Newfoundland & Labrador: Overview and Observations of Services for Autism, Eating Disorders, and General Mental Health Conditions Patricia Conrad, PhD May 27, 2014

Outline Purpose, Research Questions, Methods, Products Autism Eating Disorders General Mental Health Services Observations

Purpose and Products Compile observations about services delivered in each of the four Atlantic Provinces for the five conditions under consideration. As a baseline activity to support the research projects to be undertaken, three separate inventories of services for children and youth with autism, eating disorders, and general mental health services were compiled. Inventory of key provincial documents assembled. Each of the inventories will support various research projects to be undertaken for each condition. Summarize observations and make suggestions about possible research projects

Research Questions What health and community-based services are available for children and youth with an autism spectrum disorder in NB, PEI, NS, and NL? What health and community-based services are available for children and youth with an eating disorder in NB, PEI, NS, and NL? What health and community-based services are available for children and youth with anxiety, conduct, or depression disorders in NB, PEI, NS, and NL? What are the key observations and findings for each condition? What are suggested next steps?

Research Methods and Approach Approach was nonreactive and unobtrusive – Information gathered was extracted from documents and websites where the original intent may have been different e.g., informing patients, providers, general public – The organizations were not aware their information was being compiled since there was no contact or exchange – Caution must be exercised because this research relied only on information available in the public domain including websites, annual reports, strategic plans, accountability reports, service standards, patient guides and resource lists, evaluations, etc. Limitations – No validation or assessment of information credibility through discussion with key informants. – No clarification was sought to interpret meaning or content from the providers of services.

Inventories Annotated inventory of provincial documents related to the five conditions compiled by province. – Of particular interest, was whether any provincial evaluations or studies are available for any of the conditions? Master list of services for Autism Spectrum Disorder – Organized by province Master list of services for Eating Disorders – Organized by province Master list of services for General Mental Health Services for Children and Youth – Organized by province

PowerPoint Presentations Overall observations and research suggestions – Organized by province and by disorders Summary and overview of findings and observations for each province – New Brunswick, PEI, Nova Scotia, Newfoundland and Labrador Summary and observations of services for Autism Spectrum Disorder – Organized by province Summary and observations of services for Eating Disorders – Organized by province Summary and observations of services for General Mental Health Services for Children and Youth – Organized by province

Various Strategies, Evaluations, Reviews and Expertise in NL Annual Reports by Child and Youth Advocate Landmark reports e.g., Sixteen (2103); Clinical Services Review (2008) Special Investigations by Child and Youth Advocate e.g., Janeway Psychiatry Unit (2010) Eating Disorders Interprofessional Community Capacity Building (EDICCB) Project – Lead Researcher Dr. Olga Heath, Counselling Centre, Student Affairs and Services, MUN

Various Strategies, Evaluations, Reviews and Expertise in NL Autism Society of NL Strategic and Advocacy Plans – Elaine Dobbin Centre Autism Society needs assessment conducted in 2012 Consumers’ Health Awareness Network Newfoundland and Labrador (CHANNAL) Specific government policies and strategies – Model for Coordination of Services to Children and Youth (2011) – Office of Youth Engagement and Community Youth Network

ASD Service Delivery in NL Intervention consists of Direct Home Services Program and Community Behaviour Analysis Program Direct Home Services – Delivered by Health Regions at no cost – Child Management specialist make home visits Intensive Applied Behavioural Analysis is component of Direct Home services program – RHA Child Management Specialists with specialized clinical training deliver this service within the home and community sites Community Behavioural Services – Delivered by Health Region staff called Behaviour Management Specialists to school-aged population, voluntary participation

NL Provincial Support Programs for Persons with Disabilities Provincial Home Support Program Special Child Welfare Allowance Program – Provides assistance with the cost of services/supports to families with a child (under 18 years) who has a physical or intellectual disability living at home Residential Options – Residential options are available to adults with disabilities who meet program criteria and are unable to reside with the natural family.

Eating Disorder Services in NL (1) Central Intake for Children and Youth at Janeway Renata Elizabeth Withers Centre for HOPE – Interdisciplinary program committed to helping change eating disorder symptoms, challenging thoughts and behaviors, and developing new means of coping with everyday stressors. Adolescent Mental Health Counseling: – individual, group and family counseling is provided to youth 12-18, referred exclusively by Child, Youth and Family Services and Corrections

Eating Disorder Services in NL (2) Eating Disorders Interprofessional Community Capacity Building (EDICCB) Project – Lead Researcher Dr. Olga Heath, Counselling Centre, Student Affairs and Services, Memorial University Body Image Network The Eating Disorder Foundation of Newfoundland and Labrador – Leadership advocacy group dedicated to promoting research and providing public support services and information about matters related to eating disorders, including information on available treatment services for individuals and families who experience disordered eating. The regional health authorities offer mental health services through a number of offices – Role with respect top Eating Disorders is not known Canada Eating Disorder Addiction Treatment publishes a list of therapists for NB, PEI, NS, NL

General Mental Health Services in NL Janeway Services – Centralized intake – Short Stay Assessment Unit - 7 acute care beds – Day treatment - 6 patients – Outpatient programs – Bridges Program – rapid and brief intervention Central Health Region delivers mental health services through teams based in various community sites Western Health Region – Adolescent mental health unit – Early psychosis program – Teams distributed throughout region that delivery general mental health services Youth Services Program (Dept of Child, Youth and Family Services) – Assists at-risk young people, age 16 and 17, in making successful transition to adulthood. – Provides social work intervention and services – Can be either residential or non-residential.

Observations for NL - 1 Eating disorder research, treatment and advocacy are advanced but there is availability of service in rural areas is not known Janeway and Western Health Region have inpatient units for children and youth mental health – Role with respect to Eating Disorders is not known Robust model of regionally based delivery of services for ASD with integrated levels of intervention and support Elaine Dobbin Centre for Autism ensures high profile is upheld for ASD population

Observations for NL - 2 Child and Youth Advocate occupies an influential role in drawing attention to deficits in mental health services for children and youth e.g., Sixteen report The geography presents challenges in the delivery of general and specialized services such as eating disorders – Variation among regions and accessibility is uneven Janeway appears to have limited inpatient (7 beds) and day patient (6 patients) capacity

Observations for NL - 3 Pediatric units with special expertise in mental health are not available in every health region Access to pediatric psychiatry is limited No provincial guidelines for mental health services were identified Proposed treatment centre for youth with complex needs under development in Gander Unknown the extent to which the school system is with mental health and ASD Government has established Mental Health and Addictions Advisory Council – Attention to services for children and youth is not known