Child and Youth Centralized Psychiatry Services Hamilton Family Health Team

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Vanessa Lloyd
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1 Child and Youth Centralized Psychiatry Services Hamilton Family Health Team A One Year Review of Our Shared Experience in Primary Care June 20 & 21, 2014

2 Disclosures Speakers: Dr. Kathryn Macdonald, Michelle Stockwell, Sheri Clark None of the speakers have any relationship with commercial interests Have received financial support other than as employees of the HFHT Have any known conflict or bias in presenting this material

3 Presenters and Collaborators Speakers: Dr. Kathryn Macdonald Psychiatrist Clinical Lead and Development CYCPS Michelle Stockwell RN MHSc Coordinator of CYCPS Sheri Clark MSW Intensive Stabilization Program CYCPS CYCPS Child & Youth Centralized Psychiatry Services

4 Collaborators Dr. Cathy Mancini Complex Anxiety Disorders Dr. Peter Kondra Indirect Psychiatry Service Dr. Lindsey George HFHT Psychiatry Lead Catherine McPherson Doe Manager Mental Health Program Special thanks to summer student Lana Vedelago and Elka Persin

5 Hamilton Context

6 Hamilton Family Health Team

7 Success of the HFHT Mental Health Model

8 Objectives of Session Review the role of a child and youth centralized psychiatric service (CYCPS) within primary care in Hamilton Family Health Team Hamilton Ontarioour first year experience Examine the successes and challenges of the first year of our CYCPS experience Encourage an interactive exchange with the audience to have the opportunity to discuss child psychiatry within the primary care setting

9 How the Initiative Originated In response to the need in Primary Care for enhanced and centralized psychiatric services (not emergency) ages 5 to 24 year olds and their families Moderate to severe complex mental health disorders difficult to diagnose/treat /not responding at the practice level Identified need to address the gap in capacity and wait times in existing system

10 CYCPS Vision Early identification, assessment and treatment of moderate to severe mental illness in 5 to 24 year olds and families CYCPS and primary care collaboration will build and support the strengths and capacity in primary care settings to provide timely, practical and effective care, build stronger relationship with community partners schools, CAS/CCAS, community and social services Ongoing evaluation opportunity to plan, allocate resources, address feedback and need for change

11 Early Intervention

12 Early Intervention

13 Early Intervention

14 Early Intervention

15 Anxiety Disorders

16 Mood Disorders

17 Depression

18 Mental Health in Children and Youth History of Service CYCPS Service originated 2011/12 with Dr. Mancini seeing cases with a specialized child and youth MHC. Also an indirect telephone consultation to family practices about treatment questions Started CYCPS in 2013 Mental health counsellors saw over 3000 new cases 2013 in the 5 to 24yr age in primary care practices Referral to CYCPS MHC, FP and NP can refer jointly to the CYCPS Referral form and assessment questionnaires are all downloaded from the website General Health Screening Questionnaires, SCARED (parent and child) SNAP (if relevant) Also included are all previous assessments and consultations, and recent notes by MHC/FP Information is faxed to the central office and appointments are booked for the family, MHC and other service providers, if relevant Anywhere from 2 to 8 weeks with an average of 6 weeks for appointment

19 Assessment Treatment Plan Stabilization The Mental Health Counsellor referring the case is expected to come to the assessment Treatment plan is discussed and follow up arranged Intensive stabilization is an option for a flexible 6 8 sessions

20 Intensive Support and Stabilization

21 Intensive Support and Stabilization

22 Intensive Support and Stabilization

23 2013 CYCPS Year One

24 Direct Reason for Referral

25 Indirect Reason for Referral

26 Primary Care Referrals 73 Physicians and MHC referred a total of 171 times Direct Service saw 92 F/U 76 1 clinic ½day/week 1 clinic 1 day/week Additional day added in late 2013 Indirect Service 72 1 clinic day /week

27 Demographics of Referrals to CYCPS Complex Anxieties N=29 M=9 F=20 Range from 5yrs to 22yrs Highest concentration DOB 95 to yrs to 18 yrs Total 26/29 in this range Clusters and for both M/F

28 Demographics for Referrals to CYCPS Mood GAD ADHD Behaviour N=65 M=28 F=35 Range 5yrs to 22yrs Highest concentration DOB 95 to 2000 Total 55/65 in this age range 20 M /35 F further breakdown 20/35 F yrs

29 Who Referred? 73 FP referred 171 patients Complex Anxieties N= FP/20MHC Mood Anxiety ADHD Behaviour N=65 36FP/28MHC/1NP Indirect N=72 64FP/9MHC/1NP

30 Question 4) Referral process was clear from website, mental health counsellor information meeting, telephone/ support. Average Response (on a scale of 1 [ Not at all ] to 7 [ Very much ]) Drs. K. Macdonald and C. Mancini (direct) Dr. P. Kondra (indirect) ) Referral process was timely ) Were your concerns identified at the time of referral addresses in the assessment consultation? ) Did you have an opportunity to provide input during the assessment? ) Were the recommendations useful? ) Did you receive timely feedback from the consultation? Same day faxed feedback sheet: Full assessment: ) Did the consultation and feedback increase your ability to manage patient care? ) Did the consultation process increase your ability to manage other patients with this diagnosis? ) Were you able to follow through with the recommendations? ) Were you able to reach members of the team if you had questions? ) Was this experience with the CYCPS collaborative?

31 Feedback From Direct

32 Feedback From Indirect

33 Direct Family Feedback

34 Direct Family Feedback

35 Opportunities and Challenges for C&YPCS and Early Intervention in Primary Care We need to identify youth earlier in illness Minimize losses Minimize missed developmental opportunities Need to intervene to reduce morbidity Need to support reintegration into developmentally appropriate social and occupational settings Need to reduce the risk and impact of relapse Need to close the gaps in the system that contribute to loss of follow through Wait times Lack of organization and links between services Multiple assessments Support mental health work in primary care

36 Year 1 Lessons Learned More attention to systems entry both the HFHT and community Meeting with FP/MHC more often Education, organization, feedback, follow up Learning from our experience that more children and youth with mental illness are being seen in primary care and being managed by FP/MHC in the HFHT Greater collaboration with community resources (Schools, CAS/CCAS, other children s health services) Need for early identification, assessment, treatment, programs Need for early family support and community involvement to build skills and foster resiliency which will offer some protection Camp, sports, arts, music

SUPPORTING COLLABORATIVE CARE THROUGH MENTAL HEALTH GROUPS IN PRIMARY CARE Hamilton Family Health Team

SUPPORTING COLLABORATIVE CARE THROUGH MENTAL HEALTH GROUPS IN PRIMARY CARE Hamilton Family Health Team Jackie Bootsma, MSW, RSW Marian Schorr, MSW, RSW About Family Health Teams Family Health Teams are