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Tuaf H, Orkibi H. Community-based rehabilitation programme for adolescents with mental health conditions in Israel: a qualitative study protocol. BMJ Open 2019; 9:e032809. [PMID: 31857314 PMCID: PMC6937008 DOI: 10.1136/bmjopen-2019-032809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In Israel, 12% of adolescents have mental health conditions. Approximately 600 adolescents with mental health conditions are hospitalised each year and about 40% of them return to the hospital and are thus cut-off from their daily lives and peers in the community. In contrast to adults, adolescents with mental health conditions in Israel are not eligible by law for rehabilitation services. Thus, the overarching goal of this qualitative study is to identify best practices for the implementation of community-based psychosocial rehabilitation programme for this population, by examining the first such programme in Israel. Amitim for Youth, which was established in 2018 by the Israel Association of Community Centers in cooperation with the Ministry of Health, the Ministry of Education and the Special Projects Fund of the National Insurance Institute. METHODS AND ANALYSIS Qualitative data will be collected through in depth semi-structured interviews and focus groups. To identify themes and patterns in the data, a six-stage reflexive thematic analysis approach will be used. A triangulation procedure will be conducted to strengthen the validity of the findings collected by different methods and from various stakeholders in the programme: the programme's decision-makers, programme team members, the intended beneficiaries and referring mental health professionals. To insure the trustworthiness of the findings, three strategies will be employed: memo writing, reflexive journaling and member checking. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee for Human Research in the Faculty of Social Welfare and Health Sciences at the University of Haifa (#455-18) and by the Chief Scientist in the Ministry of Education (#10566). All participants will sign an informed consent form and will be guaranteed confidentiality and anonymity. Data collection will be conducted in the next 2 years (2019 to 2020). After data analysis, the findings will be disseminated via publications.
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Affiliation(s)
- Hila Tuaf
- School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hod Orkibi
- School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Lieberman JA, Small SA, Girgis RR. Early Detection and Preventive Intervention in Schizophrenia: From Fantasy to Reality. Am J Psychiatry 2019; 176:794-810. [PMID: 31569988 DOI: 10.1176/appi.ajp.2019.19080865] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Scientific progress in understanding human disease can be measured by the effectiveness of its treatment. Antipsychotic drugs have been proven to alleviate acute psychotic symptoms and prevent their recurrence in schizophrenia, but the outcomes of most patients historically have been suboptimal. However, a series of findings in studies of first-episode schizophrenia patients transformed the psychiatric field's thinking about the pathophysiology, course, and potential for disease-modifying effects of treatment. These include the relationship between the duration of untreated psychotic symptoms and outcome; the superior responses of first-episode patients to antipsychotics compared with patients with chronic illness, and the reduction in brain gray matter volume over the course of the illness. Studies of the effectiveness of early detection and intervention models of care have provided encouraging but inconclusive results in limiting the morbidity and modifying the course of illness. Nevertheless, first-episode psychosis studies have established an evidentiary basis for considering a team-based, coordinated specialty approach as the standard of care for treating early psychosis, which has led to their global proliferation. In contrast, while clinical high-risk research has developed an evidence-based care model for decreasing the burden of attenuated symptoms, no treatment has been shown to reduce risk or prevent the transition to syndromal psychosis. Moreover, the current diagnostic criteria for clinical high risk lack adequate specificity for clinical application. What limits our ability to realize the potential of early detection and intervention models of care are the lack of sensitive and specific diagnostic criteria for pre-syndromal schizophrenia, validated biomarkers, and proven therapeutic strategies. Future research requires methodologically rigorous studies in large patient samples, across multiple sites, that ideally are guided by scientifically credible pathophysiological theories for which there is compelling evidence. These caveats notwithstanding, we can reasonably expect future studies to build on the research of the past four decades to advance our knowledge and enable this game-changing model of care to become a reality.
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Affiliation(s)
- Jeffrey A Lieberman
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Scott A Small
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Ragy R Girgis
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
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Iyer SN, Shah J, Boksa P, Lal S, Joober R, Andersson N, Fuhrer R, Abdel-Baki A, Beaton AM, Reaume-Zimmer P, Hutt-MacLeod D, Levasseur MA, Chandrasena R, Rousseau C, Torrie J, Etter M, Vallianatos H, Abba-Aji A, Bighead S, MacKinnon A, Malla AK. A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project. BMC Psychiatry 2019; 19:273. [PMID: 31488144 PMCID: PMC6729084 DOI: 10.1186/s12888-019-2232-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022] Open
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).
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Affiliation(s)
- Srividya N. Iyer
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Patricia Boksa
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec Canada
- Centre de recherche du Centre hospitalier de l’Universite de Montreal (CRCHUM), Montréal, Québec Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Neil Andersson
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Family Medicine, Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM), McGill University, Montréal, Québec Canada
- McGill University Institute for Human Development and Well-being, Montréal, Québec Canada
| | - Rebecca Fuhrer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
| | - Amal Abdel-Baki
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Centre de recherche du Centre hospitalier de l’Universite de Montreal (CRCHUM), Montréal, Québec Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
- Centre hospitalier de l’Université de Montréal (CHUM), CRCHUM, Montréal, Québec Canada
| | - Ann M. Beaton
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- School of Psychology, Faculty of Health Sciences and Community Services, Université de Moncton, Moncton, New Brunswick, Canada
| | - Paula Reaume-Zimmer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Mental Health and Addictions Services, Bluewater Health and Canadian Mental Health Association, Lambton Kent, Ontario, Canada
| | - Daphne Hutt-MacLeod
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada
| | - Mary Anne Levasseur
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- ACCESS Open Minds Family and Carers Council, Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Ranjith Chandrasena
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Schulich School of Medicine, Western University, London, Ontario Canada
| | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- 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
| | - Jill Torrie
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Public Health Department, Cree Board of Health and Social Services of James Bay, Cree Nation of Mistissini, Québec Canada
| | - Meghan Etter
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Counselling Services, Inuvialuit Regional Corporation, Inuvik, Northwest Territories, Canada
| | - Helen Vallianatos
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Anthropology, University of Alberta, Edmonton, Alberta Canada
| | - Adam Abba-Aji
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta Canada
| | - Shirley Bighead
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Sturgeon Lake Health Centre, Sturgeon Lake First Nation, Saskatchewan, Canada
| | - Aileen MacKinnon
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Saqijuq Project, Nunavik, Québec Canada
| | - Ashok K. Malla
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
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Shah JL, Peters MI. Early intervention in psychiatry: scotomas, representativeness, and the lens of clinical populations. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1019-1021. [PMID: 30903242 DOI: 10.1007/s00127-019-01686-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/09/2019] [Indexed: 02/08/2023]
Abstract
Evidence supporting early intervention in mental health has gained prominence in recent years, with services for first episode psychosis having led the way. Despite this momentum, however, the extent to which rapidly accumulating data has been collected in samples resembling real-world clinical populations remains unclear. Kline et al. compare and contrast two groups experiencing a first episode of psychosis: research participants, and a clinical sample receiving early intervention services at the same health centre. They find key differences-including the underrepresentation of vulnerable groups and surprisingly little overlap between the two samples-that should prompt reflection about blind spots, filters between research and clinical care, and how to tie the generation of evidence to practice-based research.
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Affiliation(s)
- Jai L Shah
- Prevention and Early Intervention Program for Psychoses (PEPP-Montréal), Douglas Mental Health University Institute, Montreal, QC, Canada. .,Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Matthew I Peters
- Prevention and Early Intervention Program for Psychoses (PEPP-Montréal), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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Settipani CA, Hawke LD, Cleverley K, Chaim G, Cheung A, Mehra K, Rice M, Szatmari P, Henderson J. Key attributes of integrated community-based youth service hubs for mental health: a scoping review. Int J Ment Health Syst 2019; 13:52. [PMID: 31367230 PMCID: PMC6651922 DOI: 10.1186/s13033-019-0306-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 07/10/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-based, integrated youth service hubs have the potential to address some of the longstanding issues with mental health services for youth, including problems with access and system fragmentation. Better understanding of these approaches, particularly efforts to create a single point of entry to comprehensive, evidence-based services through youth service hubs, is needed to help guide future implementation and evaluation. This scoping review identifies the key principles and characteristics of these models of care, as well as the state of the literature, particularly with regard to implementation and replicability. METHOD Electronic databases and grey literature sources were searched for material from 2001 to 2019, with diverse search terms capturing the concept of "integrated" or "one-stop shop" youth mental health services. Title/abstract and full text review were conducted, as well as additional focused searching. After screening 4891 texts at the title/abstract level and 496 at the full-text level, 110 documents were included for data extraction. RESULTS Several integrated care hub models for youth mental health services and related frameworks were identified internationally, largely in high-income countries. Common principles included an emphasis on rapid access to care and early intervention, youth and family engagement, youth-friendly settings and services, evidence-informed approaches, and partnerships and collaboration. Program characteristics also revealed similarities (e.g., providing evidence-informed or evidence-based services in youth-friendly spaces), with some differences (e.g., care coordination methods, types of service providers), potentially attributable to lack of available information about key ingredients. Outcome research was limited, with few rigorous evaluations of youth outcomes. Moreover, sufficient information for replication, community evaluation of feasibility or actual implementation was rarely provided. CONCLUSION Internationally, integrated youth service hubs were found to share common key principles, while providing comprehensive services to youth with mental health difficulties. There is a great need for common language and measurement framework to facilitate replication, rigorous evaluation of outcomes, knowledge exchange, and dissemination of findings.
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Affiliation(s)
- Cara A. Settipani
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Lisa D. Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Kristin Cleverley
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Amy Cheung
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Kamna Mehra
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
| | | | - Peter Szatmari
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
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Abba-Aji A, Hay K, Kelland J, Mummery C, Urichuk L, Gerdes C, Snaterse M, Chue P, Lal S, Joober R, Boksa P, Malla A, N Iyer S, Shah JL. Transforming youth mental health services in a large urban centre: ACCESS Open Minds Edmonton. Early Interv Psychiatry 2019; 13 Suppl 1:14-19. [PMID: 31243911 PMCID: PMC6771682 DOI: 10.1111/eip.12813] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper outlines the transformation of youth mental health services in Edmonton, Alberta, a large city in Western Canada. We describe the processes and challenges involved in restructuring how services and care are delivered to youth (11-25 years old) with mental health needs based on the objectives of the pan-Canadian ACCESS Open Minds network. METHODS We provide a narrative review of how youth mental health services have developed since our engagement with the ACCESS Open Minds initiative, based on its five central objectives of early identification, rapid access, appropriate care, continuity of care, and youth and family engagement. RESULTS Building on an initial community mapping exercise, a service network has been developed; teams that were previously age-oriented have been integrated together to seamlessly cover the age 11 to 25 range; early identification has thus far focused on high-school populations; and an actual drop-in space facilitates rapid access and linkages to appropriate care within the 30-day benchmark. CONCLUSIONS Initial aspects of the transformation have relied on restructuring and partnerships that have generated early successes. However, further transformation over the longer term will depend on data demonstrating how this has impacted clinical outcomes and service utilization. Ultimately, sustainability in a large urban centre will likely involve scaling up to a network of similar services to cover the entire population of the city.
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Affiliation(s)
- Adam Abba-Aji
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada.,Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds Edmonton, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Katherine Hay
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada.,ACCESS Open Minds Edmonton, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jill Kelland
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada.,ACCESS Open Minds Edmonton, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Christine Mummery
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada.,ACCESS Open Minds Edmonton, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Liana Urichuk
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada.,ACCESS Open Minds Edmonton, Edmonton, Alberta, Canada
| | - Cindy Gerdes
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada.,ACCESS Open Minds Edmonton, Edmonton, Alberta, Canada
| | - Mark Snaterse
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada
| | - Pierre Chue
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta, Canada.,Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds Edmonton, Edmonton, Alberta, Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, l'Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Patricia Boksa
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jai L Shah
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Etter M, Goose A, Nossal M, Chishom-Nelson J, Heck C, Joober R, Boksa P, Lal S, Shah JL, Andersson N, Iyer SN, Malla A. Improving youth mental wellness services in an Indigenous context in Ulukhaktok, Northwest Territories: ACCESS Open Minds Project. Early Interv Psychiatry 2019; 13 Suppl 1:35-41. [PMID: 31243916 PMCID: PMC6771701 DOI: 10.1111/eip.12816] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIM To describe a community-specific and culturally coherent approach to youth mental health services in a small and remote northern Indigenous community in Canada's Northwest Territories, under the framework of ACCESS Open Minds (ACCESS OM), a pan-Canadian youth mental health research and evaluation network. METHODS As 1 of the 14 Canadian communities participating in a 5-year, federally funded service transformation and evaluation project, the arctic Inuit community of Ulukhaktok has undertaken culturally relevant adjustments in their delivery of youth mental wellness services and related community wellness initiatives. These enhancement activities highlight connections to culture and traditional skills, honour youth- and community-expressed desires to incorporate Inuvialuit-specific approaches to wellness, and strengthen the support systems to improve access to mainstream mental healthcare, when needed. The adaptation of a Lay Health Worker model from Global Mental Health to the local circumstances resulting in creation of lay community health workers is central to this approach in meeting contextual needs. RESULTS Community leaders identified key activities for sustainable change, including human capital development, authentic collaboration and diversified engagement strategies. Building around five ACCESS OM objectives, the local site team in Ulukhaktok has identified its youth programming and mental wellness service gaps through an ongoing process of community mapping. CONCLUSIONS Information from service providers, youth and other community members demonstrates attuning of the ACCESS OM framework to Inuit paradigms in Ulukhaktok. It could prove to be a sustainable prototype for delivering youth mental health services in other communities in the Inuvialuit Settlement Region and possibly across the entire Inuit Nunangat. It needs, however, to be further supported by easier access to specialized mental health services when needed.
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Affiliation(s)
- Meghan Etter
- ACCESS Open Minds Ulukhaktok, Ulukhaktok, Northwest Territories, Canada.,Inuvialuit Regional Corporation, Inuvik, Northwest Territories, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Annie Goose
- ACCESS Open Minds Ulukhaktok, Ulukhaktok, Northwest Territories, Canada.,Inuvialuit Regional Corporation, Inuvik, Northwest Territories, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Margot Nossal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jessica Chishom-Nelson
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Carly Heck
- Department of Nursing, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Patricia Boksa
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Jai L Shah
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Neil Andersson
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Family Medicine, Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM), McGill University, Montreal, Quebec, Canada.,McGill Institute of Human Development and Well-being, McGill University, Montreal, Quebec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Hutt-MacLeod D, Rudderham H, Sylliboy A, Sylliboy-Denny M, Liebenberg L, Denny JF, Gould MR, Gould N, Nossal M, Iyer SN, Malla A, Boksa P. Eskasoni First Nation's transformation of youth mental healthcare: Partnership between a Mi'kmaq community and the ACCESS Open Minds research project in implementing innovative practice and service evaluation. Early Interv Psychiatry 2019; 13 Suppl 1:42-47. [PMID: 31243913 PMCID: PMC6771551 DOI: 10.1111/eip.12817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM ACCESS Open Minds (ACCESS OM) is a pan-Canadian project aimed at improving youth mental healthcare. This paper describes implementation of the ACCESS OM objectives for youth mental health service transformation within a pre-existing Fish Net Model of transformative youth mental healthcare service in the First Nation community of Eskasoni, on Canada's east coast. METHODS We describe an adaptation of the ACCESS OM service transformation objectives through the complementary blending of Indigenous and Western methodologies. This concept of "Two-Eyed Seeing" is illustrated as central to engaging youth in the community and attending to their mental health needs and wellness. RESULTS The ACCESS OM Eskasoni First Nation Youth Space acts as a central location for the site team and its activities, which expand into the rest of the community to facilitate early identification of youth in need. Rapid access to care is promoted via barrier-free availability through a central intake crisis and referral centre, and ease of contact through social media and other modalities. Youth are given the choice between standard Western mental health services, or Indigenous methods of improving well-being, or a combination of the two. CONCLUSIONS The ACCESS OM framework has shown early results of being a positive addition to the Eskasoni community. Local leadership and community buy-in are identified as key factors to success. Further exploration, research, and evaluation of this transformation is ongoing. Successful implementation of this model in Eskasoni could act as a model for youth mental health programmes in other First Nations across Canada.
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Affiliation(s)
- Daphne Hutt-MacLeod
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Heather Rudderham
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Arnold Sylliboy
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Mallery Sylliboy-Denny
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Linda Liebenberg
- Faculty of Graduate Studies, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeannine F Denny
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada
| | - Matthew R Gould
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Norma Gould
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds Eskasoni, Eskasoni First Nation, Nova Scotia, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Margot Nossal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Patricia Boksa
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Vallianatos H, Friese K, Perez JM, Slessor J, Thind R, Dunn J, Chisholm-Nelson J, Joober R, Boksa P, Lal S, Malla A, Iyer SN, Shah JL. ACCESS Open Minds at the University of Alberta: Transforming student mental health services in a large Canadian post-secondary educational institution. Early Interv Psychiatry 2019; 13 Suppl 1:56-64. [PMID: 31243904 PMCID: PMC6771816 DOI: 10.1111/eip.12819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Demands for mental health services in post-secondary institutions are increasing. This paper describes key features of a response to these needs: ACCESS Open Minds University of Alberta (ACCESS OM UA) is focused on improving mental health services for first-year students, as youth transition to university and adulthood. METHODS The core transformation activities at ACCESS OM UA are described, including early case identification, rapid access, appropriate and timely connections to follow-up care and engagement of students and families/carers. In addition, we depict local experiences of transforming existing services around these objectives. RESULTS The ACCESS OM UA Network has brought together staff with diverse backgrounds in order to address the unique needs of students. Together with the addition of ACCESS Clinicians these elements represent a systematic effort to support not just mental health, but the student as a whole. Key learnings include the importance of community mapping to developing networks and partnerships, and engaging stakeholders from design through to implementation for transformation to be sustainable. CONCLUSIONS Service transformation grounded in principles of community-based research allows for incorporation of local knowledge, expertise and opportunities. This approach requires ample time to consult, develop rapport between staff and stakeholders across diverse units and develop processes in keeping with local opportunities and constraints. Ongoing efforts will continue to monitor changing student needs and to evaluate and adapt the transformations outlined in this paper to reflect those needs.
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Affiliation(s)
- Helen Vallianatos
- Office of the Dean of Students, University of Alberta, Edmonton, Alberta, Canada.,Department of Anthropology, University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Kevin Friese
- Office of the Dean of Students, University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jessica M Perez
- Office of the Dean of Students, University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jane Slessor
- Office of the Dean of Students, University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Rajneek Thind
- Office of the Dean of Students, University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Joshua Dunn
- Office of the Dean of Students, University of Alberta, Edmonton, Alberta, Canada.,ACCESS Open Minds University of Alberta, Edmonton, Alberta, Canada
| | - Jessica Chisholm-Nelson
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Patricia Boksa
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Ashok Malla
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jai L Shah
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Abdel-Baki A, Aubin D, Morisseau-Guillot R, Lal S, Dupont MÈ, Bauco P, Shah JL, Joober R, Boksa P, Malla A, Iyer SN. Improving mental health services for homeless youth in downtown Montreal, Canada: Partnership between a local network and ACCESS Esprits ouverts (Open Minds), a National Services Transformation Research Initiative. Early Interv Psychiatry 2019; 13 Suppl 1:20-28. [PMID: 31243907 PMCID: PMC6772090 DOI: 10.1111/eip.12814] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM In many parts of the world, there is growing concern about youth homelessness. Homeless youth are particularly vulnerable to psychological distress, substance use and mental disorders, and premature mortality caused by suicide and drug overdose. However, their access to and use of mental health care is very limited. METHODS The Réseau d'intervention de proximité auprès des jeunes (RIPAJ), a Montreal network of over 20 community stakeholders providing a wide array of cohesive services, was created to ease homeless youth's access to mental health and psychosocial services. Its philosophy is that there should be no "wrong door" or "wrong timing" for youth seeking help. In 2014, the network partnered with the pan-Canadian transformational research initiative, ACCESS Esprits ouverts. RESULTS Created through this partnership, ACCESS Esprits ouverts RIPAJ has been promoting early identification through outreach activities targeting homeless youth and agencies that serve them. An ACCESS Clinician was hired to promote and rapidly respond to help-seeking and referrals. By strengthening connections within RIPAJ and using system navigation, the site is working to facilitate youth's access to timely appropriate care and eliminate age-based transitions between services. A notable feature of our program, that is not usually evident in homelessness services, has been the engagement of the youth in service planning and design and the encouragement of contact with families and/or friends. CONCLUSION Challenges remain including eliminating any remaining age-related transitions of care between adolescent and adult services; and the sustainability of services transformation and network coordination. Nonetheless, this program serves as an example of an innovative, much-needed, community-oriented model for improving access to mental health care for homeless youth.
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Affiliation(s)
- Amal Abdel-Baki
- Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, Quebec, Canada.,ACCESS Open Minds Réseau d'intervention de proximité pour les jeunes de la rue (RIPAJ), Montreal, Quebec, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Diane Aubin
- ACCESS Open Minds Réseau d'intervention de proximité pour les jeunes de la rue (RIPAJ), Montreal, Quebec, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Dans la rue, a Bilingual Charitable Youth Multi-Services Organization Serving Homeless Youth, Montreal, Quebec, Canada
| | - Raphaël Morisseau-Guillot
- Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, Quebec, Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Marie-Ève Dupont
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, Quebec, Canada.,ACCESS Open Minds Réseau d'intervention de proximité pour les jeunes de la rue (RIPAJ), Montreal, Quebec, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Pasquale Bauco
- Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, Quebec, Canada.,ACCESS Open Minds Réseau d'intervention de proximité pour les jeunes de la rue (RIPAJ), Montreal, Quebec, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Jai L Shah
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Patricia Boksa
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Reaume-Zimmer P, Chandrasena R, Malla A, Joober R, Boksa P, Shah JL, Iyer SN, Lal S. Transforming youth mental health care in a semi-urban and rural region of Canada: A service description of ACCESS Open Minds Chatham-Kent. Early Interv Psychiatry 2019; 13 Suppl 1:48-55. [PMID: 31243909 PMCID: PMC6771628 DOI: 10.1111/eip.12818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
AIM This study describes how mental health services for youth are being transformed within the context of a semi-urban and rural region of Canada (Chatham-Kent, Ontario), based on the framework of ACCESS Open Minds (ACCESS OM), a pan-Canadian youth mental health research and evaluation network. METHODS Transformation has focused on the five key objectives of ACCESS OM, namely early identification, rapid access, appropriate care, continuity of care, and youth and family engagement. A community mapping process was conducted at the beginning of the transformation to help develop a comprehensive inventory of services, identify challenges and optimize partnerships to address the five key objectives. RESULTS The following strategies represent key elements in the transformation: coordination and partnerships between hospital, community and voluntary organizations, as well as different sectors of the community (e.g., Child and Youth Services, Education, Community Safety and Correctional Services, CSCS); working with local champions (e.g., Youth Diversion Officer and the Mental Health and Addictions Nurse in the school sectors); establishing a youth-friendly space in a central part of the community, where services are co-located and operate within an open-concept design; training of ACCESS Clinicians to conduct an initial assessment; engaging youth and family in service-level recruitment, planning, daily operations, and evaluation, including hiring of youth and family peer navigators; and, engaging the community through awareness and educational events. CONCLUSIONS The success of this transformation needs to be measured on various outcome parameters, but it is notable that neighbouring communities are already beginning to implement a similar model.
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Affiliation(s)
- Paula Reaume-Zimmer
- Mental Health and Addiction Services, Bluewater Health and Canadian Mental Health Association Lambton-Kent, Ontario, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ranjith Chandrasena
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Shulich School of Medicine, Western University, London, Ontario, Canada
| | - Ashok Malla
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Patricia Boksa
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jai L Shah
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
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62
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Malla A, Iyer S, Shah J, Joober R, Boksa P, Lal S, Fuhrer R, Andersson N, Abdel‐Baki A, Hutt‐MacLeod D, Beaton A, Reaume‐Zimmer P, Chisholm‐Nelson J, Rousseau C, Chandrasena R, Bourque J, Aubin D, Levasseur MA, Winkelmann I, Etter M, Kelland J, Tait C, Torrie J, Vallianatos H. Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts). Early Interv Psychiatry 2019; 13:697-706. [PMID: 30556335 PMCID: PMC6563151 DOI: 10.1111/eip.12772] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/18/2018] [Accepted: 11/04/2018] [Indexed: 01/02/2023]
Abstract
AIM Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. METHOD We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post-secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. RESULTS Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. CONCLUSIONS Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.
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Affiliation(s)
- Ashok Malla
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Srividya Iyer
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Jai Shah
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Ridha Joober
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Patricia Boksa
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Shalini Lal
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
- School of Rehabilitation, Faculty of MedicineUniversité de MontréalMontréal, QuébecCanada
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)Montréal, QuébecCanada
| | - Rebecca Fuhrer
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréal, QuébecCanada
| | - Neil Andersson
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of Family Medicine, Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM)McGill UniversityMontréal, QuébecCanada
- McGill University Institute for Human Development and Well‐beingMontréal, QuébecCanada
| | - Amal Abdel‐Baki
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of PsychiatryUniversité de MontréalMontréal, QuébecCanada
- Centre hospitalier de l'Université de Montréal (CHUM), CRCHUMMontréal, QuébecCanada
| | - Daphne Hutt‐MacLeod
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Eskasoni Mental Health ServicesEskasoni, Nova ScotiaCanada
| | - Ann Beaton
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- School of Psychology, Faculty of Health Sciences and Community ServicesUniversité de MonctonMonctonNew BrunswickCanada
| | - Paula Reaume‐Zimmer
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Mental Health and Addictions ServicesBluewater Health and Canadian Mental Health AssociationLambton Kent, OntarioCanada
| | - Jessica Chisholm‐Nelson
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Cécile Rousseau
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Centre de recherche SHERPA, Institut Universitaire au regard des communautés culturellesCentre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre‐Ouest‐de‐l'Île‐de‐MontréalMontréal, QuébecCanada
| | - Ranjith Chandrasena
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Schulich School of MedicineWestern UniversityLondonOntarioCanada
| | - Jimmy Bourque
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Faculty of EducationUniversité de MonctonMonctonNew BrunswickCanada
| | - Diane Aubin
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Dans La Rue and Réseau d'intervention de proximité auprès des jeunes de la rue (RIPAJ)‐Montréal/Homeless Youth NetworkMontréal, QuébecCanada
| | - Mary Anne Levasseur
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- ACCESS Open Minds Family and Carers Council, Douglas Mental Health University Institute, MontréalQuébecCanada
| | - Ina Winkelmann
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Meghan Etter
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Counselling ServicesInuvialuit Regional CorporationInuvik, Northwest TerritoriesCanada
| | - Jill Kelland
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Young Adult and Cross Level Services, Addiction and Mental Health, Edmonton Zone, Alberta Health ServicesEdmontonAlbertaCanada
| | - Caroline Tait
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of PsychiatryUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Jill Torrie
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Public Health DepartmentCree Board of Health and Social Services of James BayMistissini, QuébecCanada
| | - Helen Vallianatos
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of AnthropologyUniversity of AlbertaEdmontonAlbertaCanada
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