Health-Related Outcome Improvements Via the ACCESS Open Minds Youth Mental Health Service Transformation Project in Edmonton, Canada: Amélioration des résultats en matière de santé grâce au projet de transformation des services de santé mentale jeunes d'ACCESS Open Minds/Esprits ouverts à Edmonton, Canada.

Abstract

ObjectiveGrowing efforts to transform youth mental health (YMH) services rest on the assumption that they will produce superior outcomes to those of traditional services. We therefore aimed to determine whether implementation of a broad YMH service model in Edmonton, Alberta (the largest site in the pan-Canadian ACCESS Open Minds [AOM] network) resulted in greater improvements in individual-level outcomes compared to a matched control group seen at non-AOM community mental health services.MethodThis retrospective cohort study used data on the Health of Nation Outcomes Scale (HoNOS) collected by trained clinicians, in youth aged 15-25 attending AOM or comparator services for any mental health problem between April 2016 and September 2019. A difference-in-differences approach compared HoNOS outcomes pre- versus post-exposure to the AOM service over a 1-year time horizon, in relation to youth attending a non-transformed service. Propensity score matching and sensitivity analyses were conducted to ensure bias reduction and robustness of observations, respectively.ResultsThe number of referrals to AOM Edmonton increased over time (36.3% [95%CI = 11.0%-68.0%] per month), and the site met benchmarks for rapid assessment (within 72 hours) and time to appropriate care (within 30 days). Of 1,078 youth (344 in the intervention [AOM] group and 734 in the control [non-AOM] group) aged 15-25 visiting community mental health centres, the intervention group had statistically greater improvements (7.4% absolute improvement or 1.2× relative improvement) in total HoNOS scores and its behavioural and symptom subscales.ConclusionsIn addition to improving the reach and timeliness of YMH services, AOM Edmonton produced greater improvements in HoNOS total scores (and two of four subscale scores) compared to a matched control group. Comparative evaluations such as these are essential to demonstrating the value of such services and generating continuous cycles of learning and improvement.Plain Language Summary TitleWhat are the outcomes of transforming youth mental health services in community settings?