CAPA Forum 19 April 2018 Dr Karin Stam, MICAMHS Bay of Plenty A - PowerPoint PPT Presentation

CAPA Forum 19 April 2018 Dr Karin Stam, MICAMHS Bay of Plenty

 A Secondary Mental Health Service needs clear and transparent Care Bundles  According to the most up to date Clinical Guidelines and/or Evidence-Based or Best Practice

 A Care Bundle is a set of interventions that when used together significantly improve the outcomes of the clients and whanau / family we support

Care Bundles = • Journey of Client through MICAMHS • Combination of referral pathway, diagnostic clarification and treatment interventions • Issue/Disorder related

 Written in a clear and straightforward way, they should be quick and easy as a point of reference  New employees; Good Guidance  Time-efficient to have general consensus from which you can deviate with the right arguments  (often 80% consensus anyway)  Quality of Care

 Before you can create a Care Bundle you must collate information of local resources.  A Team approach to creating Care Bundles helps the whole Team to understand them and to own them  Do we need a clinical pathway for…?  Additional training needed? --- > Create awareness of gaps

 NICE Guidelines  RANZCP  Ministry of Health

 The aim is to ensure everyone receives the best care based on evidence or logic 100% of the time

ISSUES/DISORDERS --- > 15 Care Bundles in MICAMHS Bay of Plenty 1. Tic Disorder 2. Autism Spectrum Disorder 3. Anxiety Disorders (incl. OCD, PTSD and Selective Mutism) 4. AOD issues (incl. Sorted referral pathway) 5. Eating Disorders 6. Intellectual Disability 7. Mood Disorders 8. Transgender 9. ODD/CD (incl. IYSS referral pathway) 10. (Emerging) Personality Disorders 11. Perinatal and Infant Mental Health Issues CHILD and MOTHER 12. Physical Comorbidity (incl. Health and Wellness Coach referral pathway) 13. Psychosis /Early Intervention 14. Somatoform Disorders 15. ADHD -Medical Review Pathway for existing ADHD -Pathway for new ADHD diagnosis

Referral pathway for AOD/CEP referrals to CAMHS New referral to CAMHS Crisis Non-urgent AOD primary AOD not primary Choice process issue issue followed * Give to Sorted Duty to follow up Honosca Honosca Coordinator for re- Risk AOD score AOD score allocation Assessment or 3-4 0-2 Priority Choice * Give to Normal CAMHS Honosca AOD Honosca AOD Sorted process applies. score 3-4 score 0-2 Coordinator Liaise with Sorted for allocation Coordinator on case-by-case basis. Normal CAMHS Sorted Worker process applies. begins/completes Sorted Worker Liaise with Sorted Sorted begins/completes Coordinator on Partnership ** Sorted case-by-case Partnership basis. *Following Choice or Priority Choice the C/PC clinician will complete Honosca, type C/PC assessment and save the assessment in Patient Correspondence as well as Assessments for Uploading. The C/PC clinician will also write to the young person (with copies to the referrer and others with consent) regarding the outcome of the C/PC assessment. During the C/PC appointment the consent/sharing info form will also be completed to the degree that is appropriate at this appointment. Note- Consent/Sharing info plan is an ongoing process. **See ‘Sorted Referral Pathway’ for process.

Western Bay of Plenty pathway for the assessment of children/ young people with suspected Intellectual Disability (ID) / Global Developmental Delay (GDD) NB: Please refer to Support Net as usual for assessment for NASC agency services for all children with ID/GDD. This algorithm refers to pathway for obtaining a cognitive assessment only. SPECIAL EDUCATION If school aged child under Concerns identified with possible GDD/ID in child by family/ ECE or school/ GP or PHN SE, approach SE keyworker first if cognitive assessment required. Child under 6 years Child over 6 years RTLB Best pathway Best pathway If school aged child under RTLB, limited funding TWK 3D pathway may be available for cognitive assessment. Discuss with RTLB as need may be better met CAMHS by other agency . Child attends CHOICE PAEDIATRICS appointment. If accepted into Child attends Paediatrician review. If service, cognitive assessment concerns following review, then arranged to determine how referral made for developmental/ young person’s strengths / cognitive assessment as below weaknesses may be contributing to mental health presentation TWK TWK PAEDIATRIC SUPPORT NET CAMHS PSYCHOLOGIST PSYCHOLOGIST PSYCHOLOGIST OCCUPATIONAL Children are accepted with ‘GDD’ if 6-17 years 0-14 years 0-18 years THERAPIST < 7 years of age. Cognitive Request where ID Request when medical issues 0-5 years. assessment results must be suspected AND child may complicate presentation Access only through provided to access services for does not have ADHD. and ID suspected or non- CAMHS. Consider older children. Children with ID and complicated ADHD. Referrals referral if presentation Request developmental ASD should be referred not otherwise accepted complex, significant assessment with TWK Support Net complete cognitive to TWK unless complex unless discussed first with risk, associated mental Occupational Therapist assessments only for young people Psychologist. health disorder over 18 if required to determine Access only through including complicated eligibility for NASC services Paediatrician ADHD

Personality Disorder

Pathway for Clients who meet criteria for the DBT Comprehensive Programme Standard Intake Procedure • Client enters service through normal routes and meets normal service criteria. • Standard choice and partnership assessment completed • Standard clinical assessment sufficient to make diagnosis (may include prior reports on client) • Review Diagnosis Agreement on Diagnosis? (see note 1) • Consult appropriate pathway Does clinical MDT team agree that primary diagnosis could fit No consideration for DBT Comprehensive programme? Is this noted in file? Begin Indicated Axis I Treatments Yes • Commence appropriate treatments \\\\\ as per appropriate pathway and/or Untreated Axis 1 Co-morbidity? Yes refer to appropriate agency. Does client have significant untreated co-morbid axis 1 problems? • See note 2 concerning relevance of axis 1 treatments for BPD clients. No • Except for BPAD, treatment does not need to be successful before Major Alcohol or Drug Problems? continuing on this pathway. No Continuing Care Treating Major A&D problems Yes • Key working and crisis care as per usual protocol. • These treatments must commence before client proceeds on the pathway. • A&D treatments may be within SORTED or at ancillary services Consider DBT Comprehensive Programme Is client in the following priority group for intensive DBT treatment? • a high service user, or likely to become so; AND/OR Yes Keyworker to discuss referral to • challenging to team, or likely to become so; AND/OR DBT Programme with DBT • Likely to significantly benefit from therapy? clinician present at MDT, then complete referral to consult if appropriate No Pursue treatment guided by above protocols and/or consider most appropriate community referral • Ensure relapse prevention plan in place Are treatment goals achieved? • Alert GP/referrer/family as appropriate Yes • Transition to appropriate community follow-up

Incredible Years Specialist Service

Health and Wellness Coach referral pathway Physical health/fitness need/goals identified High Priority Medium Priority Low Priority Psychosis/Sorted Child team Adolescent team Consult with Referral to Health Sorted Coordinator and Wellness as needed Coach Consult between Health and Wellness Coach and referring case manager Health and Wellness Coach contacts young person (& family as appropriate) for initial 1:1 Group work Individual work Ongoing consultation with referring case manager

SUGGESTIONS?