Condition category
Mental and Behavioural Disorders
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status
Results overdue

Plain English Summary

Background and study aims
Many children and adolescents suffer from mental health problems, which can greatly impact their development and general quality of life. Family physicians and nurse practitioners often report a lack of training and support for treating mental health issues in children and adolescents. This is particularly important in rural/remote regions where specialist treatment centers and professionals are limited. The aim of this study is to assess the effectiveness of an educational program designed to translate the kinds of skills practitioners need in order to provide frontline mental health care to children and adolescents.

Who can participate?
Primary care practitioners at family practices in rural areas of Southwestern Ontario and families with children aged 6-18 attending a medical visit at a participating centre.

What does the study involve?
Participating centres are randomly allocated to one of two groups. Primary care practitioners (PCPs) in the first group take part in eight hours of child mental health care training delivered in 1-5 sessions over a maximum of five weeks (as determined by the practice in question). The training includes learning communication skills (learning how to talk about mental health problems with families), learning guidelines for assessing, diagnosing and managing different mental health problems and leading therapeutic techniques for addressing different types of symptoms. PCPs in the second groups are asked their opinions about the training program but do not receive it until after the end of the study period. One week before and one week after the PCPs in the first group take part in the training programme, PCPs in both groups complete a number of assessments to measure their skills, knowledge and attitudes. At the start of the study and four months later, children complete questionnaires to evaluate their mental health functioning. Parents and children are also asked to rate the PCP visit.

What are the possible benefits and risks of participating?
Participants benefit from being able to learn how best to deal with children with a mental health concern. There are no direct risks involved with participating.

Where is the study run from?
1. The University of Western Ontario (Canada)
2. London Health Sciences Centre (Canada)

When is the study starting and how long is it expected to run for?
September 2014 to December 2016

Who is funding the study?
The Children's Health Foundation (Canada)

Who is the main contact?
1. Dr Stacey Espinet (scientific)
2. Ms Sandra Gotovac (public)
3. Dr Margaret Steele (scientific)
4. Dr Lorelei Lingard (scientific)

Trial website

Contact information



Primary contact

Dr Stacey Espinet


Contact details

1151 Richmond St
The University of Western Ontario
Centre for Education Research & Innovation
Health Sciences Addition Room 110
N6A 5C1



Additional contact

Ms Sandra Gotovac


Contact details

Child & Adolescent Mental Health Care Program
Children’s Hospital
London Health Sciences Center
800 Commissioners Rd E
N6A 5W9



Additional contact

Dr Margaret Steele


Contact details

1151 Richmond St
The University of Western Ontario
Schulich School of Medicine & Dentistry
Western University
Clinical Skills Building
N6A 5C1



Additional contact

Dr Lorelei Lingard


Contact details

1151 Richmond St
The University of Western Ontario
Centre for Education Research & Innovation
Health Sciences Addition Room 110
N6A 5C1

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Efficacy Trial of the "Practitioner Training in Child and Adolescent Psychiatry": An Educational Intervention to Enhance Paediatric Mental Health Practice and Outcomes in Rural Primary Care



Study hypothesis

Using a common factors framework for translating mental health education to primary care providers will enhance care capacity by improving their mental health skills, leading to enhanced mental health outcomes for children and youth accessing care through trained primary care providers.

Ethics approval

Health Science Research Ethics Board - The University of Western Ontario, 25/03/2016, ref: 106397

Study design

Multi-centre unblinded stratified cluster randomized controlled trial

Primary study design


Secondary study design

Cluster randomised trial

Trial setting

GP practices

Trial type


Patient information sheet

Not available in web format, please use contact details to request a participant information sheet


Child and youth mental health


Sites, stratified by regional location, are randomly assigned to the intervention or control arm of the study. Intervention and control sites are then matched based on sample size.

Intervention arm: Participants in the intervention arm receive 8-hours of paediatric mental health training delivered in 1 to 5 sessions over a maximum of 5 weeks according to site preferences. Training consists of three modules delivered in the following order:
1. Common Skills (i.e. communication and counseling skills for eliciting mental health concerns and managing mental health conversation with families)
2. Evidence-based Guidelines (to do with assessing, diagnosing, and managing ADHD, behavioral disorders, anxiety, depression and suicidality)
3. Common elements (brief, broad-based therapeutic techniques for addressing symptom clusters related to attention and behavioral issues, and anxiety and depressive symptoms)
Program delivery includes case-based discussions, as well as twelve short and three long videos demonstrating implementation of the common skills and common elements, respectively, to situate learning. Family-centered and developmental

Wait-list control arm: Participants are asked what they hope to get out of the educational program but are not provided with any aspect of the intervention until all of the final, one-month follow-up measures were collected from all sites.

The families do not receive any intervention. They only participate in the evaluation by filling out questionnaires before their medical appointment with a practitioner at a participating site and 4 months later. Follow-up involves a 15-minute standardized patient skills assessment at one-month follow-up and a semi-structured interview to assess satisfaction with the program conducted 2 to 4 months post follow-up.

Intervention type



Drug names

Primary outcome measure

Skill enhancement as assessed using:
1. A confidence scale developed by Garcia-Ortega et al at baseline (one week pre-intervention) and one week post-intervention
2. The Physician Confidence Scale at baseline and one week post-intervention
3. The Provider Confidence Scale at baseline and one week post-intervention
4. Standardized Patient Interviews coded using the Roter Interactional Analysis Scale (RIAS) at baseline, one week post-intervention and one month post-intervention
5. Standardized Patient Interviews coded using the trained-skills checklist at baseline and one week post-intervention and one month post-intervention
6. Case-scenarios one week post-intervention

Children/youth and their parents:
Mental health functioning as measured by the Strengths and Difficulties Questionnaire (SDQ) and the General Health Questionnaire (GHQ) at baseline and 4 months.

Secondary outcome measures

1. Knowledge is measured using a 45-item knowledge questionnaire designed for this study at baseline and one week post-intervention
2. Attitudes to mental health care provision are measured using the Physician Belief Scale at baseline and one week post-intervention
3. Ease of access to or consult with specialists is measured using the Ease of Consultation Scale at baseline and one week post-intervention
4. Comfort with referrals is measured using the Referral Comfort Scale (RCS) and the Identification of child mental health problems at baseline and one week post-intervention

Children/youth and their parents:
1. Satisfaction with the visit as rated by youth at baseline and at 4 months
2. Practitioner discussion of mental health topics as rated by parents at baseline and 4 months

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

Inclusion criteria for primary care providers:
1. Practicing as a Primary Care Practitioners (PCPs) i.e. a family medicine resident; family physician, nurse practitioner, paediatrician
2. Emplyed at a family practice site (i.e. a family health team, community health center, private practice
3. Located in a rural region (population under 100,000, where 0 to 30% of the population commutes to work in a large urban center; Pong & Pitblado, 2005) of Southwestern Ontario

Inclusion criteria for families:
1. Parent of at least one child/youth aged 6 to 18 years
2. The parent was attending a medical visit at a participating site with a participating or non-participating practitioner, with or without the target child/youth

Participant type


Age group




Target number of participants

Clusters: 10; Providers: 50; Parents/Children or Youth = 250

Participant exclusion criteria

There are no exclusion criteria for PCPs or families

Recruitment start date


Recruitment end date



Countries of recruitment


Trial participating centre

The University of Western Ontario
1151 Richmond Street
N6A 3K7

Trial participating centre

London Health Sciences Centre
339 Windermere Road
N6A 5A5

Sponsor information


Health Sciences Research Ethics Board - The University of Western Ontario

Sponsor details

Research Western
Room 5150 Support Services Building
1393 Western Road
N6G 1G9

Sponsor type




Funder type


Funder name

The Children's Health Foundation

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Planned publication and dissemination of findings in the form peer-reviewed publications in the health sciences, medicine, and/or psychiatry fields:
1. Preliminary findings based on the self-report questionnaire data
2. Findings based on this observational data one coding of the standardized patient videos is complete
3. Findings based on video-recordings of the training sessions and follow-up interviews in regards to intervention process and fidelity.
Planned presentation of findings provincially and nationally at conferences and through a report delivered to the Children’s Health Foundation.

Intention to publish date


Participant level data

Available on request

Basic results (scientific)

Publication list

Publication citations

Additional files

Editorial Notes