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

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.

Youth Mental Health Services: Promoting Wellness or Treating Mental Illness?

“…In order to avoid problems associated with different layers of funding and given the gravity of YMH problems, we recommend the creation of a pan-Canadian fund for YMH with proportionate contributions from Federal as well as Provincial and Territorial governments and managed according to national standards that are currently being established through multiple service transformation initiatives. 16 Such a mechanism would also incorporate an evaluation framework currently being developed across the major YMH service transformation initiatives 40,41 in Canada.…”

Shared Decision Making in a Youth Mental Health Service Design and Research Project: Insights From the Pan-Canadian ACCESS Open Minds Network

“…The NYC and AFC Council members contributed to the development of the ACCESS OM qualitative and quantitative research strategies, providing input on the instruments and measures to be used, as well as what information would be important to collect [27]. A working group with representatives from these two councils and each participating site was created to provide feedback on key outcome domains and measures that should form part of the ACCESS OM's quantitative assessment protocol.…”

“…An important achievement of the project has been the basing of its transformative endeavors in core principles (such as SDM), objectives, and protocols that have been contextualized to the realities of diverse sites. We have already described these core principles and the successful contextualization of these principles towards the creation of transformed youth mental health services in 14 contexts in our previous publications [1,2,27]. In the future, we look to publish results regarding impacts of transformed services on reach, wait times, outcomes, and service users' satisfaction with services, and on the processes underpinning youth mental health services transformation and the factors fostering and hindering such transformation.…”

Digital Game Interventions for Youth Mental Health Services (Gaming My Way to Recovery): Protocol for a Scoping Review

“…ACCESS Open Minds [ 16 , 52 ], a pan-Canadian network of 14 youth mental health service sites, will actively support this project. Youths and family members from the 3 ACCESS Open Minds Councils (National Youth Council, Family and Careers Council, and the Indigenous Council) and members of other youth networks will be invited to participate in the project.…”