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

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 netw...

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Autores principales: Iyer, Srividya N., Shah, Jai, Boksa, Patricia, Lal, Shalini, Joober, Ridha, Andersson, Neil, Fuhrer, Rebecca, Abdel-Baki, Amal, Beaton, Ann M., Reaume-Zimmer, Paula, Hutt-MacLeod, Daphne, Levasseur, Mary Anne, Chandrasena, Ranjith, Rousseau, Cécile, Torrie, Jill, Etter, Meghan, Vallianatos, Helen, Abba-Aji, Adam, Bighead, Shirley, MacKinnon, Aileen, Malla, Ashok K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729084/
https://www.ncbi.nlm.nih.gov/pubmed/31488144
http://dx.doi.org/10.1186/s12888-019-2232-2
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author Iyer, Srividya N.
Shah, Jai
Boksa, Patricia
Lal, Shalini
Joober, Ridha
Andersson, Neil
Fuhrer, Rebecca
Abdel-Baki, Amal
Beaton, Ann M.
Reaume-Zimmer, Paula
Hutt-MacLeod, Daphne
Levasseur, Mary Anne
Chandrasena, Ranjith
Rousseau, Cécile
Torrie, Jill
Etter, Meghan
Vallianatos, Helen
Abba-Aji, Adam
Bighead, Shirley
MacKinnon, Aileen
Malla, Ashok K.
author_facet Iyer, Srividya N.
Shah, Jai
Boksa, Patricia
Lal, Shalini
Joober, Ridha
Andersson, Neil
Fuhrer, Rebecca
Abdel-Baki, Amal
Beaton, Ann M.
Reaume-Zimmer, Paula
Hutt-MacLeod, Daphne
Levasseur, Mary Anne
Chandrasena, Ranjith
Rousseau, Cécile
Torrie, Jill
Etter, Meghan
Vallianatos, Helen
Abba-Aji, Adam
Bighead, Shirley
MacKinnon, Aileen
Malla, Ashok K.
author_sort Iyer, Srividya N.
collection PubMed
description 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). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12888-019-2232-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-67290842019-09-12 A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project Iyer, Srividya N. Shah, Jai Boksa, Patricia Lal, Shalini Joober, Ridha Andersson, Neil Fuhrer, Rebecca Abdel-Baki, Amal Beaton, Ann M. Reaume-Zimmer, Paula Hutt-MacLeod, Daphne Levasseur, Mary Anne Chandrasena, Ranjith Rousseau, Cécile Torrie, Jill Etter, Meghan Vallianatos, Helen Abba-Aji, Adam Bighead, Shirley MacKinnon, Aileen Malla, Ashok K. BMC Psychiatry Study Protocol 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). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12888-019-2232-2) contains supplementary material, which is available to authorized users. BioMed Central 2019-09-05 /pmc/articles/PMC6729084/ /pubmed/31488144 http://dx.doi.org/10.1186/s12888-019-2232-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Study Protocol
Iyer, Srividya N.
Shah, Jai
Boksa, Patricia
Lal, Shalini
Joober, Ridha
Andersson, Neil
Fuhrer, Rebecca
Abdel-Baki, Amal
Beaton, Ann M.
Reaume-Zimmer, Paula
Hutt-MacLeod, Daphne
Levasseur, Mary Anne
Chandrasena, Ranjith
Rousseau, Cécile
Torrie, Jill
Etter, Meghan
Vallianatos, Helen
Abba-Aji, Adam
Bighead, Shirley
MacKinnon, Aileen
Malla, Ashok K.
A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project
title A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project
title_full A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project
title_fullStr A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project
title_full_unstemmed A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project
title_short A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project
title_sort minimum evaluation protocol and stepped-wedge cluster randomized trial of access open minds, a large canadian youth mental health services transformation project
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729084/
https://www.ncbi.nlm.nih.gov/pubmed/31488144
http://dx.doi.org/10.1186/s12888-019-2232-2
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