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' 1 Geelong'and'Surrounds' 2

Catchment'Area' Primary'catchment'area'popula1on'of'350,000' 3 Service'Development' Organic'Service'Development' Opportunis1c'service' Absence'of'evalua1on' Funding'opportunity' delivery' framework' Service'Redesign' Model'of'Care' Model'of'Service' Service'Reform' Partnership'Development' Engagement'with'whole'of'Interven1on'' 4

Organic'Service'Development' Ea.ng'Disorders'in'Geelong' ' ' • Local'interest'group' ' • Minimal'services' ' • 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' ' 5 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' 6

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' of'Excellence'in'Ea1ng'Disorders'' 7 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)' ' 8

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)' 9 Service'Model' Service'Gap'for'Adults' 10

Youth'Model'Assessment' • Ini1al'referral'discussed'in'weekly'team'mee1ng'(“triage”)' ' • Intake'list'(all'ages)'held'by'Clinical'Coordinator'in'program'The'Care'Manager' ' • 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'' 11 Outcome'Measures' 12

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' • ' Weekly'mee1ng'decision'points'' • ' • Clinical'review'and'supervision' ' • PULSE'program'sends'direct'to'GP' 13 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' 14

Service'Gap' • Con1nued'to'receive'referrals'for'people'26'years'and'above' ' • Offered'review'or'secondary'consulta1on'then'send'back'to'care' team' ' • Need'to'offer'something'more' ' • June'AlexanderX'Recovery'at'any'age' 15 Partnerships' 16

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' 17 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' 18

Adult'Model' Deakin' Psychology' Clinic' Barwon' Health'Adult' Community' Mental' Health'Teams' Ea1ng'Disorder'Service' 19 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' ownership'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)' 20

Model'of'Care' 21 Clinical'Pathways' 22

Region'Connec.ons' 23 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' ' 24

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' ' ' 25 The'Geelong'Clinic;'Healthscope' Ea1ng'Disorder'Program' 26

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' 27 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'' 28

The'tragedy'of'anorexia'' Picture'of'Rachael'and'Bailey' 29 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' ' ' '''' ' 30

'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' 31 And'how'does'one'do'that?' • Living'the'theory'yourself' • Informal'modelling' • Formal'supervision'and'teaching' • Crea1ng'a'LEAP'culture'' 32