1. © Provincial Health Services Authority Link: Connecting Patients and Families with Mental Health Resources Shawna Wilwand (BCMHSUS) Kristen Barnes (PHSA imPROVE)

2. © Provincial Health Services Authority BC Mental Health and Substance Use Services Provincial specialized services for children, youth and their families Inpatient units Outpatient clinics Supported by PHSA imPROVE to implement lean thinking and tools One tool used is the Rapid Process Improvement Workshop (RPIW)

3. © Provincial Health Services Authority Context: BC Children’s Hospital Emergency Department Mental Health patients – approximately 900 visits a year 66% are discharged directly from Emergency Where the patient is referred upon discharge depends on a number of factors and is a complex process

4. © Provincial Health Services Authority Current State Emergency Physician Feedback

5. © Provincial Health Services Authority Problem 40% of families with mental health concerns discharged from BC Children’s Hospital Emergency did not receive services in a timely manner after discharge.

6. © Provincial Health Services Authority Contributing Factors 25% of referrals did not go to the right service Quality of referrals Access to community services Inequity in Service: Psychiatric Liaison Nurse position only available to patients during working hours-37.5 hours/week. Only 15% of patients presenting with mental health concerns received follow up.

7. © Provincial Health Services Authority Intervention-BCCH Emergency Department Created one standardized crisis referral form (down from 11) Created an information handout for patients and families to access community supports Psychiatry and Emergency Physicians collaborated on a standardized assessment tool Created an algorithm for disposition in Emergency

8. © Provincial Health Services Authority Measurement: ED Outcomes 99% of families directed to the correct service (compared to 75% before interventions) Equity in Service: All patients with mental health concerns presenting to the emergency department who require follow up receive follow up

9. © Provincial Health Services Authority Intervention-BCMHSUS Link New service to help connect families with community mental health resources. Provides mental health assessment, medication initiation and management, and resource consultation. Link can provide a maximum of 4 follow up sessions. Without adding new resources, Link is expected to provide services to an estimated 300 families in it’s first year

10. © Provincial Health Services Authority Who is LINK? Link is a team of Mental Health professionals including: –Nurse Clinician- Shawna Wilwand –Nurse Practitioner- Ardelle Komaryk –Social Worker- Karen Cooper –Psychiatrist- Dr. Jennifer Russel

11. © Provincial Health Services Authority Measurement: Services Provided by Link Received 108 referrals – accepted 91% others already connected and the patient’s care provider notified. Since August 15 th, 2014 Link has provided services for 98 families Contact patient/family within 2 business days 99% of the time Services provided 88% connected with nurse clinician 13% connected with social worker 5% connected with nurse practitioner 11 patients (11%) urgent non-emergent psychiatric assessment

12. © Provincial Health Services Authority Measurement: Patient Experience Feedback from families and the community has been overwhelmingly positive. When asked about their experience with Link’s over the phone services: Patients and families said: Community partners said: “We felt safe, helped and supported” Link is a great program, I am thankful for the follow-up call Helpful, glad someone followed up Always good…to communicate with community and all partners – clients often present in the emergency department and we are not aware Thank you for everything you did getting us support. Son is doing better now and what you did really made a difference “Amazing you helped my child so much”

13. © Provincial Health Services Authority Patient Experience Survey (n=5) 100% of patients/families responded “definitely” when asked if Link had helped 100% strongly agreed/agreed: –Told about resources –Understood purpose of service –Knew who to contact –Comfortable asking questions –Given answers I could understand –Felt respected

14. © Provincial Health Services Authority Key Messages Without increased cost and assigning new resources, we created a service that has increased the quality of patient care and follow up for mental health presentations to the emergency This process involved working across organizations, regions, and sectors of care. To overcome this challenge, members of the BC Children’s Hospital Emergency Department, BC Mental Health, community partners and families worked collaboratively to design the new process.

15. © Provincial Health Services Authority Contact Information Shawna Wilwand Link Nurse Clinician Email:swilwand@cw.bc.ca Phone: 604-875-2345 Ext 4948 Kristen Barnes imPROVE Facilitator Email: kristen.barnes@phsa.ca Phone: 604-813-7682