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Link: Connecting Patients and Families with Mental Health Resources

Shawna Wilwand (BCMHSUS)Kristen Barnes (PHSA imPROVE)

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BC Mental Health and Substance Use Services

• Provincial specialized services for children, youth and their families

• Inpatient units• Outpatient clinics• Supported by PHSA imPROVE to implement lean thinking

and tools• One tool used is the Rapid Process Improvement

Workshop (RPIW)

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Context: BC Children’s Hospital Emergency Department

• Mental Health patients – approximately 900 visits a year• 66% are discharged directly from Emergency• Where the patient is referred upon discharge depends on

a number of factors and is a complex process

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Current State Emergency Physician Feedback

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Problem

• 40% of families with mental health concerns discharged from BC Children’s Hospital Emergency did not receive

services in a timely manner after discharge.

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Contributing Factors

• 25% of referrals did not go to the right service• Quality of referrals • Access to community services• Inequity in Service: Psychiatric Liaison Nurse position only

available to patients during working hours-37.5 hours/week. Only 15% of patients presenting with mental health concerns received follow up.

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Intervention-BCCH Emergency Department

• Created one standardized crisis referral form (down from 11)• Created an information handout for patients and families to access community

supports• Psychiatry and Emergency Physicians collaborated on a standardized

assessment tool• Created an algorithm for disposition in Emergency

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Measurement: ED Outcomes

• 99% of families directed to the correct service (compared to 75% before interventions)

• Equity in Service: All patients with mental health concerns presenting to the emergency department who require follow up receive follow up

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Intervention-BCMHSUS Link

• New service to help connect families with community mental health resources.

• Provides mental health assessment, medication initiation and management, and resource consultation.

• Link can provide a maximum of 4 follow up sessions.• Without adding new resources, Link is expected to provide

services to an estimated 300 families in it’s first year

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Who is LINK?

• Link is a team of Mental Health professionals including:– Nurse Clinician- Shawna Wilwand– Nurse Practitioner- Ardelle Komaryk– Social Worker- Karen Cooper– Psychiatrist- Dr. Jennifer Russel

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Measurement: Services Provided by Link

• Received 108 referrals – accepted 91% others already connected and the patient’s care provider notified.

• Since August 15th, 2015 Link has provided services for 98 families

• Contact patient/family within 2 business days 99% of the time• Services provided

• 88% connected with nurse clinician• 13% connected with social worker• 5% connected with nurse practitioner

• 11 patients (11%) urgent non-emergent psychiatric assessment

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Measurement: Patient Experience

• Feedback from families and the community has been overwhelmingly positive. When asked about their experience with Link’s over the phone services:

• Patients and families said:

• Community partners said:

“We felt safe, helped

and supported”

Link is a great program, I am

thankful for the follow-up

call

Helpful, glad someone

followed up

Always good…to communicate with

community and all partners – clients often present in

the emergency department and we are not aware

Thank you for everything you did

getting us support. Son is doing better now

and what you did really made a difference

“Amazing you

helped my child so much”

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Patient Experience Survey (n=5)

• 100% of patients/families responded “definitely” when asked if Link had helped

• 100% strongly agreed/agreed:– Told about resources– Understood purpose of service– Knew who to contact– Comfortable asking questions– Given answers I could understand– Felt respected

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Key Messages

• Without increased cost and assigning new resources, we created a service that has increased the quality of patient care and follow up for mental health presentations to the emergency

• This process involved working across organizations, regions, and sectors of care. To overcome this challenge, members of the BC Children’s Hospital Emergency Department, BC Mental Health, community partners and families worked collaboratively to design the new process.

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Contact Information

Shawna WilwandLink Nurse ClinicianEmail:swilwand@cw.bc.caPhone: 604-875-2345 Ext 4948

Kristen BarnesimPROVE FacilitatorEmail: kristen.barnes@phsa.caPhone: 604-813-7682