September 17 th 2018 1 p.m. – 2 p.m. (EDT) 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.
YWHO An Overview Dr. Joanna Henderson Executive Director, Youth Wellness Hubs YWHO An Overview Shauna MacEachern Project Manager, Youth Wellness Hubs Ontario Manager of Implementation, CAMH Presenting on behalf of YWHO Backbone and partners
Our system needs fixing… • 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 outcomes of services • Inappropriate care given at the wrong time by the wrong provider
Our core values • Youth and family-centred services • Engagement & co-creation of services • Increasing visibility & addressing stigma • Collaboration across sectors & stakeholders • Evaluation and quality
What are hubs? 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 we trying to do with 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
How are hubs designed to help? Current state problems Desired future state Hub features Long wait times & poor No/minimal wait times & Walk-in/low barrier service delivery access enhanced access platform; clear service pathways Lack of clarity re where Good awareness & clarity Branding Poor communication, Strong communication, Integration & co-location; continuum coordination & transitions coordination & seamless of services transitions Age cliff at 18 Developmentally-based Serve 12-25 years services & no age cliff Lack of standard services & Standardized high quality Standardized core services; EBP quality services Lack of meaningful Meaningful outcomes Systematic evaluation of meaningful reportable outcomes consistently measured & outcomes reported Service-centred care Youth & family-centred Youth & family centred, responsive care (e.g., hours, location); Stepped care; Youth friendly space Lack of youth & family Meaningful youth and Co-creation with youth & family engagement family engagement members
Engagement: What we heard from youth • 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 families • 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
Implementation Advisory Group: Critical Hub Components Identity Location Peers Relationships Validated tools Communication Ask Feedback Welcome Consent Follow up Outreach Quality services Connection Technology
Site selection criteria 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
YWHO sites • Eastern Champlain • Haliburton • Kenora • Malton • North Simcoe • Niagara Region • Chatham-Kent • Central Toronto • Scarborough • Toronto East
Backbone resources • Project management and facilitation • Evaluation • Coaching across the community, organizations 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
Why Implementation Science? NOT ADOPTED EVIDENCE NOT USED ADOPTED WITH FIDELITY NOT USED WITH FIDELITY SUSTAINED NOT SUSTAINED REPLICATED
For more information Website: youthhubs.ca centresbien-etrejeunesse.ca Online Community of Practice: eenetconnect.ca/ g/youth-wellness-hubs-ontario Inquiries: info@youthhubs.ca
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
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