Welcome everyone to the orientation webinar for the Practice Support Program’s Child and Youth Mental Health and thank you for joining us. On the agenda for this webinar, we’ll discuss why Child and Youth mental health issues are so important, and then we’ll describe, briefly, how the Practice Support Program works and the role you can play in the program. We’re quite excited about the results that we have seen so far during a very short period of time during our Train the Trainer Phase and we will share those with you. Finally we will discuss how you can become part of this program and participate in your local community.
These are some numbers specific to British Columbia. Again, on this slide, the most common mental health disorders in children and youth are anxiety disorders, ADHD and depressive disorders. We are not specifically addressing conduct disorder in this module. This practice support program module addresses mild to moderate anxiety and ADHD in children and youth, and mild to moderate depression in youth. More severe symptoms and conditions, childhood depression, and those children and youth with more than one condition will need to be referred for specialty mental health services. The rationale behind this program is that we know that if we can help children and families and schools manage these conditions appropriately early on in a child or youth’s life they are more amenable to treatment. By detecting and treating these conditions in children and youth we hope to improve their quality of life and prevent more severe symptoms or complications as they get older.
The impetus behind this particular module is that the vast majority of adult mental health disorders have their onset at a very early age The onset of anxiety disorders occurs commonly in childhood and the teen years, and the first onset of depression is often in adolescence or early adulthood. Even more important is that research shows us that we can change the trajectory of these conditions in children and youth by effective treatment in primary care. . As well, ADHD may be diagnosed as early as age 6, and has a significant impact on a child or youth’s educational performance.
We know that excellent child and youth mental health care always involves a variety of both clinical and community based supports and services for both the clients and their families. The overarching goal of the child and youth mental health module is to support the creation of a community of practice in your region that will improve child and youth mental health in participating practices and communities. We hope to see evidence of these improvements by using tools that allow us to measure improved symptom scores on clinical assessment scales. We hope to see significant improvements within the 6 to 8 month timeframe within which the learning sessions will occur..
These improvements will be accomplished by providing opportunities for physicians to learn and plan in conjunction with their MOAs, school counsellors, Child and youth MH service providers, child psychiatrists and pediatricians. This co-learning is intended to support better communication and integration of care at a community level. We foster a respectful conversation among all these disciplines as equal partners in the training and planning to work together. We also offer physicians and other service providers a common suite of tools and non drug strategies that can be used to screen, identify, diagnose, and manage, children and youth with the three most common disorders early on in their lives. We provide physicians with very easy to use tools in their practice in a wide variety of clinical settings.. These tools emphasize psychotherapeutic support over medication and include some Cognitive Behavior Therapy skills to be used with patients and families. However there are also very clear medication algorithms and guidelines for physicians for when medications or referral are required
“ it was easy to get to” “ unstressful “ “ it is a great things for troubled kids. it has helped me a lot “ “ it was convenient “ “ did not have to go far. comfortable environment “ “ that I did not have to leave class as long “ “ It has made a huge difference in my school life “
This module is all about communication and collaboration among disciplines, and each community will have different needs and resources. . We have heard from school counsellors how helpful this module has been for them when we ensure that all of the team members are part of the care for children and the youth so that nobody falls through the cracks . This is an unprecedented opportunity to impact and improve the care of children and youth in your community by leveraging existing resources and strengthening the role of family physicians.
These are some of the data from one family physician using the tools they learned and already seeing the benefits to their patients in improved symptom scores for all three conditions.
With this learning program, we have an enormous opportunity to make an impact on population health. This is a chance to change the trajectory of mental health disorders in young people, and support long term improvements in care. We are increasing the capacity of the primary care system, we’re filling a gap where there really has been a lack of services. We’ve been told by family doctors, their medical office assistants, school counsellors, mental health clinicians, specialists and patients and families that this is really important and rewarding work. The tools and skills we offer are intuitive, easy to use and make sense in a busy setting. We hope you will join us in this exciting work.
1. It Takes a Village to Support Child & Youth Mental Health Dr. Tara Guthrie Quality Forum Vancouver BC March 1, 2013 www.pspbc.ca
2. Learning Objectives At the end of this presentation, you will learn: How family doctors, MH clinicians, and school counsellors can use new clinical tools How everyone works together in local communities forming a ‘wrap-around’ care team for young people, and use the same language 2
3. Prevalence Rates in Children and Youth in BC Disorder 3
5. Module AimWithin 6 - 8 months, we aim to: › Improve child and youth mental health in participating practices as evidenced by improved scores on clinical scales › Help create an interdisciplinary community of practice for child and youth mental health in local communities 5
6. By Focusing on… Early identification, diagnosis and management Appropriate use of evidence-based treatments Appropriate application of standardized methods of measurement Awareness of community mental health resources available Family doctor collaboration with community partners 6
7. Program Structure • Sharing and learning • Sharing and learning • Anxiety-specific tools • Community resources• Why Child and Youth Mental Depression and ADHD • CYMH billing Health? • Medications • School boards• Lifespan framework • Strongest Families BC • Sustainability• Suicide risk assessment • Action Planning• Non-disorder specific tools• Action planning• Measures LS1 AP1 LS2 AP2 LS3 Ongoing support • Screening • Identification, diagnosing, LS = Learning session • Building relationships treating and managing anxiety, AP = Action period • Psychotherapeutic support ADHD and depression • Track outcomes • Track outcomes • Expanding the role of the MOA 7
8. Creston, BC-School District #8 Located in the southeast interior of BC, Creston`s catchment area covers the Town of Creston, Area B & Area C 8
9. Team Approach to Mental Health1. Who are our team members?2. School counsellors3. Physician4. +/-child and youth mental health workers5. +/-addictions counsellors6. +/- school administrators and teachers7. +/- parents8. +/-family physician9. +/- pediatrician10. +/- child psychiatrist 9
10. Barriers to Mental Health Resources What gets in the way of STUDENTS going to the DOCTOR? 10
11. Identification Identifying students with potential Mental Health concerns or high risk behaviors 11
12. How does a student get referred? Triage meetings Self-referral Counsellors Family/parents Family physician 12
13. Students identified……..So what now? 13
14. Wednesdays with Tara 14
15. Flow Through the Clinic 15
16. Tools Clinical Global Impression (CGI) Screen for Childhood Anxiety Related Emotional Disorders (SCARED) Swanson, Nolan and Pelham (SNAP) – IV CRAFFT Tool for Assessment of Suicide Risk – Adolescent (TASR-A) Kutcher Adolescent Depression Scale – Six Item (KADS-6) Teen Functional Assessment (TeFA) 16
17. Websites Practice Support Programhttp://www.pspbc.ca Kelty Teen Mental Healthhttp://keltymentalhealth.ca/ Teen Mental Health http://teenmentalhealth.org 17
18. Grappling with CONFIDENTIALITY 18
19. Confidentiality Autonomy of students - they guide us as to who is part of the mental health team and who they would like to participate in their care. Points for discussion include family physician and parents. Goal is to preserve the confidentiality of the student in the context of a team environment Sealed assessment packages and electronic medical records ensure no paper trail is left at the school. 19
20. Changing the Culture of Mental Health in theClassroom 20
21. So what are students saying Did not have to go far. It is a great things comfortable environment for troubled kids. it has helped me a lot It was easy to get Made a huge to difference 21
22. Results from November to June…. 17 students screened Of screened students: › 76% diagnosed with the Anxiety, ADHD, and Depression › 38% of diagnosed students who are treated with protocol- driven medications › 100% of diagnosed students treated with psycho-therapeutic interventions › 69% showed substantive improvement 22
23. Students Report (6 Students) 100% I was more likely to access this service because it was in my school 100% I was comfortable seeing [doctor] at the school 83% I would recommend this clinic to my friends and other students 83% I would come to another appointment at the school 100% Overall I was satisfied with my appointment 23
25. “... By bringing in the GP or the school, you bring in more comprehensive support” -GP 25
26. But best of all… 26
27. GP Champions’ Confidence with Tools and Resources for Childand Youth Mental Health Care
28. Number (Percentage) of GPs who Rated Themselves as “Very” or“Moderately Confident” on Several Aspects Related to Mental Health for Children and Youth: Comparison Over Time
29. Summary The potential impact of this work is BIG We are increasing capacity in primary care Collaboration is embedded Real results can be seen quickly and appear to be sustainable System change is leveraged 29
30. www.pspbc.ca For more information Practice Support Program 115 - 1665 West Broadway Vancouver, BC V6J 5A4 Tel: 604 638-2854www.pspbc.ca