Mental Health Walk-In Clinic: Using CPS as a Single Session Modality

1. Mental Health Walk-In Clinic:Using CPS as a Single Session Modality

2. Overview Crossroads Children’s Centre

3. Mission of Crossroads Children’s Centre (CCC) • Work with children and their families struggling with severe emotional, behavioural and social difficulties.  This is accomplished through a wide range of services and targets children up to the age of twelve years. • Our belief is that “children do well if they can, not if they want to” (Core CPS Philosophy).

4. Guiding Philosophy • All CCC services include: • Children have access to a comprehensive array of services • Services are individualized • Services are received within the least restrictive environment • Families are included as full participants • Services are integrated, collaborative and coordinated • Case management is provided to ensure service coordination and system navigation • The system promotes early identification and intervention • Children are ensured a smooth transition between services • Children receive services regardless of race, religion, national origin, sex, physical disability, or other characteristics. • We recognize the value of teaching, research, and evaluation in improving the outcomes for children and families and are committed to evidence based practices

5. Core Values at CCC • Child centered & family focused • Community-based • Culturally competent • Committed to evidence-based practices • Specifically Collaborative Problem Solving

6. Who we serve? • 0-12 years of age • Externalizing (often with internalizing) problems • Problems of long duration in school, home, community. • Demonstrating impulsivity, aggression, suicidal ideation, anxiety, sadness, depression, fear, etc. • No requirement of formal diagnosis in order to access service.

7. Programs and Services • Day Treatment Program (Children 6 to 12 years of age – 5 classrooms serving up to 60 Children) • Home Based Services, (0-6 and 6 to 12) • Intensive Services (3 visits per week) • Wraparound • Fire-setting Assessment & Treatment

8. Other Services Available to CCC Clients • Parent training/coaching • Family life skills • Clinical Assessment • Psychological and Psycho-educational Assessment (Day Treatment) • Speech and language assessment • Family counselling • Individual counselling

9. Crossroads Children’s Centre Mental Health Walk-In Clinic

10. Why A Mental Health Walk-In Clinic? • 14 month waitlist for home based services • Therapy services wait times of 9 months or more • Funding opportunity meant to directly impact on wait times within mental health setting across the Province. • An interest in developing a different approach than typically used in other mental health settings (modality of treatment).

11. Mental Health Walk-In Clinic: What does it look like? Staffing: • Reception • Clinician’s, CYW and Supervisor • On-Call Manager Space: • 5 therapy rooms, & waiting room area

12. Mental Health Walk-In Clinic: Process • Client arrives completes demographics form • Lists a problem to be solved and rates it on likert scale • 1 hour session occurs • Debrief with Tier 2 Trained team for final recommendations • Parent provided with Think:Kids Plan B card and TSI • Carbon Copy of Plan B provided to Parent • Parent completes satisfaction survey

13. Mental Health Walk-In Clinic Session • Type 1: Parent Alone • Worker, meets with parent and helps shift mindset around the specific problem that brought them to the clinic. • A discussion occurs about the TSI with the parent and worker helps fill this out. • Parent is provided some coaching on how to conduct a Plan B, Plan B card is provided. • Offered an opportunity to return to clinic with child for a facilitated conversation.

14. Mental Health Walk-In Clinic Session • Type 2: Parent and Child • Parent and child meet with CYW and Clinician • Come to an agreement on problem to be solved • Either a facilitated Plan B or • Child may leave with worker and parent meets with second worker for 20 minutes • Then all meet together to sort through the problem to be solved

15. Key Ingredients – Single Session • Find a specific incident to discuss • Bring from general trigger to something very specific • Determine what has been attempted to date • Explore history • Need to help caregiver see behavior through a different lens. • Thinking Skills Inventory (TSI) • Philosophy of CPS

16. Key Ingredients – Single Session • Help parents see benefit of hearing their child’s concern. • Restores relationship

17. Crossroads Children’s Centre Mental Health Walk-In Clinic Demographics

18. Mental Health Walk-In Clinic Demographics • 560 Separate Admissions to the clinic • Breakdown to October 2013 • CCC clients waiting for services - 54 • Current CCC clients - 16 • New clients to CCC - 414 • Repeat walk-in clients - 76

19. Gender

20. Age Breakdown

21. Ethnicity

22. Family Constellation

23. Presenting Problems

24. Diagnosis

25. Crossroads Children’s Centre Mental Health Walk-In Clinic Outcomes

26. Did you feel welcome? Walk In Clinic Evaluation Results (512 SEQ’s – 91% response rate) • Did you feel welcome?

27. Did you feel heard, understood and respected? Walk In Clinic Evaluation Results • Did you feel heard, and understood?

28. 3. Today’s session was helpful to me? Walk In Clinic Evaluation Results • Today’s session was helpful to me?

29. Would you recommend the clinic to others? Walk In Clinic Evaluation Results • Would you use the walk in clinic again?

30. Would you recommend the clinic to others?

31. Overall, my visit to the walk-in clinic was a positive experience? Walk In Clinic Evaluation Results • Overall my visit to the walk-in clinic was helpful?

32. Here are some of the comments from our clients from the Walk-in Clinic: • The visit helped me learn why my son was so frustrated.  I never would’ve known he felt unsafe at school otherwise.  My son felt he was heard. • I appreciated reviewing the TSI and pinpointing the lagging skills experienced by my son.  I appreciated the emphasis placed on the fact that this strategy (CPS) is a real shift in perspective on how to parent kids (re-training my brain to understand the root/"why" behind the triggers/behaviours.  • Very positive experience.  Thankful and grateful for this service. • Staff was very welcoming.  All of my concerns were addressed and I left the clinic with a lot of helpful information and resources. • It was nice to be able to have someone help breakdown what seems like a bigger problem into smaller problems, with ideas of how to have conversations about possible solutions.

33. Here are some of the comments from our clients from the Walk-in Clinic: • Very reassuring, validates our flexible, child-centered approach.  Gives us a more systematic way to identify and target lagging skills/competencies and engage our sons in constructive conversations to surface issues and engage them in solutions, give them ownership. • Child’s Comments: I think it really helped, they have a very positive attitude.  They helped me solve my problem and I'm very happy.  Thank you. • One phrase that is sticking with me and comforts me so much is "Children do well if they can" – this struck a chord with me. Everyone was very friendly and supportive. Hopefully Plan B will work!  Thank you!  • Helped me to understand how my son felt.  When you have a third party involved, it helps you to see/understand the other person's feelings.  Had some good recommendations for us to start with which is what I wanted to get out of this visit

34. Crossroads Children’s Centre Mental Health Walk-In Clinic: Next steps

35. Next Steps: • To further evaluate the Clinic and CPS as a treatment modality • Focus Groups to be scheduled with past users of service to explore impact and perceptions of service • Both quantitative and qualitative measures are being explored and developed to continue gathering data long term • Session Outcome Measure or similar means to be used to gather data.

36. Next Steps: • Disseminate information to other Walk-In Clinic Providers • A number of organizations across the Province have been trained and are using CPS in various programs within their setting • No other organization is using CPS as the intervention in their respective clinics. By providing evidence to support the efficacy of CPS it is hoped that other organization will consider using CPS in their clinic.

37. Next Steps • Developing an implementation guide and lessons learned for using CPS in a Mental Health Walk-In Clinic modality.

38. Questions? • Feedback and Suggestions from the Participants?