Presentation - Hamilton Family Health Team

Our Journey in Addressing
the Mental Health Needs
of Paediatric Populations
FHT’ing the Mental Health Puzzle Together
FHT Mental Health Networking & Education Days
April 30, 2015
“Let’s start at the very beginning. A very good place to start.”
(Maria Von Trapp)
http://www.wattif.ca/2014/03/24/the-journey-starts/
Child and Youth Mental Health Program
• June 2006 – HFHT Child and Youth Mental Health Initiative
was born
• With the start of this initiative, began an intentional focus on
the clinical needs of paediatric populations within the HFHT
• As a first point of contact for children, youth and families,
family physician offices are better able to support individuals
before minor challenges become life long issues
• Initial purpose was to enhance support to children, youth and
their families experiencing emotional, behavioural or social
difficulties
C&Y MH Initiative
Increase
Capacity
Increase Early
Identification
Provision of
Care
Timely Access
Overall Goals and Objectives of C&Y
MH Program
1.
Increase Capacity
– Consultations provided to IHP’s as requested (direct/indirect
consultations and C&Y MH Hotline)
– Provision of up-to-date information/professional development
around C&Y MH (MHC Meetings, L&L’s, CoP, website)
– Intentional hiring of new MHC’s with experience and/or
expressed interest in working with children, youth and their
families
– Access to child and youth psychiatrists through our Centralized
Psychiatry Program (interim specialized counselling support also
offered)
Overall Goals and Objectives of C&Y
MH Program Continued
2. Increase Early Identification
– C&Y MH Questionnaire completed for all children and youth
accessing MH services within HFHT (assesses inattention,
anxiety – general and separation, depression, conduct and
impulsivity)
– Other screening measures utilized as appropriate (SNAP IV,
SCARED, PHQ-9 Adolescent Version etc.)
– Well Baby, Well Child and Well Teen Visits (identified
practices)
– Team Unbreakable and Growing Up With Worries Groups
Overall Goals and Objectives of C&Y
MH Program Continued
3. Provision of Care
– MHC’s provide individual and family therapeutic support
to all demographics. Support provided as needed.
– Clinical groups – Growing Up with Worries, Team
Unbreakable & Social Anxiety for Young Adults
– C&Y MH Consultations (psychiatric and social work)
Overall Goals and Objectives of C&Y
MH Program Continued
4. Timely Access
– C&Y MH Consultations
– C&Y Centralized Psychiatry Program
– Increase MHC knowledge of community
resources
– HFHT clinical groups programming
Future Directions …
• Increase offerings of clinical groups for children, youth and parents:
• Film Therapy
• Growing Up With Worries (expanded version)
• Social Anxiety for Youth (youth focused materials)
• Inattention and Impulsivity Workshop for parents
• Coping Skills Group for Adolescents (DBT interventions)
• Youth Peer Support Group
• Community Partnerships around Team Unbreakable, Coping Skills
Group and Youth Peer Support Group
• Continue to build knowledge and capacity of all primary care
providers in the area of C&Y MH
• Continue to build C&Y MH capacity with new hires
HFHT Groups
https://socialpsychologyeye.wordpress.com/2011/04/05/why-do-we-join-groups
Growing up with Worries
General Overview
• Two session parent education group which helps parents
learn how to support their child/youth in coping with worries,
fear and anxiety
• Topic covered include:
• What is anxiety
• The many faces of anxiety and examples
• How to encourage courageous vs anxious behaviours
• Managing anxiety problems at school
• Steps to realistic thinking
• Review of anxiety resources, books and provide handouts and
tip sheets
Growing up with Worries
General Client Feedback:
• ‘Overall positive feedback (73% found information presented
as being very useful while the remaining 27% of participants
found the information presented as somewhat useful).
Respondents indicate they learned some of the following from
attending the group:
• ‘I learned that I need to control my own anxiety before I can
help my child.’
• ‘I am not alone, others have same issues.’
• ‘Different types of anxiety and strategies to help my child deal
with them (fear ladder).’
• ‘I learned to watch for triggers and ways to ease my son’s
worries using different tools.’
Growing up with Worries Evaluation
Moving Forward
• Changes based on feedback from group participants:
• Change the structure of the group (more than 2 sessions)
• Increase opportunity for greater group discussion
• Explore more immediate strategies and techniques for
parents/caregivers to utilize in an effort to help their child
manage anxiety
• Have a group for children/youth to attend
• Consider the value of providing a group for children and
another for youth (specific to developmental stages)
Social Anxiety for Youth
General Overview
• Therapeutic group for youth ages 14-18 years. Please note:
this group was a pilot based on the available Social Anxiety
for Young Adults group
Topics covered:
• Cognitive Behavioural Therapy
• Exposure Therapy
• Listening and Nonverbal Skills
• Assertiveness Skills
• Interviewing, Meeting New People, Dating and Public
Speaking
• Planning for the Future
Social anxiety for Youth
General Feedback
• Overall satisfaction with the group (87.5% somewhat or very
satisfied, 100% would recommend the group to others)
• Comments on how the group could be improved (better
attendance of members, have more engaging activities, gear
information toward teenagers as opposed to young adults,
offer the group earlier in the day).
• Other comments (‘it is fairly fun,’ ‘no pressure at all and
everyone is understanding,’ ‘more helpful than I thought it
would be’ and ‘can’t wait for the next one!’
Social anxiety for Youth
Moving Forward
• Creating a new, more youth friendly manual utilizing engaging
mediums to enhance learning such as film clips and
encouraging group discussions
• Increasing opportunity for discussion during sessions (less
pen/paper activities)
• Provide a framework which is client driven (i.e., less structure
in pre-planned sessions – deliver preplanned material (CBT,
hierarchies etc.) in response to ongoing client input
throughout group process (flexible schedule of topics
covered).
Team Unbreakable
General Overview
• Therapeutic Adolescent Running Group for youth aged 14-18 years.
• No experience with running necessary
• Based on mounting evidence supporting physical activity as an
important component to effective treatment of mental health
disorders
• Group meets twice weekly for a total of 10 weeks.
• Youth train for a community led 5K run
• Clinical focus on such areas such as enhancing interpersonal skills,
social connections, increasing personal self efficacy and resiliency
skills and optimizing the team experience for participants
• In partnership with CameronHelps.ca
Team Unbreakable
General Feedback (2013/2014 groups)
• Youth experienced a 100% reduction in symptoms of depression
while 83% experienced a reduction in symptoms of anxiety.
• 100% of members would recommend the group to others.
Historically we have had several youth return to participate in
multiple offerings of the Team Unbreakable group.
• What was the most valuable thing(s) you got from the group? ‘It
taught me how to re-establish my sense of self,’ ‘that there are a lot
of people who go through the same thing as me,’ ‘It’s not your
fault,’ ‘the link between actions, feelings and thoughts. The
difference between real thoughts and depressive thoughts,’ and ‘I
met nice people to talk to and be friends with.’
Team Unbreakable
Moving Forward
• We are currently working with the Lead Agency (Children’s
Mental Health Centre) as well as a community based hospital
program in partnership around 3 of our clinical groups in an
effort to enhance community agency collaboration and
increase accessibility for children, youth and caregivers.
• Revisions to the group clinical materials is a current focus
based on evidence based practices, client feedback and
facilitator experience.
Questions & Group Discussion
Contact Information:
Peter Evans – Mental Health Counsellor & Group Facilitator:
[email protected]
Tamara Grundland – Mental Health Counsellor and Group Facilitator:
[email protected]
Kelly Ironside – Mental Health Counsellor & Group Facilitator:
[email protected]
Cynthia Robinson – Child & Youth Mental Health Coordinator:
[email protected]
Thank you!!!
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C&Y MH General Screening Questionnaire – Caregiver http://hamiltonfht.ca/docs/public/child-youthquestionnaire----caregiver.pdf
C&Y MH General Screening Questionnaire – Youth http://hamiltonfht.ca/docs/public/mental-healthyouth-questionnaire.pdf
SNAP-IV Teacher and Parent Rating Scale http://hamiltonfht.ca/docs/public/adhd-snap-iv-ratingquestionnaire.pdf
SCARED – Parent Version http://hamiltonfht.ca/docs/public/scaredparent-final.pdf
SCARED – Child Version http://hamiltonfht.ca/docs/public/scaredchild-final.pdf
PHQ-9 – Adolescent Modified Version http://hamiltonfht.ca/docs/public/adolescent-phq.pdf
The future belongs to those
who believe in the beauty of
their dreams
Eleanor Roosevelt