Literature Collection

The majority of research and policy directives targeting opioid use and overdose prevention are based in larger urban settings and not easily adaptable to smaller Canadian settings (i.e., small- to mid-sized cities and rural areas). We identify a variety of research and policy gaps in smaller settings, including limited access to supervised consumption services, safer supply and novel opioid agonist therapy programs, as well as housing-based services and supports. Additionally, we identify the need for novel strategies to improve healthcare access and health outcomes in a more equitable way for people who use drugs, including virtual opioid agonist therapy clinics, episodic overdose prevention services, and housing-based harm reduction programs that are better suited for smaller settings. These programs should be coupled with rigorous evaluation, in order to understand the unique factors that shape overdose risk, opioid use, and service uptake in smaller Canadian settings.

OBJECTIVE: This review aimed to explore how integrated and transdiagnostic youth service models assess varied mental health needs and operationalize them to provide appropriate care. Furthermore, given the wide treatment gap for youths with severe needs, it highlights how models identify these youths and direct them to appropriate care. METHODS: This scoping review includes peer-reviewed and gray literature available in English. PsycInfo, MEDLINE, Embase, and CINAHL databases were searched for academic literature (January 2005-June 2023). Gray literature was acquired through outreach to service representatives. Eligible studies described an integrated and transdiagnostic youth mental health service model and included content related to the research objectives. RESULTS: This review included 121 pieces of literature describing 49 service models. Findings indicated substantial variability in the services provided and methods used to assess needs, as well as offerings and processes that were frequently insufficient for supporting youths with severe needs. Most models used two intake assessment tools, and approximately one-quarter had no service option for youths with severe needs. Multiple models did not explicitly describe how identified needs were operationalized into care decisions, with some incorporating exclusions for severe case presentations. CONCLUSIONS: Little evidence has been found for how integrated and transdiagnostic youth mental health service models should be operationalized, and their implementation varies considerably-potentially leaving young people without care or with needs that go unnoticed. Prioritizing research to enhance the operations of these initiatives is critical to ensure that they consistently meet the full breadth of needs experienced by youth populations.

The integration of a telepsychiatry application into an inner-city community mental health service was evaluated over 10 months. ISDN videoconferencing at 128 kbit/s was employed for psychiatric consultation between a primary care centre and a community mental health centre. A convenience sample of patients and referrals seen by videoconferencing was compared with a sample seen face to face. During the study period 19 patients were managed by videoconferencing and 12 face to face. There were 162 consultations, comprising 81 prearranged teleconsultations and 81 prearranged face-to-face consultations. There was no significant difference in attendance between videoconferencing and face-to-face consultations. Nine of the videoconferencing new referrals had not completed their treatment at the end of the study period, compared with only three in the face-to-face group. This implies that it takes longer to complete treatment for new referrals managed by videoconferencing.