View the slides - The Werry Centre

Primary Mental
Health
A working model of
integrated care
What do we do at the Youth
Health Hub ?
We provide a range of child and youth
health
Sector
Leadership
and youth development services through a multidisciplinary team, working in collaboration with
partner agencies and an extended provider
network to meet the needs of young people and
their families throughout the Waitemata District.
•Youth health
Advice
•Workforce
Development
HealthWEST
Te Puna Manawa
The Youth Health Hub Team
Tania Wilson – Clinical Director
Tanya Mulholland - Your Choice/Youth Clinic Administrator
Justine Leef – Service Manager
Jess Durston- Your Choice Administrator
Leilani Fata - Administrator
Natasha Wilson – Administrator
Mo Harte – Nurse Practitioner
Dave Hawkridge –Registered Nurse
Elizabeth Johnston – Social Worker/Programme Manager
Junior Tavai – Social Worker/Practice Advisor
Christine Cammell – Nurse Educator
Mandy Milne – Registered Nurse
Jodie Smith – Registered Nurse
Cherrill Rave – Youth Development Lead
Neli Alo, Youth Development Worker
Tony O’Rourke, Youth Development Worker
Jaime Speeden – Youth Physician/Psychiatrist/Paediatrician
Deb Gray – Clinical Psychologist
Nicole Robertson – Clinical Social Worker/Family Therapist
HealthWEST
Te Puna Manawa
School Based Clinics
Victoria Bland - GP
Holly Shine - GP
Glenn Doherty - GP
Kate Harrison - GP
Alita Neria – GP
Courtney White - GP
Contract /Visiting Clinicians
Youth Clinic
Tania King, AoD Worker (0.2), Odyssey
Sue Wilson, Public Health Nurse (0.2)
Oliver Rook , Psychiatrist (0.1) Marinoto
Carly Poi, Mental Health Clinician/OT, Marinoto
Your Choice
Various Providers in the Waitemata district
Service components
Enhanced Youth
Health Clinics
with
Health
Promotion
Te Puni Kokiri –
Rangatahi Suicide
Prevention
Project
Youth
Engagement
Sector
Leadership
Youth
Health
Hub
Primary Mental
Health Services
Choice Plus
•Youth health
Advice
•Workforce
Development
School
Based Health
Services
AE Cover
GP Clinics
Nursing Practice
Primary Mental
Health Services
Your Choice
HealthWEST
Te Puna Manawa
Oversight
Primary Mental Health
Service
Purpose
Primary Mental
Health
“Your Choice”
Provide Primary Mental Health via the coordination/provision of
packages of care to youth (10 – 24 years) with mild to moderate or
complex mental health and AOD issues that do not require
intervention from secondary mental health services. Joint triage
with MH secondary services
Primary Mental
Health
“Choice Plus”
Reduce the number of non urgent referrals for young people
(aged 5 – 19 years ) by providing initial assessments and brief
intervention as required or package of care if additional support is
required. Attendance at Marinoto daily triage.
Enhanced
Community Youth
Clinic
Deliver a specialised youth health service for young people with
chronic health conditions, behavioural issues, mental health and
other complex issues. Prioritising Maori, Pacific and underserved
young people between the ages of 10 – 24 years.
HealthWEST
Te Puna Manawa
HELP !! - Choice Plus is hatched...
• Late 2014 Marinoto North CAMHS experiencing a 62%
increase in referrals
• Implemented CAPA utilising Choice Assessments
• Our Hub PMH programme was also experiencing an increase
• Increased population in the North & Rodney district
• Urgent response was needed
• Initiated a pilot service Dec 2014 – April 2015 (fee for service)
• A further request received Dec 2015 ( FTE based funding)
• Current service commenced 18 Jan 2016
• Contract extended until 31 Dec 2016
HealthWEST
Te Puna Manawa
The Choice Plus Service -The Model
• The CAPA model underpins the Choice Plus service. Aim to
minimize wait-times
promote full booking
manage workload flow.
• The design of the service has also incorporated the values and
other elements of CAPA.
Key to this model is ensuring the young person and their family understand the
process in entering in to service, and that the clinician understands the
expectation of the client and agreement is reached on the decision whether
further intervention is needed
HealthWEST
Te Puna Manawa
Service Pathway & Options
• Referrals received from attendance at Marinoto North daily
triage
• Choice Plus appointments incorporating a Choice session plus
a comprehensive mental health assessment.
• Brief intervention
• Utilizing a package of care M2M or Complex
• Entering into Partnership with Marinoto (if needs require
this).
• Referral to the Youth Health Hub
• Or other options if appropriate
HealthWEST
Te Puna Manawa
Referrals & eligibility for Service
Monitoring period 18 Jan-10 May 2016
• # referrals received = 176 referrals
By 30 June 2016
• # referrals received = 225 referrals
Eligibility
• Mild to moderate/complex
• Not acute
• Not requiring a psychiatric evaluation &/or medication review
HealthWEST
Te Puna Manawa
Capacity
• The demand is based on the number of referrals received
from Marinoto North (av 6 - 10 referrals/wk)
• Targeted referrals - mild to moderate end level due to
clinician capability extend to complex presentations.
• Complemented by the collaborative relationship with
Marinoto should psychiatric advice be needed or Partnership
intervention.
• Developing a shared care pathway options with Marinoto
which will include involvement of GP’s in overseeing
medication options.
HealthWEST
Te Puna Manawa
Capacity
• 18 contact appointments included Choice Appointments and
Brief intervention
• Initially 20 M2M Packages of care + 5 Complex Packages of
Care
• HONOSCA scores confirmed that further intervention was
needed so we received a further 50 POC
HealthWEST
Te Puna Manawa
Capability - Skill Mix
“Right skills for the right need”.
Key strength - Experienced Child and Adolescent Mental
Health Clinicians.
•
FTE 0.8. Clinical Psychologist
•
FTE 0.4 Clinical Social Worker/Family Therapist
•
FTE 0.6 Administrator
Contracted Providers for Packages of Care (link to our Your
Choice Programme)
HealthWEST
Te Puna Manawa
Presenting Issues
Anger
Anxiety
Behaviour Issues
Low Mood/Depressed
11%
19%
9%
20%
25%
16%
Self-harm
Other
Age of Clients (n=176)
5 -10
11--14
15-19
30%
47%
23%
HealthWEST
Te Puna Manawa
Service to Service Performance
Wait times Between Referral Received by Marinoto to transfer to HealthWEST
< 5 days
< 3weeks (21days)
>3weeks < 8 weeks
1%
4%
8%
87%
HealthWEST
Te Puna Manawa
>8weeks ( 56 days)
Service Performance
Wait-times Referral to HealthWEST to Choice Appointment
< 5 days
< 3weeks (21days)
>3weeks < 8 weeks
1%
25%
36%
38%
HealthWEST
Te Puna Manawa
>8weeks ( 56 days)
Number of Clients Seen & Reasons Not
Seen (n=134/176)
1%
6%
4%
2%
Declined
4%
DNA
7%
To Marinoto for Ax
No response
Awaiting confirmation of appts
76%
Appoinment confirmed
Clients Seen
HealthWEST
Te Puna Manawa
Post Choice Appointment HONOSCA
Ratings
0-5
6.-10
11+
12%
28%
60%
HealthWEST
Te Puna Manawa
Choice Point Agreed Outcomes
60
50
40
30
20
10
0
HealthWEST
Te Puna Manawa
Service User Satisfaction – Young Person
HealthWEST
Te Puna Manawa
Service User Satisfaction – Family /Whanau
HealthWEST
Te Puna Manawa
More Feedback............
HealthWEST
Te Puna Manawa
Our Strengths
• The existing relationship with Marinoto
• The service was an extension of an existing primary MH &
youth health Hub
• Access to psychiatric consult – Marinoto shared care
pathway/YHH
• Backing from an MDT (The Hub)
• CAPA/Choice knowledge
• Experienced clinicians
• Location/community based premise
HealthWEST
Te Puna Manawa
Our Challenges
• Uncertainty of funding
• Funding models for primary care (PC vs MH commissioning
frameworks)
• Being an NGO in the Primary Care arena !!
• Limited flexibility in funding
• Retention of the clinicians when tenure of employment
cannot be guaranteed.
• Small team – so backfill for PD & Leave difficult
HealthWEST
Te Puna Manawa
Our Learning's
• Highlights the value of a strong partnership secondary service and a
primary service to extend capacity
• By actively using our current resources in an integrative manner we
can increase the access for children and youth decrease wait-times
and broaden our skill mix
• Provided an opportunity to develop infrastructure for integration
between primary and specialist services.
• Contributed to positive patient experience.
• Averted young people and their family needing to access a
secondary MH service unnecessarily
• Specialist Primary MH Care has a role to support early intervention
• Choice can be used at a PC/NGO if the clinicians have the right skills
HealthWEST
Te Puna Manawa
Acknowledgement – The team Deb, Nicole & Tanya
Tania Wilson
[email protected]
HealthWEST
Te Puna Manawa