INTEGRATED SERVICE

DELIVERYFor Children and Youth

A CASE FOR CHANGE Drivers for Change

Reverse demographics ↑ needs ↓ resources

+ complexity of needs + complex systems

Silo approach

A CASE FOR CHANGEMultiple reports outlining the need for ISD

Status quo is not an option!

A CASE FOR CHANGE Multiple reports outlining the need for

ISDMacKay ReportConnecting the Dots ReportAshley Smith Report

Many of the recommendations in these reports referred to the need for Integrated Service Delivery

Clients, families and service providers have difficulty navigating multiple service systems

A CASE FOR CHANGE System inefficiencies – children & youth

receiving multiple assessments Lack of coordination in the assessment,

planning and delivery of services Wait lists and wait times for key services Criminalization of children and youth with mental health issues

A CASE FOR CHANGE Canadian Statistics:

Up to 20% of youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide

Only 1 in 5 of those receive servicesSuicide is the second leading cause of death

in youth age 15 – 24 (accounts for 24% of deaths)

Canada’s youth suicide rate is the 3rd highest in the industrialized world

Mental illness affects people of all ages, educational and income levels, and cultures

GOVERNMENT’S RESPONSE An inter-governmental committee was

formed with the mandate to develop an integrated Service Delivery Model

Fall of 2010 – two demonstration sites are chosenCharlotte CountyAcadian Peninsula

Commitment to a Province wide roll-out of the ISD model based on the results and learnings from the 2 regional demonstration sites

GOVERNMENT’S RESPONSEBackground: Development of the ISD framework Evidence informed practices from the literature

Review of internal government reports and evaluations

Consultations with RHAs, School districts, DECs, departmental directors and professional front line staff, NGOs, universities, advocacy groups, national and international experts and site visits

Interdepartmental committees (4 departments) have developed a framework for provincial implementation

A NEW APPROACH From ‘silos’ to ISD:

One file, many perspectives

Shared Responsibility = Shared Ownership

WHAT IS INTEGRATED SERVICE DELIVERY? Involves the collaboration of four

government departments:

Education and Early Childhood Development Health (Addictions and Mental Health

Services) Social Development Public Safety

A strength-based, child and youth centered framework

Addresses the needs of children and youth with complex emotional and behavioural concerns

WHAT IS INTEGRATED SERVICE DELIVERY? Prevention and earlier interventions A holistic team-based approach Bringing services directly to children, youth

and their families Strength-based strategies and the

development of a common plan Continuous case management and follow-up Wrapping the community around the

child/youth Child, youth and family-centered approaches

The right service, the right time, the right intensity

INTERATED SERVICE DELIVERY

The collective impact of partners working together!

Child

Ed

DPS

A&MH

SD

CHILD AND YOUTH TEAMS C&Y teams are composed of child and youth

professionals with training in psychiatry, psychology, counseling, social work, nursing, mental health and addictions and education/exceptionalities

C&Y team members provide: Assessment Consultation Therapeutic Interventions Positive mental health strategies/initiatives Crisis Intervention

Service is provided to individuals, families and groups, in both the school and community

CHILD AND YOUTH TEAMS C&Y teams may be comprised of:

School social workers Education Support Teacher - GuidanceEducation Support Teachers - ResourceSchool psychologistsAddictions and Mental Health Psychologists

and Social workersSchool Behavior MentorsHuman Services Counselors

CHILD AND YOUTH TEAMS Team members from the School Districts

maintain their collective agreements and their salaries and expenses continue to be paid by their home departments.

The RHA is responsible for the administration and clinical supervision of the Child and Youth Teams.

Re-assignment agreements are in place between the regional Health Authorities and the school districts and the plan is to continue these.

ELIGIBILITY CRITERIA Children and youth, aged 0 to 21, with

identified multiple needs within these core areas of development:

Mental Health and AddictionsEmotional and Behavioral functioning

Educational developmentFamily relationships

Physical Health and Wellness

Triage &Semi-Weekly AssignmentTherapeutic Interventions

Further AssessmentOngoing Review and Discussion

Feedback to ESST

School requests for service

Education Support Services Team (ESST)

With C&Y Team Member

Consultation with C&Y Team Member

Crisis/Urgent situation Duty Worker

Referral to C&Y TeamConsultation / Discussion

Planning Skills Intervention

Primary Intervention

ACCESS TO CHILD & YOUTH TEAM SERVICES

80%

15%

5%

Specialized therapeutic services

Treatment and support services

Universal and prevention services

PYRAMID OF INTERVENTIONS

ASSESSMENT PROCESS ISD duty worker assigned daily

Requests for service screened immediately and brought to team for assignment

Assignment based on skill set and capacity

Initial assessment completed and brought back to team for discussion

ISD TEAM PROCESS Each team meets twice weekly

Discuss all new cases

Develop interventions and assign team members

Case review

Triage with psychiatry and psychology

Discuss intensity of services

EDUCATION CONNECTION Each school has an ESST Teams are composed of:

AdministrationEST - ResourceEST - GuidanceC&Y Team Member (new and permanent

member)SLP/Others as required (OT/PT)Literacy and Numeracy Mentors

Discuss students with academic, behavioural and or emotional concerns

ROLE OF THE ESST The ESST meets at regular intervals

One of the critical roles is the discussion and planning around school wide prevention strategies

Data based decision making (surveys, statistics, evaluations, etc.)

Opportunity to build on expertise of C&Y team member

ACCESS POINTS School – Main point of access Public Health Health care provider Hospital Emergency Department Early Childhood Programs Justice Other

EVALUATION – SIGNIFICANT SUCCESSES IDENTIFIED Prior to ISD, only 4% of the school population would receive MH

services. Today – 12% of children and youth in Charlotte and 8% in AP/Alnwick have been seen by C&Y teams.

Client-centered service provision by the Child and Youth Teams. Efficient use of resources through interdisciplinary team work.

Waiting lists for Mental Health services and psycho-educational assessments have decreased.

ISD effectively reduces duplication and redundancies between departments and creates greater coherence in services.

Pre-Post clinical assessment of ISD clients shows significant improvement (decreased Internalizing, Externalizing, and Total Problems as well as increased Adaptation)

Positive feedback from school principals of the involvement of the Child and youth Team members in the schools. Parents report a high level of satisfaction with the services their child or youth received under the ISD model.

OUTCOMES TO DATE Creation of one list of children and youth

needing services Increased requests for services/Greater

accessibility Enhanced skill mix of C&Y teams Ability to adjust level of intensity of

services Earlier intervention Greater capacity to provide addiction

services Reduction in stigma associated with

accessing services

OUTCOMES TO DATE Enhanced collaboration, case planning,

joint service delivery, shared resources Shared common plan Enhanced crisis response/Threat risk

assessments (VTRA) Service delivery provided from a

strength based perspective Increased efficiency in service delivery

WHAT’S NEXT? Roll out the new model in an urban area

Planning underway to expand the two existing sites

REQUIRED ACTIVITIES The following Evaluation recommendations are completed or

presently underway: Create change Management plan (done) Complete detailed Implementation plan (done) Implementation of an electronic case management system

(Share-point or CSDS) (in progress) Significant re-profiling of existing counseling and clinical

resources as well other programs and services are required from all departments to accommodate inter-disciplinary teams (in progress)

Bill 23 - Completion of changes in the sharing of information legislation (done)

Sharing of information - development of associated policies, training (in progress)

Stakeholder and partner consultation and engagement process (in progress)

MEC to government on approval for expansion (in progress)

QUESTIONS?