Evaluating ACCESS, a large-scale youth mental health services transformation project in Canada

Presentation First Author: 
Srividya Iyer

Rationale: Canadian youths with mental health difficulties face delayed detection, long waiting lists, inaccessible services, poor-quality care and abrupt inter-service transitions. To address these issues, ACCESS, a multistakeholder network will implement and systematically evaluate a transformation of mental healthcare services to cater to youths aged 11 to 25. The transformation plan has four key foci: early case identification, rapid access, appropriate care, and the elimination of age-based transitions between services.

Objectives: This presentation will provide an overview of the rationale for and design of a mixed methods stepped wedge cluster randomized trial of the ACCESS model of youth mental healthcare transformation.

Approach: Our stepped wedge trial will be conducted at six demonstration sites. The intervention (a transformed system of early detection, rapid access and appropriate care) will be rolled out in two waves. In Wave 1, three randomly chosen sites will implement the transformation. A year later, the other three sites will initiate Wave 2. The one-year inter-wave gap, an integral feature of our stepped wedge design, will let Wave 2 sites observe and learn from Wave 1 sites. We chose this design because all stakeholders thought it more ethical for all sites to implement the transformation rather than for some sites to serve as “controls” as in a typical randomized controlled trial (RCT). Yet, like a traditional RCT, a stepped wedge trial can generate evidence that has a high impact on practice and policy. Staggering the intervention roll-out also enhances feasibility in terms of resource allocation. Our primary hypotheses pertain to increased referral numbers and reduced wait times to initial assessment and appropriate care. This presentation will elaborate these hypotheses and our quantitative and qualitative approaches to testing them.

Practice/Policy Implications: Data from our stepped wedge design will help test the effectiveness of the ACCESS model, refine it further, and inform the scale-up of youth mental health services transformation. The process by which the ACCESS research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholders and address unique considerations in designing evaluations of complex healthcare interventions.

Conclusions: The cluster randomized trial design represents a viable, ethical solution to the problem of evaluating community interventions. Coupled with a mixed methods framework, such an approach can generate both concrete evidence and nuanced insight. More such innovative approaches are needed to advance youth mental health services research.

Conference Name: 
Date of Presentation: 
9th Oct 2015
Type of presentation: 
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