Integrated Collaborative Care for Youths With Mental Health and Substance Use Challenges
Notice bibliographique
Résumé
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.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».