Transformational Roadmap

Transcription

1 Transformational Roadmap ADDICTION & MENTAL HEALTH STRATEGIC CLINICAL NETWORK March 2017

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3 Message A MESSAGE FROM THE ADDICTION & MENTAL HEALTH STRATEGIC CLINICAL NETWORK SENIOR LEADERS The Addiction and Mental Health Strategic Clinical Network (AMH SCN ) is dedicated to improving addiction and mental health patient care and outcomes by engaging stakeholders to identify meaningful, evidence based opportunities for transformational change. This three year transformational roadmap reflects a bold vision and path forward for our community. It is intended to be a dynamic and responsive plan. We have engaged broadly and looked critically at areas of need to determine where there are opportunities now, and in the future. With a focus on innovation and the application of existing knowledge, the roadmap contains goals and strategies that reflect our commitment to develop, implement and evaluate change. The network also supports sustainability of Alberta s health care system through careful examination of current practices and the use of research and innovation to achieve excellence in care, and good value for investment. In partnership with patients and families, clinicians, administrators, policy makers, researchers, and community partners, we strive to bring together people, evidence and data to improve addiction and mental health outcomes. Including patients and families in all aspects of our work will help ensure a focus on the patient experience and on obtaining the best outcomes possible. This roadmap also highlights the necessity of our network to be integrated and aligned with Alberta Health Services vision and health plan to meet the needs of all our stakeholders. Thank you to our incredibly engaged Core Committee, including all previous and new members, our Zone and Provincial AMH partners, and the many work groups making substantive contribution to the work of the AMH Strategic Clinical Network. Most importantly, we would also like to thank our patient advisors who keep our conversations grounded in what matters most. We invite all of you to use this transformational roadmap as a gatewayto engage with the AMH Strategic Clinical Network and become partof the transformation. We look forward to a road well-travelled- together! Many thanks, Allison, Nick, Marni and Frank Allison Bichel Senior Provincial Director Nick Mitchell Senior Medical Director Marni Bercov Executive Director Frank McMaster Scientific Director Transformational Roadmap 3

4 AMH Strategic Clinical Network TRANSFORMATIONAL ROADMAP VISION Improving Addiction and Mental Health Together. MISSION To improve addiction and mental health patient care and health outcomes in Alberta by engaging stakeholders to identify meaningful, evidence based opportunities for transformational change. STRATEGIC DIRECTIONS Enhance patient & public health system experience Empower People & Communities Improve Health Outcomes & Clinical Best Practice Strengthen Financial Health & Operational Best Practice Alignment with AHS Health Plan Strategies and Balanced Scorecard AMH Alternate Models to Emergency Care Patient Experience Patient First Strategy Our People Peer Support Choosing Wisely Naloxone Evaluation TMS for Treatment Resistant Depression Clinical Health Research, Innovation & Analytics Strategy Patient & Population Health Outcomes Health Plan & Business Plan Patients & Families AHS Vision, Mission & Values Our People Strategy Information Management / Information Technology Strategy Financial Health & Value for Money Mental Health in Schools Perinatal Mental Health Research Capacity in Care KEY ENABLERS Research & Innovation Stakeholder Engagement Health System Integration Collaboration & Coordination Quality Improvement & Measurement 4 Addiction and Mental Health Strategic Clinical Network

5 Executive Summary The Addiction and Mental Health SCN Transformational Roadmap (TRM) looks forward at It builds on our previous work and highlights our planned actions for the next three years. The vision and mission of the AMH SCN is as follows: VISION: Improving Addiction and Mental Health Together. MISSION: To improve addiction and mental health patient care and health outcomes in Alberta by engaging stakeholders to identify meaningful, evidence based opportunities for transformational change. FOUR STRATEGIC DIRECTIONS have been identified to focus on for These strategic directions are: Enhance patient and public experience with the health system Improve Health Outcomes and Clinical Best Practice Empower People and Communities Strengthen financial health and operational best practices FIVE KEY ENABLERS have been identified as critical to achieving the strategic directions. Strengthening and building on these enablers will also contribute to our continued maturity as a network. The enablers are: Research and innovation Stakeholder engagement Collaboration and coordination Health system integration Quality improvement and measurement This document outlines the network s direction for and provides further detail about each of the TRM components with a focus on the priority initiatives identified to improve addiction and mental health service delivery in Alberta. The Addiction & Mental Health Strategic Clinical Network is excited to share its roadmap and looks forward to collaborating with network partners to share in this journey Transformational Roadmap 5

6 PRIORITY INITIATIVES FOR have been established under each of the strategic directions; these are broad in scope and provide opportunity to move forward on multiple fronts. Priority initiatives currently underway range in scope and are in various stages of development and include: PRIORITY INITIATIVE Addiction and Mental Health Alternate Models to Emergency Care Peer support Child and youth mental health School mental health initiative Perinatal Mental Health Repetitive Transcranial Magnetic Stimulation (rtms) for Treatment Resistant Depression (TRD) Naloxone evaluation Choosing Wisely Supporting implementation of Psychiatry Recommendations Provincial dialogue for Addiction and Mental health Research capacity in care settings Clinical knowledge development ROLE OF AMH SCN Collaborate with the Emergency SCN and Maternal Newborn Child & Youth SCN to create a comprehensive Journey Map of what children, youth and their families experience when they go to the ED with addiction and/or mental health issues. Through this process, identify areas for improvement both in the ED as well as in community-based services. Support the Canadian Mental Health Association (CMHA) Calgary branch to expand peer support programming and training throughout the province Collaborate with cross ministry and other partners to contribute to the development of a full-continuum provincial model for school mental health. Collaborate with the Maternal Newborn Child & Youth SCN to support the design and implementation of a single access point for perinatal mental health care across the province including screening, access to online treatment, peer support and pathway to appropriate referral to treatment and resources. Support province-wide implementation of rtms as a treatment option for TRD through the integration of research and clinical delivery to design and implement service model(s) that will best support the Alberta context. Lead the provincial evaluation of the Take-Home Naloxone Kit (THNK) program in collaboration with the Alberta Community Council on HIV (ACCH), Alberta Health Services (AHS) and Alberta Health. Work in partnership with zones to implement provincial strategy to support the uptake of evidence-based prescribing practices for psychiatry. Convene provocative conversations; design sessions; and engage in deliberative dialogue and conversations with stakeholders, especially persons and families with lived experience. Support initiatives and projects that engage clinicians in research, connect scientists into clinical research, and provide tools and supports for AHS staff to build clinical research capacity. Partner with the AHS Clinical Knowledge and Content Management (CKCM) service to develop provincial knowledge and standards focused on priority addiction and mental health topics and service delivery. 6 Addiction and Mental Health Strategic Clinical Network

7 Contents TRANSFORMATIONAL ROADMAP INTRODUCTION... 8 About the Addiction & Mental Health Strategic Clinical Network... 8 Vision and Mission... 8 Governance Structure... 8 DEVELOPMENT OF THE TRANSFORMATIONAL ROADMAP CONTEXT ADDICTION & MENTAL HEALTH SCN STRATEGIC DIRECTIONS FOR Strategic Direction #1: Enhance patient and public experience with the health system Strategic Direction #2: Improve Health Outcomes and Clinical Best Practice Strategic Direction #3: Empower People and Communities Strategic Direction #4: Strengthen financial health and operational best practices ANTICIPATED OUTCOMES KEY ENABLERS LOOKING FORWARD AND NEXT STEPS CONCLUSION GLOSSARY APPENDIX A: SCN LEADERSHIP AND CORE COMMITTEE MEMBERS APPENDIX B: ADDICTION & MENTAL HEALTH SCN PRIORITIES TIMELINES REFERENCES Transformational Roadmap 7

8 Introduction The mission of Alberta Health Services (AHS) is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans. Strategic Clinical Networks (SCNs) are province-wide teams that bring together the experiences, perspectives and expertise of patients and their families, health care professionals, researchers, communities and government to improve Alberta s health system. SCNs are the mechanism through which AHS empowers and supports physicians and clinical leaders both within AHS and the community to develop and implement innovative, evidenceinformed, clinician-led, team-delivered health improvement strategies 1. SCN Transformational Roadmaps (TRMs) are a key deliverable for all SCNs that align with provincial and AHS strategic directions, system priorities, and capabilities. TRMs represent the outcomes of significant work undertaken by each SCN to understand current health needs and services, identify best and promising practices, and chart out key strategies to transform services across the continuum of care over the next three years and beyond. TRMs are used to guide the work and direction of the network, with ongoing review and revision to respond to a changing environment and emerging issues. The initial Transformational Roadmap for the Addiction & Mental Health Strategic Clinical Network (AMH SCN ) covered the years This roadmap for builds on early achievements, highlights changes in our environment, and outlines our future direction and next steps in the journey. ABOUT THE ADDICTION & MENTAL HEALTH STRATEGIC CLINICAL NETWORK The Addiction & Mental Health Strategic Clinical Network (AMH SCN ) was created in 2012 as one of the first SCNs to be launched. Over the past four years the SCN led several large initiatives that have helped to inform addiction and mental health service delivery in Alberta. Of particular note are two major projects that were recently completed: The Adult Depression randomized controlled trial in Primary Care compared the outcomes of four different treatment arms on moderate depression. The economic analysis is currently underway in partnership with the Institute of Health Economics. The EMPATHY project, a partnership with Red Deer Public School District, the Red Deer PCN and AHS Addiction and Mental Health, screened over 6,000 students (Grades 6-12) for depression, anxiety, suicide ideation, self-esteem, quality of life and use of drugs, alcohol and tobacco. Intervention as well as referral to services were provided for high-risk youth when required. Results indicated that students showed significant decreases in depression and suicidality 2. VISION AND MISSION The Vision of the AMH SCN was developed in 2016 through consultation with our network membership. The Mission was developed in our early years and will continue to carry us forward to VISION: Improving Addiction and Mental Health Together MISSION: To improve addiction and mental health patient care and health outcomes in Alberta by engaging stakeholders in identifying meaningful, evidence based opportunities for transformational change. GOVERNANCE STRUCTURE The AMH SCN s composition reflects our broad scope and complexity. A leadership dyad comprised of a Senior Provincial Director (SPD) and Senior Medical Director (SMD) co-leads the SCN and works with a small leadership team including an Executive Director, Manager, Senior Consultants, and administrative support. The recent combining of Senior Medical Director roles for the AMH SCN and the AHS AMH provincial program will further strengthen coordination across SCN, provincial program, zone and primary care addiction and mental health services. Also part of the leadership team, a Scientific Director and Assistant Scientific Director support our network s mandate to facilitate provincial research in collaboration with academic partners to create new knowledge and to support knowledge translation that 8 Addiction and Mental Health Strategic Clinical Network

9 contributes to improved addiction and mental health care for Albertans. A Core Committee includes leaders from zones, provincial services, front-line clinicians, research, government and communities, and patients and their families. The functions of Core Committee members include: serve as a Brain trust to plan, design, implement and evaluate innovation in Addiction and Mental Health care delivery; provide opportunities to engage and widen the circle of involvement with people to lead/collaborate on the work; form a Network Node by bringing forward new ideas, informing decisions, and consulting with partners; prime the innovation pipeline by providing a view of the current and future landscape; ensure the work of the network is anchored in research and evidence, and advocate and endorse work on new and emerging issues/technologies. Working groups are created to support work on the priority initiatives to ensure progress on network activities and to more broadly engage stakeholders in the work of the network. Within the AHS organizational structure, the AMH SCN reports up to the Senior Program Officer and Associate Chief Medical Officer of Health responsible for Strategic Clinical Networks. The SCN links to other SCNs and program and service areas of AHS, including the AHS Addiction and Mental Health Provincial team and Zone operations. The SCN also accesses various AHS business and corporate supports as required to achieve its goals as well as provincial supports including the Provincial Advisory Council on Mental Health and Addiction. Key provincial partners linked to the network include Alberta Health, Alberta Innovates, the Canadian Mental Health Association (CMHA), Child Adolescent and Family Mental Health (CASA), PolicyWise for Children and Families, and the Universities of Alberta, Calgary, and Lethbridge. The SCN also connects nationally with other partners including the Centre for Addiction and Mental Health, the University of British Columbia and other provincial governments to support its priority initiatives. I believe the key to the success of the Addiction and Mental Health SCN is the emphasis on actually doing something positive, instead of just talking about it, as we so often do when faced with the enormity of the task before us. The opportunity for the input and active involvement of core members and others is also critical. With respect to the Provincial Advisory Council on Addiction and Mental Health, our participation in the SCN has enabled us, not only to share and exchange information on an on-going basis, but also to re-examine our goals and priorities, and also to work more collaboratively and effectively in meeting the challenges facing the Albertans we serve. We support this SCN because it offers some real possibilities for meaningful change, as laid out in the Road Map. - Geoff Tagg, Chair Provincial Advisory Council on Addiction and Mental Health Transformational Roadmap 9

10 Development DEVELOPMENT OF THE TRANSFORMATIONAL ROADMAP TRM refresh work started in 2015 with a priority setting process completed with the Core Committee to identify key priorities. Also as part of the refresh process, the Leadership team reviewed the Transformational Roadmap. The AMH SCN has intentionally aligned its strategic directions for with the four foundational strategies and Balanced Scorecard of the AHS Health Plan and Business Plan. The strategic directions also reflect the three SCN priorities of outcomes improvement through clinical pathways, clinical appropriateness, and health and social system integration. Planning is underway to ensure strong alignment and coordination of the activities of the AMH SCN, AHS AMH provincial team and zone operations going forward. Priority initiatives and expected outcomes will contribute to achieving the provincial recommendations outlined in Valuing Mental Health: Report of the Alberta Mental Health Review Committee The AMH SCN will actively work to ensure ongoing alignment with the Valuing Mental Health Action Plan that is currently being developed for implementation by the Government of Alberta. 10 Addiction and Mental Health Strategic Clinical Network

11 Context CONTEXT MAKING THE CASE The AMH SCN provides direction and leads provincial initiatives to transform addiction and mental health care for Albertans. The following information highlights the need for continued collaborative and coordinated action to address addiction and mental health as part of overall health. It affirms the value and relevance of the AMH SCN as an integral member of the SCN family working to improve all health outcomes for Albertans. Worldwide and nationally Mental, neurological and substance use disorders accounted for 13% of the total global burden of disease in the year Mental disorders affect and are affected by other diseases including cancer and cardiovascular disease. People with mental disorders also experience disproportionately higher rates of disability and mortality as their physical health problems are often not addressed 4. In 1990, depression was the fourth largest contributor to the total global disease burden; it is expected to rank second after ischaemic heart disease by Depression continues to rank among the largest single causes of disability worldwide, particularly for women 6. Depression is expected to rank as second largest contributor to the total global disease burden by in people in Canada will experience a mental health problem or illness in any given year Transformational Roadmap Mental health costs are not sustainable; experts estimate the total cost to society could exceed that of the entire cost of Canada s healthcare system 7. While the economic burden of mental illness constitutes more than 15 per cent of the burden of disease in Canada, these illnesses only receive 5.5 to 7.3 per cent of health care dollars 8. One in five people in Canada will experience a mental health problem or illness in any given year, with a cost of over $50 billion to our economy 9. 70% of adults living with a mental health problem or illness report their symptoms started in childhood; 60% of people with a mental health problem or illness do not seek help due to concerns of being labeled. In any given week, 500,000 Canadians are unable to work due to mental health problems or illnesses 9. A rapid synthesis completed by McMaster Health Forum in 2016 highlighted that mental health services should be delivered within and across multiple settings with emphasis on evidence-based approaches and that while important to deliver services across the lifespan; the biggest impact exists for programs targeting children, youth and their families 7. Five key actions that could make a difference to addiction and mental health services are transforming primary care; focusing on children and youth; focusing on diversity; leveraging online platforms and other technologies; and collaborating with people with lived experience to set targets and develop indicators 7. Through public programs such as Bell Let s Talk, there is increasing focus on addiction and mental health issues by both the public and the media with attention being given to addressing issues of stigma. In any given week, 500,000 Canadians are unable to work due to mental health problems or illnesses. 11

12 Provincially About 20% (or 1 in 5) of Alberta adults experienced an addiction or mental health problem in 2012 equating to 614,861 people 10. A provincial study of system resources including data from programs, services and initiatives funded and operated by AHS and its subcontractors, Government of Alberta (GoA) and its subcontractors, and those receiving partial or full funding from the GoA that are administered by a non-governmental organization (NGO) indicates that while there is greater investment in providing care for adults versus supporting children and youth, existing services do not provide sufficient care to meet the needs of Alberta adults. System resources are heavily invested in providing inpatient, residential, and crisis services. Supportive services for people with addiction and mental health problems including referrals to transitional services, case management, transportation to treatment, and assistance with social services and housing are not well-integrated into addiction and mental health care 10. Early identification and intervention are critical as the onset of most mental health problems and mental illness occurs during adolescence and young adulthood 11. While AHS continues to work with other government ministries to streamline access to children s addiction and mental health services, the percent of children offered scheduled mental health treatment within 30 days from referral deteriorated from 89% in to 85% in In June 2015, an Alberta Mental Health Review Committee was established to comprehensively review addiction and mental health services and the mental health system in Alberta. After undertaking an extensive public consultation process, the report and recommendations were provided to government in December Valuing Mental Health: Report of the Alberta Mental Health Review Committee 2015 highlights the need to improve and sustain the provincial addiction and mental health system. Key recommendations focus on improving access and system integration and coordination, strengthening communities, collaborating with Indigenous people and communities, partnering for change, and applying learnings to current issues 3. Recommendations from the Officer of the Auditor General (OAG) and Valuing Mental Health reports identify the need to: - improve addiction and mental health care in Emergency Departments, - improve linkages between community-based services and formal health services, - provide timely access to treatment and ongoing support services, and - support transitions and integrated care planning 3. As a Family/Patient Advisor, I am constantly confronted with the reality of how far we need to go to adequately address the needs of Albertans afflicted with addiction and mental illness, but as a member of the AHS AMH SCN I am constantly reassured by how far we ve come. Never could I have imagined the impact that the SCN could have made in a few short years, and what that means for the long-term outlook of Addiction and Mental Health in Alberta. We ve got the right people, the right tools, and now we re on a roll! - Alexander Cook, Family/Patient Advisor 12 Addiction and Mental Health Strategic Clinical Network

13 Strategic Directions ADDICTION & MENTAL HEALTH SCN STRATEGIC DIRECTIONS FOR Four strategic directions have been identified for the AMH SCN to focus on for These strategic directions are: Enhance patient and public experience with the health system Improve Health Outcomes and Clinical Best Practice Empower People and Communities Strengthen financial health and operational best practices The strategic directions have been developed in the context of the full continuum of care and contribute to the overall goals of SCNs, which are ensuring: comprehensive care across the continuum, smooth transitions between services efficiency is optimized, and value for money. The AMH SCN strategic directions for intentionally align with the four strategies and quadrants of the Balanced Scorecard for the AHS Health Plan and Business Plan. While the SCN s priority initiatives identified for impact all quadrants of the Balanced Scorecard, they have each been assigned under one strategic direction according to best fit. Each of the priorities identified are broad in scope and provide opportunity for moving forward on multiple fronts. Work is ongoing within the Network to further scope, define, sequence and phase next steps and projects under each of the priorities. Priority initiatives currently underway are in various stages of development; highlights of these are presented. The SCN also recognizes that new issues and initiatives will emerge over time. Projected project timelines will inform where capacity exists within the SCN to look at bringing on additional projects as existing projects are completed or transitioned for implementation to SCN partners, including AHS zone operations. As a community based service organization the Canadian Mental Health Association in Alberta has appreciated having the voice of not-for-profit grassroots organizations at the SCN table. Over the last number of years CMHA Calgary Region has been supported by the SCN in the identification of Peer to Peer Mental Health support as a leading practice in community based mental health. Additionally, CMHA Alberta has been involved with the SCN in significant work related to Transcranial Magnetic Stimulation an important emerging technological intervention for treatment resistant depression. - Canadian Mental Health Association Transformational Roadmap 13

14 AHS Health Plan Strategies Patient Experience Patient First Strategy Our People Clinical Health Research, Innovation & Analytics Strategy Patient & Population Health Outcomes Health Plan & Business Plan Patients & Families AHS Vision, Mission & Values Our People Strategy Information Management / Information Technology Strategy Financial Health & Value for Money 14 Addiction and Mental Health Strategic Clinical Network

15 Figure 1 summarizes the AMH SCN strategic directions and priorities and includes examples of work underway or in development. Appendix B illustrates the anticipated timelines over the next three years for the AMH SCN priority initiatives. Timelines are approximate and will be continuously reviewed; this will also assist with identifying our network s capacity to take on new initiatives to address emerging issues. FIGURE 1 - AMH SCN Strategic Directions and Priorities AMH SCN STRATEGIC DIRECTIONS (What we want to achieve and how we will do it) Enhance patient and public experience with the health system Improve Health Outcomes and Clinical Best Practice Empower People and Communities Strengthen Financial Health and Operational Best Practices AMH SCN STRATEGIC DIRECTION #1: Enhance patient and public experience with the health system Addiction and Mental Health Alternate Models to Emergency Care Peer Support AMH SCN STRATEGIC DIRECTION #2: Improve Health Outcomes and Clinical Best Practice Child and Youth Mental Health - School Mental Health Initiative Perinatal Mental Health Repetitive Transcranial Magnetic Stimulation (rtms) for Treatment Resistant Depression (TRD) AMH SCN STRATEGIC DIRECTION #3: Empower People and Communities Facilitation of provincial dialogue / conversations for Addiction and Mental Health Research capacity in care settings AMH SCN STRATEGIC DIRECTION #4: Strengthen financial health and operational best practices Choosing Wisely - Supporting Implementation of Psychiatry Recommendations Clinical Knowledge Topics starting with rtms Naloxone Evaluation Transformational Roadmap 15

16 OVERVIEW OF AMH SCN STRATEGIC DIRECTIONS The SCN s priority initiatives are highlighted under each strategic direction, including information that informed their selection as priorities for A summary of anticipated high-level outcomes for all of the work being undertaken by the AMH SCN is also presented. STRATEGIC DIRECTION #1: Enhance patient and public experience with the health system This strategic direction addresses improving the patient and family experience with addiction and mental health service delivery. The focus is on service options that increase patient choice and access to supports and that are responsive to patient needs across the continuum of care. Priority initiatives will focus on designing, piloting, sustaining and spreading evidencebased alternative or complementary models of care in order to improve patient experience and increase public confidence in the system. Work underway is intended to increase service and support options for Albertans wherever they live in the province; enhance and profile the network of community-based addiction and mental health recovery supports; improve social support and quality of life; and reduce demands on acute care. Work Underway: Priority initiatives of the AMH SCN currently underway to support this strategic direction include: Addiction and Mental Health Alternate Models to Emergency Care: There has been an increase in the number of Emergency Department (ED) visits by children and youth with addiction and/or mental health concerns across the province. This rise in numbers, as well as hearing directly from patients and their families about their dissatisfaction with the care that they have recieved brought about an opportunity for a partnership between the AMH SCN, the Emergency SCN, and the Maternal Newborn Child and Youth SCN to improve the quality of care for children, youth, and their families. In order to ensure that any changes made are responsive to patients and family s needs, the SCNs are creating a comprehensive Journey Map of what children, youth and their families experience when they go to the ED with addiction and/or mental health issues. This Journey Map will create an in-depth understanding of why children, youth and their families are presenting to the ED in higher numbers and what type of care and support they are looking for. Through this process, areas for improvement both in the ED as well as in community-based services will be identified. The Journey Map will include four layers of information gathering: ➊ Data analysis including summarizing zone and provinicial data as well as reviewing pertinent Alberta based research. ➋ Mapping of the patient s journey which will be articulated by children, youth, and their families including what led up to their ED visit, their experience in the ED, and after being discharged. ➌ Mapping of ED processes for patients and the providcers including ED and AMH clinicians. ➍ Reviewing national and international literature to identify evidence-based methods for improving this area of health care delivery. Once the Journey Map is complete and validated by patients, families, and clinicians, the SCNs in collaboration with their partners will prioritize areas for business case development. 16 Addiction and Mental Health Strategic Clinical Network

17 Provincial Peer Support Action Plan: The AMH SCN is working in partnership with the Canadian Mental Health Association (CMHA) Calgary branch to expand peer support programming and training throughout the province. The initiative objectives are to support legitimization of peer support as part of the Addiction and Mental Health recovery model in Alberta and to identify opportunities to scale and spread peer support across the province. The AMH SCN will be a key partner in driving research and evaluation into the continued development of a centre of excellence in peer support within CMHA Calgary and will advocate for the integration of peer support programming across the province. Key factors driving the SCN s work for this strategic direction include: the need to better understand what addiction and mental health services are being provided in Emergency Departments and explore patient experience related to service delivery, including what service gaps exist and how we can better respond. concerns about the increasing rates of ED visits and inpatient hospitalizations for mental disorders among children and youth. Findings from a 2015 CIHI study indicate that rates of ED visits and inpatient hospitalizations for mental disorders among children and youth increased 45% and 37%, respectively, between and ; the greatest increases in rates of hospital service use are among youth 10 to 17 years old, those with mood and Findings from a 2015 CIHI study indicate that rates of ED visits and inpatient hospitalizations for mental disorders among children and youth increased 45% and 37%, respectively, between and anxiety disorders and those living in urban areas 13. increasing recognition of the benefits of strong social networks to support treatment for addiction and mental health conditions. Models such as peer support encourage increased community involvement by people who identify as having a mental health condition or addiction, support increased engagement with formal and informal supports, contribute to symptom reduction and individual recovery successes, provide opportunity to engage with underserved disconnected populations, and contribute to less demand on acute care services 14. Increasing evidence supporting positive outcomes for peer support in the context of self help groups, peer-run organizations and services as well as peer support workers in mainstream services. Peer support is well-embedded within the recovery model and research demonstrates the effectiveness of employing peer support in combination with mental health clinical supports 14. STRATEGIC DIRECTION #2: Improve Health Outcomes and Clinical Best Practice This strategic direction focuses on identifying and developing innovative, collaborative service models and care pathways that will improve mental health outcomes at the individual, system and population levels. Priority initiatives address key areas of need and have the potential to improve outcomes for high volume areas of need. Work Underway: Priority initiatives of the AMH SCN currently underway to support this strategic direction include: Child and Youth Mental Health Mental Health in Schools: The AMH SCN is working with cross ministry and other partners to contribute to the development of a fullcontinuum model for school mental health. The model will address age and stage Transformational Roadmap 17

18 of development and identify and build on programs that have demonstrated improved outcomes. For example, learnings from the EMPATHY project will inform this broader school mental health discussion and initiatives. Work to date recognizes the importance of collaboration and building on cross-ministry connections, linking with the research community to support this work (e.g., PolicyWise for Children & Families) and connecting with the Regional Collaborative Service Delivery network (RCSD) to ensure strong connections with the provincial education system. Further consultation and discussion will define the role and scope of involvement of the AMH SCN and identify initiatives for our involvement. Perinatal Mental Health: The AMH SCN is working in collaboration with the MNCY SCN to establish a single virtual point of access for screening and services related to perinatal mental health. Researchers in Calgary have conducted research around the feasibility and acceptability of virtual screening that is linked to an algorithm based pathway for referral to appropriate treatment and support services. This work will expand on this concept to help support mothers and families provincially to access appropriate perinatal mental health care. Each zone will be engaged to ensure that implementation and adoption is sustainable within the local zone context. Repetitive Transcranial Magnetic Stimulation (rtms) for Treatment Resistant Depression (TRD): rtms has been approved for the treatment of adults with TRD in Alberta; it has been identified as a potential treatment option for between 36,000 and 72,000 Albertans. The AMH SCN will support province-wide implementation of rtms as a treatment option for TRD through the integration of research and clinical delivery to design and implement service model(s) that will best support the Alberta context. Work is jointly underway with partners including the zones to develop a provincial Business Case that will support moving this initiative forward. Key factors driving our work for this strategic direction include: the need to improve health and educational outcomes for children and youth and to collaborate to address key system drivers that will facilitate improved outcomes. the identification of school mental health as a priority by the Provincial Advisory Council on Addiction and Mental Health and the SCN core committee. the recognition of schools as a primary setting to reach Albertans. Schools play an integral role in the delivery of programs intended to improve the mental health of children and adolescents. There are currently a number of school-based initiatives that address mental health, social/emotional learning, stigma reduction, resiliency, and drug and alcohol use; this presents an opportunity to move forward with a coordinated provincial approach. the number of adults struggling with TRD that could benefit from provincial access to rtms treatment. In Alberta, over 120,000 people suffer from Major Depressive Disorder (MDD); between 30-60% will not respond to first line treatment or have contraindications to available first line treatment (such as seniors, pregnant and postpartum women). Individuals with TRD are at high risk for global impairment and depression is a major risk factor for suicide 15. The evidence strength for rtms use Level A (definite efficacy) 16. While rtms is not a replacement for Electroconvulsive Therapy (ECT), it does provide the potential to increase Alberta s capacity to address Treatment Resistant Depression (TRD). ECT is available through Alberta s public healthcare system but requires delivery in an inpatient setting and is associated with high resource costs. Between 30-60% will not respond to first line treatment or have contraindications to available first line treatment. 18 Addiction and Mental Health Strategic Clinical Network

19 STRATEGIC DIRECTION #3: Empower People and Communities This strategic direction focuses on building capacity at the individual, organizational, community and provincial levels to better respond to the addiction and mental health care needs of Albertans. Work Underway: Priority initiatives of the AMH SCN currently underway to support this strategic direction include: Provincial Dialogue for Addiction and Mental Health: To support collaborative transformation of Alberta s Addiction and Mental Health system, the AMH SCN will: convene provocative conversations; design sessions; and engage in deliberative dialogue and conversations with stakeholders, especially persons and families with lived experience. The Alberta Depression Research Priority Setting project is a collaboration between the Alberta SPOR SUPPORT Unit Patient Engagement Platform, the Addiction and Mental Health Strategic Clinical Network, and the Canadian Depression Research Intervention Network. This multi-stage project focuses on the perspective of clinicians and persons with lived experience to identify and prioritize depression research questions that will inform depression research. The final product will be a list of the top 10 research questions of importance to people with lived experience and the clinicians that care for them. The goal of this project is that questions prioritized by people with lived experience and clinicians caring for those with depression will be answered by researchers and funders. Research capacity in care settings: The AMH SCN will support initiatives and projects that engage clinicians in research, connect basic scientists into clinical research, and provide tools and supports for AHS staff to build clinical research capacity. Working within our constantly changing environment, the SCN will continue to actively seek out innovative opportunities to expand research capacity for addiction and mental health across the province. Key factors driving our work for this strategic direction include: the critical role the health workforce plays in healthcare transformation. Improving their experience of providing care is a precondition for health system transformation 17. the increasing recognition that patients and families are best able to help direct us to gaps in care they have experienced. STRATEGIC DIRECTION #4: Strengthen financial health and operational best practices This strategic direction focuses on reducing provincial practice variation; reducing unnecessary tests, treatments and procedures; provincial implementation of innovative evidence-based treatment options that will contribute to care transformation; and developing performance measures to evaluate interventions across the six dimensions of quality (appropriateness, acceptability, accessibility, effectiveness, efficiency and safety) 18. Work Underway: Priority initiatives of the AMH SCN currently underway to support this strategic direction include: Choosing Wisely - Supporting Implementation of Psychiatry Recommendations project is a provincial strategy to support the uptake of evidence-based prescribing practices for psychiatry. The Canadian Psychiatric Association identified thirteen Choosing Wisely Canada (CWC) recommendations that address the DSM-IV diagnoses of insomnia, attention deficit and hyperactivity disorder, depression, Transformational Roadmap 19

20 psychosis and dementia as well as the ordering of specific tests. A provincial steering committee and working group has been struck to guide work under this initiative. Consultation and collaboration with the Zones will focus on prioritizing the national recommendations for the Alberta context. Zones will be provided their data related to the prescribing recommendations. Zone-level meetings will be conducted to acknowledge successes where good prescribing practices are already in place and to determine next steps and where best to focus attention on practice changes where required. Partners including the Canadian Psychiatric Association, the Alberta Psychiatric Association, the Alberta Medical Association, the Physician Learning Program, and the College of Family Physicians of Alberta have been engaged to explore opportunities for ongoing collaboration and support. Education for physicians and patients will be considered as well as the development of an ongoing monitoring program to provide feedback related to the recommendations. Clinical Knowledge Development: The SCNs and the AHS Clinical Knowledge and Content Management (CKCM) service are partnering to improve patient care through the creation of provincial knowledge and standards. Clinical Knowledge Leads (CKLs) are located within the Chief Medical Information Office (CMIO) and are aligned with each SCN. They are working collaboratively with the SCNs to identify, prioritize, and develop Clinical Knowledge Topics (CKTs) for defined diseases/ conditions, specific patient populations or segments of a clinical pathway. These will then be built into provincial clinical information systems to improve the quality and safety of patient care. The first Clinical Knowlede Topic being developed with the AMH SCN is around rtms. Take-home Naloxone Evaluation: The SCN is leading a provincial evaluation of the Take-Home Naloxone Kit (THNK) program; the program is a collaboration of the Alberta Community Council on HIV (ACCH), Alberta Health Services (AHS) and Alberta Health. Takehome Naloxone kits are being distributed throughout Alberta as a key response to the growing number of opioid-related deaths; it is critical to determine whether the program is contributing to reducing opioid-related deaths. Evaluation results will focus on the efficacy of Alberta s approach and program reach and may work to improve the program with all three groups involved. The final evaluation, expected to be completed in 2017, will include recommendations for future program direction including funding, program improvements or expansion, protocols and education. Results will inform leading practices in THNK programs, contribute to identifying promising practices for holistic harm reduction policies and programs, and inform development of a harm reduction strategy for Alberta. Key factors driving our work for this strategic direction include: alignment with AHS s implementation of Choosing Wisely Canada recommendations, organizational direction and implementation of the provincial Clinical Information System (CIS) Program and Clinical Knowledge Content Management (CKCM) service. SCN leadership for provincial implementation of the Choosing Wisely recommendations and the organization s focus on appropriateness of care. the significant increase in overdose deaths involving opioids. In 2015, there were 274 fentanyl-related overdose deaths in Alberta, a significant increase from 120 deaths reported in Alberta Health and AHS making naloxone kits accessible since May 2015 through community harm reduction organizations, community pharmacies, AHS addiction services and emergency departments. In 2015, there were 274 fentanylrelated overdose deaths in Alberta, a significant increase from 120 deaths reported in Addiction and Mental Health Strategic Clinical Network

21 Anticipated Outcomes Identified outcomes for will inform how the AMH SCN is moving the dial to transform addiction and mental health care in Alberta. They link directly to the vision, mission and strategic directions of the SCN with actions under more than one strategic direction expected to influence the outcomes. Specific outcomes for individual priority initiatives will roll up to contribute to the broader SCN outcomes. Outcomes of AMH SCN initiatives for will also align with and contribute to outcomes identified for the AHS Health Plan and those expected through implementation of the Valuing Mental Health recommendations. The AMH SCN sits at various tables focused on the complex issue of outcomes for addiction and mental health; SCN outcomes are being intentionally aligned with provincial PerMEF outcomes currently under development as well as national outcomes identified for addiction and mental health. SCN outcomes target overall system improvements in: Patient and family reported experiences Depression related outcomes Innovations that move the dial to transform care The following information will be gathered and reported to demonstrate success: Individuals/families report improved experiences of AMH care within the health system Improved provincial access and equity of access to core AMH services and treatment options Increased capacity for AMH care in the community Individual / family voice is visible / reflected in provincial decision making for AMH service delivery Reported provincial reduction in stigma associated with addiction and mental health issues Decreased variability in AMH care across the province Improved AMH outcomes through implementation of evidence-based care pathways The chart on page 22 depicts how these components are all connected. In Addiction and Mental Health care, there is science and art. I see the SCN following the science through the pursuit of measurement and evidence-directed care; and the art of relationships is being fostered through collaboration with those with lived experience and harnessing the power of peers. Who wouldn t want to be part of this! - Dr. Michael Trew, Psychiatrist Transformational Roadmap 21

22 ADDICTION AND MENTAL HEALTH Transformational Roadmap Outcomes VISION AMH SCN VISION: Improving Addiction and Mental Health Together STRATEGIES Enhance patient and public experience with health system Improve Health Outcomes and Clinical Best Practice Empower People and Communities Strengthen financial health and operational best practices HIGH LEVEL OUTCOMES Individuals/ families report improved experiences of AMH care within the health system Improved provincial access and equity of access to core AMH services and treatment options Increased capacity for AMH care in the community Individual/family voice is visible and reflected in provincial decision making for AMH service delivery Reported provincial reduction in stigma associated with addiction and mental health issues Decreased variability in addiction and mental health care across the province Improved AMH outcomes through implementation evidence-based care pathways PROJECT OUTCOMES EMERGENCY DEPARTMENT: - Youth and families contribute to improving AMH care in the ED through sharing their experiences rtms: - patients report/ demonstrate a positive response to intervention for Treatment Resistant Depression and a reduction in symptoms NALOXONE EVALUATION: - Improved distribution and access to patients of Take-home Naloxone Kits Perinatal MH: - Patients are screened and appropriately referred to treatment rtms: - Increased number of sites providing rtms for treatment resistant depression School MH: - evidence-based MH programming delivered in schools - Youth requiring support identified in early schools and receive appropriate care CHOOSING WISELY: - Physicians are engaged in the implementation of the CW Psychiatry recommendations Peer Support: - Integration of peersupport as part of the AMH recovery model in Alberta Perinatal MH: - develop supports for community agencies to ensure appropriate treatment to mothers rtms: - Edmonton Zone PCN based rtms model implementation School MH: - Teachers/school based counsellors knowledgeable in evidencebased school MH programming EMERGENCY DEPARTMENT - Service design reflects an increased understanding of the issues that drive youth and families to EDs Depression Research Priority Setting: - patients and family identified depression research priorities are disseminated and leveraged by Alberta researchers EMERGENCY DEPARTMENT: - reduce stigma towards AMH in the ED for youth and their families Peer Support: - increase knowledge and understanding of value of peer support in a health professional recovery team to promote workplace readiness CHOOSING WISELY: - Physicians and psychiatrist in high prescribing zones engage in CW KT/ Implementation to change prescribing behaviours rtms: - rtms delivered in accordance with established provincial clinical standards PERINATAL MH: - development and implementation of algorithm for screening and referral to appropriate services for women with perinatal MH concerns rtms: - rtms delivered in accordance with established provincial clinical standards - clinical measurement embedded in rtms treatment program to allow for continued evaluation and research School MH: - develop evidencebased standards for school based MH programming with uptake from schools 22 Addiction and Mental Health Strategic Clinical Network