full presentation - Med-e-Tel

The CAPTOS Story
15 years of rural professionals’
capacity building through video
conferencing:
How has it happened?
2012
Sue Foley Senior Social Worker MAASW (Acc)
B.Soc.Stud., M.S.W., M.A., M.Ed
The Department of Psychological Medicine
The Children’s Hospital at Westmead
Authors
• (Presenter) : Mrs Sue Foley B.Soc Stud., M.A.,
M.S.W., M.Ed. Ed.D. Candidate Senior Social
Worker and CAPTOS Co-Ordinator
• Assoc Professor Dr Ken Nunn Senior
Consultant Child and Family Psychiatrist
• Associate Professor Dr David Dossetor, MA,
MBBChir, DCH, RRCP, FRCPsych, MD, Child
Psychiatrist
CAPTOS
Child and Adolescent Psychiatry
Telemedicine Outreach Service.
It is sometimes now known as the Child
and Adolescent Psychological Medicine
Telemedicine Outreach Service.
The Department of Psychological Medicine,
• A large child psychiatry
department in the largest
paediatric hospital in NSW
• Links are made by video
conference – some ISDN,
some IP, some telephone
• Links are to CAMHS teams
although other clinicians and
teachers and community
services and paediatricians
may attend.
• Conference room and office
based equipment
The CAPTOS team
• Nine FTE psychiatrists (not at present)
• 14 clinical psychologists, 4 social workers,
OTs, CNCs, pharmacist, 4 registrars
(paediatric and psychiatry)
• Eight bed acute Child and Adolescent
Mental Health Ward
• CAPTOS is included in every staff
member’s job description (approx 25% of
the department work load and budget)
Case conference/
case planning
The CHW
consultation
liaison team
planning an
admission
for a rural
child with
paralysis
?conversio
n disorder
Tele-supervision Models
• Models include:
– Individual: attempts to match profession, interest etc
of rural clinician with CHW clinician
• Maybe telephone or video conference
– Reflective group : usually 2- 4 rural and 2 CHW
– Traditional group: usually 2 – 6 rural and 1 – 2 CHW
– Family therapy group: more structured around family
therapy training
Tele-Education
•
•
•
•
Regular Trauma Think Tank
Specialist Education
Family Therapy Consultation
Collaborative, constructivist and
generative learning
• About to be replicated to support parent
infant therapy practitioners
Rural visits
• Get to know the rural
clinicians
• Get to know the rural
towns
15 years of rural
professionals’ capacity
building through video
conferencing:
How has it happened?
Champions
• Very important to continue to motivate
service providers
• Philosophy is that the service provides
specialist consultations, capacity building
and clinical supervision that supports and
develops regional clinicians.
• That happens through both telepsychiatry
and tele supervisions
• Site visits are magic!
Not always rosy
•
•
•
•
Rural clinicians sometimes overwhelmed!
City clinicians sometimes overwhelmed!
The technology doesn’t always work
The technology can be adversely affected
by weather!
• The paperwork might not arise
• The clinicians may be very basely
untrained
Feedback
• Initial evaluation of psychiatry service led
to ongoing funding (1999 – 2001)
• Ongoing surveys of rural and departmental
clinicians
• Regular feedback from site visits
• Regular discussions with rural coordinators
• Supervision / discussion with service
providers (fairly informal_
Rural Practitioners say
(December 2011)
•
•
•
•
I am more reflective about my practice
I love the “feel Batter Bag technique”.
I approach my team management better
The consultation with psychiatrists means
I have a different perspective on the client
• My case formulation has improved
• I have access to so many more resources
through Captos
In Conclusion
• CAPTOS means that CHW has expanded its
clinical walls to include an important group of
clinicians throughout NSW.
• We are developing clinicians who are more
flexible, less office bound and more ready to
address the needs of the most seriously
mentally ill children.
• Clinicians at CHW are becoming increasingly
aware of the special needs and skills of
clinicians in regional areas.
Commitment
• All the authors are very committed to the
CAPTOS service. They have been
champions of the responsibility of this
funded city service to remain responsive to
the needs, wishes and resource gaps of
our rural colleagues.
• We are direct service providers,
advocates, educators, colleagues and
consultants
Advocacy
• In the past week one rural team, 800km away
from a major hospital was able to consider ways
of working with young people with Asperger’s
Syndrome who are also struggling with
depression and social anxiety.
• Another service who are struggling following the
loss of a local Child and Family psychiatrist were
supported to negotiate with local adult
psychiatrist and CHW staff to ensure that
children in crisis are able to access specialist
services in a timely fashion.
• Telepsychiatry is a well tolerated and
effective means of providing psychiatry
services to remote children and families
• The service can be sustained (and
expand) as an integral part of a
metropolitan service
• The metropolitan clinicians can become
part of the rural teams
• Telesupervision and capacity building
activities are well respected and enjoyable
Publications
1. Dossetor DR, Nunn KP, Fairley M, Eggleton D. A child and adolescent psychiatric outreach service for rural New
South Wales: a telemedicine pilot study. Journal of Paediatrics & Child Health. 1999; 35: 525-529
2.
Gelber H,.Alexander M. An evaluation of an Australian videoconferencing project for child and adolescent
telepsychiatry. Journal of Telemedicine & Telecare. 1999; 5(suppl. 1): 21-23
3.
Ermer DJ. Experience with a rural telepsychiatry clinic for children and adolescents. Psychiatric Services. 1999;
50: 260-261
4.
Kopel H, Nunn K, Dossetor D. Evaluating satisfaction with a child and adolescent psychological telemedicine
outreach service. Journal of Telemedicine & Telecare. 2001; 7(suppl. 2): 35-40
5.
Starling J, Rosina R, Nunn K, Dossetor D. Child and adolescent telepsychiatry in New South Wales: Moving
beyond clinical consultation. Australasian Psychiatry 2003; 11: (suppl. 1): 117-119.
6.
Starling, J. and Dossetor, D. Child and Adolescent Telepsychiatry. Wootton, R and Batch, J. Telepaediatrics:
Telemedicine and Child Health. 2006. London, Royal Society of Medicine Press.
7.
Dr. Jean Starling, FRANZCP, MPH, Ms Sue Foley, B.Soc. Stud., M.S.W., M.A., M.Ed, Senior Social Worker,.
From Pilot to Permanent Service: Ten years of paediatric telepsychiatry.
8.
Bartik W,.Dixon A. Aboriginal and Torres Strait Islander mental health training opportunities in the bush. Auseinet
2005; 2:10-13.
Thank you