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BMC Psychiatry. 2019 Sep 5;19(1):273. doi: 10.1186/s12888-019-2232-2.

A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project.

Iyer SN1,2,3,4,5, Shah J6,7,8,9, Boksa P6,7,9, Lal S7,10,11, Joober R6,7,8,9, Andersson N7,12,13, Fuhrer R7,14, Abdel-Baki A7,11,15,16, Beaton AM7,17, Reaume-Zimmer P7,18, Hutt-MacLeod D7,19, Levasseur MA7,20, Chandrasena R7,21, Rousseau C6,7,22, Torrie J7,23, Etter M7,24, Vallianatos H7,25, Abba-Aji A7,26,27, Bighead S7,28, MacKinnon A7,29, Malla AK6,7,8,9,14.

Author information

1
Department of Psychiatry, McGill University, Montréal, Québec, Canada. srividya.iyer@mcgill.ca.
2
ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada. srividya.iyer@mcgill.ca.
3
Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec, Canada. srividya.iyer@mcgill.ca.
4
Douglas Mental Health University Institute, Montréal, Québec, Canada. srividya.iyer@mcgill.ca.
5
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada. srividya.iyer@mcgill.ca.
6
Department of Psychiatry, McGill University, Montréal, Québec, Canada.
7
ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada.
8
Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec, Canada.
9
Douglas Mental Health University Institute, Montréal, Québec, Canada.
10
School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
11
Centre de recherche du Centre hospitalier de l'Universite de Montreal (CRCHUM), Montréal, Québec, Canada.
12
Department of Family Medicine, Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM), McGill University, Montréal, Québec, Canada.
13
McGill University Institute for Human Development and Well-being, Montréal, Québec, Canada.
14
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
15
Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.
16
Centre hospitalier de l'Université de Montréal (CHUM), CRCHUM, Montréal, Québec, Canada.
17
School of Psychology, Faculty of Health Sciences and Community Services, Université de Moncton, Moncton, New Brunswick, Canada.
18
Mental Health and Addictions Services, Bluewater Health and Canadian Mental Health Association, Lambton Kent, Ontario, Canada.
19
Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.
20
ACCESS Open Minds Family and Carers Council, Douglas Mental Health University Institute, Montréal, Québec, Canada.
21
Schulich School of Medicine, Western University, London, Ontario, Canada.
22
Centre de recherche SHERPA, Institut Universitaire au regard des communautés ethno culturelles, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Ouest-de-l'Île-de-Montreal, Montréal, Québec, Canada.
23
Public Health Department, Cree Board of Health and Social Services of James Bay, Cree Nation of Mistissini, Québec, Canada.
24
Counselling Services, Inuvialuit Regional Corporation, Inuvik, Northwest Territories, Canada.
25
Department of Anthropology, University of Alberta, Edmonton, Alberta, Canada.
26
Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada.
27
Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
28
Sturgeon Lake Health Centre, Sturgeon Lake First Nation, Saskatchewan, Canada.
29
Saqijuq Project, Nunavik, Québec, Canada.

Abstract

BACKGROUND:

Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families.

METHODS:

The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention.

DISCUSSION:

Data from our overall research strategy will help test the effectiveness of the ACCESS Open Minds transformation, refine it further, and inform its scale-up. The process by which our research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholder groups and address unique considerations in designing evaluations of complex healthcare interventions in multiple, diverse contexts. Our approach will generate both concrete evidence and nuanced insights, including about the challenges of conducting research in real-world settings. More such innovative approaches are needed to advance youth mental health services research.

TRIAL REGISTRATION NUMBER:

Clinicaltrials.gov, ISRCTN23349893 (Retrospectively registered: 16/02/2017).

KEYWORDS:

Adolescents; Canada; Early intervention; Indigenous; Mental health services; Patient-oriented research; Rapid access; Young adults; Youth mental health

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