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We are…..

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Our Team Aim

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Interview at CYMH… click on couch

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A story of a youth…. click on grass

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Continue spreading the word

Continue to collaborate

Communication is

› Amongst everyone involved with the youth

To do…

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Thanks to everyone….

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Child and Child and Youth Mental Youth Mental Health – EMR Health – EMR TrialTrialDr. Bruce HobsonDr. Bruce Hobson

ACCESS to Experts and Information

Jana Davidson, MD, FRCP(C)

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Currently a service for Family Physicians and Community Specialists in Vancouver CoastalProvided by Providence Health Care specialists in 10 areasPlan to expand it to include Child and Adolescent Mental HealthProvided by BC Children’s Hospital Child and Adolescent Mental Health Programs – will provide the service provincially for Family Physicians and Community Specialists (Paediatricians)Target start April 2012

RAPID ACCESS TO CONSULTATIVE EXPERTISE “RACE”

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www.keltymentalhealth.ca

1-800-665-1822 or Vancouver 604-875-2084

KELTY MENTAL HEALTH RESOURCE CENTRE

Role of Specialist Physicians

Dr. Rivian Weinerman

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HOW Learn/practice tools Train Mental health System clinicians

WHY

CONTINUITY OF CARE One language, similar tools in Primary and Secondary care

SPREAD Teach to Family Practice/Psych Residents, nursing

students

Successes with this with Adult Mental Health Module VIHA

SPECIALIST PSYCHIATRISTSWhy Should you? How Can You Help?

Revisions to material

Dr. Stan Kutcher

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Auto tally forms – SCARED, SNAP, KADS

DSM-IV for diagnosis

Letters to and from school

Feedback on materials

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Kutcher Generalized Social Anxiety Disorder Scale for Adolescents (K-GSADS-A)

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Teen Functional Assessment (TeFA)

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“We (I) have been able to figure out why Johnny has been having such a tough time. He's been struggling with depression/anxiety/ADHD which is so common in kids and which is so treatable.”

“We can best help Johnny by having the school work together with me. Can I have your permission to involve the school in Johnny’s care?”

“We are working in a new program with the schools and school counselors in a team approach to help kids like your Johnny.”

“They need to know that Johnny is struggling with depression/anxiety/ADHD so that we can start working together

“Would it be ok with you if I let the school team know that Johnny is depressed/anxious/has ADHD so that we can start working together?”

Anti-stigma Approach – Useful Phrases

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A mental disorder is a medical illness diagnosed using

internationally recognized criteria (International Classification of

Disease; Diagnostic and Statistical Manual). It is thought to arise

from a complex interaction between genetic and environmental

factors that impact brain development from the time of conception

and that result in substantial perturbations in brain function,

producing a variety of emotional, behavioral, cognitive, perceptual

and somatic disturbances leading to functional impairment in many

domains of life. Mental disorders usually require treatments from

appropriately trained providers using best evidence based methods.

Synthetic Definition: 2011

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Mental Distress: The expected and usual emotional, cognitive, behavioral, perceptual and somatic response of an individual to external or internal stress. It is a signal that adaptation is required and it attenuates once sufficient adaptation or removal of the stressor has occurred. Mental distress does not require medical treatments and responds to common and usual personal and social mechanism of support.

  Mental Health Problem: Substantial and persistent mental

distress leading to functional impairment but not meeting diagnostic criteria for a mental disorder. It is a signal that adaptation is failing and that extraordinary assistance may be required. Medical treatments are sometimes applied if other methods of amelioration are not proving to be successful.

More Definitions

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Mental Health: Mental health is the ability of the individual to successfully meet the challenges of life and adapt to stress and various life circumstances. It does not mean a lack of distress.

   Mental Health Intervention: Any activity by an individual or

a group designed and appropriately demonstrated to help enhance mental health and possibly prevent mental disorders or negative psychological and social outcomes.

More Definitions (2)

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Mental Health Treatment: A best evidence based

intervention given by appropriately trained and socially

sanctioned providers to individuals with a mental disorder.

Can we stop using these phrases please: mental health

disorder; mental health issue; mental health challenge;

mental health disturbance and can we stop equating all

aspects of social and economic well-being with not having

good mental health

More Definitions (3)

Child and Youth Mental HealthBilling

Dr. Cathy Clelland

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MSP› Counseling (00120)

Maximum 4 services per year per patient – not restricted to patient’s own FP

Minimum 20 minutes, see preamble definition/requirements

› Office Visit (00100) For follow-up that does not meet Pre-amble requirements of

counseling (time &/or nature of visit)

› Group Medical Visits (13763 [3 pts] – 13781 [> 20 pts]) New sliding scale based on number of patients billed per patient Billed per ½ hour or greater portion to max of 3 units per patient Removes individual face-to-face “service” requirement Not included in HVLIP cap calculations

Child/Youth Mental Health Billing Family Physicians

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MSP – Non-face-to-face services› Telehealth Service with Direct Interactive Video Link with Patient

In Office – FP has equipment at office to provide service

o P13037 Telehealth GP in-office Visit o P13038 Telehealth GP in-office Individual counselling (minimum time per visit –

20 minutes – up to 4 per calendar year)o P13041 – Group counseling of 2 or more patients first hour, P13042 2nd hour per

½ hr or greater portion – bill only on one patient

Out-of-Office – FP must go to HA facility to access equipment to provide service

o P13017 Telehealth GP in-office Visit o P13018 Telehealth GP in-office Individual counselling (minimum time per visit –

20 minutes – up to 4 per calendar year)o 13021 – Group counseling of 2 or more patients first hour, 13022 2nd hour per ½

hr or greater portion – bill only on one patient

› Advice about Patient “In Care” (13005) For phone/fax requested by AHP for brief advice.

Child/Youth Mental Health Billing Family Physicians (continued)

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GPSC – fees restricted to FP accepting role of MRP for longitudinal coordinated care of patient for that calendar year› Mental Health Planning Fee (G14043)

Axis 1 diagnoses only 30 minutes face to face planning visit If longer may also bill 00100 or 00120 depending on time and nature

of service (+ 00100 if up to 49 min; or + 00120 if 50 min or more and fulfills counseling preamble requirements)

› Mental Health Management (G14044 – Counseling Equivalent) Maximum 4 services per year per patient once four 00120 used up –

restricted to patient’s FP who billed G14043 Same preamble requirements as 00120

› *Patient Telephone/e-mail Follow-up fees (G14079)

* G14079 – change Jan 1, 2011 – replaces all previous telephone e-mail fees – 14049, 14039, 14069 & 13073

Child/Youth Mental Health Billing Family Physicians

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GPSC – Conferencing Fees – restricted to FP accepting role of MRP for longitudinal coordinated care of pt for that calendar year› Community Patient Conferencing Fee (G14016)

per 15 min or greater portion, max 4 units per day, 6 units per calendar year Conferencing by phone or in person with at least 1 allied health professional

› Urgent Telephone Advice from a Specialist or GP with Specialty Training Fee (G14018) – call within 2 hours due to patient acuity

Telephone Advice Fees – Specialists (SSC – G1000X codes); GPs with Specialty Training (GPSC – G1402X codes)› G10001/G14021 – response within 2 hours

› G10002/G14022 – response within 1 week

› G10003/G14023 – telephone follow-up with patient

› GPSC definition GPs with Specialty Training GPs who has specialty training and who provides services in that specialty area through a health authority supported or approved program.

Child/Youth Mental Health Billing (continued)

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You are Anna’s FP and school counselor has contacted you about concerns resulting in visit to see her in your office.Visit #1 – 20 minute counseling visit – Dx probable Depression 311 (00120 #1)Visit #2 – 30 minute mental health planning visit – Dx 311 (14043 as you are her FP)Visit #3 – e-mail follow up 3 days later (14079 #1)Visit #4 – 25 minute counseling visit Dx 311 (0120 #2)

CYMH Workbook Case – Anna

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25 minute telephone conferencing with school counselor – Dx 311 (14016 X 2 units)

Visit #5 – 20 minute counseling Dx 311 (0120 #3 – error in booklet – listed as counseling #4)

After this, telephone conferencing with school counselor and mental health clinician totaling 30 minutes (14016 X 2 units – total 4 units now billed)

Followed by 3 regular office visit follow ups (3 X 00100) Visit #9 – 25 minute counseling Dx 311 (00120 #4) Visit #10 – regular office visit Visit #11 – 25 min counseling Dx 311 (first GPSC

counseling equivalent 14044)

CYMH Workbook Case – Anna (continued)

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GPs/MOAs› Open Space

Granville Room, South Tower Level 4 OR

› Patient Progress at a Glance: Enhancing clinical care by tracking patient information over timeGulf Islands, North Tower Lower Lobby

Psychiatrists/Pediatricians/MCFD CYMH Clinicians

› Open SpaceGaliano Room, South Tower Level 4

Schools› Open Space

Indigo, South Tower Lobby Level

12: 35 to 1:35 pm Sessions

Lunch

Modified Open Space to Gather Feedback on Future Implementation

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Docs teaching Docs: The gold standard for engagement using Adult Education Principles – Carol Ann Courneya Pavilion Ballroom

Forming a multi-disciplinary team to take action: Facilitation and Team Building Skills – Connie Davis Grand Ballroom D, North tower lower lobby level

Creative Methods for Improvement: Six Thinking Hats and TRIZ – Christina Southey Grand Ballroom C, North tower lower lobby level

1:35 to 2:35 - How to be a better facilitator, mentor, collaborator

Break and Networking

Next Steps

Christina Southey

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What is one thing that would help you to do this work most

effectively?

Report Back

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Evaluation Overview

Hollander Analytical Services Ltd.300 - 895 Fort StreetVictoria, BC V8W 1H7

Tel: (250) 384-2776Fax: (250) 389-0105E-Mail: marcus@hollanderanalytical.com

Presented at:PSP Child and Youth Mental Health TTT2

Prepared by:Marcus Hollander, PhD

January 25, 2012

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Generic Evaluation of the Train the Trainer Process

New PSP Learning Module

TtT #1 TtT #2Action Period

Preparation of Report to Inform

Planning for Action Period and TtT #2

Module Roll Out

GP Champs Pre-TtT Survey

(establish baseline at beginning of TtT#1)

Everyone in Attendance: TtT#1 Survey

(at end of TtT#1)

GP Champs Action

Period Data Collection

Everyone in Attendance:

TtT #2 Survey (at end of TtT

#2)

Module Evaluation After Roll

Out

Preparation of Final Report of

TtT process

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Evaluation Design for the Child & Youth Mental Health Learning Module

Simple Data Collection: The Data Tracking ToolKey

Indicators

Learning Module

Evaluation

Action Period 1

Learning Session 2

Action Period

2

End of Module

Survey3 (End of LS3)

Follow Up Survey4

1 To be administered to GPs, MOAs, School Counsellors

2 Option, with informed consent, for GPs to provide practitioner number to monitor progress over time for research purposes. GP data will be treated in strict confidence and all data will be presented in an aggregated manner.

3 In addition to GPs, MOAs and School Counsellors, this will include specialists and other community based professionals who attend the learning module as attendees or advisors

4 GPs Only

Follow Up

Learning Session

1

Baseline Survey1,2

(Beginning of LS1)

Learning Session 3

Patient Experience Survey. For CYMH Use

the CGI

Stan’s Reflections

Dr. Stan Kutcher

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Cases

KADS6 Scores - Senior, Female

0

2

4

6

8

10

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Baseline Month 1 Month 2

Wrap-Up

Dr. Garey Mazowita

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? More content on conflict resolution Only MRP can bill GPSC fees….? The future How to strengthen working relationships between schools

and GPs, esp for “unattached” students What about GPs “in” schools?

Questions……

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Respond to parking lot questions Summarize the results from the Open Space Sessions Teleconferences for Schools and MCFD Child and Youth

Mental Health Services Revise materials based on your feedback and evaluation Hold pilot sessions in volunteer communities Further revise materials based on pilot sessions

Next steps