kurdyak P, Lin E, Shan D. Integrated Collaborative Care for Youths With Mental Health and Substance Use Challenges: A Randomized Clinical Trial. JAMA Netw Open. 2025 May 1;8(5):e259565. doi: 10.1001/jamanetworkopen.2025.9565. |
| 39848629 | Derived | Krause KR, Lee A, Shan D, Cost KT, Hawke LD, Cheung AH, Cleverley K, de Oliveira C, Quinlan-Davidson M, Moretti ME, Henderson JL, Ma C, Szatmari P. Minimally important change on the Columbia Impairment Scale and Strengths and Difficulties Questionnaire in youths seeking mental healthcare. BMJ Ment Health. 2025 Jan 22;28(1):e301425. doi: 10.1136/bmjment-2024-301425. |
| 28167747 | Derived | Henderson JL, Cheung A, Cleverley K, Chaim G, Moretti ME, de Oliveira C, Hawke LD, Willan AR, O'Brien D, Heffernan O, Herzog T, Courey L, McDonald H, Grant E, Szatmari P. Integrated collaborative care teams to enhance service delivery to youth with mental health and substance use challenges: protocol for a pragmatic randomised controlled trial. BMJ Open. 2017 Feb 6;7(2):e014080. doi: 10.1136/bmjopen-2016-014080. |
| ID | Term |
|---|---|
| D001523 | Mental Disorders |
| D016739 | Behavior, Addictive |
| D000092862 | Psychological Well-Being |
| ID | Term |
|---|---|
| D003192 | Compulsive Behavior |
| D007175 | Impulsive Behavior |
| D001519 | Behavior |
| D010549 | Personal Satisfaction |
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| ID | Term |
|---|---|
| D013812 | Therapeutics |
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