Child and Youth Collaborative St. Clair Child and Youth Services & Bluewater Health CMHO Presentation November 2016

My Promise to Emily… We create exemplary healthcare experiences with patients and families every time - Bluewater Health Strategic Plan

Child and Youth Collaborative Number of Child and Youth ED Presentations Bluewater Health (2010-2013) Background Demand for Child and Youth services was exceeding resources. Data from 2010-2013 showed and increase in: ED visits (41%) Inpatient admissions (80%) Follow up referral service to SCCYS had tripled (40/year to 120 per year) The Child and Youth Collaborative was co-created with BWH and SCCYS to respond to the growing trends. Opportunity to adopt and evidence based practice for Child and Adolescent MH Care. - Provincial Council for Maternal and Child Health’s ED Clinical Pathway for Children and Youth Funding confirmed Fall 2015 Number of Crisis Follow up Clients Referred from Bluewater Health to St. Clair Child and Youth (2008-2013)

Memorandum of Agreement

Memorandum of Agreement Purpose This Memorandum of Agreement (MOA) will: Promote fair and timely access to children’s Mental Health services for children and youth presenting at the Emergency Department (ED), including prioritization and response within the community. Prescribe the pathway of access and referral process on behalf of children and youth requesting Mental Health services from entry to the ED to disposition to child and youth mental health and (CY MH) services). Establish clear guidelines for the nature and timeliness of community response to children and youth discharged from the ED, based on evaluation of risk and urgency. Establish processes whereby disposition decisions are regularly reviewed at the aggregate level to identify trends/patterns and ensure consistency with the protocol. Establish reporting mechanisms to track and report resource utilization both clinically and financially.

Governing Principles Response to youth with a mental illness or in acute emotional distress should be provided in the least restrictive and least intrusive means appropriate and in a manner that ensures the safety, privacy, dignity and self-respect of the youth, family and others; Provision of prompt assessment and treatment for youth who are experiencing a MH crisis is essential and timely follow-up may be required for many youth to ensure continued physical and psychological safety and wellbeing at home and in the community; Inter-agency and cross-sectorial cooperation in assessment, intervention and coordination is essential to provide a comprehensive, efficient, and effective crisis resolution, as well as facilitation of ongoing service delivery. Continuity in the relationships between children/youth and their health care providers allows for the most comprehensive and informed treatment planning and crisis management for children, youth, and their families. Where continuity in relationships may not be possible, information-sharing and coordination of services is essential. To be effective, coordinated child- and family-centered care requires consideration of the unique needs of each child or youth, and his/her family and the community context.

Crisis and Community Disposition A: Admission to hospital Disposition B: Discharge from ED with Expedited (48 hour) Follow-Up in the Community (Advanced Access Appointments) Disposition C: Discharge from ED with Follow-Up within 7 days – SCCYS Walk In Therapy Clinic Disposition D: Discharge from ED with recommended Follow-Up in the Community

Pathway Success Greater confidence to admit and discharge from the ED. Screeners support the face to face assessment and highlight areas of distress or difficulty i.e. externalizing symptoms, internalizing symptoms, suicidal ideation A platform for communication to the ED physicians. Screeners are shared with SCCYS when a referral is initiated - Memorandum of Agreement  ED Pathway / Standard of Care  Implementation Committee  Official Program Launch April 2016  Data Sharing Agreement  Routine Meetings / Case Review 

My Promise to Emily… We create exemplary healthcare experiences with patients and families every time - Bluewater Health Strategic Plan

Logic Model Main Components Referral Crisis Counselling Case Coordination Discharge Planning   Implementation Objectives To collect required mental health screening and risk assessment data To determine a case manager at admission to the program To liaison with Bluewater Health Social Work department. To provide initial appointment time To orient clients to the service To develop safety strategies To establish treatment goals To provide stabilization counselling To identify protective and resilience factors To complete CAFAS ratings To communicate service delivery outcomes to Bluewater Health To provide liaison with CCAC Mental Health Nurses in Schools To attend case review conferences To evaluate progress on case goals To communicate outcomes to service providers To complete required case recording To determine follow up treatment needs Outputs # of instruments administered # of cases assigned # of consultations undertaken # of clients orientated # of safety plans developed # of youth stabilized # of protective factors identified # of treatment goals developed # of CAFAS rating completed # of consultations conducted # of case conferences attended # of case goals evaluated # of communications with service providers # of recordings made Short-Term Objectives To increase worker knowledge of client needs To increase coordination of service between St. Clair and Bluewater Health To increase accessibility and continuity of service To establish therapeutic relationship To increase client stability To increase client resilience To improve family capacity to respond to their at risk youth To reduce risk to clients To determine the requirement for the application of the High Risk protocol To increase the effective of interventions To decrease errors and omissions of care and treatment To increase the community capacity to support children and youth with mental health problems To determine service direction at discharge To increase stakeholder understanding of client needs at discharge To increase matching needs at discharge to follow-up efforts Long-Term Objectives To reduce risk of self -harm to children, youth To increase the capacity of children, youth and families to cope and adapt to life circumstances To assess, identify and refer children, youth and families who require on-going service To reduce subsequent presentations to the ER of referred children and youth.

Return to Customary Pursuits Discharge and Follow-up Logic Model Main Components Engagement Stabilization Coping Return to Customary Pursuits Discharge and Follow-up Implementation Objectives To establish therapeutic relationship. To administer problem and strength checklists To engage patients in partnering on service direction To coordinate stabilization efforts with allied professionals To provide CBT/DBT counselling Intervention To provide therapeutic recreation activities for assigned patients To provide skill development activities for admitted youth To assist youth to identify problem solving strategies. To assist youth to set boundaries when communicating about their hospitalization To bring classroom assignments to the bedside. To assist youth to plan for re- entry to school and community To assist youth and family to identify protective factors to assist with well being To assist with identifying needs for further mental health intervention To coordinate required follow up activities with service providers, youth and family   Outputs Short-Term Objectives To increase understanding of life domains requiring support To increase patient alignment with helping efforts. To increase patient hope for change. To decrease length of stay for admitted children and youth To improve regulation off affect with admitted youth. To reduce symptoms of anxiety and depression of admitted youth To increase youth capacity to manage stressful events To improve youth capacity to effectively develop functional solutions to problems To reduce the negative impact of hospitalization on social reputation To reduce negative impact on school achievement To increase resiliency of youth To reduce impediments to successful return to home To increase family members efforts to care for discharged youth To reduce stigma for discharged youth To promote successful return to school or work To increase access to required mental health follow up services Long-Term Objectives To reduce psychological and environment risk factors for youth requiring hospitalization To increase the adaptive capacity of youth at risk. To enhance the mental health response to hospitalized children and youth To reduce the length of stay for children and youth admitted to hospital for mental health reasons. To improve the capacity of families to care for their at-risk children and youth. To decrease multiple admissions of children and youth.