Integrated models of care for youth Shauna MacEachern, MA Youth - - PowerPoint PPT Presentation

Integrated models of care for youth

Shauna MacEachern, MA Youth Wellness Hubs Initiative project manager, Provincial System Support Program, CAMH Janis Macdonald Nurse Practitioner, The Anne Johnston Health Station - Tobias House, YouthCan Impact Integrated Collaborative Care Team Welcome! The webinar will begin shortly! To hear audio for this event, please turn up your computer speakers. Please note this event will be recorded.

September 17th 2018 1 p.m. – 2 p.m. (EDT)

YWHO An Overview

• Dr. Joanna Henderson

Executive Director, Youth Wellness Hubs

Shauna MacEachern

Project Manager, Youth Wellness Hubs Ontario Manager of Implementation, CAMH Presenting on behalf of YWHO Backbone and partners

YWHO An Overview

• Long wait times, many barriers
• Lack of clarity about where to go

for help

• Little communication and coordination

between services

• Limited meaningful engagement of

youth and their families

• Mandatory and unguided transition

to the adult care system at age 18

• Lack of information about quality and
• utcomes of services
• Inappropriate care given at the wrong

time by the wrong provider

Our system needs fixing…

• Youth and family-centred services
• Engagement & co-creation of services
• Increasing visibility &

addressing stigma

• Collaboration across sectors &

stakeholders

• Evaluation and quality

Our core values

Youth friendly locations where youth aged 12-25 can easily and readily access a range of services that are integrated and high quality

• Mental health (adolescent &

young adult MH)

• Substance use
• Primary care
• Education, employment & training
• Housing and other community &

social services

• Peer support & navigation

What are hubs?

The right kind of services at the right time by the right provider in the right place.

• Provide rapid access to easily identifiable mental health

and substance use services

• Provide evidence-based interventions matched to level of need
• Integrate services into a one-stop-shop model of care offered in a youth-

friendly space

• Reduce transitions
• Establish common evaluation across sites
• Co-create with youth and families

What are we trying to do with hubs?

Current state problems Desired future state Hub features

Long wait times & poor access No/minimal wait times & enhanced access Walk-in/low barrier service delivery platform; clear service pathways Lack of clarity re where Good awareness & clarity Branding Poor communication, coordination & transitions Strong communication, coordination & seamless transitions Integration & co-location; continuum

• f services

Age cliff at 18 Developmentally-based services & no age cliff Serve 12-25 years Lack of standard services & quality Standardized high quality services Standardized core services; EBP Lack of meaningful reportable outcomes Meaningful outcomes consistently measured & reported Systematic evaluation of meaningful

• utcomes

Service-centred care Youth & family-centred care Youth & family centred, responsive (e.g., hours, location); Stepped care; Youth friendly space Lack of youth & family engagement Meaningful youth and family engagement Co-creation with youth & family members

How are hubs designed to help?

• Fun, comfortable, hang-out space
• Welcoming, culturally aware staff
• Youth-based decision making
• Peer support
• Individual/group counselling
• Medical care
• Care navigation

Engagement: What we heard from youth

• Accessible, safe, inclusive
• Appropriately supervised
• Youth/student informed
• Address the stigma of mental health
• Respect for traditional knowledge
• Triage system
• Adequate/diverse staffing
• Appropriate hours
• Transportation/meal support

Engagement: What we heard from families

Welcome Communication Validated tools Relationships Location Ask Technology Consent Peers Quality services Identity Outreach Connection Feedback Follow up

Implementation Advisory Group: Critical Hub Components

1. Vision 2. System Collaboration 3. Youth and family engagement 4. Commitment to integrated services and supports for youth 5. Demonstrated community value and impact 6. Capacity and competence 7. Implementation process, network participation, and evaluation

Site selection criteria

• Eastern Champlain
• Haliburton
• Kenora
• Malton
• North Simcoe
• Niagara Region
• Chatham-Kent
• Central Toronto
• Scarborough
• Toronto East

YWHO sites

• Project management and facilitation
• Evaluation
• Coaching across the community,
• rganizations

and staff about the hub model and approach

• Integrating principles of equity
• Supporting authentic youth engagement

and family engagement and co-design processes

• Communications, building awareness

and support, and sharing information about the hub

• Implementation planning and operations

Backbone resources

EVIDENCE NOT ADOPTED ADOPTED NOT USED WITH FIDELITY USED WITH FIDELITY NOT SUSTAINED SUSTAINED NOT REPLICATED

Why Implementation Science?

Website:

youthhubs.ca centresbien-etrejeunesse.ca

Online Community of Practice:

eenetconnect.ca/ g/youth-wellness-hubs-ontario

Inquiries:

info@youthhubs.ca

For more information

Integrated Collaborative Care Team Model for Youth in Community Mental Health Settings: YouthCan IMPACT and the role of Nurse Practitioners

Janis Macdonald RN(EC), MSc

Joanna Henderson PhD; Peter Szatmari MD MSc; Kristin Cleverley RN, PhD, CPMHN; Amy Cheung MD MSc; Gloria Chaim MSW; Lisa Hawke PhD

September 17, 2018

Objectives

1) Present the development and implementation of a co-located model of mental health care that involves multiple sectors 2) Describe evidence-based interventions used in the Integrated Collaborative Care Team (ICCT) 3) Discuss the role of nurse practitioners in the YouthCan model of care

What does an ICCT Look Like?

• One stop shop in the community
• Walk in clinic (“What’s Up Walk In”)
• In addition, other agencies provide a variety of

services

• Stepped care model based on needs assessment
• In addition to MHA, access to primary care,

housing, peer support, crisis line, case navigation, family support

Active Ingredients of ICCT Care

• Shorter time to treatment
• Multiple evidence based treatments provided in one setting
• Stepped care to ensure high risk youth access NP/Child and

Adolescent Psychiatry (CAP)* care in that setting

• Existing agencies working in partnership and pooling

resources

• ICCT designed by, and for, youth and families

NPs are ideally suited to provide MH Care

• Already situated in the community
• Salaried – therefore able to spend more time with

patients/clients

• Holistic approach to care
• Address individual needs such as diet, exercise, sleep,

structured routine

• Identify external factors such as adverse living

conditions, stigma, deceased social and cognitive skills

NP Role in YouthCan

System Navigator  assisting clients (patients) and their parents to access mental health services Primary Care  providing youth immediate access to health care services and testing (ie PT, STI/HIV testing, bloodwork) Follow Up  working closely with psychiatry to ensure timely f/u to questions/concerns, monitoring SEs, medication renewals and dose adjustments Accessible  flexible hours working within the community within a multidisciplinary team

NP Case Study

18 year old male seen in YouthCan walk-in by counsellor

• Previously dx’d with ADHD, major depressive disorder (MDD) and

generalized anxiety disorder (GAD)

• PMH: Behavioural problems including school avoidance, irritability,

insomnia and aggression

• Meds: Celexa, Biphentin and Nabalone (initially for Cannabis withdrawal

– continues b/c of calming effect on body and depression)

• Substance Use: Tobacco 5/day, ETOH – binges when available,

Mushrooms 3x/month

• Sexual Hx: 4 previous partners - one without protection – fearful of STIs

and current genital rash which is enhancing his anxiety

• Sensory Conversion Disorder due to sensory processing issue hearing

sounds as colours and difficulty with food texture and therefore consumption

NP Referral to Assess PHC Concerns

 STI testing done  Blood work –revealed no Hep B immunity; immunizations brought utd  Assessed pelvic rash  Medications reviewed  Sensory issues r/t eating discussed; client referred to CHC dietitian  Substance abuse issues discussed & safety concerns addressed

MD and NP Collaboration Case Study

16 year old female with MDD, GAD, Substance Use Disorder and trauma history

• While receiving care at the hub, was admitted

multiple times for suicidality

• NP able to bridge care when MD was unavailable post

discharge

• NP also able to address new concerns about emerging

eating issues

MD and NP Collaboration in ICCT

• Collaboration requires redefining of professional

roles

• Factors to consider

– Youth and Family preferences – Expectations of other health professionals/team members – Training needs of NP – Administrative barriers

Challenges Faced by Youth Looking for MH Care

• Age criteria of programs and services can

restrict access and flow between services

• MH service burnout
• Diagnosis clarification
• Inadequate f/u due to stigma, limited access

to primary care, lack of parental support

Lessons learned from participating in the youth hub model

• NPs are ideally suited to integrate MH into primary

health care

• Gaps in knowledge, education and support are

identified as key barriers to NPs optimizing scope

• f MH practice
• MH care team and Community Partners essential

in providing ongoing follow up and support to youth and families

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Marilyn & Charles Baillie

A Collaborative Project! Principal Funders:

Thank you + Questions

janism@ajhs.ca

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To learn about upcoming events visit:

• EENet Opioid Resource Hub

http://eenet.ca/initiatives/ORH

• RNAO Mental Health & Addiction Initiative

http://rnao.ca/bpg/initiatives/mhai