for children and youth. drivers for change reverse demographics ↑ needs ↓ resources +...
TRANSCRIPT
INTEGRATED SERVICE
DELIVERYFor Children and Youth
A CASE FOR CHANGE Drivers for Change
Reverse demographics ↑ needs ↓ resources
+ complexity of needs + complex systems
Silo approach
A CASE FOR CHANGEMultiple reports outlining the need for ISD
Status quo is not an option!
A CASE FOR CHANGE Multiple reports outlining the need for
ISDMacKay ReportConnecting the Dots ReportAshley Smith Report
Many of the recommendations in these reports referred to the need for Integrated Service Delivery
Clients, families and service providers have difficulty navigating multiple service systems
A CASE FOR CHANGE System inefficiencies – children & youth
receiving multiple assessments Lack of coordination in the assessment,
planning and delivery of services Wait lists and wait times for key services Criminalization of children and youth with mental health issues
A CASE FOR CHANGE Canadian Statistics:
Up to 20% of youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide
Only 1 in 5 of those receive servicesSuicide is the second leading cause of death
in youth age 15 – 24 (accounts for 24% of deaths)
Canada’s youth suicide rate is the 3rd highest in the industrialized world
Mental illness affects people of all ages, educational and income levels, and cultures
GOVERNMENT’S RESPONSE An inter-governmental committee was
formed with the mandate to develop an integrated Service Delivery Model
Fall of 2010 – two demonstration sites are chosenCharlotte CountyAcadian Peninsula
Commitment to a Province wide roll-out of the ISD model based on the results and learnings from the 2 regional demonstration sites
GOVERNMENT’S RESPONSEBackground: Development of the ISD framework Evidence informed practices from the literature
Review of internal government reports and evaluations
Consultations with RHAs, School districts, DECs, departmental directors and professional front line staff, NGOs, universities, advocacy groups, national and international experts and site visits
Interdepartmental committees (4 departments) have developed a framework for provincial implementation
A NEW APPROACH From ‘silos’ to ISD:
One file, many perspectives
Shared Responsibility = Shared Ownership
WHAT IS INTEGRATED SERVICE DELIVERY? Involves the collaboration of four
government departments:
Education and Early Childhood Development Health (Addictions and Mental Health
Services) Social Development Public Safety
A strength-based, child and youth centered framework
Addresses the needs of children and youth with complex emotional and behavioural concerns
WHAT IS INTEGRATED SERVICE DELIVERY? Prevention and earlier interventions A holistic team-based approach Bringing services directly to children, youth
and their families Strength-based strategies and the
development of a common plan Continuous case management and follow-up Wrapping the community around the
child/youth Child, youth and family-centered approaches
The right service, the right time, the right intensity
INTERATED SERVICE DELIVERY
The collective impact of partners working together!
Child
Ed
DPS
A&MH
SD
CHILD AND YOUTH TEAMS C&Y teams are composed of child and youth
professionals with training in psychiatry, psychology, counseling, social work, nursing, mental health and addictions and education/exceptionalities
C&Y team members provide: Assessment Consultation Therapeutic Interventions Positive mental health strategies/initiatives Crisis Intervention
Service is provided to individuals, families and groups, in both the school and community
CHILD AND YOUTH TEAMS C&Y teams may be comprised of:
School social workers Education Support Teacher - GuidanceEducation Support Teachers - ResourceSchool psychologistsAddictions and Mental Health Psychologists
and Social workersSchool Behavior MentorsHuman Services Counselors
CHILD AND YOUTH TEAMS Team members from the School Districts
maintain their collective agreements and their salaries and expenses continue to be paid by their home departments.
The RHA is responsible for the administration and clinical supervision of the Child and Youth Teams.
Re-assignment agreements are in place between the regional Health Authorities and the school districts and the plan is to continue these.
ELIGIBILITY CRITERIA Children and youth, aged 0 to 21, with
identified multiple needs within these core areas of development:
Mental Health and AddictionsEmotional and Behavioral functioning
Educational developmentFamily relationships
Physical Health and Wellness
Triage &Semi-Weekly AssignmentTherapeutic Interventions
Further AssessmentOngoing Review and Discussion
Feedback to ESST
School requests for service
Education Support Services Team (ESST)
With C&Y Team Member
Consultation with C&Y Team Member
Crisis/Urgent situation Duty Worker
Referral to C&Y TeamConsultation / Discussion
Planning Skills Intervention
Primary Intervention
ACCESS TO CHILD & YOUTH TEAM SERVICES
80%
15%
5%
Specialized therapeutic services
Treatment and support services
Universal and prevention services
PYRAMID OF INTERVENTIONS
ASSESSMENT PROCESS ISD duty worker assigned daily
Requests for service screened immediately and brought to team for assignment
Assignment based on skill set and capacity
Initial assessment completed and brought back to team for discussion
ISD TEAM PROCESS Each team meets twice weekly
Discuss all new cases
Develop interventions and assign team members
Case review
Triage with psychiatry and psychology
Discuss intensity of services
EDUCATION CONNECTION Each school has an ESST Teams are composed of:
AdministrationEST - ResourceEST - GuidanceC&Y Team Member (new and permanent
member)SLP/Others as required (OT/PT)Literacy and Numeracy Mentors
Discuss students with academic, behavioural and or emotional concerns
ROLE OF THE ESST The ESST meets at regular intervals
One of the critical roles is the discussion and planning around school wide prevention strategies
Data based decision making (surveys, statistics, evaluations, etc.)
Opportunity to build on expertise of C&Y team member
ACCESS POINTS School – Main point of access Public Health Health care provider Hospital Emergency Department Early Childhood Programs Justice Other
EVALUATION – SIGNIFICANT SUCCESSES IDENTIFIED Prior to ISD, only 4% of the school population would receive MH
services. Today – 12% of children and youth in Charlotte and 8% in AP/Alnwick have been seen by C&Y teams.
Client-centered service provision by the Child and Youth Teams. Efficient use of resources through interdisciplinary team work.
Waiting lists for Mental Health services and psycho-educational assessments have decreased.
ISD effectively reduces duplication and redundancies between departments and creates greater coherence in services.
Pre-Post clinical assessment of ISD clients shows significant improvement (decreased Internalizing, Externalizing, and Total Problems as well as increased Adaptation)
Positive feedback from school principals of the involvement of the Child and youth Team members in the schools. Parents report a high level of satisfaction with the services their child or youth received under the ISD model.
OUTCOMES TO DATE Creation of one list of children and youth
needing services Increased requests for services/Greater
accessibility Enhanced skill mix of C&Y teams Ability to adjust level of intensity of
services Earlier intervention Greater capacity to provide addiction
services Reduction in stigma associated with
accessing services
OUTCOMES TO DATE Enhanced collaboration, case planning,
joint service delivery, shared resources Shared common plan Enhanced crisis response/Threat risk
assessments (VTRA) Service delivery provided from a
strength based perspective Increased efficiency in service delivery
WHAT’S NEXT? Roll out the new model in an urban area
Planning underway to expand the two existing sites
REQUIRED ACTIVITIES The following Evaluation recommendations are completed or
presently underway: Create change Management plan (done) Complete detailed Implementation plan (done) Implementation of an electronic case management system
(Share-point or CSDS) (in progress) Significant re-profiling of existing counseling and clinical
resources as well other programs and services are required from all departments to accommodate inter-disciplinary teams (in progress)
Bill 23 - Completion of changes in the sharing of information legislation (done)
Sharing of information - development of associated policies, training (in progress)
Stakeholder and partner consultation and engagement process (in progress)
MEC to government on approval for expansion (in progress)
QUESTIONS?