Abstract
Intervention
Alberta Health Services (AHS) Community Helpers Program (CHP) to enhance mental health among youth.
Research question
Identifying the impact of CHP on mental illness–related acute care use among adolescents aged 12–18 years in Edmonton and determining cost avoidance.
Methods
Using administrative data from AHS, public school catchment area data from the Edmonton Public School Board, and area-level socioeconomic deprivation status indicators from the Pampalon deprivation index, we applied geographical regression discontinuity design to estimate the effect of CHP implementation on depression-, anxiety-, and suicide-related acute care use (emergency department visits and inpatient admissions). Cost data were derived from Interactive Health Data Application of Alberta Health. The study period (2002–2022) included pre (2002–2011) and post (2012–2020) CHP implementation periods.
Results
CHP had statistically significant impact when distance from the boundary (catchment area identifier to divide the sample into treated and control groups) was between 600 and 800 m. About 90 and 80 fewer anxiety- and depression-related visits (per 1000 visits) were observed among individuals aged 12–15 and 16–18 years, respectively, in catchment areas of the public schools where CHP was implemented. Impact of CHP on suicide-related visits was only statistically significant among individuals aged 12–15 years. Annual cost reduction ranged from $161,117 to $269,255 for anxiety- and depression-related visits.
Conclusion
Findings show contextual effect of CHP; i.e., being potentially exposed to the program reduced the likelihood of anxiety- and depression-related visits. Costs of CHP implementation could be compared with the avoided costs to assess economic benefits of implementing CHP.
Résumé
Intervention
Le Programme d’aidants communautaires (CHP, Community Helpers Program) des Alberta Health Services (AHS) sert à améliorer la santé mentale des jeunes de l’Alberta.
Sujet de la recherche
Déterminer l’incidence du CHP sur l’utilisation des soins de courte durée liés à la maladie mentale chez les adolescents d’Edmonton âgés de 12 à 18 ans et l’évitement des coûts.
Méthodes
Utilisant les données administratives des AHS, les données sur les zones d’implantation du conseil des écoles publiques d’Edmonton et les indicateurs de pauvreté socioéconomique au niveau régional de l’indice de défavorisation de Pampalon, nous avons appliqué un plan de discontinuité de la régression géographique pour estimer l’effet de la mise en œuvre du CHP sur l’utilisation des soins de courte durée liés à la dépression, à l’anxiété et au suicide (visites aux services d’urgence et admissions de patients hospitalisés). Les données relatives au coût ont été calculées à partir de l’application interactive des données sur la santé du ministère de la Santé de l’Alberta. La période de l’étude (2002-2022) inclut les périodes précédant (2002-2011) et suivant (2012-2020) la mise en œuvre du CHP.
Résultats
Le CHP a eu une incidence statistiquement significative lorsque la distance de la limite (identificateur de la zone d’implantation pour diviser l’échantillon en groupes traités et témoins) était entre 600 et 800 mètres. Environ 90 et 80 visites de moins, liées à l’anxiété et à la dépression (pour 1 000 visites), ont été observées chez les personnes de 12 à 15 ans et de 16 à 18 ans, respectivement dans les zones d’implantation des écoles publiques où le CHP a été mis en œuvre. L’incidence du CHP sur les visites liées au suicide n’était statistiquement significative que chez les personnes de 12 à 15 ans. La réduction annuelle des coûts variait de 161 117 $ à 269 255 $ pour les visites liées à l’anxiété et à la dépression.
Conclusion
Les résultats montrent qu’un effet contextuel du CHP, c.-à-d. le fait d’être potentiellement exposé au programme, réduit la probabilité de visites liées à l’anxiété et à la dépression. Le coût de la mise en œuvre du CHP comparé aux coûts évités permet d’évaluer les avantages économiques de la mise en œuvre du CHP.
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Availability of data and material
Data used in this study are held securely in coded and de-identified form at Alberta Health Services. Although data-sharing agreements prohibit Alberta Health Services from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access. Please contact [research.administration@ahs.ca] for more information.
Code availability
This study used R and Stata for statistical analysis. Codes are available from the authors upon reasonable request.
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Acknowledgements
The authors are grateful to the Planning Department in the Edmonton Public School Board for providing school catchment area data. The authors thank participants for their comments and suggestions at the science team meeting of Public Health Innovation and Evidence, Alberta Health Services and at the Canadian Association for Health Services and Policy Research (CAHSPR) Annual Conference, 2023.
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All authors contributed to the study concept and design. Material preparation, data collection, and analysis were performed by Habibullah Pulok and Novaes de Amorim. The first draft of the manuscript was written by Habibullah Pulok and all authors commented on previous versions of the manuscript. Johansen, Pilon, and Lucente critically reviewed and edited the final version of the manuscript. Saini was involved in conceptualization, investigation, and supervision. All authors read and approved the final manuscript.
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Pulok, M.H., Novaes de Amorim, A., Johansen, S. et al. Evaluating the impact of the Community Helpers Program on adolescents 12–18 years old in Edmonton, Canada. Can J Public Health (2024). https://doi.org/10.17269/s41997-024-00878-6
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DOI: https://doi.org/10.17269/s41997-024-00878-6