Barwon'Health'' Ea.ng'Disorder'Service ' Geelong,'Victoria' - - PDF document

Barwon'Health'' Ea.ng'Disorder'Service'

Geelong,'Victoria'

Hollie'Laver;'Clinical'Coordinator' Dr.'Peter'O’Keefe;'Consultant'Psychiatrist' Beth'Tinney;'Consumer'Consultant'

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Geelong'and'Surrounds'

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Catchment'Area'

Primary'catchment'area'popula1on'of'350,000'

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Service'Development'

Service'Reform'

Partnership'Development' Engagement'with'whole'of'Interven1on''

Service'Redesign'

Model'of'Care' Model'of'Service'

Organic'Service'Development'

Funding'opportunity' Opportunis1c'service' delivery' Absence'of'evalua1on' framework'

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Organic'Service'Development'

Ea.ng'Disorders'in'Geelong'

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• Local'interest'group'

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• Minimal'services'

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• The'establishment'of'a'dedicated'Ea1ng'Disorder'

Service'(EDS)'in'Geelong'represented'one'of'the' first'efforts'to'provide'specialist'regional'care'to' clients'with'ea1ng'disorders' '

• Pilot'project'for'3'years'

'

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Drivers'for'Change'

Key'Drivers:' – Ea#ng&Disorders&Mapping&Project&(DHS&2006)'' – Linking&together:&Treatment&of&ea#ng&disorders&in&Victoria&(Ministerial&Advisory& CommiHee&on&Mental&Health)'' – DHS'Program'Management'circular'‘Clinical&mental&health&service&responses&for&people& with&ea#ng&disorders&in&Victoria’' – ‘Because'Mental'Health'MaSers’,'the'Victorian'Mental'Health'Reform'Strategy' 2009X2019'' – CEED'(“Op1mal'Ea1ng'Disorder'Services'for'Victoria:'CEED'Discussion'Paper'July'2010)'' – Pending:'A'Victorian&Framework&for&the&Assessment&and&Treatment&of&Ea#ng&Disorders& '' Local'opportuni.es:' – Reform'and'redevelopment'within'Barwon'Health'MHDAS'towards'a'0X25'years' framework' – The'establishment'of'Headspace'Barwon' – State'government'investment'via'the'Youth'Early'Interven1on'Team'Ini1a1ve'(YEITI)' – Commonwealth'investment'via'the'Specialist'Training'Program'(Psychiatry'Registrar' Posi1on)'in'partnership'with'the'Geelong'Clinic'

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Service'Redesign'

• Move'to'Barwon'Health'='increase'

structure'and'governance' '

• “BeSer'Fit”'

'

• Need'to'provide'treatment'not'just'

assessment' '

• Ini1ally'part'of'youth'mental'health'team'

then'increased'funding'to'expand'to' dis1nct'service' '

• In'partnership'with'the'Victorian'Centre'
• f'Excellence'in'Ea1ng'Disorders''

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The'Youth'Team'

Clinical'Coordinator'(0.5'FTE)' Consultant'Psychiatrist'(0.3'FTE)' Psychiatry'Registrar'(0.5'FTE)'' Psychologists'(1.4'FTE)' Die11ans'(0.8'FTE)' '

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Budget' Opera.ng'budget'approx.'$500,000'

'

• Grant'income'$430,186'
• Salaries'of'EDS'staff '($284,495)'
• Salaries'of'Consultant'&'Registrar'(aher'RANZCP'funding)

'($156,575)'

• Office'etc'expenses'of'EDS'team

'($2,721)'

• Office'rent,'payroll,'IT,'supply'etc'(approx.'$60K)'

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Service'Model'

Service'Gap'for'Adults'

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Youth'Model'Assessment'

• Ini1al'referral'discussed'in'weekly'team'mee1ng'(“triage”)'

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• Intake'list'(all'ages)'held'by'Clinical'Coordinator'in'program'The'Care'Manager'

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• Young'person'and'family'contacted'by'coordinatorX'process'and'model'

explained,'appointment'booked' '

• Supported'during'wai1ng'period'(medical'monitoring'with'GP)'
• Young'person'and'family'aSend'for'2.5'hour'assessment''

''''''Psychologist'and'Die11an'–'Young'Person' ''''''Psychiatric'Registrar'–'Family'' '

• Reflec1on'together'about'best'way'forwardX'plan'made'on'the'day''

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Outcome'Measures'

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Youth'Model'Documenta.on'

• Assessment'document'

Comprehensive'informa1on'about'presen1ng'problem'(ea1ng'disorder'pathology'and' comorbid),'nutri1onal'intake,'medical'history,'developmental'history,'family'func1oning'and' family'history,'psychiatric'risk'and'other'issues'iden1fied'as'important' Formula1on,'diagnosis'and'treatment'plan'

• Case'notes'aher'each'session'
• Crisis'Plan'
• Recovery'and'Treatment'Plan'

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• Weekly'mee1ng'decision'points''

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• Clinical'review'and'supervision'

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• PULSE'program'sends'direct'to'GP'

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Youth'Model'Func.oning'

• Young'people'and'their'family'aSend'weekly'

appointments'

• Clinicians'monthly'clinical'review'with'psychiatrist'and'

monthly'supervision'with'clinical'coordinator'

• Weekly'mee1ng'discussion'of'acute'issues'

'

• Monthly'FBT'consulta1on'group'with'CEED'
• Twice'yearly'carer’s'group'in'conjunc1on'with'Deakin'

University'

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Service'Gap'

• Con1nued'to'receive'referrals'for'people'26'years'and'above'

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• Offered'review'or'secondary'consulta1on'then'send'back'to'care'

team' '

• Need'to'offer'something'more'

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• June'AlexanderX'Recovery'at'any'age'

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Partnerships'

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Service'Reform'

• Barwon'Ea1ng'Disorder''Regional'Working'Group'chaired'by'

CEED' '

• Representa1on'from'all'areas:'

Adult'triage,'Adult'community'teams'program'manager,'BH'Deakin' Psychology'clinic'manager,'Paediatric'nurse'unit'manager,'inpa1ent' diete1cs,'private'diete1cs,'The'Geelong'clinic,'Pathways'Support' Services,'Adult'team'clinicians,'Deakin'university,'carer' representa1ve' ' '

• Service'gap'iden1fied'together'

'

• Considera1on'of'opportuni1es'and'commitment'

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Barwon'Region'Ea.ng'Disorders'Working'Group'

Purpose' “Barwon&Health&services&network&in&conjunc#on&with&CEED&shall&develop&an&effec#ve&system&of& care&across&all&service&levels&in&the&Barwon&region&for&individuals&&&their&families&to&facilitate& recovery&from&an&ea#ng&disorder.”& & Membership'' Representa1ve'of'services'and'stakeholders'in'the'region'which'may'includeX'' Triage,'Emergency'Department,'Pediatrics,'Deakin'University,'Youth'and'Adult'mental'health,' Community'health,'medical'and'inpa1ent'units.' ' Expected'Outcomes'

• 'Improved'access'via'a'single'point'of'entry'to'the'service'system'
• 'Improved'(early)'iden1fica1on'and'recovery'pathways''
• 'An'improved'system'of'care'for'individuals'and'their'families'in'the'Barwon'region'''
• 'An'improved'integra1on'between'inpa1ent'care'and'outpa1ent'mental'health'treatment'
• 'An'improved'linkage'and'rela1onship'between'services'within'Barwon'Health''

First'mee1ng'August'2011X'opera1onal'for'approx.'2'years'

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Adult'Model'

Ea1ng'Disorder'Service' Barwon' Health'Adult' Community' Mental' Health'Teams' Deakin' Psychology' Clinic'

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Model'of'Care'for'Adults'

• ASended'CEED'adult'models'forum'with'Adult'community'program'

manager,'Psychology'clinic'manager,'Child'&'Youth'program'manager' '

• Cogni1ve'Behaviour'TherapyXEnhanced'(CBTXE)'and'Specialist'

Suppor1ve'Clinical'Management'(SSCM)'most'appropriate'models' '

• Met'with'adult'clinical'coordinators,''adult'program'manager'and'

psychology'clinic'manager'to'discuss'proposed'modelX'enhance'

• wnership'and'investment.'Adult'teams'wan1ng'to'provide'something'

if'supported' '

• Training'planned'with'CEED/WETS'for'inXhouse'trainingX'intro'to'ea1ng'

disorders'and'SSCM,'CBTXE'training'also'through'CEED'(interested' cliniciansX'2'from'each'team)'

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Model'of'Care'

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Clinical'Pathways'

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Region'Connec.ons'

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Inpa.ent'

17'years'and'under' '

• Medically'unstable'–'Paediatric'Ward'BH'
• Psychiatric'Risk'–'Banksia'Royal'Children’s'Hospital'Melbourne'
• Private'health'insurance'16+'years'–'The'Geelong'Clinic'

18'years'and'above' '

• Medically'Unstable'–'Endocrinology'ward'BH'or'John'Cade'Unit'

RMH'

• Psychiatric'Risk'–'BH'Psychiatric'Inpa1ent'Unit'
• Private'health'insurance'16+'years'–'The'Geelong'Clinic'

'

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Inpa.ent'Priority'

• Paediatric'Ward'increased'admissions'of'higher'acuity'
• Inconsistent'staff'responses'and'request'for'support'
• Need'for'collabora1on'
• Engagement'with'NUM'and'paeds'
• Shared'guideline'
• Ward'staff'training'with'CEED'(MH'funding)'
• Ongoing'support'and'review'

' '

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The'Geelong'Clinic;'Healthscope' Ea1ng'Disorder'Program'

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The'Ea1ng'Disorder'Program'

• 8'bed,'40'day'inpa1ent'program'
• Started'2007'
• Anorexia,'Bulimia,'Binge'ea1ng'disorder'
• Meal'support'with'intensive'group'program''
• SemiXdedicated'wing'of'The'Geelong'Clinic'
• Day'program'and'outreach'service'

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Why'Ea1ng'Disorders?'

• Consumer'driven'–'‘Saving'Private'Ryan’'
• Needs'driven''

' '' ' '' ' '“We'don’t'do'ea1ng'disorders”' '' ' '“Folie'a'deux”'

• Challenge'driven'

'' ' 'Biopsychosocial'model' '' ' 'Flexibility'of'treatment'approaches' '' ' 'Therapeu1c'rela1onships''

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The'tragedy'of'anorexia''

Picture'of'Rachael'and'Bailey'

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LEAP'(Learning'To'Eat'at'Peace)'

' Collabora1on,'containment','care'and'commitment'' Respect,'dignity'and'an1Xperfec1onism'' Curiosity'about'the'person'–'fostering'therapeu1c'rela1onship' Curiosity'about'therapeu1c'process' Externalisa1on'of'Ea1ng'disorder' Focus'on'change'and'nurturing'hope'(turtle'steps)' Skills'acquisi1on'and'Health'acquisi1on' Family'inclusive' ' ' '''' '

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'Integra1on'between'services''

Collabora1on,'containment,'care'and'commitment'' Respect,'dignity'and'an1Xperfec1onism' Curiosity'about'the'person'–'fostering'rela1onship'' Curiosity'about'therapeu1c'process' Externalisa1on'of'Ea1ng'disorder' Focus'on'change'and'nurturing'hope'(turtle'steps)' Skills'acquisi1on'and'Health'acquisi1on' Family'sensi1ve'

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And'how'does'one'do'that?'

• Living'the'theory'yourself'
• Informal'modelling'
• Formal'supervision'and'teaching'
• Crea1ng'a'LEAP'culture''

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Consumer'driven'services'

• Consumers'as'customers'
• Consumers'as'advisors'
• Consumers'as'vital'team'members'

'Fostering':' '' 'Heightened'respect'for'pa1ents' '' 'Opportuni1es'for'team'learning' '' 'Strengthening'pa1ents’'empathic'experience' '' 'Providing'hope' ''

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Consumer'Consultant'

Beth'Tinney'

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• Consumer'Consultant'Based'at'The'Geelong'Clinic'
• Unique'perspec1ve'''
• Observa1ons'

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Service'Wide'Engagement'

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Community'Engagement'

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Community'Engagement'

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Community'Engagement'

• GP'training'with'CEED'and'Ea1ng'Disorders'Founda1on'of'

Victoria'

• Mental'Health'Professionals'Ea1ng'Disorder'Network'in'

Geelong'

• Secondary'Consulta1on'

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Community'Awareness'

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Media'Engagement'

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Media'Engagement'

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Celebra.ng'Success'

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What'Works…'

• Integra1on'among'services'in'the'region'(shared'agenda)'
• Educa1on,'ongoing'support'and'supervision'
• Team'atmosphereX'finding'the'right'people'
• Commitment'at'the'top'

'

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S.ll'going…'

• Further'engage'with'adult'community'mental'health''

''''''Refine'referral'pathway'

• Inpa1entX'rela1onship'with'John'Cade,'BH'psychiatric'inpa1ent'unit,'adult'

medical'

• Consumer'consultant,'peer'support,'family'consultant'at'BH'
• Website'

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• Further'integra1on'with'headspace'
• Formalize'research'

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Thank'You'

' ' ' ' '

Thank'You' Ques.ons'or'Comments?'

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Contacts'

Hollie'Laver' Clinical'Coordinator'' Ea1ng'Disorder'Service' Barwon'Health'' 03'52226690' Hollie.Laver@Barwonhealth.org.au' ' ' Dr.'Peter'O’Keefe' Consultant'Psychiatrist' Barwon'Health' 03'52226690' The'Geelong'Clinic' PETERO@Barwonhealth.org.au'' Bethany'Tinney' Consumer'Consultant' The'Geelong'Clinic' '03'5240'0700'

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