Mental Health and Addictions Care Connections Update May 2013 Susan Lalonde Rankin, MH&A System Coordinator, Waypoint Eric Sutton, Clinical Services Planner, Waypoint

Care Connections Health System Design February 2011 INPUT from: 6,500 individuals 350 professionals 140 organizations

Care Connections RESULT: Care Connections Plan to improve the health System in NSMuskoka  6 Priorities: 1.Complex & Chronic Health 2.In home and Community Capacity 3.Maternal Child Health 4.Mental health and Addictions 5.Medicine 6.Surgery  System Enablers Communications/Community engagement Governance Ehealth Human resources System Navigation Transportation

MH and Addiction Committees

Key issues in Mental Health & Addictions Access – especially for youth Continuity – full range of services Equity – distribution of adult acute care inpatient services Coordination - Standard Tools, Effective Care Practices Integration - Single Intake for Children’s system, Police and crisis response models

Vision: Stepped Care Treatment at lowest appropriate tier Step up if required Level of professional input increases with each tier Evidence based practice at all tiers Recovery orientation

The Vision: Stepped Care Step 0 Public Health, Schools, Social Services, Health services Health Promotion & prevention General population interventions Source: Care Connections Appendix D7 See also Brian Rush, 2010 Tiered Frameworks for planning substance use service delivery systems. Nordic Studies on Alcohol and Drugs

Vision: An integrated regional system of mental health and addiction services that provides effective, efficient quality person directed care in a coordinated, timely, appropriate and accessible way. NSMuskoka LHIN Care Connections Mental Health & Addiction Plan Enhance crisis and community resources Coordinate Regional Acute Care System Increase access for child & youth Goals ER visits by age/ facility - Hospital admission rates by age/facility ER repeat visits <30days by age/facility - Hospital re-admissions < 30 days by age/geography % MH ALC days - Parent and client satisfaction System Indicators DELIVERABLES in PROGRESS ( ) Outcomes TBD - possibly % communities with 24/7 crisis beds Wait times in ER for police # police trained % communities with ER/police protocols TBD possibly: % discharged with plan % follow up with community % seen post discharge within 7 days TBD: Wait times Client outcomes – duration of untreated symptoms, % whose first treatment is via ER, % youth out of region for acute care Standardized interventions Standardized discharge Standardized access - use of extra care beds, care in ER Redistribute inpatient beds to meet benchmarks (21 per 100,000) Improve System Navigation # calls to I&R # calls to agencies Client satisfaction Single point of Information and Referral Coordination and Performance monitoring Single session walk in clinics Midland & Collingwood Crisis intervention training for police & ER protocol Expansion of safe beds SA Crisis Management in ER Early recovery & stabilization after withdrawal Seniors common protocol for clients presenting with dementia Common Screening/ assessment tools (WTFKMH) Hospital and community protocols on crisis and collaborations TIP Implementation (CAMH Service Collaborative ) Adaptation of tools for FNMI (BANAC ) Strategy for Wellness Promotion 0-5 years Provide Single point of intake Proposal for Intensive in home treatment for youth with dual diagnosis Draft May 16, 2013 Susan LR Psychiatric consultation Outreach Psychiatrist Waypoint Meeting Crisis Service Standards Support for youth leaving inpatient (CCAC Nurses) Training for educators (MH Leads )

MH & Addiction Steering Committees -Committee structure increases collaboration between -Hospital and Community -Addiction and Mental Health -Child MH and Adult MH -Health & Education & Social Services -North Simcoe Muskoka LHIN and Child, Youth and Family Coalition Simcoe

Mental Health & Addictions Coordinating Council Chair: Chair Carol Lambie, Waypoint Acute Care Clinical Services Steering Committee (formerly Beds Redistribution Committee) Crisis & Community Resources Steering Committee Chair: Jim Harris, Mental Health & Addiction Services of Simcoe County - CMHA Crisis Training and Police Partnerships Led by Walk In Workgroup Led by Michelle Bergin Catholic Fam. Serv. Substance Use /AOD Strategy Led by Greg Howse, MH & A Services Simcoe Child & Adolescent Mental Health & Addictions Steering Committee Chair: Janet Harris, Waypoint Complex Needs Workgroup Led by Giselle Forrest, Catulpa & Eric Sutton Central Intake Workgroup Led by Eric Sutton & Susan LR Wellness Promotion Workgroup Led by Peggy Govers, SMDHU Interim bed Workgroup No chair presently Intersectoral Collaborations WTFKMH, CCAC Nurses in Schools, FNMI adaptations. Service Collaborative Transition Age Youth Led by CAMH Maternal Infant Child & Youth Coordinating Council Chair: Elisabeth Riley, OSMH Chiefs / Directors of Psychiatry BSS Lead: Val Powell MH Information & Referral Project – Joint project with System Navigation CC Child Youth & Family Coalition of Simcoe County Mental Health & Addictions Care Connections Committee Structure Workgroups for Permanent Committees DRAFT May 21, 2013

Vision: An Ontario in which children and youth mental health is recognized as a key determinant of overall health and well-being, and where children and youth reach their full potential. Provide fast access to high quality service Kids and families will know where to go to get what they need and services will be available to respond in a timely way. Identify and intervene in kids’ mental health needs early Professionals in community-based child and youth mental health agencies and teachers will learn how to identify and respond to the mental health needs of kids. Close critical service gaps for vulnerable kids, kids in key transitions, and those in remote communities Kids will receive the type of specialized service they need and it will be culturally appropriate THEMES INDICATORS Reduced child and youth suicides/suicide attempts Educational progress (EQAO) Fewer school suspensions and/or expulsions Decrease in severity of mental health issues through treatment Decrease in inpatient admission rates for child and youth mental health Higher graduation rates More professionals trained to identify kids’ mental health needs Higher parent satisfaction in services received Fewer hospital (ER) admissions and readmissions for child and youth mental health Reduced Wait Times OVERVIEW OF THE 3 YEAR PLAN starting with Child & Youth - Open Minds, Healthy Minds Provide designated mental health workers in schools Implement Working Together for Kids’ Mental Health Newpath (for Simcoe) 2012 Point in Time (for Haliburton – TLDSB) 2010 Hire Nurse Practitioners for eating disorders program RVH Improve service coordination for high needs kids, youth and families INITIATIVES Implement standardized tools for outcomes and needs assessment Amend education curriculum to cover mental health promotion and address stigma Develop K-12 resource guide for educators Mental health & addiction SC (Aleta Armstrong) Implement school mental health ASSIST program (lead K. Short at HWDSB) & mental health literacy provincially MH literacy training pilot TLDSB Haliburton 2011 with Ont Centre for Excellence Enhance and expand Telepsychiatry model and services Provide support at key transition points Hire new Aboriginal workers Implement Aboriginal Mental Health Worker Training Program Create 18 service collaboratives CAMH Susan LR Expand inpatient/outpatient services for child and youth eating disorders Reduce wait times for service, revise service contracting, standards, and reporting Funding to increase supply of child and youth mental health professionals Newpath 6.5, Kinark 4.5, La Cle 2, FYCS Muskoka 2 Improve public access to service information Pilot Family Support Navigator model Y1 pilot Kinark & Parents for Children’s Mental Health Increase Youth Mental Health Court Workers Provide nurses in schools to support mental health services Agency lead & FTE TBA Implement Mental Health Leaders in selected School Boards TLDSB Suzanne WittFoley SMCDSC Pat Carney Outcomes, indicators and development of scorecard Strategy Evaluation Candian Institute for Health Information CIHI OTHER SIMCOE MUSKOKA INITIATIVES: Student Support Leadership Initiative SSLI ER pathways – potential pilot with -Prov. Council for Maternal & Child Health MCYS one time Transformation funding: Newpath Common Assessment Framework Co-location study crisis services CMHA/Kinark)

Physicians / Primary Health Care Schools (once internal school processes and school outreach efforts exhausted) Other Community Partners (CAS, Justice etc.) Family / Self Referrals Functions Receive and review all referrals to children’s mental health and addictions services, including referrals of children and youth that may be appropriate for adult services such as CMHA ‘s addiction, youth case management, and early Intervention psychosis services, or referrals to Catholic Family Services. Determine if referral meets the basic criteria for one the above and, if not, facilitate referral to other services. Determine severity and urgency of referral by reviewing the agreed-upon screening tool results that will accompany the referral, and by conducting telephone calls of clarification as necessary with the referral source and / or family. Conduct a scheduled brief telephone intake interview, which would include expanded screening questions, risk questions, and an issue conversation. Recommend and implement disposition option. Advise client / referral source of potential access issues related to recommended service (Central Intake would need to maintain awareness of service pressures, wait lists etc.) Forward referral to appropriate program or service of a participating agency, or for supplementary face to face assessment. Advise referral source of intake disposition. Flag potential candidates for “Complex Service Stream” Central Intake / Triage Disposition Options Direct Program Placement If appropriate service match has been determined, the referral goes directly to a program of a participating agency. Full assessment is conducted at the program level. Program provides assessment and program plan results to referring party, along with high level key information back to Central Intake and Triage Program (not Central Intake) provides case management (to be defined) and arranges access to wait list programs or interim supports as required The program conducting the full assessment will be also identify or confirm candidates for Complex Service stream and organized “Combo Team” strategies Additional Face to Face Intake Assessment While an extension of the intake function, this would not be done by the Central Intake/Triage The referral is directed to Kinark, New Path, CMHA or other participating agency for a face to face intake assessment, after which a decision on programming is made Assessment results and disposition recommendations go back to referral source. The receiving agency would connect the client with an alternate agency or service as required and would advise central intake (The client would not be required to go back to central intake). Other Services and Supports Central intake will arrange referrals to alternative programs and supports if formal mental health services are not required. May recommend and facilitate assessments with family physicians, paediatricians, child psychiatrists Central Intake Discussion Document Draft 3 January 24, 2013 Prepared by Eric Sutton Note Re Crisis Connection Some referrals may go directly from the Central Intake to the Kinark Crisis response Some referrals may come from the Crisis Response system once the crisis has been assessed and stabilized.

Child and Adolescent Steering Committee Workplan Overview

Questions? Susan Lalonde Rankin Phone : X 2873