Enhanced Case Management for Mental Health and Substance Use Disorders

(TeachMeToBuild Trial)

Overseen By Giulio DiDiodato, MD PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Royal Victoria Hospital, Canada

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

400 Participants Needed

Trial Summary

What is the purpose of this trial?

Youth unemployment is a chronic problem in most societies. Some young adults are neither in employment, education or training (NEET), and are at high risk of chronic unemployment, social disengagement and poor quality of life. Identifying this high risk population and providing them with career skills training and opportunities is critical for their full participation in society. Vocational training programs provide an opportunity for these NEET youth to develop a skilled trade. Barriers to successful completion of these programs include high prevalence of mental health and substance use disorders among NEET youth. This study will use a daily self-report distress tool to identify vocational program trainees at risk of absence or drop-out due to mental health and/or substance abuse issues. These at-risk trainees will then be referred to a mental health crisis program through a fit-for-purpose referral process to accommodate their training program requirements. It is hypothesized that early identification and referral for mental health and substance abuse issues will reduce both program absence and drop-out rates and result in improved in long-term employment for these NEET youth.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Enhanced Case Management for Mental Health and Substance Use Disorders?

Research shows that case management can be more effective than standard care in reducing hospital visits and improving social interactions and patient satisfaction. Additionally, enhanced psychiatric case management has been found to help engage patients with both depression and substance abuse into treatment. ^{1 2 3 4 5}

Is Enhanced Case Management for Mental Health and Substance Use Disorders safe for humans?

The research articles reviewed do not provide specific safety data for Enhanced Case Management or its variations. However, one article mentions a treatment model that uses the principle of 'safety first' to guide interventions, suggesting a focus on safety in similar integrated treatment approaches. ^{6 7 8 9 10}

How does the Enhanced Case Management treatment for mental health and substance use disorders differ from other treatments?

This treatment is unique because it combines basic case management with tools for distress assessment and rapid access to mental health and addiction services, aiming to improve engagement and outcomes for patients with severe mental and substance use disorders. Unlike standard treatments, it focuses on coordinated care and quick access to necessary services, which can be crucial for individuals with complex needs. ^{3 5 7 11 12}

Research Team

Giulio Didiodato, MD

Principal Investigator

Royal Victoria Regional Health Centre

Eligibility Criteria

This trial is for young adults who are not in employment, education, or training (NEET), specifically visible minorities or females with mental health and substance use issues. Participants must have Wi-Fi access, a computing device, speak English or French, and possess an Ontario Health Insurance Plan number and Canadian Social Insurance Number.

Inclusion Criteria

Must have an active Ontario Health Insurance Plan number

I am a visible minority or female.

Must have a valid Canadian Social Insurance Number

Exclusion Criteria

Not applicable.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training Program

Participants undergo a 12-week vocational training program including in-classroom education and supervised hands-on experiential learning at construction sites

12 weeks

Daily in-person attendance required

Follow-up

Participants are monitored for program completion and employment outcomes

24 weeks

Treatment Details

Interventions

• Basic Case Management
• Basic Case Management plus Distress Tool
• Basic Case Management plus Distress Tool and rapid mental health & addictions healthcare access
• Basic Case Management plus rapid mental health & addictions healthcare access

Trial Overview The study tests if adding a daily self-reporting tool for distress and rapid access to mental health services improves the completion rates of vocational training programs for NEET youth at risk due to mental health/substance abuse.

Participant Groups

Group I: Basic case management supplemented by self-reporting distress tool (DT) Experimental Treatment 1 Intervention

Basic case management plus access to the self-report daily distress tool. The trainees are provided web-based access to the daily distress tool and report their distress levels using a validated visual analog scale (Distress Thermometer), along with reporting their risk of missing work/class or dropping out of the program. The case manager responds to the distress tool by coordinating external support services as needed.

Group II: Basic case management supplemented by rapid access healthcare services Experimental Treatment 1 Intervention

Basic case management supplemented by a fit-for-purpose rapid referral process for trainees with active mental health and/or substance use disorders affecting their program participation.

Group III: Basic case management supplemented by DT and rapid access healthcare services Experimental Treatment 1 Intervention

Basic case management supplemented by both the self-report distress tool and rapid referral process for those trainees at-risk of program absence or drop-out from either mental health or addictions issues.

Group IV: Basic case management Active Control 1 Intervention

Basic case management with bi-weekly meetings between case manager and trainees that includes check-ins, frequent visits to construction sites and monitoring of feedback forms from mentors. Case managers attempt to connect trainees with external support services as needed.

Who Is Running the Clinical Trial?

Royal Victoria Hospital, Canada

Lead Sponsor

Trials

18

Recruited

10,400+

References

1. United States pubmed.ncbi.nlm.nih.gov

Clinical case management of revolving door patients - a semi-randomized study. [2018]

2. Canada pubmed.ncbi.nlm.nih.gov

[Case management for moderate-need patients and recovery: what can we learn from experimental and quasi-experimental studies?]. [2019]

3. England pubmed.ncbi.nlm.nih.gov

Improving treatment services for substance abusers with comorbid depression. [2016]

4. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of specialized treatment programs for veterans with serious and persistent mental illness: a three-year follow-up. [2019]

5. England pubmed.ncbi.nlm.nih.gov

Does case management influence the rate of violence and self-destructive behaviours in the severely mentally ill? [2014]

6. England pubmed.ncbi.nlm.nih.gov

Clinical and economic evaluation of a Case Management Service for patients with back pain. [2018]

7. England pubmed.ncbi.nlm.nih.gov

Case management in aftercare of involuntarily committed patients with substance abuse. A randomized trial. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

Case management services for adolescent substance abusers: a program description. [2019]

9. England pubmed.ncbi.nlm.nih.gov

Study protocol for a randomised controlled trial evaluating the effectiveness of strengths model case management (SMCM) with Chinese mental health service users in Hong Kong. [2020]

10. United States pubmed.ncbi.nlm.nih.gov

Integrated treatment for the survivor of childhood trauma who is chemically dependent. [2007]

11. England pubmed.ncbi.nlm.nih.gov

Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study. [2018]

12. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of different models of case management for substance-abusing populations. [2019]