Patrick McGrath

Distance Mental Health Services
Patrick J. McGrath, OC, PhD, FRSC, FCAHS
CEO Strongest Families Institute
VP Research and Innovation, IWK Health Centre CDHA
Canada Research Chair, Professor of Pediatrics, Psychiatry and Community
Health and Epidemiology, Dalhousie University
Patricia Pottie RN PhD
President and Chief Operating Officer
Strongest Families Institute
Adjunct Professor of Psychiatry
Dalhousie University
The Problem
1. Mental health problems begin
early, are common and costly
2. Poor access to services
3. High dropout rates
4. Little quality control
5. System inefficient, unable to serve
all who need it
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Increase access to services
Reduce dropout rates
Embrace quality control
Make system efficient
Scalable
Family and Patient Centred
 Respect and dignity
 Listen to and honour patient and family perspectives and
choices.
 Knowledge, values, beliefs and cultural backgrounds are
incorporated into the planning and delivery of care.
 Information Sharing complete and unbiased
 Participation participating in care and decision-making at the
level they choose
 Collaboration collaborate with patients and families in policy
and program development
http://www.ipfcc.org/ Institute for Patient and Family Centred Care
Anxiety Module
Coaches
•Work till after midnight
•Bright, capable, personable
•Demonstrate excellent
communication skills
•Calls digitally recorded for quality
assurance
•Attuned to treatment and risk
management protocols
Coach’s role is to:
• Reinforce information learned
• Problem-solve with
parent/child
• Encourage and support family
Percentage successful Treatment vs. Control
ODD Trial: 3-7 years (n=80)
Percentage
Successful
ODD N=80
*χ² 7.09,
p=0.01
*χ² 4.33,
p=0.04
χ² 2.37,
p=0.12
100
Usual care
50
Treatment
0
120 Days
240 Days
365 days
Percentage successful Treatment vs. Control
ADHD Trial: 8-12 years (n=80)
Percentage
Successful
ADHD N=72
100
χ² 2.43,
p=0.12
*χ² 4.57,
p=0.03
*χ² 4.38,
p=0.04
Usual care
50
Treatment
0
120 Days
240 Days
365 days
Percentage successful Treatment vs. Control
Anxiety Trial: 6-12 years (n=80)
Percentage
Successful
Anxiety N=90
χ² 1.07,
p=0.30
*χ² 5.00,
p=0.02
*χ² 4.01,
p=0.04
100
50
Usual care
0
120 Days
240 Days
365 days
Assessment Times from Baseline
Treatment
Before/after t scores on BCFPI
starting with t>65 (Total n=1190)
100
90
80
70
60
50
40
30
20
10
0
98%
50%
Before
After
Before/after t scores on BCFPI
starting with t>65 (Total n=1190)
90
80
98%
70
60
50
50%
Before
40
After
30
20
10
0
Social (609)
School (299)
Family Function
(892)
Parent mood
(309)
Strongest Families Satisfaction
600
89%
.
500
76%
77%
76%
73%
77%
72%
64%
62%
400
Excellent
Very Good
300
Good
Fair
Poor
200
100
0
Location
convenient
Time on WL Service time of Staff Courtesy Information re
Useful
day
Problem
Techniques
Particiapation Helpfulness of Overall Quality
in Planning
Service
Scalability
• Scaling up is not easy
– Build organization (business people!!!)
– Insure sustainability
– Not for profit or for profit?
• Major systems
–
–
–
–
–
Quality control
Efficiency
StaffTraining
Management of staff
Selling program to government
Begin M, Eggertson L, Macdonald N. A country of perpetual pilot
projects. CMAJ 2009;180;1185
Funding from CIHR included: Dr. McGrath’s CRC, 2Team Grants,
Current RCT and KT Grant to set up Institute, other grants to develop
new modules