Mental Health and Addictions Nurses in District School Boards Program Update

1. Mental Health and Addictions Nurses in District School Boards Program Update April 17, 2013

2. Meeting Agenda • Welcome • Program development updates • New nurses hired • MHAN program stats • New referral form for WRDSB • Program feedback from our partners • Next steps

3. Starting with Child and Youth Mental Health Our Vision: An Ontario in which children and youth mental health is recognized as a key determinant of overall health and well-being, and where children and youth reach their full potential. Identify and intervene in kids’ mental health needs early Professionals in community-based child and youth mental health agencies and teachers will learn how to identify and respond to the mental health needs of kids. Close critical service gaps for vulnerable kids, kids in key transitions, and those in remote communities Kids will receive the type of specialized service they need and it will be culturally appropriate Provide fast access to high quality service Kids and families will know where to go to get what they need and services will be available to respond in a timely way. THEMES • Fewer hospital (ER) admissions and readmissions for child and youth mental health • Reduced Wait Times • Reduced child and youth suicides/suicide attempts • Educational progress (EQAO) • Fewer school suspensions and/or expulsions • Higher graduation rates • More professionals trained to identify kids’ mental health needs • Higher parent satisfaction in services received • Decrease in severity of mental health issues through treatment • Decrease in inpatient admission rates for child and youth mental health INDICATORS Implement standardized tools for outcomes and needs assessment Implement Working Together for Kids’ Mental Health Enhance and expand Telepsychiatry model and services Provide support at key transition points Pilot Family Support Navigator model Y1 pilot Improve public access to service information Develop K-12 resource guide for educators Improve service coordination for high needs kids, youth and families Amend education curriculum to cover mental health promotion and address stigma Funding to increase supply of child and youth mental health professionals Increase Youth Mental Health Court Workers Hire new Aboriginal workers Implement Aboriginal Mental Health Worker Training Program INITIATIVES Outcomes, indicators and development of scorecard Expand inpatient/outpatient services for child and youth eating disorders Hire Nurse Practitioners for eating disorders program [part of New Nurses Initiative] Provide designated mental health workers in schools Reduce wait times for service, revise service contracting, standards, and reporting Implement school mental health ASSIST program and mental health literacy provincially Plan Evaluation Create 18 service colllaboratives Provide nurses in schools to support mental health services Implement Mental Health Leaders in selected School Boards OVERVIEW OF THE THREE YEAR STRATEGY

5. Three Pillars of the MHAN Program

6. MHAN Target Population Children & Youth with Mental Health and/or Addictions issues who meet the following criteria: • Multiple hospital/ER admissions • Complex medication issues • Concerns about medication follow up when medication is a key concern • With concurrent medical/mental health diagnoses • With conflicting/complicated diagnoses • Families who could benefit from medical health system navigation/coordination • Those who present a threat risk to the schools and where the benefit of a mental health nurse may be of assistance to the schools

7. MHAN Target Population Exclusion Criteria • Children and youth who have predominant developmental concerns • Children and youth who are actively connected with a mental health worker/provider • Children and youth with non-medical issues (referral must be appropriate and have a role for the RN/RPN)

8. The MHAN program Updates Total Number of Nurses hired to date - 7.6 FTE • Upper Grand District School Board (2 FTE): • Melanie Stothart • Cheri Fitzpatrick • Wellington Catholic District School Board (1 FTE): • Billie Chornoboy • Waterloo Region District School Board (3 FTE ): • Virginia Bateman • Wayne Paddick • Kim Schnarr • Waterloo Catholic District School Board (1.6 FTE - to hire 0.4): • Cheryl Coffey (0.6 FTE) • Lori Monnikendam

9. MHAN Program Referrals • 76 referrals as of Monday April 15, 2013 • Average age of referrals is : 14 years old • Ages vary from 8 to 18 years of age • Most Common Diagnoses: • Depression: 28 out of 76 referrals or (37%) • Anxiety: 15 out of 76 referrals (20%) • Suicidal ideation: 18 out of 76 referrals (24%)

10. MHAN Program Referral Stats • School Board Referral break down: • 63 % WRDSB • 15% UGSDB • 18% Wellington Catholic DSB • 1% Waterloo Catholic DSB • 1% Private School

11. MHAN Program Referral Stats

12. MHAN Program Referral Stats

13. Indicators for the Three Year Strategy • Reduced child and youth suicides/suicide attempts • Educational progress (EQAO) • Fewer school suspensions and/or expulsions • Higher graduation rates • More professionals trained to identify kids’ mental health needs • Higher parent satisfaction in services received • Decrease in severity of mental health issues through treatment • Decrease in inpatient admission rates for child and youth mental health • Fewer hospital (ER) admissions and readmissions for child and youth mental health • Reduced Wait Times

14. The MHAN Process • Referral is received via fax email to the intake assistant, Jennifer Andrade • Jennifer Andrade rosters the referrals to various nurses • each nurse generally works with kids in their school area, but we also ensure caseloads are fairly distributed • MHAN nurse receives notification of new referral from Jennifer Andrade and checks electronic folder to view new referral

15. MHAN process cont’d • MHAN nurse sees referral electronically and can begin calling client to book first home visit and : • Develop nursing care plan for the child/youth • Link to school and physician as soon as possible • Assist physician in titrating medications • Monitor vital signs while on psychiatric medications • Link to community resources and programming • System navigate with client and family • Provide short term home and school visits (1-3 months) until youth is medically and psychiatrically stabilized

16. MHAN Program Stats Timeline from Referral to first visit with MHAN nurse : • Goal is 72 hours • Actual : 7 days • Reasons for variance: • Parent/ client choice and availability • Referrals incorrectly filled out • Consent • Average Length of Stay on MHAN services: • Target Stay : 30-90 days • Actual Average Stay : 60 days

17. A Day in the Life of a MHAN nurse • Home Visit with client • Back to the office for follow up calls/ faxes to community services and physicians’ offices regarding clients • Meeting clients at physician visits, titrating medications, discussion of side effects • School visits to meet with school staff & clients • Back to the office to document a busy day!

18. MHAN referral form WRDSB

19. Feedback from our MHAN partners

20. Next Steps