1. Improving Patient Flow Using Groups SYDNEE SWAN, O.T. REG. (MB) JENNIFER PHILLIPS, O.T. REG. (MB) GARY ALTMAN M.D.

2. OUR CLINIC & TEAM Anxiety Disorder Service for Children and Youth (ADSCY) Health Sciences Centre Winnipeg, MB Team: Occupational Therapists Psychiatrists Nurse Therapists Social Worker Interdivisional Student Services Teacher

3. THE BACKGROUND ADSCY moved from St. Boniface Hospital to Health Sciences Centre in 2013 Change of staff Decreased total EFT (Nurse Therapists and Social Workers) Service Delivery Model: Each clinician case managed and provided individual therapy Group therapy occurred on a regular basis Group members were a mix of existing and new clients Groups were provided by clinicians that were available

4. PREVIOUS SERVICE DELIVERY MODEL Centralized Intake C&A Mental Health Inpatient Unit Other C&A Mental Health Clinics Initial Assessment Waitlist Individual and/or Group Therapy Psychiatric Assessment Family Therapy Consult the Interdivisional Student Services Teacher Discharge from Clinic Referral to Different Clinic

5. THE CHALLENGE Summer 2014 ADSCY team was informed that the current service delivery model was not meeting the referral rate, patient flow or target wait time ADSCY team met and discussed possible solutions Team agreed to implement (and “swear allegiance” to) a CBT based group as the clinic’s treatment entry point Occupational Therapists developed the new CBT based group, led and organized its implementation

6. NEW SERVICE DELIVERY MODEL Centralized Intake CBT Group Other C&A Mental Health Clinics C&A Mental Health Inpatient Unit Initial Assessment Waitlist Psychiatric Assessment Referral to Different Clinic Discharge from Clinic Individual Therapy Consult the Interdivisional Student Services Teacher Family Therapy

7. START OF PILOT Fall 2014 Team agreed to trial the proposed service delivery model to be reviewed in Fall 2015 Clients on waitlist were divided into age cohorts Started with 1 group that ran for 10 weekly sessions in October 2014 Progressed to having 2 groups run per season in January 2015 Length and number of group sessions were modified as the pilot progressed

8. PILOT GROUPS (SEPTEMBER 2014- JULY 2015) Total Number of Clients Contacted for Group= 92

9. GROUP OUTCOMES (September 2014 to July 2015) Total number of Clients Confirmed for Group= 60

10. MEASURING SUCCESS  2 Areas of Measurement Patient Flow Outcomes  Number of months on waitlist  Length of treatment period  Number of clients removed from waitlist  Number or rate of discharge as seen through the individual clinicians ability to pick up new clients Client outcomes  MASC-2  Group Goal Sheet  Anecdotal feedback  Discharge rate from group

11. CURRENTLY ADSCY team adopted this service delivery model following the review of the pilot in September 2015 Groups increased to 4 during the fall and the winter (2 in spring and potentially 2 in summer) Maintained wait list times of 4-6 months (dependent on number of referrals and staffing levels) Nurse Therapists began contributing to the completion of the initial assessments in order to increase the number of patients assessed and therefore groups being offered

12. AUGUST 2015 - JANUARY 2016 Total Contacted for Group = 87

13. LESSONS LEARNED Group learning vs. Group therapy Less Sessions within the 9-12 year olds (8 sessions, 1.5 hours) 8 weekly sessions of 2 hours enable group process to occur for age 13 and up Older teens’ anxiety is more entrenched, so require more time to focus on building discrepancies and readiness for change Patients who report not learning strategies in group are often using the knowledge and strategies in their day to day lives

14. SUMMARY 1. A long wait-list for treatment in our service and the strong evidence base of using groups to deliver CBT for anxiety disorders in youth, led to our QI project. 2. The primary objective was to improve patient flow into and through our service. The secondary objective was to i) deliver CBT for anxiety disorders in a group format. ii) improve patient/family knowledge of, and readiness for, individual CBT for anxiety disorders. 3. The new service delivery model resulted in decreased client wait times and shorter treatment duration. Positive client outcomes regarding group treatment were reflected in the client goal sheets and anecdotal feedback. The clients’ and parents’ overall improved understanding and awareness of the client’s anxiety was demonstrated by the Multidimensional Anxiety Scale for Children 2nd Edition t-scores.

15. Gary Altman galtman@exchange.hsc.mb.ca Jennifer Phillips jphillips2@exchange.hsc.mb.ca CONTACT INFORMATION

16. QUESTIONS?