mental health and addictions care connections update may 2013 susan lalonde rankin, mh&a system...
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Mental Health and AddictionsCare Connections Update
May 2013 Susan Lalonde Rankin, MH&A System
Coordinator, WaypointEric Sutton, Clinical Services Planner, Waypoint
Care Connections Health System Design February 2011
INPUT from:• 6,500 individuals • 350 professionals • 140 organizations
Care Connections RESULT: Care Connections Plan to improve the health System in NSMuskoka
6 Priorities:1. Complex & Chronic Health2. In home and Community Capacity3. Maternal Child Health4. Mental health and Addictions5. Medicine6. Surgery
System Enablers • Communications/Community engagement• Governance• Ehealth• Human resources• System Navigation• Transportation
MH and Addiction Committees
Key issues in Mental Health & Addictions
• Access – especially for youth• Continuity – full range of services• Equity – distribution of adult acute care
inpatient services• Coordination - Standard Tools, Effective Care
Practices• Integration - Single Intake for Children’s
system, Police and crisis response models
Vision: Stepped Care
• Treatment at lowest appropriate tier• Step up if required • Level of professional input increases with each
tier• Evidence based practice at all tiers• Recovery orientation
The Vision: Stepped Care
Step 0 Public Health, Schools, Social Services, Health
services
Health Promotion & prevention General population interventions
Source: Care Connections Appendix D7See also Brian Rush, 2010 Tiered Frameworks for planning substance use service delivery systems. Nordic Studies on Alcohol and Drugs
Vision: An integrated regional system of mental health and addiction services that provides effective, efficient quality person directed care in a coordinated, timely, appropriate and accessible way.
NSMuskoka LHIN Care Connections Mental Health & Addiction Plan 2010-2020
Enhance crisis and community resources
Coordinate Regional Acute Care System
Increase access for child & youth G
oal
s
• ER visits by age/ facility - Hospital admission rates by age/facility • ER repeat visits <30days by age/facility - Hospital re-admissions < 30 days by age/geography• % MH ALC days - Parent and client satisfaction Sy
stem
In
dica
tors
DEL
IVER
ABLE
S in
PRO
GRE
SS (2
012-
14)
Out
com
es TBD - possibly% communities with 24/7 crisis bedsWait times in ER for police# police trained % communities with ER/police protocols
TBD possibly:% discharged with plan% follow up with community % seen post discharge within 7 days
TBD: Wait times Client outcomes – duration of untreated symptoms, % whose first treatment is via ER, % youth out of region for acute care
Standardized interventions
Standardized discharge
Standardized access - use of extra care beds,
care in ER
Redistribute inpatient beds to meet benchmarks (21 per 100,000)
Improve System Navigation
# calls to I&R# calls to agencies Client satisfaction
Single point of Information and
Referral
Coordination and Performance monitoring
Single session walk in clinics Midland
& Collingwood
Crisis intervention training for police
& ER protocol
Expansion of safe beds
SA Crisis Management
in ER
Early recovery & stabilization
after withdrawal
Seniors common protocol for clients
presenting with dementia
Common Screening/ assessment
tools (WTFKMH)
Hospital and community
protocols on crisis and
collaborations
TIP Implementation (CAMH Service Collaborative)
Adaptation of tools for FNMI
(BANAC)
Strategy for Wellness
Promotion 0-5 years
Provide Single point of intake
Proposal for Intensive in
home treatment for youth with dual diagnosis
Draft May 16, 2013 Susan LR
Psychiatric consultation
Outreach Psychiatrist Waypoint
Meeting Crisis Service
Standards
Support for youth leaving
inpatient (CCAC Nurses)
Training for educators (MH
Leads )
MH & Addiction Steering Committees
- Committee structure increases collaboration between - Hospital and Community - Addiction and Mental Health- Child MH and Adult MH- Health & Education & Social Services- North Simcoe Muskoka LHIN and Child, Youth and
Family Coalition Simcoe
Mental Health & Addictions Coordinating CouncilChair: Chair Carol Lambie, Waypoint
Acute Care Clinical Services Steering
Committee (formerly Beds Redistribution
Committee)
Crisis & Community Resources Steering
Committee Chair: Jim Harris, Mental
Health & Addiction Services of Simcoe County - CMHA
Crisis Training and Police
PartnershipsLed by
Walk In Workgroup
Led by Michelle Bergin Catholic
Fam. Serv.
Substance Use /AOD Strategy
Led by Greg Howse, MH & A Services Simcoe
Child & Adolescent Mental Health &
Addictions Steering Committee
Chair: Janet Harris, Waypoint
Complex Needs Workgroup
Led by Giselle Forrest, Catulpa &
Eric Sutton
Central Intake Workgroup
Led by Eric Sutton & Susan LR
Wellness Promotion Workgroup
Led by Peggy Govers, SMDHU
Interim bed Workgroup
No chair presently
Child Youth & Family Coalition of Simcoe County
Mental Health & Addictions Care Connections Committee Structure W
orkg
roup
s fo
r 201
3-14
Perm
anen
t Com
mitt
ees
DRAFT May 21, 2013
Vision: An Ontario in which children and youth mental health is recognized as a key determinant of overall health and well-being, and where children and youth reach their full potential.
Provide fast access to high quality service
Kids and families will know where to go to get what they need and services will be available to respond
in a timely way.
Identify and intervene in kids’ mental health needs early
Professionals in community-based child and youth mental health agencies and teachers will learn how to
identify and respond to the mental health needs of kids.
Close critical service gaps for vulnerable kids, kids in key transitions, and those in
remote communitiesKids will receive the type of specialized service they need
and it will be culturally appropriate
TH
EM
ES
IND
ICA
TO
RS • Reduced child and youth suicides/suicide
attempts
• Educational progress (EQAO)
• Fewer school suspensions and/or expulsions
• Decrease in severity of mental health issues through treatment
• Decrease in inpatient admission rates for child and youth mental health
• Higher graduation rates
• More professionals trained to identify kids’ mental health needs
• Higher parent satisfaction in services received
• Fewer hospital (ER) admissions and readmissions for child and youth mental health
• Reduced Wait Times
OVERVIEW OF THE 3 YEAR PLAN starting with Child & Youth - Open Minds, Healthy Minds
Provide designated mental health workers in schools
Implement Working Together for Kids’ Mental Health
Newpath (for Simcoe) 2012Point in Time (for
Haliburton – TLDSB) 2010
Hire Nurse Practitioners for eating disorders program
RVH
Improve service coordination for high needs
kids, youth and families
INIT
IAT
IVE
S
Implement standardized tools for outcomes and
needs assessment
Amend education curriculum to cover mental health promotion and address
stigma
Develop K-12 resource guide for educators
Mental health & addiction SC (Aleta Armstrong)
Implement school mental health ASSIST program (lead K. Short at HWDSB) & mental
health literacy provincially MH literacy training pilot
TLDSB Haliburton 2011 with Ont Centre for Excellence
Enhance and expand Telepsychiatry model and
services
Provide support at key transition points
Hire new Aboriginal workers Implement Aboriginal Mental
Health Worker Training Program
Create 18 service collaboratives
CAMH Susan LR
Expand inpatient/outpatient services for child and youth
eating disorders
Reduce wait times for service, revise service contracting, standards, and reporting
Funding to increase supply of child and youth mental health
professionalsNewpath 6.5, Kinark 4.5, La
Cle 2, FYCS Muskoka 2
Improve public access to service information
Pilot Family Support Navigator model
Y1 pilotKinark & Parents for
Children’s Mental Health
Increase Youth Mental Health Court Workers
Provide nurses in schools to support mental health
servicesAgency lead & FTE TBA
Implement Mental Health Leaders in selected School
Boards TLDSB Suzanne WittFoley
SMCDSC Pat Carney
Outcomes, indicators and development of scorecard
Strategy EvaluationCandian Institute for
Health Information CIHI
OTHER SIMCOE MUSKOKA INITIATIVES: Student Support Leadership InitiativeSSLI
ER pathways – potential pilot with -Prov. Council for Maternal & Child Health
MCYS one time Transformation funding: Newpath Common Assessment Framework
Co-location study crisis services CMHA/Kinark)
Physicians / Primary Health Care
Schools (once internal school
processes and school outreach efforts exhausted)
Other Community Partners (CAS, Justice
etc.)
Family / Self Referrals
Functions• Receive and review all referrals to
children’s mental health and addictions services, including referrals of children and youth that may be appropriate for adult services such as CMHA ‘s addiction, youth case management, and early Intervention psychosis services, or referrals to Catholic Family Services.
• Determine if referral meets the basic criteria for one the above and, if not, facilitate referral to other services.
• Determine severity and urgency of referral by reviewing the agreed-upon screening tool results that will accompany the referral, and by conducting telephone calls of clarification as necessary with the referral source and / or family.
• Conduct a scheduled brief telephone intake interview, which would include expanded screening questions, risk questions, and an issue conversation.
• Recommend and implement disposition option.
• Advise client / referral source of potential access issues related to recommended service (Central Intake would need to maintain awareness of service pressures, wait lists etc.)
• Forward referral to appropriate program or service of a participating agency, or for supplementary face to face assessment.
• Advise referral source of intake disposition.
• Flag potential candidates for “Complex Service Stream”
Central Intake / TriageDisposition Options
Direct Program Placement• If appropriate service match has been determined, the
referral goes directly to a program of a participating agency.
• Full assessment is conducted at the program level.• Program provides assessment and program plan
results to referring party, along with high level key information back to Central Intake and Triage
• Program (not Central Intake) provides case management (to be defined) and arranges access to wait list programs or interim supports as required
• The program conducting the full assessment will be also identify or confirm candidates for Complex Service stream and organized “Combo Team” strategies
Additional Face to Face Intake Assessment• While an extension of the intake function, this would
not be done by the Central Intake/Triage• The referral is directed to Kinark, New Path, CMHA or
other participating agency for a face to face intake assessment, after which a decision on programming is made
• Assessment results and disposition recommendations go back to referral source.
• The receiving agency would connect the client with an alternate agency or service as required and would advise central intake (The client would not be required to go back to central intake).
Other Services and Supports• Central intake will arrange referrals to alternative
programs and supports if formal mental health services are not required.
• May recommend and facilitate assessments with family physicians, paediatricians, child psychiatrists
Central Intake Discussion Document Draft 3 January 24, 2013Prepared by Eric Sutton
Note Re Crisis Connection• Some referrals may go
directly from the Central Intake to the Kinark Crisis response
• Some referrals may come from the Crisis Response system once the crisis has been assessed and stabilized.
Child and Adolescent Steering Committee
• Workplan Overview
