E1 Dr.Tara Guthrie - It Takes a Village To Support Child & Youth Mental Health

www.pspbc.ca

It Takes a Village to Support Child & Youth Mental Health

Dr. Tara Guthrie

Quality ForumVancouver BC

March 1, 2013

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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

Learning Objectives

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Prevalence Rates in Children and Youth in BC

Disorder

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Within 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

Module Aim

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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

By Focusing on…

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Program Structure

• Why Child and Youth Mental Health?

• Lifespan framework• Suicide risk assessment• Non-disorder specific

tools• Action planning• Measures

LS1 AP1 LS2 AP2 LS3 Ongoing support

LS = Learning session

AP = Action period• Screening• Building relationships• Psychotherapeutic

support• Track outcomes

• Sharing and learning• Anxiety-specific tools

Depression and ADHD

• Medications• Strongest Families

BC• Action Planning

• Sharing and learning• Community

resources• CYMH billing• School boards• Sustainability

• Identification, diagnosing, treating and managing anxiety, ADHD and depression

• Track outcomes• Expanding the role of the

MOA

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Located in the southeast interior of BC, Creston`s catchment area covers the Town of Creston, Area B & Area C

Creston, BC-School District #8

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1. 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

Team Approach to Mental Health

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What gets in the way of STUDENTS going to the DOCTOR?

Barriers to Mental Health Resources

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Identifying students with potential Mental Health concerns or high risk behaviors

Identification

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Triage meetings Self-referral Counsellors Family/parents Family physician

How does a student get referred?

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Students identified……..So what now?

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Wednesdays with Tara

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Flow Through the Clinic

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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)

Tools

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Practice Support Programhttp://www.pspbc.ca

Kelty Teen Mental Healthhttp://keltymentalhealth.ca/

Teen Mental Health http://teenmentalhealth.org

Websites

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Grappling with CONFIDENTIALITY

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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.

Confidentiality

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Changing the Culture of Mental Health in the Classroom

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So what are students saying

It was easy to

get to

It is a great

things for

troubled kids. it

has helped me a

lot

Did not have to go far.

comfortable

environment

Made a huge

difference

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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

Results from November to June….

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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

Students Report (6 Students)

Conclusions

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“... By bringing in the GP or the school, you bring in more comprehensive

support” -GP

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But best of all…

GP Champions’ Confidence with Tools and Resources for

Child and Youth Mental Health Care

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

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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

Summary

www.pspbc.ca

For more informationPractice Support Program

115 - 1665 West BroadwayVancouver, BC V6J 5A4

Tel: 604 638-2854

www.pspbc.ca