1. For Children and Youth

2.  Drivers for Change  Reverse demographics ↑ needs ↓ resources + complexity of needs + complex systems Silo approach

3. Multiple reports outlining the need for ISD Status quo is not an option!

4.  Multiple reports outlining the need for ISD  MacKay Report  Connecting the Dots Report  Ashley Smith Report  Many of the recommendations in these reports referred to the need for Integrated Service Delivery  Clients, families and service providers have difficulty navigating multiple service systems

5.  System inefficiencies – children & youth receiving multiple assessments  Lack of coordination in the assessment, planning and delivery of services  Wait lists and wait times for key services  Criminalization of children and youth with mental health issues

6.  Canadian Statistics:  Up to 20% of youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide  Only 1 in 5 of those receive services  Suicide is the second leading cause of death in youth age 15 – 24 (accounts for 24% of deaths)  Canada’s youth suicide rate is the 3 rd highest in the industrialized world  Mental illness affects people of all ages, educational and income levels, and cultures

7.  An inter-governmental committee was formed with the mandate to develop an integrated Service Delivery Model  Fall of 2010 – two demonstration sites are chosen  Charlotte County  Acadian Peninsula  Commitment to a Province wide roll-out of the ISD model based on the results and learnings from the 2 regional demonstration sites

8. Background: Development of the ISD framework  Evidence informed practices from the literature  Review of internal government reports and evaluations  Consultations with RHAs, School districts, DECs, departmental directors and professional front line staff, NGOs, universities, advocacy groups, national and international experts and site visits  Interdepartmental committees (4 departments) have developed a framework for provincial implementation

9.  From ‘silos’ to ISD:  One file, many perspectives Shared Responsibility = Shared Ownership

10.  Involves the collaboration of four government departments:  Education and Early Childhood Development  Health (Addictions and Mental Health Services)  Social Development  Public Safety  A strength-based, child and youth centered framework  Addresses the needs of children and youth with complex emotional and behavioural concerns

11.  Prevention and earlier interventions  A holistic team-based approach  Bringing services directly to children, youth and their families  Strength-based strategies and the development of a common plan  Continuous case management and follow-up  Wrapping the community around the child/youth  Child, youth and family-centered approaches The right service, the right time, the right intensity

12. The collective impact of partners working together! Child EdDPSA&MHSD

13.  C&Y teams are composed of child and youth professionals with training in psychiatry, psychology, counseling, social work, nursing, mental health and addictions and education/exceptionalities  C&Y team members provide:  Assessment  Consultation  Therapeutic Interventions  Positive mental health strategies/initiatives  Crisis Intervention  Service is provided to individuals, families and groups, in both the school and community

14.  C&Y teams may be comprised of:  School social workers  Education Support Teacher - Guidance  Education Support Teachers - Resource  School psychologists  Addictions and Mental Health Psychologists and Social workers  School Behavior Mentors  Human Services Counselors

15.  Team members from the School Districts maintain their collective agreements and their salaries and expenses continue to be paid by their home departments.  The RHA is responsible for the administration and clinical supervision of the Child and Youth Teams.  Re-assignment agreements are in place between the regional Health Authorities and the school districts and the plan is to continue these.

16.  Children and youth, aged 0 to 21, with identified multiple needs within these core areas of development: Mental Health and Addictions Emotional and Behavioral functioning Educational development Family relationships Physical Health and Wellness

17. Triage &Semi-Weekly Assignment Therapeutic Interventions Further Assessment Ongoing Review and Discussion Feedback to ESST School requests for service Education Support Services Team (ESST) With C&Y Team Member Consultation with C&Y Team Member Crisis/Urgent situation Duty Worker Referral to C&Y Team Consultation / Discussion Planning Skills Intervention Primary Intervention ACCESS TO CHILD & YOUTH TEAM SERVICES

18. 80% 15% 5% Specialized therapeutic services Treatment and support services Universal and prevention services

19.  ISD duty worker assigned daily  Requests for service screened immediately and brought to team for assignment  Assignment based on skill set and capacity  Initial assessment completed and brought back to team for discussion

20.  Each team meets twice weekly  Discuss all new cases  Develop interventions and assign team members  Case review  Triage with psychiatry and psychology  Discuss intensity of services

21.  Each school has an ESST  Teams are composed of:  Administration  EST - Resource  EST - Guidance  C&Y Team Member (new and permanent member)  SLP/Others as required (OT/PT)  Literacy and Numeracy Mentors  Discuss students with academic, behavioural and or emotional concerns

22.  The ESST meets at regular intervals  One of the critical roles is the discussion and planning around school wide prevention strategies  Data based decision making (surveys, statistics, evaluations, etc.)  Opportunity to build on expertise of C&Y team member

23.  School – Main point of access  Public Health  Health care provider  Hospital Emergency Department  Early Childhood Programs  Justice  Other

24.  Prior to ISD, only 4% of the school population would receive MH services. Today – 12% of children and youth in Charlotte and 8% in AP/Alnwick have been seen by C&Y teams.  Client-centered service provision by the Child and Youth Teams. Efficient use of resources through interdisciplinary team work.  Waiting lists for Mental Health services and psycho-educational assessments have decreased.  ISD effectively reduces duplication and redundancies between departments and creates greater coherence in services.  Pre-Post clinical assessment of ISD clients shows significant improvement (decreased Internalizing, Externalizing, and Total Problems as well as increased Adaptation)  Positive feedback from school principals of the involvement of the Child and youth Team members in the schools. Parents report a high level of satisfaction with the services their child or youth received under the ISD model.

25.  Creation of one list of children and youth needing services  Increased requests for services/Greater accessibility  Enhanced skill mix of C&Y teams  Ability to adjust level of intensity of services  Earlier intervention  Greater capacity to provide addiction services  Reduction in stigma associated with accessing services

26.  Enhanced collaboration, case planning, joint service delivery, shared resources  Shared common plan  Enhanced crisis response/Threat risk assessments (VTRA)  Service delivery provided from a strength based perspective  Increased efficiency in service delivery

27.  Roll out the new model in an urban area  Planning underway to expand the two existing sites

28.  The following Evaluation recommendations are completed or presently underway:  Create change Management plan (done)  Complete detailed Implementation plan (done)  Implementation of an electronic case management system (Share-point or CSDS) (in progress)  Significant re-profiling of existing counseling and clinical resources as well other programs and services are required from all departments to accommodate inter-disciplinary teams (in progress)  Bill 23 - Completion of changes in the sharing of information legislation (done)  Sharing of information - development of associated policies, training (in progress)  Stakeholder and partner consultation and engagement process (in progress)  MEC to government on approval for expansion (in progress)