Integrated Collaborative Care for Youths With Mental Health and Substance Use Challenges
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".