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Developing next-generation youth mental health service frameworks

We have been deeply involved in efforts to update the field’s understanding of how mental illness begins and evolves in young people.  This includes the development of clinical staging as a framework for conceptualizing illness progression, the development of stages, and the articulation of what stage-based and transdiagnostic early intervention and youth mental health service systems should look and function like.  We have also contributed to developing stepped care models in youth mental health, to match presentations and trajectories to appropriate interventions and services. We are involved in working groups and initiatives in each of these areas, and staging was incorporated as a central recommendation in the 2024 Lancet Psychiatry Commission on Youth Mental Health. 

Key Projects:

  • Advocacy for novel frameworks: We have articulated the need for novel approaches and infrastructures to better appreciate the burden and impact of youth mental health problems on individuals, families, communities and society.

  • McGorry PD, Hickie IB, Kotov R, Schmaal L, Wood SJ, Allan SM, Altınbaş K, Boyce N, Bringmann LF, Caspi A, Cuthbert B, Gawęda Ł, Groen RN, Guloksuz S, Hartmann JA, Krueger RF, Mei C, Nieman D, Öngür D, Raballo A, Scheffer M, Schreuder MJ, Shah JL, Wigman JTW, Yuen HP, Nelson B (2025). New diagnosis in psychiatry: beyond heuristics. Psychological Medicine, 55, e26. 

  • McGorry PD, Mei C, Dalal N, Alvarez-Jimenez M, Blakemore SJ, Browne V, Dooley B, Hickie IB, Jones PB, McDaid D, Mihalopoulos C, Wood SJ, El Azzouzi FA, Fazio J, Gow E, Hanjabam S, Hayes A, Morris A, Pang E, Paramasivam K, Quagliato IN, Tan J, Adelsheim S, Broome MR, Cannon M, Chanen AM, Chen EYH, Danese A, Davis M, Ford T, Gonsalves PP, Hamilton MP, Henderson J, John A, Kay-Lambkin F, Long LJK, Kieling C, Mac Dohnnagain N, Malla A, Nieman DH, Rickwood D, Robinson K, Shah JL, Singh S, Soosay I, Tee K, Twenge J, Valmaggia L, van Amelsvoort T, Verma S, Wilson , Yung A, Iyer SN, Killackey E (2024). The Lancet Psychiatry Commission on Youth Mental Health. Lancet Psychiatry, 11(9), 731-774. 

  • Uhlhaas PJ, Davey CG, Mehta UM, Shah J, Torous J, Allen NB, Avenevoli S, Bella-Awusah T, Chanen A, Chen EYH, Correll CU, Do KQ, Fisher HL, Frangou S, Hickie IB, Keshavan MS, Konrad K, Lee F, Liu CH, Luna B, McGorry PD, Meyer-Lindenberg A, Nordentoft M, Öngür D, Patton GC, Paus T, Reininghaus U, Sawa A, Schoenbaum M, Schumann G, Srihari VH, Susser E, Verma SK, Woo TW, Yang L, Yung AR, Wood SJ (2023). Towards a Youth Mental Health Paradigm: A Perspective and Roadmap. Molecular Psychiatry, in press.

  • McGorry P, Nelson B, Wood SJ, Shah JL, Malla A, Yung A (2020). Transcending false dichotomies and diagnostic silos to reduce disease burden in mental disorders. Social Psychiatry & Psychiatric Epidemiology, 55(9), 1095-1103. 

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  • Transdiagnostic clinical staging: We have co-led the development and articulation of transdiagnostic clinical staging models, core concepts and assumptions underpinning them, and their implications for care settings.  We coordinate a global working group on the same topic

  • Ratheesh A, Chen Y, Hammond D, Aitken Z, Shah J, Iorfino F, Scott J, Hickie I, Davey C, Chanen A, Berk M, McGorry P, Marwaha S, Thompson A, & Nelson B. (2025). Progression of Transdiagnostic Stages From Childhood to Young Adulthood. JAMA psychiatry, 82(11), 1113–1122. 

  • Scott J, Iorfino F, Capon W, Crouse J, Nelson B, Chanen AM, Dwyer D, Conus P, Bechdolf A, Ratheesh A, Raballo A, Yung A, Berk M, McKenna S, Hockey S, Hutcheon A, Scott E, McGorry P, Shah J, Hickie IB (2024). Staging 2.0: Refining trans-diagnostic clinical staging frameworks to enhance reliability and utility for youth mental health. Lancet Psychiatry, in press.

  •  Iorfino F, Varidel M, Marchant R, Cripps S, Crouse J, Prodan A, Oliveira R, Carpenter J, Hermans D, Guastella A, Scott E, Shah J, Merikangas K, Scott J, Hickie I (2023). The temporal dependencies between social, emotional, and physical health factors in young people receiving mental health care: A dynamic Bayesian network analysis. Epidemiology and Psychiatric Sciences, in press.

  • Capon W, Hickie IB, Fetanat M, Varidel M, LaMonica HM, Prodan A, Piper S, Davenport TA, Mughal S, Shah J, Scott EM, Iorfino F (2023). A multidimensional approach for differentiating the clinical needs of young people presenting for primary mental health care. Comprehensive Psychiatry, in press.

  • Capon W, Varidel M, Prodan A, Crouse JJ, Carpenter JS, Cross SP, Nichels A, Zmicerevska N, Guastella AJ, Scott EM, Scott J, Shah J, Hickie IB, Iorfino F. Clinical staging and the differential risks for clinical and functional outcomes in young people presenting for youth mental health care. BMC Psychiatry, in press. 

  • Monego E, Cremonese C, Gentili F, Fusar-Poli P, Shah JL, Solmi M (2022). Clinical high at-risk mental state in young subjects accessing a mental disorder prevention service in Italy. Psychiatry Research, 316: 114710. 

  • Shah JL, Jones N, Van Os J, McGorry P, Gülöksüz S (2022). Early intervention service systems for youth mental health: integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis. Lancet Psychiatry, 9(5), 413-422. 

  • Shah JL, Scott J, McGorry P, Cross SPM, Keshavan MS, Nelson B, Wood SJ, Marwaha S, Yung A, Scott E, Öngür D, Conus P, Henry C, Hickie IB; International Working Group on Transdiagnostic Clinical Staging in Youth Mental Health (2020). Transdiagnostic clinical staging in youth mental health: a first international consensus statement. World Psychiatry, 19(2), 233-242. 

  • Shah JL (2019). Bringing Clinical Staging to Youth Mental Health: From Concept to Operationalization (and Back Again). JAMA Psychiatry, 76(11), 1121-1123.

  • Stepped care: Within Canada, these models - which attempt to match care to needs - are being increasingly invoked by service designers and broader mental health systems, particularly with respect to child and youth mental health.  Since 2017, we have co-led a national working group on this topic with funding from the Cundill Foundation via Frayme, and CIHR via a national standards development grant. ​

  • Mughal S, Young B, Churchill A, Rash J, Tee K, Salmon A, Shah JL (2025). Proposed standards for implementing stepped care models in child and youth mental health service systems: Results of a pan-Canadian Delphi study. Early Intervention in Psychiatry, 19:e70057.

  • Young B, Mughal S, Churchill A, Rash J, Tee K, Salmon A, Shah JL (2024). Developing standards for the implementation of stepped care in child and youth mental health service settings: protocol for a multi-method, delphi-based study. BMJ Open, 14(12):e096453. doi:10.1136/bmjopen-2024-096453

  • Harris-Lane LM, King A, Bérubé S, Burke K, Churchhill A, Cornish P, Jaouich A, Michaud M, Losier A, Shah JL, Rash J (2024). Improving access to child and youth addiction and mental health services in New Brunswick: implementing one‐at‐a‐time therapy within an integrated service delivery model. International Journal of Mental Health and Addiction. In press.

  • Mughal S, Salmon A, Churchill A, Tee K, Jaouich A, Shah J (2023). Guiding principles for implementing stepped care in mental health: Alignment on the bigger picture. Community Mental Health Journal, in press.

  • Berger M, Fernando S, Churchill AM, Cornish P, Shah JL, Tee K, Salmon A (2021). Scoping review of stepped care interventions for mental health and substance use service delivery to youth and young adults. Early Intervention in Psychiatry, 16(4), 327-341. 

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