Nova Scotia: 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

NS Policy and Planning Documents for ASD Government of NS. (2012). Autism Spectrum Disorder Action Plan - Progress Report. Government of NS. (ND). Autism Spectrum Disorder Action Plan. NS Department of Education. (2012). Developing and Implementing Programming for Students with Autism Spectrum Disorder Guide. Autism Nova Scotia. (2011) Autism Information and Resource Kit For Newly Diagnosed Families. NS Department Education. (2010) Lifespan Needs for Persons with Autism Spectrum Disorder. Government Fact Sheets aimed parents and guardians Smith, I.M. (2008). Early Intensive Behaviourial Intervention – Final Evaluation Summary.

Various Strategies, Evaluations, Reviews and Expertise in NS Landmark report in 2006 by Justice Merlin Nunn Spiralling Out of Control. Specific government policies and strategies – Child and Youth Strategy: Our Kids are Worth It, ASD Annual progress reports for Child and Youth strategy Independent evaluations and external service reviews – e.g. Davidson and Coniglio (2013), Smith (2008), Schoolsplus Evaluation (2012) Externally funded Research Chairs – Pat McGrath/IWK, Stan Kutcher/Capital Health Psychiatry Independent, unsolicited evaluations and commentaries – see Bennett (2013), NS School Boards (2010)

Components of NS Autism Spectrum Disorder Action Plan Designed to support children, youth and adults with ASD and their families through a phased-in approach. Five key focus areas: Intervention and support services for families with preschool children Supports for school-aged children Supports for adults with ASD and their families Skills training and awareness Partnerships to support programming and services

NS Service Delivery Model for ASD Provincial Policy: Autism Spectrum Disorder Action Plan Early Intensive Behavioural Intervention (EIBI) program provides direct intensive services to young children funded by Department of Health and Wellness – District Health Authorities deliver assessment and intevention services through autism teams Home to School transitioning process funded by Department of Education and Early Childhood Services – Delivered by Autism teams Student Services funded by Department of Education and Early Childhood Services Early intervention centres funded by Department of Community Services Direct and Enhanced Family Support programs funded by Department of Community Services

ASD Findings In December of 2004 NS Department of Health implemented a province-wide Early Intensive Behaviour Intervention program for young children with ASD Autism Research Centre housed at IWK IWK Autism team with developmental pediatricians Autism NS and regional chapters Early Intervention Association – Provides advocacy for 21 early intervention programs

Eating Disorder Services in NS (1) IWK has a specialized Eating Disorders team – Includes Psychiatrist, Psychologist, Dietitian, Nurse and Social Worker, who provide outpatient therapy – The IWK also offers outpatient therapy through Community Mental Health clinics in Dartmouth, Sackville and Halifax NS has an Eating Disorder Treatment Network Nova Scotia – Network was established to connect clinicians and services from around NS so they can provide integrated care – Offers a variety of treatment options through a series of outpatient groups that address a variety of concerns associated with eating disorders. – Each district health authority offers services through the network

Eating Disorder Services in NS (2) Capital Health Eating Disorder Clinic – Provides group treatment: outpatient, inpatient, day hospital for 18 years and older The Self-Help Connection has an Eating Disorders Project – There are 12 week, structured Peer Support Groups led by trained professionals who have recovered from an eating disorder There is no provincial eating disorder in NS Canada Eating Disorder Addiction Treatment publishes a list of therapists for NB, PEI, NS, NL There are four regional networks under the auspices of the Department of Community Services – The connection with eating disorders is not specified; mandate specifies each respond to local needs

NS Child and Youth Strategy Precipitated by Nunn report Improve services to children, youth, and families through greater collaboration among four key government departments: Health and Wellness, Education, Community Services, and Justice. Identifies policy opportunities, breaks down barriers, and develops innovative partnerships and initiatives Supports and advances collaboration at the community level and across government Led by the Department of Community Services Supported by a network of youth and youth agencies i.e., Leaders of Today Annual provincial symposium to share lessons and challenges Strategic areas for annual reporting – Youth engagement – Collaborative service-delivery approaches, – Horizontal (governance) practices, and – Improving evaluation, data collection and sharing

NS Schoolsplus Model of Integrated Service Delivery Announced in 2007, evaluated in 2012 Characterized by a comprehensive, collaborative, seamless delivery of services, sharing of information and resources between agencies, timely and effective services and services beyond the school day Schools become centres of service delivery; promote co-location and/or partnerships including Community Services, Justice, Mental Health, Addiction Services, Health and other community organizations The SP Coordinator was hired by the Department of Education in October 2008 to model collaborative approach involving coordination and linkage – Social work versus education background – Role is crucial to success 95 schools involved

Components of NS (SP) Model Each school board provided with resources to hire SP Facilitator - liaison and link b/w school and community. SP Community Outreach Workers hired in most school boards and role is to advocate, coordinate, and expand services for students and families. Roles of SP facilitators and SP community outreach workers are essential to the success of the model Each site has a SP Advisory Committee with representation from government departments e.g., Education, Community Services, Justice, Health and Wellness, the Child and Youth Strategy, and community organizations. Unique needs of each community are respected and addressed by the services provided.

Components of Mental Health Services in NS District health authorities provide community-based child and youth mental health services – First contact – Day treatment – Includes eating disorders – Referrals to inpatient units and specialty clinics at IWK IWK programs serving residents of NS – Inpatient Units, Specialty clinics – Secure Care Unit at NS Youth Facility – Youth Forensic Services Various agencies such as Phoenix Schools as “sites of care” through Schoolsplus Eating disorder network – Provincial expertise supports DHA delivery

IWK programs serving residents of Capital District Health Authority Adolescent Centre for Treatment focuses on anxiety, depression Child and Family Day Treatment (5-12 years) Adolescent Day Treatment (13-19years) Shared Care Team does outreach to various providers Inpatient Units Specialty clinics Residential 24/5 treatment Community Mental clinics – Dartmouth, Sackville, and Halifax

Follow-Up Next Day Service (FUNDS) Coordinated crisis stabilization services serving Metro Area / HRM service Capital District Health Authority Mental Health Mobile Crises Team, IWK Health Centre, Halifax Regional Police, RCMP, and Regional office for Department of Community Services identified need for coordinated crisis stabilization services for families experiencing severe parent/child conflict

Specialized Mental Health Services in NS NS Autism Spectrum Disorder Action Plan NS Child and Youth Strategy – Initiated by provincial government – Inter-agency provincial and regional networks NS Schoolsplus (SP) Model of Integrated Service Delivery NS has an Eating Disorder treatment network Follow-Up Next Day Service (FUNDS) IWK Youth Forensic Services, Secure Unit at Justice Centre

Observations for NS - 1 Proliferation of specialized services and strategies – To what extent is there overlap and duplication between Schoolsplus and Child and Youth Strategy? Apparent heavy concentration of mental health services in Metro Area – Focus on homeless and youth at risk Extent of outreach to health districts by IWK is not known Schools (n=95) evolving as “sites of care” Independent residential providers e.g., Phoenix, Laing House Various provincial strategies and specialized models promoting integration – Schoolsplus, Child and Youth Strategy, Autism Action Plan

Observations for NS - 2 ASD – Very engaged and active cross-department Autism Management Advisory Team – Extensive Information and Resource Kit for Parents (2011) NS Child and Youth Strategy – Grew out of various provincial reports e.g., Nunn, – Active regional interdisciplinary networks for capacity building in place – Annual conference to share lessons and practices – Focus on Accountability - annual report on progress and activities – Active, engaged interdisciplinary departmental committee and regional networks managed by Department of Community Services SchoolsPlus – Independent, external evaluation of 2012 – see inventory – Investigator-initiated evaluation by programs – see Bennett (2013)

Observations for NS - 3 Robust eating disorder service network – Regional services supported by provincial expertise No provincial advocacy group for eating disorders – Similar to PEI Dedicated Research Chairs – Kutcher, McGrath