By Jillian Stringer, General Member
We are on the brink of a new era in mental health care.
As we navigate the complexities of the 21st century, the need to prioritize the mental well-being of our youth has become an urgent and pressing matter. The current state of the youth mental health system is plagued with challenges, leaving many struggling individuals and families to navigate a labyrinth of barriers.
It's time for a transformative revolution, one that reimagines and reinvents how we approach youth mental health.
In this blog, we explore one approach to system transformation that holds immense promise: Integrated Youth Services (IYS). By integrating various aspects of physical, mental, and social well-being into a comprehensive and holistic model of care, IYS aims to revolutionize the way we approach youth mental health.
It's time to reimagine a system that puts the mental health and well-being of our youth at the forefront, and IYS may just be the key to unlocking their potential by empowering them with the support and resources they need to thrive.
Join us as we take a closer look at this innovative approach and its potential to pave the way towards a brighter, healthier future for our young people.
What is IYS?
As a young person with lived experience navigating the mental health system, and as an early-career researcher working in the youth mental health sector, I find myself talking about IYS a lot.
I can see the potential benefits from both sides. And I understand the need for change.
It’s hard, if not impossible, to separate mental health from our other fundamental basic needs like physical health, food, and housing.
Integrated Youth Services (IYS) aim to reflect this interconnectedness by bringing local care providers and community supports together under one roof. That way, if a young person walks in (or logs in) to a central hub, they can feel confident that they will have all their needs addressed.
For instance, an IYS site might bring together nurses and doctors, peer supporters, counseling services, disability support organizations, and financial and employment programs.
Over time, as different integrated youth service sites have developed around the country, we have been learning a lot about what works and what doesn’t for operating effective IYS.
So far, we have been able to boil successful IYS down to a set of key guiding principles, covering things like engagement, accessibility, and health promotion [1].
You can see all 8 in the image below.
Image based on the work of Frayme [1].
These core components play a crucial role in ensuring quality of care and guiding integrated services towards their goals.
You may notice, however, that none of these key principles mention exactly what programs or supports an integrated youth services hub is expected to provide.
Essentially, Integrated Youth Services refers to a way of organizing and delivering resources to young folks without dictating exactly what those services are. This approach has benefits for a couple of reasons.
First, it allows care hubs to be built around local strengths, resources, and needs. Youth and caregiver engagement are key to this. Practitioners and health & social services workers at IYS sites work together with the community, not just for them to design, deliver, and evaluate care.
Second, this flexibility allows for IYS hubs to continually improve and adapt to meet needs. Exchanging knowledge and best practices among services in integrated systems makes sure that care is delivered based on sound evidence. Further, regularly gathering input from youth and caregivers and evaluating services themselves ensures programs and initiatives are effective, accessible, and responsive to users’ needs and that any gaps are identified quickly.
SO DOES IYS WORK?
Thriving together
Of course, this all sounds great, but the first thing you may want to know when talking about healthcare is whether this approach actually improves the health of those who use the service.
Early evidence from the sites we have in Canada is promising, and internationally, the data tell an even more convincing story.
According to data from the national youth mental health network, ACCESS Open Minds, their Integrated Youth Services have helped lower youth distress, lessened the severity of mental health symptoms, and improved their schoolwork and social functioning [2].
Findings from BC-based site Foundry have shown similar improvements in young folks’ ability to manage their health, life, and problems [3].
Bridging the gap
Another useful question to ask is whether this approach does any better than the status quo.
Given the challenges we know many young folks face in accessing mental health services, you would certainly hope so…
And it seems IYS can improve accessibility, as evidenced by shorter wait times and reductions in mental health stigma, which continues to be a barrier to help-seeking [2, 4, 5].
On a positive note, early data from ACCESS Open Mind sites showed that the vast majority of services met standards for “rapid access” with more than 80% of youth being assessed within 72 hours of referral and waiting less than 30 minutes on average for an appointment [2].
The need for these services is clear. A significant portion of youth getting care from three different IYS providers say they would not have known where to go for help otherwise or wouldn’t have had their needs met [2, 4, 6].
Notably, many Canadian integrated youth services are focused on serving Indigenous youth, with almost half of ACCESS Open Minds sites located in Indigenous communities or serving a large portion of Indigenous youth [7]. Additionally, with several IYS sites in BC, Manitoba, and Ontario that are Indigenous-led, this offers an important opportunity to dedicate services specifically toward combating some of the social and structural inequities that contribute to worse mental health outcomes for Indigenous peoples as a result of historical and ongoing colonization [7].
Advances and innovations we have seen in response to the COVID-19 pandemic, including virtual care and online care platforms, have also contributed to making support services more accessible for young folks through several IYS providers [7].
Thriving with Care
At its core, IYS focuses on involving youth and caregivers in their implementation. So these perspectives are crucial.
We have seen youth and families expressing satisfaction with the approach and the youth-friendliness of BC-based IYS services [8].
And young folks in Ontario are reporting high levels of satisfaction with their services as indicated by 99% who agreed that they would recommend Ontario IYS services to another [6].
So What’s Next for IYS?
Given the growth of IYS around the country and its promising evidence, it is encouraging to see the Canadian government launch a federation of IYS leaders from nine provinces and a network of services around the country to exchange knowledge, improve mental health outcomes, and jointly collect more research evidence [7].
These knowledge sharing initiatives aim to increase the impact of IYS through collaboration, increased data collection, the development of common standards, and supporting provincial and territorial IYS initiatives. They will also focus on sharing best-practices for culturally appropriate youth care, especially in Indigenous and racialized communities [7].
All that said, system transformation is not easy work.
Just as the growth of IYS in Canada has identified strengths, it has also highlighted opportunities for growth.
For instance, many IYS providers still face challenges with integrating partner organizations and aligning services, particularly when conditions of the participating sites vary in terms of geography, language, and political context.
Developing IYS in rural communities for example, is often still limited by the availability of the community services to begin with, acknowledging that the success of IYS sites themselves is dependent on the response from other parts of the youth healthcare system [7].
Fortunately, some of these barriers can be overcome as we collect more evidence, collaborate, and acquire sustained funding and support for system transformation.
Canada is well-positioned at the moment to use our new national networks to establish a robust plan for data collection and knowledge exchange to build a national learning health system that provides evidence-informed care to all those who need it.
One thing we cannot forget, however, is the importance of the voices of youth and caregivers and lived and living expertise in this process. Evidence must continue to include knowledge from practice, lived experience, and traditional ways of knowing for meaningful and appropriate care.
Grassroots organizing and community-led initiatives have been central to the development of IYS in Canada so far, and we’ve seen just how impactful this can be.
Communities have power.
As service providers and health professionals share evidence through our new professional networks, we call on community members themselves to get involved.
It's time to ignite change, to create a future where our youth can flourish, unencumbered by the barriers of a broken mental health system. Integrated Youth Services have shown us a path forward, one that prioritizes holistic care, breaks down silos, and empowers young people to thrive.
But we cannot stop here.
It's time for communities to come together, to raise their voices, and advocate for system transformation. Let's break down the stigma, raise awareness, and demand accessible, equitable, and comprehensive mental health services for our youth.
Together, we can create a world where our young people receive the support and resources they need to lead fulfilling lives. It's time to be the champions of change and pave the way for a brighter, healthier future for our youth.
Join the movement, take action, and let's transform the youth mental health system for the better. Our youth deserve nothing less.
References
The Core Components and Principles of Integrated Youth Services: Workshop Findings (February, 2020). Frayme. Available at: https://frayme.ca/sites/default/files/interactive_-_core_components_of_iys_final.pdf
ACCESS Open Minds. (2021). https://accessopenminds.ca/wp-content/uploads/2021/02/AOMInterimResults-1.pdf
Foundry (2018). Foundry early learnings: Proof of concept evaluation report. Vancouver, BC: Foundry. https://foundrybc.ca/wp-content/uploads/2020/06/L.8-Foundry-Proof-of-Concept-Evaluation-Report.pdf
Henderson, J., Hess, M., Mehra, K., & Hawke, L. D. (2020). From planning to implementation of the YouthCan IMPACT Project: A formative evaluation. The Journal of Behavioral Health Services & Research, 47(2), 216–229. https://doi.org/10.1007/s11414-019-09658-4
Salmon, A. Fernando, S. & Berger, M. (2018). Development Evaluation of Foundry’s Proof of Concept. Centre for Health Evaluation and Outcome Sciences. Retrieved from https://foundrybc.ca/wp-content/uploads/2020/06/L.7-Foundry-Developmental-Evaluation-Report.pdf
Youth Wellness Hubs Ontario. (2017). Youth Wellness Hubs Ontario: A primer. https://youthhubs.ca/wp-content/themes/ywo/assets/files/YWHO_Primer_FINAL.pdf
Fowler H, Odegbile K, Celeste L, Narine J. (2022). Integrated Youth Services in Canada A portrait. The Social Research and Demonstration Corporation. https://grahamboeckhfoundation.org/wp-content/uploads/2022/07/Portrait-of-IYS-in-Canada-by-SRDC-2022-accessible.pdf
Salmon, A. Fernando, S., Berger, M., Tee, K., Gerty, K., Helfrich, W., & Liversidge, P. (2020). Distributive leadership within an emerging network of integrated youth health centres: A case study of Foundry. International Journal of Integrated Care, 19, 1–9. https://doi.org/10.5334/ijic.4709