Srividya N Iyer, Patricia Boksa, Ridha Joober, Jai Shah, Rebecca Fuhrer, Neil Andersson, Shalini Lal, Giuseppe D'Andrea, Nora Morrison, Valerie Noel, Daniel Rabouin, Tovah Cowan, Kathleen MacDonald, Mary Anne Levasseur, Feodor Poukhovski-Sheremetyev, Amal Abdel-Baki, Lacey Augustine, Kevin Friese, Isabelle Godin, Katherine Hay, Daphne Hutt-MacLeod, Vickie Plourde, Norma Rabbitskin, Paula Reaume-Zimmer, Cécile Rousseau, Heather Rudderham, Adam Abba-Aji, Diane Aubin, Liana Urichuk, Helen Vallianatos, Shirin Golchi, Ina Winkelmann, Jessica Chisholm-Nelson, Ashok Malla
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ACCESS Open Minds (ACCESS-OM) transformed services at urban, rural, and Indigenous sites in Canada using 5 principles (early identification, rapid access, appropriate care, no age-based transitions from 11-25 years, and youth and family engagement).</p><p><strong>Objective: </strong>To evaluate whether the number of youths referred (hypothesis 1), offered evaluation appointments within 72 hours of referral (hypothesis 2), and receiving services within 30 days of the first appointment (hypothesis 3) increased over the course of ACCESS-OM's implementation.</p><p><strong>Design, setting, and participants: </strong>This cohort study included youths (aged 11-25 years) at 11 sites referred between March 2016 and December 2020. Data were analyzed from April 2022 to April 2024.</p><p><strong>Exposure: </strong>Existing primary and/or community services implemented ACCESS-OM's core components: broad-spectrum mental health services, outreach, youth-friendly walk-in spaces, open systems accepting referrals from multiple sources, and response-time benchmarks (72 hours to evaluation and 30 days to start treatment).</p><p><strong>Main outcomes and measures: </strong>Outcomes were the referral rate and the probability of being offered a first evaluation within 72 hours and receiving services within 30 days. Dates of referral and/or help-seeking, first offered appointment, first evaluation, and first services received were recorded. Multilevel negative binomial regression was used for hypothesis 1, and time-to-event analyses followed by multilevel accelerated failure time (AFT) models were used for hypotheses 2 and 3.</p><p><strong>Results: </strong>A total of 7889 youths were referred; 4519 (mean [SD] age, 19.3 [3.4] years; 2440 [54%] cisgender women; 1049 [23.21%] Indigenous; 991 [21.93%] Visible Minority [Arab, Black, Chinese, Filipino, Japanese, Korean, Latin American, South Asian, Southeast Asian, West Asian, other ethnicity, and multiple ethnicities]; and 1525 [49.10%] White) were evaluated before March 2020. Each 6-month progression after implementation was associated with a 10% increase in referral rates (IRR, 1.10; 95% CI, 1.07-1.13). The probability of being offered an initial appointment (χ22 = 20.30; P < .001) and receiving services (χ22 = 4.48; P = .01) after any given delay differed significantly over the 3 years. In adjusted AFT models, each 6-month progression was associated with a 3% decrease in time to offered evaluation (time ratio [TR], 0.97; 95% CI, 0.95-0.99) and first services (TR, 0.97; 95% CI, 0.94-1.00). Moderate to severe mental health problems were associated with longer delays to offered first appointments (TR, 1.14; 95% CI, 1.06-1.24) and services (TR, 1.11; 95% CI, 1.01-1.22).</p><p><strong>Conclusions and relevance: </strong>As hypothesized, after ACCESS-OM implementation, more youths sought help, and the timeliness of initial response and services improved over time. These findings suggest that core principles, benchmarks, and implementation supports are valuable in organizing youth mental health care. Future efforts should make benefits equitable for those with severe problems.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":""},"PeriodicalIF":22.5000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866065/pdf/","citationCount":"0","resultStr":"{\"title\":\"An Approach to Providing Timely Mental Health Services to Diverse Youth Populations.\",\"authors\":\"Srividya N Iyer, Patricia Boksa, Ridha Joober, Jai Shah, Rebecca Fuhrer, Neil Andersson, Shalini Lal, Giuseppe D'Andrea, Nora Morrison, Valerie Noel, Daniel Rabouin, Tovah Cowan, Kathleen MacDonald, Mary Anne Levasseur, Feodor Poukhovski-Sheremetyev, Amal Abdel-Baki, Lacey Augustine, Kevin Friese, Isabelle Godin, Katherine Hay, Daphne Hutt-MacLeod, Vickie Plourde, Norma Rabbitskin, Paula Reaume-Zimmer, Cécile Rousseau, Heather Rudderham, Adam Abba-Aji, Diane Aubin, Liana Urichuk, Helen Vallianatos, Shirin Golchi, Ina Winkelmann, Jessica Chisholm-Nelson, Ashok Malla\",\"doi\":\"10.1001/jamapsychiatry.2024.4880\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Accessing mental health care is challenging for youths, especially those facing intersectional disadvantages, but whether enhancing youth services increases reach and timeliness has rarely been investigated. 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Data were analyzed from April 2022 to April 2024.</p><p><strong>Exposure: </strong>Existing primary and/or community services implemented ACCESS-OM's core components: broad-spectrum mental health services, outreach, youth-friendly walk-in spaces, open systems accepting referrals from multiple sources, and response-time benchmarks (72 hours to evaluation and 30 days to start treatment).</p><p><strong>Main outcomes and measures: </strong>Outcomes were the referral rate and the probability of being offered a first evaluation within 72 hours and receiving services within 30 days. Dates of referral and/or help-seeking, first offered appointment, first evaluation, and first services received were recorded. Multilevel negative binomial regression was used for hypothesis 1, and time-to-event analyses followed by multilevel accelerated failure time (AFT) models were used for hypotheses 2 and 3.</p><p><strong>Results: </strong>A total of 7889 youths were referred; 4519 (mean [SD] age, 19.3 [3.4] years; 2440 [54%] cisgender women; 1049 [23.21%] Indigenous; 991 [21.93%] Visible Minority [Arab, Black, Chinese, Filipino, Japanese, Korean, Latin American, South Asian, Southeast Asian, West Asian, other ethnicity, and multiple ethnicities]; and 1525 [49.10%] White) were evaluated before March 2020. Each 6-month progression after implementation was associated with a 10% increase in referral rates (IRR, 1.10; 95% CI, 1.07-1.13). The probability of being offered an initial appointment (χ22 = 20.30; P < .001) and receiving services (χ22 = 4.48; P = .01) after any given delay differed significantly over the 3 years. 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引用次数: 0
摘要
重要性:获得精神卫生保健对青年来说是一项挑战,特别是那些面临交叉劣势的青年,但很少调查加强青年服务是否会增加覆盖面和及时性。ACCESS Open Minds (ACCESS- om)利用5项原则(早期发现、快速获取、适当护理、11-25岁之间无年龄过渡以及青年和家庭参与)改变了加拿大城市、农村和土著地区的服务。目的:评估在ACCESS-OM实施过程中,青少年的转诊人数(假设1)、转诊后72小时内的评估预约(假设2)以及首次预约后30天内接受服务的人数(假设3)是否有所增加。设计、环境和参与者:该队列研究包括2016年3月至2020年12月期间11个地点的青少年(11-25岁)。数据分析时间为2022年4月至2024年4月。暴露:现有的初级和/或社区服务实施了《无障碍网络》的核心组成部分:广域精神卫生服务、外联、方便青年的无障碍空间、接受多种来源转诊的开放系统,以及反应时间基准(72小时进行评估,30天开始治疗)。主要结果和措施:结果是转诊率和72小时内提供第一次评估和30天内接受服务的概率。记录转诊和/或求助日期、第一次预约、第一次评估和第一次接受服务的日期。假设1采用多水平负二项回归,假设2和3采用时间到事件分析和多水平加速失效时间(AFT)模型。结果:共转介青少年7889例;4519(平均[SD]年龄,19.3[3.4]岁;2440名(54%)顺性别女性;[23.21%]土著;991[21.93%]少数族裔[阿拉伯人、黑人、中国人、菲律宾人、日本人、韩国人、拉丁美洲人、南亚人、东南亚人、西亚人、其他族裔和多族裔];2020年3月前评估1525例(49.10%)。实施后每6个月进展与转诊率增加10%相关(IRR, 1.10;95% ci, 1.07-1.13)。获得初次预约的概率(χ22 = 20.30;P结论和相关性:正如假设的那样,在ACCESS-OM实施后,更多的年轻人寻求帮助,并且随着时间的推移,初始响应和服务的及时性得到了改善。这些发现表明,核心原则、基准和实施支持在组织青少年精神卫生保健方面是有价值的。未来的努力应该使那些有严重问题的人得到公平的福利。
An Approach to Providing Timely Mental Health Services to Diverse Youth Populations.
Importance: Accessing mental health care is challenging for youths, especially those facing intersectional disadvantages, but whether enhancing youth services increases reach and timeliness has rarely been investigated. ACCESS Open Minds (ACCESS-OM) transformed services at urban, rural, and Indigenous sites in Canada using 5 principles (early identification, rapid access, appropriate care, no age-based transitions from 11-25 years, and youth and family engagement).
Objective: To evaluate whether the number of youths referred (hypothesis 1), offered evaluation appointments within 72 hours of referral (hypothesis 2), and receiving services within 30 days of the first appointment (hypothesis 3) increased over the course of ACCESS-OM's implementation.
Design, setting, and participants: This cohort study included youths (aged 11-25 years) at 11 sites referred between March 2016 and December 2020. Data were analyzed from April 2022 to April 2024.
Exposure: Existing primary and/or community services implemented ACCESS-OM's core components: broad-spectrum mental health services, outreach, youth-friendly walk-in spaces, open systems accepting referrals from multiple sources, and response-time benchmarks (72 hours to evaluation and 30 days to start treatment).
Main outcomes and measures: Outcomes were the referral rate and the probability of being offered a first evaluation within 72 hours and receiving services within 30 days. Dates of referral and/or help-seeking, first offered appointment, first evaluation, and first services received were recorded. Multilevel negative binomial regression was used for hypothesis 1, and time-to-event analyses followed by multilevel accelerated failure time (AFT) models were used for hypotheses 2 and 3.
Results: A total of 7889 youths were referred; 4519 (mean [SD] age, 19.3 [3.4] years; 2440 [54%] cisgender women; 1049 [23.21%] Indigenous; 991 [21.93%] Visible Minority [Arab, Black, Chinese, Filipino, Japanese, Korean, Latin American, South Asian, Southeast Asian, West Asian, other ethnicity, and multiple ethnicities]; and 1525 [49.10%] White) were evaluated before March 2020. Each 6-month progression after implementation was associated with a 10% increase in referral rates (IRR, 1.10; 95% CI, 1.07-1.13). The probability of being offered an initial appointment (χ22 = 20.30; P < .001) and receiving services (χ22 = 4.48; P = .01) after any given delay differed significantly over the 3 years. In adjusted AFT models, each 6-month progression was associated with a 3% decrease in time to offered evaluation (time ratio [TR], 0.97; 95% CI, 0.95-0.99) and first services (TR, 0.97; 95% CI, 0.94-1.00). Moderate to severe mental health problems were associated with longer delays to offered first appointments (TR, 1.14; 95% CI, 1.06-1.24) and services (TR, 1.11; 95% CI, 1.01-1.22).
Conclusions and relevance: As hypothesized, after ACCESS-OM implementation, more youths sought help, and the timeliness of initial response and services improved over time. These findings suggest that core principles, benchmarks, and implementation supports are valuable in organizing youth mental health care. Future efforts should make benefits equitable for those with severe problems.
期刊介绍:
JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.