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Multicenter Study
. 2025 May 1;8(5):e259565.
doi: 10.1001/jamanetworkopen.2025.9565.

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

Jo Henderson  1   2 , Peter Szatmari  2   3   4 , Kristin Cleverley  2   5 , Clement Ma  6   7 , Lisa D Hawke  2   8 , Amy Cheung  2 , Jacqueline Relihan  8 , Mahalia Dixon  9 , Meaghen Quinlan-Davidson  1   10 , Myla Moretti  11   12 , Claire de Oliveira  11   13   14   15 , Alina Lee  16 , Darren B Courtney  1   2   3 , David O'Brien  17 , Heather McDonald  18 , Krista Lemke  19 , Tony Pignatiello  2 , Suneeta Monga  20 , Nicole Kozloff  2   12   21 , Leigh Solomon  22 , Brendan F Andrade  1   2 , Melanie Barwick  23 , Alice Charach  24 , Lynn Courey  25 , Karleigh Darnay  10   26 , Paul Kurdyak  2   13 , Elizabeth Lin  8 , Di Shan  27
Affiliations
Multicenter Study

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

Jo Henderson et al. JAMA Netw Open. .

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Henderson reported receiving grants from the Canadian Institutes of Health Research (CIHR), the Ontario SPOR SUPPORT Unit, the Marilyn and Charles Baillie Foundation, the Margaret and Wallace McCain Family Foundation, the Graham Boeckh Foundation, the Schulich Foundation, the Bedolfe Foundation, and the Peter Gilgan Foundation during the conduct of the study. Dr Henderson reported serving as executive director of Youth Wellness Hubs Ontario, funded by the Government of Ontario, since 2017. Dr Szatmari reported receiving royalties from Guildford Press and Simon & Schuster and support from the Centre for Addiction and Mental Health (CAMH) and the University of Toronto Department of Psychiatry. Dr Ma reported receiving honoraria from the Canadian Academy for Child and Adolescent Psychiatry and the Hospital for Sick Children as well as grants from Northwestern Mutual Life Insurance Company, the CIHR, and the Ontario Brain Institute (OBI) outside the submitted work. Dr Hawke reported receiving grants from the CIHR during the conduct of the study as well as from the CIHR, University of Toronto Reasons for Hope, and the CAMH Foundation outside the submitted work. Dr Monga reported receiving grants from the CIHR and the OBI as well as royalties from Springer outside the submitted work. In addition, Dr Monga reported researching research support from TD Bank Financial Group (Chair in Child & Adolescent Psychiatry). No other disclosures were reported.

Figures

Figure.
Figure.. Study Flow Diagram
ICCT indicates integrated collaborative care team; TAU, treatment as usual.
See this image and copyright information in PMC

References

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