Figure 1
PRISMA flow chart.
Table 1
Summary of the core components of integration taken from each included paper.
| AUTHOR DATE | ARTICLE TYPE | COUNTRY | COMPONENTS OF INTEGRATED YMH CONSIDERED | ||||||
|---|---|---|---|---|---|---|---|---|---|
| SD | W | IS&C | P&T | F | V | LG&P | |||
| Ådnanes and Steihaug, 2013 | Evaluation (implementation) | Norway | ✔ | ✔ | ✔ | ✔ | |||
| Asarnow et al 2015 | Literature review (meta analysis) | USA | ✔ | ✔ | |||||
| Asarnow. et al 2005 | Evaluation (impact) | USA | ✔ | ✔ | |||||
| Barbic et al 2022 | Evaluation (impact) | Canada | ✔ | ✔ | ✔ | ||||
| Bartholomeusz 2022 | Literature review & evaluation (implementation) | Australia | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Birchwood et al 2018 | Evaluation (impact & implementation) | UK | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Callaly et al 2009 | Evaluation (implementation) | Australia | ✔ | ✔ | ✔ | ✔ | |||
| Callaly et al 2011 | Literature review & evaluation (implementation) | Australia | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Chiodo et al 2022 | Evaluation (implementation) | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | |
| Clarke et al 2005 | Evaluation (impact & implementation) | USA | ✔ | ✔ | |||||
| De Voursney and Huang 2016 | Perspective | USA | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Fusar-Poli 2019 | Literature review | UK | ✔ | ✔ | ✔ | ✔ | ✔ | ||
| Glowacki et al 2022 | Evaluation (implementation) | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ||
| Halsall et al 2020 | Description | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Henderson et al 2022 | Evaluation (implementation) | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Hetrick et al 2017 | Literature review | Australia | ✔ | ✔ | ✔ | ✔ | ✔ | ||
| Illback et al 2010 | Evaluation (implementation) | Ireland | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Malla et al 2018 | Evaluation (impact & implementation) | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Mathias et al 2021 | Evaluation (implementation) | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| McGorry et al 2019 | Perspective | Australia | ✔ | ✔ | ✔ | ||||
| McGorry et al 2022 | Literature review | Australia | ✔ | ✔ | ✔ | ✔ | ✔ | ||
| Mufson et al 2018 | Evaluation (impact & implementation) | USA | ✔ | ✔ | ✔ | ||||
| Nadeau et al 2012 | Evaluation (implementation) | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ||
| O’Reilly et al 2021 | Description | Ireland | ✔ | ✔ | ✔ | ✔ | ✔ | ||
| Pomare et al 2018 | Evaluation (implementation) | Australia | ✔ | ✔ | |||||
| Rapp et al 2017 | Evaluation (implementation) | USA | ✔ | ✔ | ✔ | ||||
| Richardson et al 2014 | Evaluation (impact) | USA | ✔ | ✔ | ✔ | ||||
| Rickwood et al 2020 | Description | Australia | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Salmon et al 2021 | Evaluation (implementation) | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Schlesinger et al 2022 | Literature review | USA | ✔ | ✔ | ✔ | ✔ | |||
| Scott et al 2009 | Description | Australia | ✔ | ✔ | ✔ | ✔ | ✔ | ||
| Settipani et al 2019 | Literature review | Canada | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Shippee et al 2018 | Evaluation (impact) | USA | ✔ | ✔ | ✔ | ||||
| Weersing et al 2017 | Evaluation (impact) | USA | ✔ | ✔ | |||||
| Wright et al 2016 | Evaluation (implementation) | USA | ✔ | ✔ | ✔ | ||||
| Yonek et al 2020 | Literature review | USA | ✔ | ✔ | ✔ | ✔ | |||
[i] SD = Service delivery, W = Workforce, IS&C = Information systems and communication, P&T = Products and technology, F = Finance, V = Values, LG&P = Leadership, governance, and policy.
Table 2
Levels and components of Integration: The Youth Integration Project (YIP) Framework*.
| COORDINATED | CO-LOCATED | INTEGRATED | |
|---|---|---|---|
| Service delivery | Separate screening, treatment plans, and evidence based practices. | Agree on specific screening. Separate service plans informed by some shared knowledge. Some shared EBPs and training | Consistent screenings across disciplines. Shared treatment planning. EBPs and training shared across system |
| Health Workforce | Multidisciplinary workforce. No appreciation of each other’s culture. View each other as outside resources | Multidisciplinary workforce. Some appreciation of each other’s role. One discipline overshadows others. | Multidisciplinary workforce. In-depth appreciation of roles and culture. Shared sense of ownership of model |
| Information Systems and Communication/Products and technology | Separate facilities. Separate systems. Communicate rarely | Co-location. Separate systems. Communicate occasionally | Co-location. Shared systems. Face-to-Face consultation. Regular formal and informal meetings and communication. |
| Finance | Separate funding. Limited sharing of resources. Separate billing practices | Separate funding but may share grants. Some sharing of costs. Separate billing due to system barriers | Integrated funding from multiple sources of revenue. Resources shared and allocated. Billing maximised for integrated model and single billing structure |
| Leadership, governance, and policy/ Values | No shared vision. Limited shared leadership. Limited provider buy-into collaboration. | Some shared vision. Organisation leaders support integration nominally. Some buy-in to integration but not consistent across all providers. | Documented shared vision clearly communicated. Organisation leaders strongly support integration. Integrated care and all components embraced by providers |
[i] *A more complete version of the table is included as supplementary file 3.
Table 3
headspace integration evaluation.
| BUILDING BLOCKS | INTEGRATION EVALUATION AS PER THE YIP FRAMEWORK (TAKEN FROM (28)) |
|---|---|
| Service Delivery | A single, visible location, a on stop shop with providers providing the full spectrum of care around a young person and his/her family. Focus on early intervention approach offering safe, holistic, evidence-informed, proportional and stage-linked care, including risk-benefit considerations and shared decision-making, with social and vocational outcomes as the key targets. (Level 5/6). |
| Health Workforce | Centres are staffed by multidisciplinary teams comprising mental health, physical health, alcohol and other drug, and vocational support along with non-clinical (peer worker) staff. Workforce capacity is a challenge for some centres, particularly those in rural and remote locations where a full complement of the necessary workforce may not be available. (Level 5/6). |
| Health Information Systems and Communication/Products and Technology | On-site integration is achieved within the headspace centre and co-located services through collaborative care planning and delivery, shared-care arrangements and multidisciplinary case review. headspace centres are required to maintain an up-to-date register of other services in the community that YP might need. Strong partnerships, established referral pathways and warm referrals are used to integrate care with external service providers. (Level 5/6). |
| Leadership, Governance, and Policy/Values | headspace has a foundation in touth (and family) participation and co-design at all levels. National network oversight is balanced against local context-specific governance. headspace centres model are governed by a Lead Agency i.e. an independent organisations commissioned to operate each headspace centre. The Lead Agency provides the infrastructure and is responsible for corporate and clinical governance. Additional governance is provided by a Consortium of local service providers that collaborate with the Lead Agency to give strategic direction, additional capacity through in-kind contributions and local planning oversight. (Level 5/6). |
| Funding | Multiple funding streams are combined to support a headspace centre. The Australian Government Department of Health provides core funding which covers infrastructure and salaries for essential staff positions. The Australian Government’s Medical Benefits Scheme rebates medical and allied health staff for designated health services. In-kind contributions are expected from Consortium member and local partner organisations to provide the full range of services. Additional state/territory government funding is provided to some centres. Core staff are directly employed through the headspace centre grant, while others are employed through contracted private practitioner arrangements or via in-kind contributions. (Level 5/6). |
| Overall Level | Level 5/6 Integrated as per the YIP Framework |
Table 4
Foundry integration evaluation.
| BUILDING BLOCKS | INTEGRATION EVALUATION AS PER THE YIP FRAMEWORK (TAKEN FROM (22)) |
|---|---|
| Service Delivery | Diverse services co-located and accessed individually or concurrently, and staff and organizations work collaboratively so that YP experience seamless care, in a single visit, many youths access one or more of Foundry’s five distinct services (i.e., primary care, mental health care, substance use support, peer support, and/or social services). (Level 5/6). |
| Health Workforce | Services at each centre include primary care (physical and sexual health), mental health, substance use, peer support and social services (e.g., employment, housing, and income assistance) (Level 5/6). |
| Health Information Systems and Communication/Products and Technology | Same Facilities; Shared systems; Face-to-Face consultation; Have formal and informal meetings to support integrated model of care. Foundry Virtual (foundrybc.ca) offers YP and their caregivers drop-in counselling, peer support, primary care, and youth relevant information and resources online. (Level 5/6). |
| Leadership, Governance, and Policy/Values | Foundry’s leadership structure, comprising a provincial Governing Council, Foundry Central Office, and Lead Agencies (LA) support the development of Foundry centres through integrating services and practices within a complex system. The Foundry central office leads the provincial initiative and supports the development of local centres. Each Foundry centre is operated by a lead agency that brings together local stakeholders. (Level 5/6). |
| Funding | Lead Agencies were selected in each community to have organisational accountability for the overall financial management and service delivery accountability for their centre. However, by agreement with all partners, Lead Agencies rely heavily on direct and indirect contributions from partnering agencies to deliver all onsite services, thus requiring a coordinated and collaborative approach. (Level 5/6). |
| Overall Level | Level 5/6 Integrated as per the YIP Framework |
Table 5
SCIPT-A integration evaluation.
| BUILDING BLOCKS | INTEGRATION EVALUATION AS PER THE YIP FRAMEWORK (TAKEN FROM (43)) |
|---|---|
| Service Delivery | Combined screening stepped care model, EBP: SCIPT-A (phase I: 8 weeks of weekly IPT, phase II: 8 weeks of either weekly sessions, or 3 sessions in total) implemented by social worker. Pharmacotherapy implemented by PCP. (Level 1/2). |
| Health Workforce | Clinic social worker (master’s level), PCP (7 paediatricians and 1 nurse practitioner). Trained separately. (Level 1/2). |
| Health Information Systems and Communication/Products and Technology | Same Facilities. No detail about systems. Clinic social worker and PCP would collaborate after an assessment of patient’s response to treatment and synthesis. “… medical providers reported the need for improved communication with social work clinicians and back-up support with a consulting psychiatrist to implement the model successfully” (Level 1/2). |
| Leadership, Governance, and Policy/Values | Mental health focused intervention. Siloed delivery of service. Limited data on shared vision (Level 3). |
| Funding | Funded by research grant (National Institute of Mental Health Grant) therefore no funding buy in from local stakeholders (Level 1–4). |
| Overall Level | Level 1/2 Coordinated as per the YIP Framework |