Integrating Innovation in Service Delivery and Research to Connect Inner City Youth with Wellness

Transcription

1 Lead Donor: Integrating Innovation in Service Delivery and Research to Connect Inner City Youth with Wellness Drs. Steve Mathias 1,2 and Chris Richardson 1,2,3 1 Inner City Youth Program, St. Paul s Hospital, Providence Health Care 2 Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care 3 School of Population and Public Health, UBC CHÉOS Centre for Health Evaluation and Outcome Sciences

2 Disclosures Dr. Mathias Speaker Bureau: Janssen Ortho Advisor: Oksuka, Janssen Ortho Dr. Richardson Member: From Grief to Action

3 Inner City Youth Program: Lead Donor Silver Wheaton How did we begin? Initially established in 2007 at St Paul s Hospital Now an Intensive Case Management Program Case managers (nurses and social workers) 16-20:1 ratio Substance use and/or mental health Attachment informed therapy Stabilized housing is prioritized Mental health goals are set by the youth

4 ICY Staffing Expansion Our Intensive Case Management Team GREW! Social Workers (3 ->6) Nurses (1->6) Clinical Supervisor (1) Our Rehab Team BLOSSOMED! Occupational Therapist (1) Rehab Assistants (1->2) Peer support worker (0->3) Recreation worker (0->1) Our Prescriber Team PRIMARIED! Nurse Practitioner (1-> 3) Psychiatrists (7) Family Doctors (0->2)

5 ICY Housing Continuum What is the inter-relationship between health and social services? More than 90 housing units assigned to ICY youth in collaboration with various partners Low threshold- St Helen s Hotels (25), Margherite Ford (20), Imuoto (16) Medium threshold- Pacific Coast Apartments (15) and Burrard Building (20) 10 market rent housing subsidies Nov. 3, > Group home 24/7 support, abstinence based period of stabilization outside of DTES

6 ICY Access and Referral

7 Service Level From : Over 600 youth annual psychiatric appointments 200+ contacts/week 80+ youth in housing Average wait time less than one month 12+ groups Evolving an integrated ICY research team A Centre of REAL GOOD

8 Chart review of ICY intake assessments conducted between Mar and Dec (n=494) What are the basic health needs of street involved youth? Average age of 21 64% male, 35% female, 1% transgendered Primarily Caucasian (57%) or Aboriginal (21%) Education Completed: High school grad (11%), Grade 11/12 (30%), Grade 7-10 (42%) 37% reported history of foster care Income sources: 46% on IA, 20% working, 9% PWD

9 Housing at Intake Family 5.3% Shelter 46% SRO 8.5% Supported 7.5% Independently 9.9% Street/Couch Surfing 9.9% Other 3.2%

10 Mental Health Diagnoses at Intake 84% were diagnosed with a mental illness 56% diagnosed with both mental illness and substance abuse/dependence Anxiety Disorders 34.6% PTSD 10.7% Generalized Anxiety Disorder 3.8% Panic Disorder 3.6% Social Phobia 6.1% OCD 3.8% Anxiety Disorder NOS 11.9%

11 Mood Disorders 48% Major Depressive Disorder 12.8% Dysthymic Disorder 1.8% Depressive Disorder NOS 5.7% Bipolar I 3.6% Bipolar II 8.1% Bipolar NOS 6.3% Mood Disorder NOS 11.1%

12 Psychotic Disorders 20.4% Schizophrenia 5.1% Substance-induced psychosis 1.6% Schizoaffective 1.6% Psychosis NOS 13.8%

13 ADHD & FAS ADHD 15.4% FAS 12.1%

14 Substance Abuse/Dependence Alcohol Abuse 10.9% Cannabis Abuse 10.9% Alcohol Dependence 13.0% Cannabis Dependence 21.7%

15 Substance Abuse/Dependence Amphetamine Abuse 2.0% Cocaine Abuse 5.7% Amphetamine Dependence 12.4% Cocaine Dependence 12.3%

16 Substance Abuse/Dependence Opioid Abuse 1.7% Opioid Dependence 8.1%

17 History of Foster Care Among Youth Enrolled in ICY ( ) 33.6% reported history of foster care 30 fold over representation compared to children and youth living in British Columbia. Youth with history of foster care were: More likely to be of Aboriginal heritage Less likely to to have graduated from high school History of foster care was associated with: History of FASD Cocaine abuse/dependence Concurrent mental illness and cocaine abuse/dependence

18 Housing Snapshot 25 youth housed with ICY 4 move outs to market rental 2 moves to other SROs 2 moves to other supported housing 1 transfer to treatment 1 move to CLBC

19 So where did we land? What did we do to integrate health and social services? Given the steady stream of youth with significant untreated mental health and substance use concerns Given the prevalence and acuity of mental illness in this population We opened a Centre

20 Meet us at the G!

21 Meet us at the G!

22 Primary Care and Integrated Services

23 Our Rehab team including the peeps

24 The burden of mental illness across the lifespan in the general population

25 Burden of mental illness by age and disorder

26 Why aren t more youth ACCESSING mental health services? In the past 12 months, did you ever feel that you needed care for a mental health issue (like depression or anxiety), but you didn't use any services or get treatment? [BASUS Wave 6 n= > 270 (16.2%) said yes] 14% 13% 12% 6% 6% 37% 38% 27% 49%M/37%F 63%

27 Tablet-based waiting room survey All youth complete a tablet based HEADSS assessment that includes the GAIN-SS Secure, user friendly interface A brief report is generated as a pdf which flags high risk items for clinician to check in initial interview Full report includes all responses Youth are connected to services

28 Report to practitioner

29 What we will be monitoring What are the health and psychosocial characteristics of youth using the clinic? Does the waiting room survey enhance the capacity of ICY to connect youth with wellness in terms of: Improved physical/mental health and psychosocial development? Reduced substance use? Reduced initiation of hard drug use? Based on large RCT using SURPS to target high risk youth 13yrs 16 yrs to a 2- session group coping skills intervention, Conrod et al. found substantial reductions in risk of initiating cocaine use (OR=o.2) and other hard drugs (OR=0.50) as well as reductions in frequency of use. Conrod PJ, Castellanos-Ryan N, Strang J. Brief, Personality-Targeted Coping Skills Interventions and Survival as a Non Drug User Over a 2-Year Period During Adolescence. Arch Gen Psychiatry. 2010;67(1):85-93.

30 Thanks to our donors Silver Wheaton HSBC Janssen Ortho Variety The Children s Charity of BC St Paul s Hospital Foundation Check us out at