2Toronto, ON  June 20‐21, 2014

TOGETHER We Make it Work:

Mental Health and Addictions (MHA) Nurses in School Boards

for Student Well-Being

A Joint Presentation of

and their respective School Board partners,

Mississauga Halton

CCAC

&            Waterloo Wellington CCACBecky Mantynen

RN, BScN, MSW, ManagerBillie Chornoboy

RN, BScN, MHA NurseCynthia Johnston RN, BSN, Manager

Shauna Johnston RN, BScN, BSc, MHA Nurse

Halton

Catholic DSB

&                    Upper Grand DSB Dr. Lynn Woodford, Psychologist, Mental Health and Addictions Lead 

Patricia Codner, MSW, RSW, Chief Social Worker

Presenters:

◈Rebecca Mantynen, RN, BScN, MSW, WWCCAC, Client Service Manager◈Dr. Lynn Woodford, Psychologist, Upper Grand DSB, MHA Lead◈Billie Chornoboy, RN, BScN, WWCCAC, MHA Nurse◈Patricia Codner, MSW, RSW, Halton

Catholic DSB, Chief Social Worker◈Cynthia Johnston, RN, BSN, MHCCAC, Client Service Manager◈Shauna Johnston, RN, BScN, BSc, MHCCAC, MHA Nurse

Relationships with commercial interests: ◈Grants/Research Support: none; Speakers Bureau/Honoraria: none; Consulting Fees: none; Other: none.

Disclosure of Commercial Support: ◈This program has received financial support from the Ontario Ministry of Health and Long-term Care in the form of funding for mental health and addiction Nurses.◈This program has not received in-kind support.◈The potential for conflict of interest does not exist.◈The potential for bias does not exist.

Disclosure…

Program Overview: ◈What we started with; how we grew

Similarities & Differences between Regions: ◈The Mississauga-Halton

MHAN Program:◈

Nursing Perspective◈

School Board Perspective

◈The Waterloo-Wellington MHAN Program:◈

Nursing Perspective ◈

School Board Perspective

Sharing Stories:◈Video 1: Stacey’s Story◈Video 2: Helping Halton

Students

Agenda…

Open Minds, Healthy Minds: Ontario’s Comprehensive

Mental

Health and Addiction Strategy

Overview…

“Early signs of mental disorders frequently appear in adolescence, yet they are often

undiagnosed and go untreated.

Young people with mental health disorders are at great risk for dropping out of school,

ending up in jail and of not being fully functional members of society in adulthood.”

– UNICEF

Our Motivation…

Mental Health & Addictions Nurses in School Boards

Mandate: ◈Identify mental health and addiction problems early; ◈intervene by providing timely, high quality, integrated and person-

directed health services

Approach:◈Utilize the four Guiding Principles from Open Minds, Healthy Minds (2011): Awareness, Promotion, Prevention, and Intervention◈Create customized MHAN programs based on region

Tri-Ministerial Involvement & Funding: ◈Ministry of Education◈Ministry of Child and Youth Services◈Ministry of Health and Long-term Care

Ontario’s Response…

Students Who:

◈Need fast access to support◈Have had multiple hospital / ER admissions◈Have complex medication issues and follow-up◈Have concurrent medical / mental health diagnoses◈Have competing / conflicted diagnoses◈Have families who could benefit from support◈Present a threat risk

Target Population…

Regionalized Implementation…

Inte

nsity

& A

cuity

Waterloo-Wellington CCAC Mississauga-Halton

CCAC

Cons

ulta

tion

/ Ed

ucat

ion

for

Scho

ol S

taff

Using a range of activities and resources, MHA Nurses directly and indirectly assist students:

◈Enhance school-based support services◈Direct service to students◈Capacity building◈Collaboration with system partners◈Student and family education◈Promotion of mental well-being

MHA Nurse Services…

I appreciated the support

You have helped mein ways you can never

imagineService was a great benefitVery

helpful in transitioning

Thanksfor b

eing there!

13

School Referral Process…

Halton Catholic District School Board Upper Grand District School Board

External Agencies Referrals(through the Chief Social Worker)

Woodview School-based Support Staff, ROCK, Mental Health School Worker (North),

CCAC MHA Nurse, MH Region Nurses

Multidisciplinary Team: ◈Itinerant

◈Psychology

Board Team

Referral to either:◈CYC

◈Social Worker

Teacher / Student / Parent ◈in-School Team Meeting

Resp

onse

to In

terv

entio

n

Inte

nsity

of n

eed

91% felt student was appropriately supported

What was helpful:◈Attending medical appointment with student◈Frequent check-ins◈Advocating◈Parent education◈Support over summer

What Students & Families Say…

78% felt MHANs were supportive to school staff

What was helpful:◈Accessibility and availability◈Collaboration◈Communication◈Transparency

“We have seen an immediate impact on our students and our schools from the implementation of this program.”

“We have seen an immediate impact on our students and our schools from the implementation of this program.”

What Teachers Say…

Value Added with MHA Nurses…

17

Helping Halton Students…

Special to have someone come into our home and school

Helped us understand medication

Great support in a difficult time

Vis

its

wer

e in

val

uab

le

Service was a great benefit

Jennifer’s Story

◈17 y.o. came to MHAN summer school drop-in program, no current MH supports in place◈Symptoms of depression: low mood, self-harm, suicidal ideation, poor sleep, reduced functioning, weight gain◈Student had been struggling for months, but did not disclose symptoms to her family, school, or doctor

With support from WWCCAC MHAN:◈Jennifer shared her concerns with her family◈Received Mental Health Teaching◈Referred to CMHA CBT coping skills peer group◈Safety plan developed◈Soft transfer to school supports (CYW, SW)◈Collateral provided to family doctor◈Initiated on sleep aid

WW Student Success…

Tamiko’s Story◈14 y.o. recently moved to the community, excluded by peers at her new high school◈Had 4 previous in-patient admissions within 12 months following suicide attempts◈Diagnoses of Major Depression disorder, Learning disorder, Eating Disorder (mixed anorexia and bulimia), and Social Anxiety Disorder◈Struggling with weight, body image, isolation from peers, academics, and non-

suicidal self-injury

With support from WWCCAC MHAN◈Coordinated school conferences to support Tamiko’s mental health needs; IEP updated◈Connected to community mental health agency for therapy◈Coordinated with community Eating Disorder Team and family physician; student’s eating disorder symptoms decreased◈Achieved, and maintained, stability during admission to MHAN program; reduction in self-harm; no further presentations to hospital

WW Student Success…

Health education

System navigationTiered model

Tri-ministerial initiative

Enhanced services

Early identification

Care coordination

Co

llab

ora

tio

nPPM149

MHAN

Ment

al He

althStudent well-being

22

MH Student Success…Melinda’s Story◈15 y.o girl, new to Canada◈Was identified by the school team with concerns about communication skills

With support from MHCCAC MHAN◈Medical system navigation◈Family education and support◈School staff education and support◈Community supports navigation (both for ASD and support for signs and symptoms of anxiety)

23

Stacey’s Story…

24

Discussion…