New Brunswick: Overview and Observations of Services for Autism, Eating Disorders, and General Mental Health Conditions Patricia Conrad, PhD May 27, 2014

Outline Purpose, Research Questions, Methods, Products Autism Eating Disorders General Mental Health Services Observations

Purpose and Products Compile observations about services delivered in each of the four Atlantic Provinces for the five conditions under consideration. As a baseline activity to support the research projects to be undertaken, three separate inventories of services for children and youth with autism, eating disorders, and general mental health services were compiled. Inventory of key provincial documents assembled. Each of the inventories will support various research projects to be undertaken for each condition. Summarize observations and make suggestions about possible research projects

Research Questions What health and community-based services are available for children and youth with an autism spectrum disorder in NB, PEI, NS, and NL? What health and community-based services are available for children and youth with an eating disorder in NB, PEI, NS, and NL? What health and community-based services are available for children and youth with anxiety, conduct, or depression disorders in NB, PEI, NS, and NL? What are the key observations and findings for each condition? What are suggested next steps?

Research Methods and Approach Approach was nonreactive and unobtrusive – Information gathered was extracted from documents and websites where the original intent may have been different e.g., informing patients, providers, general public – The organizations were not aware their information was being compiled since there was no contact or exchange – Caution must be exercised because this research relied only on information available in the public domain including websites, annual reports, strategic plans, accountability reports, service standards, patient guides and resource lists, evaluations, etc. Limitations – No validation or assessment of information credibility through discussion with key informants. – No clarification was sought to interpret meaning or content from the providers of services.

Inventories Annotated inventory of provincial documents related to the five conditions compiled by province. – Of particular interest, was whether any provincial evaluations or studies are available for any of the conditions? Master list of services for Autism Spectrum Disorder – Organized by province Master list of services for Eating Disorders – Organized by province Master list of services for General Mental Health Services for Children and Youth – Organized by province

PowerPoint Presentations Overall observations and research suggestions – Organized by province and by disorders Summary and overview of findings and observations for each province – New Brunswick, PEI, Nova Scotia, Newfoundland and Labrador Summary and observations of services for Autism Spectrum Disorder – Organized by province Summary and observations of services for Eating Disorders – Organized by province Summary and observations of services for General Mental Health Services for Children and Youth – Organized by province

NB ASD Service Delivery Model Early Intervention Program - Department of Education and Early Childhood Development (EECD) contracts with 7 approved Early Intervention Agencies for delivery of preschool services Early Intervention Agencies are part of the Early Childhood Network(s) in their community Autism Resource Centres are distributed across NB Autism Team at Stan Cassidy Centre for Rehabilitation (Fredericton) has a provincial mandate and provide on- site and outreach/off-site services Community Based Services for Children with Special Needs Program – extra-ordinary care and support for severely disabled children and youth

NB Early Intervention Program The Early Intervention Program offers targeted services to families of children aged 0 to 8 who are at greatest risk of developmental delays Focus on healthy childhood growth and development, healthy parent child interaction and family wellness through voluntary in-home visitation Model is based on Healthy Families America critical elements which provide a competency based framework for intervention and evaluation. The intensity of an intervention should be proportionate to the extent of need. The Department of Education and Early Childhood Development (EECD) contracts with 7 approved Early Intervention Agencies

NB Early Intervention Agencies The Early Intervention Agency is part of the Early Childhood Network(s) in their community. Early Intervention Agencies are community based and operate under nonprofit governance. Screen for eligibility, assess for services, and assume case management responsibilities using standardized and validated tools to identify the risk and protective factors Build an individual family service intervention plan based on the needs of the child and his family Develop goals and outcome indicators for each child and family receiving services Maintain enrollment, retention and service completion data

Services Provided by NB Early Intervention Agencies In-Home Visitation; Infant-Parent Attachment Program; Group Based Parent Support; Creative Outreach; Transition to School Activities; Developmental Child Care Services.

NB Standards for Early Intervention Agencies Standards establish a minimum level of performance to meet compliance requirements established by the NB Department of Education and Early Childhood Development Standards apply only to Early Intervention Agencies funded by the NB Department of Education and Early Childhood Development Agency compliance with the standards is mandatory

NB Community Resource Centers for Persons with ASD – Objectives Provide a place where people can meet to exchange ideas and information and develop a sense of belonging. Provide families, children and youth with opportunities to participate in meaningful activities, which contribute to increasing their well-being, self-esteem and social functioning. Foster community integration and inclusion. Assist families to gain access to community-based resources. Educate the public and the formal service delivery system about Autism Spectrum Disorder.

NB Funding Criteria for Community Centers for Persons with ASD Centre should be the least restrictive and most natural environment. Model should be family-oriented and responsive to families' priorities. Family values should guide practices - each child's and family's intervention should be individualized and developmentally appropriate. The practices must be validated by evidence-based research. Boards should be made up of various community stakeholders including professionals, families and where possible, users of the service. Centers provide the Mental Health Services Division with a report on annual expenditures and description of program and project outcomes. A purchase-of-service contract is signed between the center and the Mental Health Services Division. Centers should be open to all community members wishing to participate. Centers must make a conscious decision to be broad-based and eclectic in what they provide as information related to autism, i.e. centers do not promote one specific intervention over others, but rather provide information and resources regarding an broad array of options from which families may choose.

Eating Disorder Services in NB (1) Thirteen Community Mental Health Centres deliver mental health services within a defined catchment area Extent to which CMHCs provide assessment and treatment for eating disorders is not known – Pediatric Eating Disorders program at St. Joseph Community Health Centre appears as only community-based center specializing in eating disorder – Program is result of a partnership involving hospital social work, psychology, and nutrition departments and the CMHC in the Restigouche Zone

Eating Disorder Services in NB (2) The role of child and youth psychiatric inpatient unit at Moncton re: treating eating disorders is not known The role of Pierre Caissie Youth Treatment centre (provincial service) in accepting eating disorder patients is not known How IWK as tertiary centre treats NB patients with eating disorders is not known Canada Eating Disorder Addiction Treatment publishes a list of private herapists for NB, PEI, NS, NL

Eating Disorder Services in NB (3) Eating Disorder Council of NB established by Kate Weaver Research at UNB – Kate Weaver

Components of Mental Health Services in NB Mental Health Division in Department of Health provides leadership on quality and standards 13 Community Mental Health Centers provide services to defined catchment areas Psychiatric Units provide hospital- based services on provincial basis e.g., Child and Adolescent Unit in Moncton serves the province Specialized Provincial Programs; e.g., Autism Team at Stan Cassidy Centre for Rehabilitation (Fredericton), 6-bed unit at Pierre Caissie Centre (Moncton) Funding to non-profit organizations e.g., CMHC Provincial Youth Treatment Program focuses on severe conduct disorders Integrated Service Delivery teams led by Department of Public Safety focus on at-risk children and youth

Overview: NB Community Mental Health Centers 13 sites provide services for defined catchment area 7 sites have additional mandate to maximize use of regional resources Community Advisory Committee provides advice to each centre Centers provide acute adult services, child and adolescent services, and adult long term services Child and youth Host regional teams for Youth Treatment, Integrated Service Delivery program??? Autism Spectrum Disorder services???

NB Youth Treatment Program for Severe Conduct Disorders Provincial team offers consultation, education, training, and coordination to 14 regional teams 14 regionally based, multidisciplinary clinical teams support primary youth workers Comprised of professionals representing five participating departments - Health, Community Services, Education, Public Safety, Addictions Specialized in-patient care available at Pierre Caissie Centre in Moncton

Integrated Service Delivery for At-Risk Children & Youth in NB Led by Department of Public Safety Focus is on providing seamless services and programs Provincial clinical team + regional Child and Youth Development (CYD) teams Each regional CYD team consists of four professionals; e.g., school psychologist, mental health and addictions social worker, school counsellor, interventionist, and support services Regional Advisory Committees consist of Social Development, Public Safety, Regional Health Authority, and school district representation; consult about most complex and challenging cases Regional Community Mobilization Committees consult and collaborate to enhance services through community engagement

NB Youth Engagement Networks NB Department of Health operating a three- year youth engagement pilot project Youth Engagement Networks set up within various communities Networks are at present focused on addiction issues and devising community-based solutions The NB Youth Strategy included youth engagement as one of its three pillars debated at the Youth Summit held in February 2011

NB Observations 1 Action Plan for Mental Health – NB government provides annual report on progress (see NB section in document inventory) – Report is silent about services targetted to children and youth Comprehensive data and monitoring - NB Health Council works with Office of Provincial Child and Youth Advocate to produce annual State of the Child Reports – Beginning in 2008, reports have evolved to measure performance on a wide-ranging set of indicators using CIHI plus other provincial data Stand alone Child and Youth Advocate played role in developing service integration model for at-risk youth through Public Safety “Robust” community-based, decentralized, and integrated delivery of general mental health services for children and youth – Community mental health centres play key role – Centralized provincial expertise supports service delivery by local, multidisciplinary teams – Focus on seamlessness, integration, coordination and engagement

NB Observations 2 Integrated Service Delivery Framework (Department of Public Safety) evolved from reports by Ombudsman and Youth identifying need for better coordination and seamless services for at risk children Provincial Youth Treatment Program focuses on severe conduct disorders Substantial gap in services to diagnose and treat Eating Disorders Educational brochures promote ASD services Provincial standards in place for agencies delivering Early Intervention Services for ASD Provincial Youth Engagement Strategy and Youth Engagement Networks Many services available close to home via multidisciplinary specialized teams located within community settings and supported by provincially available expertise

NB Observations 3 No specific provincial policy / strategy or action plan guiding services for Autism Spectrum Disorder IWK provides in-patient specialty clinics IWK provides subspecialty consultation service for Eating Disorders, etc.