TY - JOUR
AU - J. Henderson
AU - P. Szatmari
AU - K. Cleverley
AU - C. Ma
AU - L. D. Hawke
AU - A. Cheung
AU - J. Relihan
AU - M. Dixon
AU - M. Quinlan-Davidson
AU - M. Moretti
AU - C. de Oliveira
AU - A. Lee
AU - D. B. Courtney
AU - D. O'Brien
AU - H. McDonald
AU - K. Lemke
AU - T. Pignatiello
AU - S. Monga
AU - N. Kozloff
AU - L. Solomon
AU - B. F. Andrade
AU - M. Barwick
AU - A. Charach
AU - L. Courey
AU - K. Darnay
AU - P. Kurdyak
AU - E. Lin
AU - D. Shan
A1 - 
AB - IMPORTANCE: Research on the integrated collaborative care team (ICCT) model, a version of an integrated youth service, with youths and families is needed to evaluate its effectiveness in improving mental health functioning compared with hospital outpatient treatment as usual (TAU). OBJECTIVES: To test the benefits of the ICCT in improving youth functioning compared with TAU, to assess youths' general psychopathology symptoms and substance use problems, and to quantify health service access, use, and satisfaction. DESIGN, SETTING, AND PARTICIPANTS: This 2-group pragmatic randomized clinical trial enrolled youths (14-17 years) and caregivers in Canada from September 2016 to March 2020. Participants were randomized to either 1 of 5 outpatient mental health hospital programs or 1 of 3 community ICCTs. Data analyses began on July 12, 2021, and concluded on November 12, 2023. INTERVENTION: Youths were offered services in the ICCT or TAU groups. Outcomes were assessed at baseline, 6 months, and 12 months. MAIN OUTCOMES AND MEASURES: The primary outcome was change in youth-reported mental health functioning as measured with the Columbia Impairment Scale (CIS). Secondary outcomes included the following: (1) caregiver-reported functioning and youth- and caregiver-reported general psychopathology and substance use, (2) mental health service satisfaction, and (3) health service access and use. Linear mixed-effects and generalized estimating equation models were used to compare outcomes in intention-to-treat analyses. RESULTS: This study included 247 youths; 124 were randomized to the ICCT and 123 were randomized to TAU. There were no baseline differences between groups; youths had a mean (SD) age of 15.7 (1.1) years. A total of 85 (34.4%) youths identified as boys or men, 157 (63.6%) identified as girls or women, and 5 (2.0%) identified as transgender, reported diverse gender identities, or were missing these data. CIS scores improved over the 12 months for both the ICCT group (Cohen d = -3.59 [95% CI, -4.99 to -2.20]; P < .001) and the TAU group (Cohen d = -2.59 [95% CI, -4.01 to -1.18]; P < .001). Significant differences in changes between groups were not observed (unadjusted CIS model, partial η2 = 0.002; P = .59). Both groups had mean scores suggesting satisfaction with services. The ICCT group accessed services sooner (median, 9 days; IQR, 5-16 days) compared with the TAU group (median, 27 days; IQR, 14-57 days) (Cohen d = 0.54 [95% CI, 0.27-0.81]; P < .001, t test). Fewer youths in the ICCT group saw a psychiatrist compared with youths in the TAU group (22 [17.5%] vs 104 [82.5%]; P < .001, χ2 test; φ = -0.67). CONCLUSIONS AND RELEVANCE: Although no clinical differences between groups were observed in this trial, youths receiving ICCT care improved in multiple metrics, accessed services sooner, and used fewer psychiatric resources than those in TAU programs. Future research should focus on how ICCT models can integrate and collaborate with hospital outpatient services. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02836080.
AD - Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.; Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.; Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Biostatistics Core Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; Education Department, Collaborative Learning College, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Youth and Family Mental Health, Margaret and Wallace McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.; Biostatistics Core, Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Yorktown Family Services, Toronto, Ontario, Canada.; LOFT Community Services, Toronto, Ontario, Canada.; Michael Garron Hospital, Toronto East Health Network, Toronto, Ontario, Canada.; Temerty Faculty of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.; Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Department of Psychiatry, North York General Hospital, University of Toronto, Toronto, Ontario, Canada.; Department of Psychiatry, Dalla Lana School of Public Health, Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada.; Division of Child and Youth Psychiatry, Department of Psychiatry, University of Toronto, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.; The Sashbear Foundation, Toronto, Ontario, Canada.; Youth Wellness Hubs Ontario, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.; Canadian Institute for Health Information, Toronto, Ontario, Canada.
AN - 40358950
BT - JAMA Netw Open
C5 - Healthcare Disparities; Education & Workforce
CP - 5
DA - May 1
DO - 10.1001/jamanetworkopen.2025.9565
DP - NLM
ET - 20250501
IS - 5
JF - JAMA Netw Open
LA - eng
N2 - IMPORTANCE: Research on the integrated collaborative care team (ICCT) model, a version of an integrated youth service, with youths and families is needed to evaluate its effectiveness in improving mental health functioning compared with hospital outpatient treatment as usual (TAU). OBJECTIVES: To test the benefits of the ICCT in improving youth functioning compared with TAU, to assess youths' general psychopathology symptoms and substance use problems, and to quantify health service access, use, and satisfaction. DESIGN, SETTING, AND PARTICIPANTS: This 2-group pragmatic randomized clinical trial enrolled youths (14-17 years) and caregivers in Canada from September 2016 to March 2020. Participants were randomized to either 1 of 5 outpatient mental health hospital programs or 1 of 3 community ICCTs. Data analyses began on July 12, 2021, and concluded on November 12, 2023. INTERVENTION: Youths were offered services in the ICCT or TAU groups. Outcomes were assessed at baseline, 6 months, and 12 months. MAIN OUTCOMES AND MEASURES: The primary outcome was change in youth-reported mental health functioning as measured with the Columbia Impairment Scale (CIS). Secondary outcomes included the following: (1) caregiver-reported functioning and youth- and caregiver-reported general psychopathology and substance use, (2) mental health service satisfaction, and (3) health service access and use. Linear mixed-effects and generalized estimating equation models were used to compare outcomes in intention-to-treat analyses. RESULTS: This study included 247 youths; 124 were randomized to the ICCT and 123 were randomized to TAU. There were no baseline differences between groups; youths had a mean (SD) age of 15.7 (1.1) years. A total of 85 (34.4%) youths identified as boys or men, 157 (63.6%) identified as girls or women, and 5 (2.0%) identified as transgender, reported diverse gender identities, or were missing these data. CIS scores improved over the 12 months for both the ICCT group (Cohen d = -3.59 [95% CI, -4.99 to -2.20]; P < .001) and the TAU group (Cohen d = -2.59 [95% CI, -4.01 to -1.18]; P < .001). Significant differences in changes between groups were not observed (unadjusted CIS model, partial η2 = 0.002; P = .59). Both groups had mean scores suggesting satisfaction with services. The ICCT group accessed services sooner (median, 9 days; IQR, 5-16 days) compared with the TAU group (median, 27 days; IQR, 14-57 days) (Cohen d = 0.54 [95% CI, 0.27-0.81]; P < .001, t test). Fewer youths in the ICCT group saw a psychiatrist compared with youths in the TAU group (22 [17.5%] vs 104 [82.5%]; P < .001, χ2 test; φ = -0.67). CONCLUSIONS AND RELEVANCE: Although no clinical differences between groups were observed in this trial, youths receiving ICCT care improved in multiple metrics, accessed services sooner, and used fewer psychiatric resources than those in TAU programs. Future research should focus on how ICCT models can integrate and collaborate with hospital outpatient services. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02836080.
PY - 2025
SN - 2574-3805
SP - e259565
ST - Integrated Collaborative Care for Youths With Mental Health and Substance Use Challenges: A Randomized Clinical Trial
T1 - Integrated Collaborative Care for Youths With Mental Health and Substance Use Challenges: A Randomized Clinical Trial
T2 - JAMA Netw Open
TI - Integrated Collaborative Care for Youths With Mental Health and Substance Use Challenges: A Randomized Clinical Trial
U1 - Healthcare Disparities; Education & Workforce
U3 - 10.1001/jamanetworkopen.2025.9565
VL - 8
VO - 2574-3805
Y1 - 2025
ER -