Aim Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. Method We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post‐secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. Results Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. Conclusions Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.

how me the evidence" is the frequent response of skeptics of patient-oriented research, or of those who are not convinced of the merit of this approach without evidence of its positive impact on research or health outcomes. The advance of patient-oriented research is rooted primarily in moral, ethical and political arguments 1-5 and social trends in health care that are breaking down the barriers between health professionals and patients. 6 The moral argument is that patients have a fundamental right to be engaged in research, or that it is an ethical mandate that leads to better transparency and accountability. 1,7-9 Politically, patient-oriented research introduces democratic ideals so that public funding for research is spent responsibly and serves the public interest, 1,6 leading to the democratization of science and the research process. 3,7,10 Patientoriented research is also based on a social imperative of engaging those who are most affected by health care decisions; such studies aim to build on patients' perspectives, needs and priorities. 9 Patient-oriented research is conducted in collaboration with patients (including their families and informal caregivers), clinicians and decision-makers; focuses on priorities and outcomes that matter to patients; and ultimately aims to integrate research into policy and practice to improve health care outcomes. 11 Most importantly, it extends the role of a patient beyond that of a research subject to engage patients as meaningful and active partners of the research team. This approach is reflective of a global movement away from a traditional and often paternalistic model of health care, toward such models as self-management programs, patient-centred care and participatory action research.

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Healthcare has a long tradition of silence around mistakes that cause or have the potential to cause harm to a patient, and there is evidence that this culture may be present from the beginning of a health professional's training. The purpose of this pilot study was to examine a team of interprofessional students' interactions with a preceptor in a simulation environment. The debriefing explored the students' reactions and assisted them with how to manage similar situations in the future to improve patient safety. The results showed that the students felt powerless to stop the simulated preceptor from doing harm to the patient, or to even question the preceptor's unsafe actions. Recommendations for educators include incorporating discussions and interprofessional training about handling mistakes into the curriculum, in the context of patient safety.