Primary mental health support for people with diabetes

Transcription

1 Primary mental health support for people with diabetes

2 Today s presentation Background to the project Profile Northland and Tairāwhiti s approaches Hear from participants in Northland s Rangatahi project Early feedback on what is working and what challenges have been encountered

3 Background Improving mental health and wellbeing has the potential to improve both quality of life and glycaemic control The MOH funded projects aim to improve access to primary mental health services for people with poorly controlled diabetes The project includes Northland and Tairāwhiti DHBs rapid implementation within existing resources (over 200 contracts across community providers) Opportunity to be innovative, supported by Ministry flexibility The Ministry funded an evaluation to learn from the project

4 The evaluation The projects are pilots the evaluation is focussed on learning from the pilots Data collection (2017) Formative evaluation contributes to local planning Plan timelines and finalise approach Co-design evaluation with sites Site visits Interviews/ workshop (key stakeholders) Develop evaluation approaches for specific initiatives Set up admin data templates/ client recruitment Workshop to discuss first quarter evaluation findings Timelines Logic model and evaluation questions Practical approaches to data collection Complete ethics review process agree site requirements Agree evaluation approach Process evaluation provides feedback on progress February to October 2017 Outcomes evaluation Site visits September- October 2017 Quarterly interviews key stakeholders Final interviews with key stakeholders Interviews Progressive data collection from clients (Hua Oranga, survey) Final provider interviews and survey Quarterly admin data reporting Final extract of admin data, financial data - 30 September Quarterly evaluation reports Final evaluation workshop and synthesis report

5 Hua Oranga Tool developed based on Te Whare Tapa Whā Developed by Mason Durie and Te Kani Kingi and adapted by Dr Simon Bennett Four domains with four (5-point scale) questions in each domain Taha whānau Taha wairua - Spiritual Taha tinana - Physical health Taha hinengaro - Mental health

6 Tairāwhiti approach

7 Tairāwhiti approach about Tairāwhiti Population around 48,000 people. Over half of population Māori Average deprivation score of 7 with 67% of Māori and 30% of non-māori considered to live in the most deprived areas Rurality with around 30% of residents living in rural districts and facing additional challenges in accessing services Around 2,000 people identified with diabetes and approximately 700 with an HbA1c over 64 Three PHOs (12 practices): Ngati Porou Hauora, National Hauora Coalition, Midlands/Pinnacle Health and further iwiled NGOs.

8 Tairāwhiti approach - consultation Child & youth diabetes service doing well focus on adults Appropriate messaging and communication Is diabetes a disease? My doc doesn t tell me nothing about it. It only seems to affect me when I m hurt takes ages to recover Whanau approach I come home to a greasy meal and cakes Flexible approach no use coming to see just me when you turn up during the day, wait until everyone is home Finding the right triggers it s only me and my sister left. My mum and dad and siblings died because of diabetes and I still lived the way I did until recently Mana-enhancing, aspirational and empowering service

9 Tairāwhiti approach targeted Māori or Pacific person with poorly controlled Diabetes (HbA1c level of 64mmol/mol or more) and an indication of potential mild to moderate mental health issues: poorly controlled diabetes low/non-attendance low/non-adherence with medication regimes living in socially isolated situations pressing issues (wider than health)

10 Tairāwhiti approach Adult Service Multi-model trialling four pathways Kaiāwhina-led supports (external referral model) Kaiāwhina-led supports ( in-house model) Social worker-led supports ( in-house model) Primary MH service only more flexible approach Approaches to reflect whānau needs and aspirations firstly Supported by: Clinical champion Hua Oranga assessment tool Workforce development

11 Tairāwhiti approach Mihi and time to connect is crucial Small wins Translator approach

12 Tairāwhiti s achievements early days yet A case study Mark in kaiāwhina programme: Before No interest in preparing meals Difficulty shopping Little contact with whānau Overweight (127kg), no exercise Now six weeks later Engaged in sandwich club Kaiāwhina supermarket tours, gaining confidence in buying right food within his budget Joined lunchtime walking group Losing weight (125kg) Uncontrolled diabetes (HbA1c 86) Reducing HbA1c (now 82) Wanted to lose weight and sort out his lounge. Felt hopeless. Feeling happier and has a plan towards new lounge suite.

13 Northland s approach about Northland 2013 census population of about 151,692, predicted to increase to 171,100 by A high proportion of Māori - Nga Iwi o Te Tai Tokerau comprises 30% of Northland s population. An ageing population driven by decreasing numbers of children. A higher proportion of economically deprived communities than New Zealand as a whole A dispersed rural population poverty and lack of public transport can make it difficult for people living in rural localities to access some services. Two PHOs Manaia Health and Te Tai Tokerau Three programmes the tamariki, the rangatahi, the adult programme

14 Northland s tamariki programme Whānau with child newly diagnosed with T1 DM in previous year n = 7 HbA1c = 47-94mmols Average HbA1c = 65mmols European/ Samoan/Other = 5 Maori = 2 Whānau with Child with poorly controlled T1 DM high HbA1c n = 11 HbA1c = 67 to >130 mmols Average HbA1c = 91 mmols European / Other = 2 Maori = 9

15 Hine s story Whānau with child newly diagnosed with T1 DM in previous year Hine: 10 yrs old Solo mother on benefit Lives with Grandmother (2 years) T1 DM. Dx HbA1c = 93mmols Agency involvement: Police, CYF, Community Mental Health, NDHB Diabetes Team, NDHB Psychologist, Grandparents Raising Children, GP, School

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17 What parents said 1. How well do you understand your child s diabetes? 1. Do you feel that looking after your child s diabetes is taking over your life? Not at all Yes I fully understand No - never Yes almost all the time 2. How well do you know what to do to care for your child s diabetes? 2. Do you feel angry, scared and/or sad when you think about your child (tamaiti) /family/whānau living with diabetes? Not at all Yes I fully understand No - never Yes almost all the time 3. Do you feel your whānau/family know how difficult it is to care for a child with diabetes? Not at all How well do you think your child is coping with diabetes? Not at all well Yes - they fully understand Very well What would help? Not having it at all Being closer to support Normal things Technology to assist with lows at night Support with other diabetes families More education Pump Tax free healthy food

18 What children said Do you know what to do for your diabetes? Do you feel that diabetes is taking over your life? Do you feel angry, scared or sad when you think about living with diabetes? Yes Sometimes No Very often Sometimes Not often How often do you do what you are supposed to when caring for your diabetes? No Some of it Yes Not often Sometimes Most of the time Does your whānau/family know how difficult it is for you to live with diabetes? Do your parents worry about your diabetes? No Maybe Yes How often do you feel sick because of the highs and lows from your diabetes? Very often Sometimes Not often They worry way too much A little too much About the right amount How often does having diabetes stop you from doing something you want to do? How well do you think you are coping with diabetes? Very often Sometimes Not often Not very well Okay Very well What would help? Having new and different strategies to help me take every injection and blood sugar levels Not taking injections To get a routine quickly because I think that routine will help me get used to my diabetes Having a monitor to see my levels Having friends who have diabetes

19 Northland s rangatahi programme Aims: Innovative ways to engage with youth with diabetes Activities: A series of workshops delivered by the Company of Giants theatre group Bring together clinicians and patients in a new model of care that removed barriers of access, and where the clinicians were naïve participants engaging in full and level playing field Progress to date: First cohort Five youth Second cohort Nine youth; five continuing from cohort one

20 A little something from our participants

21 Meet Heath and Mataara

22 Northland s rangatahi programme - feedback Evaluation of the first cohort found: The group s size, age and composition all worked Inclusion of the clinical team as active and equal participants was important. Youth appreciated family/whānau not being included Awareness of diabetes and being part of a group with other young people with diabetes was important but youth were not very positive about a formal or explicit focus on diabetes Flexibility to design and adapt the content to meet the needs of the youth attending is important Planned transitions are important for participant safety and to build on the progress made in the workshops

23 Northland s rangatahi programme - evaluation The workshops made a difference for youth: Feedback from youth It made me feel not quite as alone. They made me get out of my comfort zone and gave me motivation for the next step in life I learnt don t let diabetes hold you back you re not the only one with it. There was a fair amount of discussion about diabetes. It wasn t the focal point but it was good just knowing they were diabetics and knew about what I was going through A lot of diabetes situations that made me feel lonely before don t now because I know someone else is going through it. Objective measures (Hua Oranga)

24 Northland s adult programme Consultation: Identifying gaps and managing different perspectives Aim: to include six general practices with high proportions of patients with diabetes and HbA1c above 64 The adult programme provides: funding for e-therapy with clinician oversight sessions with mental health credentialed primary care nurses acceptance and commitment group sessions a flexifund to respond to identified needs whakamana hauora (development of a diabetes specific module) the whakawhānaungatanga programme (a culturally appropriate whānau focused programme) some additional specialist mental health support. Progress: currently 20 patients enrolled; significant activity to implement

25 Learnings Design: 12-month pilot innovation takes time, time limited funding creates recruitment and buyin challenges Co-design included local provider organisations and clinicians Time limitations What is the best use of resources for time-limited pilot projects Management Funding and time to involve a project manager from the start Implementation: Contracting and agreements Appointing new roles Buy-in from managers versus frontline staff Competing demands Promotion and communicating what is required to practices keep it simple Resourcing PHO additional support for practices, impact on other programmes Recruiting patients screening

26 Summary The two DHBS now have a number of different interventions in place positive feedback about the need for the pilot interventions To address mild to moderate mental health a holistic model is required whānau ora approaches, integrated responses, system wide change Benefits for people taking part Learning from innovative approaches: kaiāwhina role in primary and secondary service Rangatahi programme taking risks with different models of care It has opened our eyes to a new model

27 Thank you For more information contact: Ministry of Health: Megan Grant Northland: Ian Hartley-Dade Ph ext Tairāwhiti: Matt Tong Ph Evaluation: Debbie McLeod Ph