Child and Youth Mental Health Train the Trainer 2

1. Child and Youth Mental Health Train the Trainer 2 Sheraton Wall Centre Vancouver January 25, 2012

2. Breakfast with Stan Dr. Stan Kutcher

3. Child and Youth Mental Health Train the Trainer 2 Sheraton Wall Centre Vancouver January 25, 2012

4. Session Opening Dr. Garey Mazowita

5. So far…out of 23 teams that reported 228Children and youth screened 225On a registry with anxiety, depression or ADHD 110Treated with non-pharmacological interventions 42 Treated with protocol driven medications

6. What else is happening? 10Teams working on processes between GPs and Schools 6 Teams working on processes between GP and specialists 7Teams working on involving pt and family in care 7 Teams working on leveraging community/provincial supports

7. Strongest Families BC 123 families have been referred. 88 Families have taken the intake assessment. 64 have been accepted into treatment. Many Families at mid point of the sessions.

8. What did you find useful? • Screening tools! • Confidence in screening and treatment • Relationships built in the community • Finding new ways to communicate • Using the same language The new screening tools are fantastic!

9. “The meetings reduced the sense of isolation and worry at having patients not being seen by services with long waiting lists.” “The collaboration provided alternative interventions to use and provided the ability to get at the whole story.” “Developing relationships are helping team members better navigate through each other’s organizations.”

10. What challenges did you have? • ‘Working through’ the screening tools • Feedback Loops • Scoring SCARED • TIME • Follow-up with patients • Getting all team members involved

11. Encouraging….. • Meeting with College of Family Physicians of Canada and Canadian Pediatric Society (through their joint committee JACCAH) to explore endorsement and presentation of CYMH module at 2012 FMF • Metabolic monitoring work to be folded in when complete

12. More opportunities …. • To all HAs: consider at least 1 pilot • To GPs: consider the Hollander session at this meeting at 1235 in the Gulf Islands Room, North Tower lower lobby

13. and the work continues! Photo courtesy of photostock

14. Patient/Family Voice Jeannie Rohr

15. Adding Value for the PatientThe Provincial ADHD Task Force Jana Davidson, MD, FRCP(C)

16. Translating the Journey The Value Stream Map

17. Example of potential ADHD VSM Future State Parents Schools Screens Recognition of a problem Tier 1 (local) Tier 2 (community) Tier 3 (regional) Tier 4 (provincial) Assessment per CADDRA Guidelines severe with comorbities sig fxn imprmt mild mild fxn imprmt moderate with comorbidity mod fxn imprmt severe & severe comorbidities severe fxn imprmt Escalating Severity/Complexity & Co-morbidity & Increasing Functional Impairment Burden 50,000: 100% 80% ?20% ?10% CHBC Service Planning Tool 2/3’s into adulthood 4% prevalence 140,000 Tier 4 Tier 3 Tier 2 Tier 1 Providers Facilities Clinical Support Services Minimum Service volume Interdependencies Other requirements Referral Criteria

18. Sharing Stories: Changes in Action

19. “Ideas are like rabbits. You get a couple and learn how to handle them, and pretty soon you have a dozen.” --John Steinbeck

20. “But how shall I get ideas? Keep your wits open! Observe! Observe! Study! Study! But above all, Think! Think! And when a noble image is indelibly impressed upon the mind --Act!” --Orison SwettMarden

21. The Cowichan Experience

22. Team Photo South Cowichan Team – only slightly photo-shopped

23. Background Information • 6 Patients/Clients between Trudy and Mary TEAM MEMBERS: Dr.Trudy Woudstra GP Mary Kirchner, School Counsellor Dr. Dale McDermit, Child Psychiatrist Dan McGee, MCFD Dr. Kristi Zinkiew, Pediatrician Michelle Bell, CYF Addictions, VIHA Megan Milne, CYF Addictions VIHA Dave Ehle, CMHA Christina Rozema, PSP • 6 Patients in Addition for Trudy

24. Our Team Aim An aim template for the team: We aim to improve communication around child and youth mental health patients in Cowichan in order to provide more comprehensive care We aim to improve provider satisfaction with communication amongst team member organizations

25. Changes We Tried – Identification and Treatment • Trudy tried the SCARED, KADS, K-GSADS, Worry Reducing Prescription, the Mood Enhancing Prescription and the CRAFFT • Mary tried out the Teen Functional Assessment in a clinical situation, and the WRP and MEP on 40 teen peer counsellors What we did

26. Changes We Tried – GP & School Collaboration • Trudy and Mary collaborated on 6 youth • Email • Phone • Face-to-face meetings Both began to regularly ask youth for consent to speak to the other • Mary provided an introduction to another school counsellor for Trudy • Trudy provided an introduction to another GP for Mary • Trudy assisted another GP in her office to complete the KADS on a patient then accessed a consult from Stan when the results were inconclusive

27. Changes We Tried – Working with Specialists • We held two team meetings to get acquainted and did program overviews and PSP orientations • Cross-consultation between Trudy, Mary and Dale has occurred since then on two patients in common • Trudy and Mary collaborated with Michelle Bell of CY Addictions for one client/patient

28. Changes We Tried – Working with MCFD/Community • We held two team meetings with members from the community • Helped to decrease sense of isolation felt by service providers • Provided a sense of something to offer to patients if they were waitlisted by another service • Increased understanding of the issues when each service provider brought their piece of the story to the meeting • Trudy and Mary each had two referrals to the Strongest Families program • Mary reviewed the Kelty website for materials and sent link to her school counsellor colleagues What we did

29. Provider Story – how this has impacted you • “…connectedness, reassurance that youth will have follow up by other team members – I feel less like kids will fall through the cracks” Mary Kirchner, School Counsellor • “in the long run for the parents that are closed [to services] they may eventually see that their child has a team of supports and will become more open to help. By bringing in the GP or the school, you bring in more comprehensive support” Dr. Trudy Woudstra

30. Things We Are Doing Next • Continuing to try out tools in GP Practice • Organizing another team meeting to determine how we can best support our clients – the “pseudo-navigator” approach • Increase collegiality and support to each member of the team • Improve awareness amongst team around other supports/services • Case studies involving “hypothetical” patients

31. Team CrestonDr. Tara Guthrie, MOA Lorraine Smith, School Counsellor Dianne MacDonald-Sutcliffe

32. Child Youth and Mental Health Northern Health

33. Map of Northern Health Authority Ibolya Agoston – Fort St. John Shirley Hahn - Terrace Kim Nordli – Valemount Margie Wiebe - Quesnel Shelley Crack - Masset

34. CYMH Communities Fort St. John Terrace Massett/Queen Charlotte City Quesnel Valemount

35. CYMH Collaborative Terrace

36. In School Care Model Terrace

37. CYMH Collaborative Fort St John

38. Masset/QueenCharlotteCityCollaborative

39. Our Team Aim An aim template for team: We aim to improve the CYMH referral process between community partners and Physicians in NH communities so that the number of students screened, referred and receiving treatment as defined by KADS-6, SCARED, or SNAP-IV increases monthly in each participating community with recorded patient numbers available by June 1st2012

40. Communication Trial Communication strategy

41. Communication Strategies between GP and School, GP and MCFD Considered: • Review existing communication strategies within and between agencies • Standardized Referral Form • SBAR template – communicate with MOA ! • Identify one contact person from each agency as a conduit for all referrals – communicate with MOA

43. Things We Are Doing Next

44. Nanaimo, CYMH PSP Team

45. Nanaimo CYMH PSP Team

46. Background Information • Nanaimo population: 105,000 • SD68 population: 14,500 (includes Ladysmith) TEAM: • Dr. Wilma Arruda, Pediatrician • Dr. Rex Bowering, Child Psychiatrist • Dr. Sheila Findlay, GP Champion • Rhonda Bradley, MOA Champion • Jerry Boychuk, CYMH Clinician • Yvette Macarthur, CYMH Team Leader • Bob Esliger, District Principal, Student Support Services, SD68 • Dona Billingsley, District Behaviour Resource Teacher, Registered Psychologist, SD68 • Lisa Hoefer, PSP Coordinator

47. TEAM AIM We aim to improve patient’s journey through all levels of CYMH system in Nanaimo. Our goals are to: • Remove boundaries of care through improved communication and commonality of language • Ensure that 100% of children are appropriately screened at level they enter the system • Improve process for initiation of mental health service to children and youth so that 100% of them present necessary documentation to physician on first visit • Ensure 100% of family doctors are sent a disposition letter .

48. Changes We Tried in Practice – Identification and Treatment • Dr. Findlay and Rhonda Bradley developed registry (15 patients) • Most tools tried and progress recorded on VIHA pilot log sheets • Barriers: • Time taken to complete tools, including scoring • Integrating into GP practice • Demographics practice skewed to children, not youth • Navigating Algorithm

49. Changes We Tried – Working with MCFD • Orientation to MCFD • Re-worked disposition letter to clarify to GPs what was happening to patient in process Testing: • Tuesday Intake meetings will be open for urgent phone calls from GPs. Barriers identified: • Unattached children/youth • Aboriginal CYMH separate Division. Aboriginal representatives have been invited to attend intake meetings.

50. Changes We Tried – Working with Specialists • Need identified for more timely communication to GPs about discharge plans from hospital. • Now GP is notified in more timely basis of discharge planning meetings. If cannot attend NOW sent meeting minutes. • GP needs: • Reason for admission • Discharge medications • Follow up arranged