Integrated Collaborative Care for Youths With Mental Health and Substance Use Challenges: A Randomized Clinical Trial

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