CAPA Forum 19 April 2018 Dr Karin Stam, MICAMHS Bay of Plenty A - - PowerPoint PPT Presentation

CAPA Forum 19 April 2018 Dr Karin Stam, MICAMHS Bay of Plenty

• A Secondary Mental Health Service needs

clear and transparent Care Bundles

• According to the most up to date Clinical

Guidelines and/or Evidence-Based or Best Practice

• A Care Bundle is a set of interventions that when used together

significantly improve the outcomes of the clients and whanau / family we support

Care Bundles =

• Journey of Client through MICAMHS
• Combination of referral pathway, diagnostic clarification and

treatment interventions

• Issue/Disorder related

• Written in a clear and straightforward way, they should be quick and easy

as a point of reference

• New employees; Good Guidance
• Time-efficient to have general consensus from which you can deviate with the

right arguments  (often 80% consensus anyway)

• Quality of Care

• Before you can create a Care Bundle you must collate information
• f local resources.
• A Team approach to creating Care Bundles helps the whole Team to

understand them and to own them

• Do we need a clinical pathway for…?
• Additional training needed? --- > Create awareness of gaps

• NICE Guidelines
• RANZCP
• Ministry of Health

• The aim is to ensure everyone receives the best care based on

evidence or logic 100% of the time

ISSUES/DISORDERS --- > 15 Care Bundles in MICAMHS Bay of Plenty

• 1. Tic Disorder
• 2. Autism Spectrum Disorder
• 3. Anxiety Disorders (incl. OCD, PTSD and Selective Mutism)
• 4. AOD issues (incl. Sorted referral pathway)
• 5. Eating Disorders
• 6. Intellectual Disability
• 7. Mood Disorders
• 8. Transgender
• 9. ODD/CD (incl. IYSS referral pathway)
• 10. (Emerging) Personality Disorders
• 11. Perinatal and Infant Mental Health Issues CHILD and MOTHER
• 12. Physical Comorbidity (incl. Health and Wellness Coach referral pathway)
• 13. Psychosis /Early Intervention
• 14. Somatoform Disorders
• 15. ADHD
• Medical Review Pathway for existing ADHD
• Pathway for new ADHD diagnosis

Referral pathway for AOD/CEP referrals to CAMHS

*Following Choice or Priority Choice the C/PC clinician will complete Honosca, type C/PC assessment and save the assessment in Patient Correspondence as well as Assessments for Uploading. The C/PC clinician will also write to the young person (with copies to the referrer and others with consent) regarding the outcome of the C/PC assessment. During the C/PC appointment the consent/sharing info form will also be completed to the degree that is appropriate at this appointment. Note- Consent/Sharing info plan is an ongoing process. **See ‘Sorted Referral Pathway’ for process. New referral to CAMHS Crisis Non-urgent AOD primary issue AOD not primary issue Give to Sorted Coordinator for allocation Duty to follow up re- Risk Assessment or Priority Choice * Choice process followed * Honosca AOD score 3-4 Honosca AOD score 0-2 Normal CAMHS process applies. Liaise with Sorted Coordinator on case-by-case basis. Honosca AOD score 3-4 Honosca AOD score 0-2 Normal CAMHS process applies. Liaise with Sorted Coordinator on case-by-case basis. Give to Sorted Coordinator for allocation Sorted Worker begins/completes Sorted Partnership ** Sorted Worker begins/completes Sorted Partnership

Western Bay of Plenty pathway for the assessment of children/ young people with suspected Intellectual Disability (ID) / Global Developmental Delay (GDD)

NB: Please refer to Support Net as usual for assessment for NASC agency services for all children with ID/GDD. This algorithm refers to pathway for obtaining a cognitive assessment only.

Child under 6 years Child over 6 years Best pathway Best pathway TWK 3D pathway PAEDIATRICS

Child attends Paediatrician review. If concerns following review, then referral made for developmental/ cognitive assessment as below CAMHS Child attends CHOICE

• appointment. If accepted into

service, cognitive assessment arranged to determine how young person’s strengths / weaknesses may be contributing to mental health presentation

TWK PSYCHOLOGIST

6-17 years Request where ID suspected AND child does not have ADHD. Children with ID and ASD should be referred to TWK unless complex

PAEDIATRIC PSYCHOLOGIST

0-14 years Request when medical issues may complicate presentation and ID suspected or non- complicated ADHD. Referrals not otherwise accepted unless discussed first with Psychologist. Access only through Paediatrician

SUPPORT NET

Children are accepted with ‘GDD’ if < 7 years of age. Cognitive assessment results must be provided to access services for

• lder children.

Support Net complete cognitive assessments only for young people

• ver 18 if required to determine

eligibility for NASC services

CAMHS PSYCHOLOGIST

0-18 years Access only through

• CAMHS. Consider

referral if presentation complex, significant risk, associated mental health disorder including complicated ADHD

SPECIAL EDUCATION If school aged child under SE, approach SE keyworker first if cognitive assessment required.

TWK OCCUPATIONAL THERAPIST

0-5 years. Request developmental assessment with TWK Occupational Therapist

Concerns identified with possible GDD/ID in child by family/ ECE or school/ GP or PHN

RTLB If school aged child under RTLB, limited funding may be available for cognitive assessment. Discuss with RTLB as need may be better met by other agency.

Personality Disorder

Pathway for Clients who meet criteria for the DBT Comprehensive Programme

\\\\\ No

No Yes

Standard Intake Procedure

• Client enters service through normal routes and meets normal service criteria.
• Standard choice and partnership assessment completed
• Standard clinical assessment sufficient to make diagnosis (may include prior reports on client)

Consider DBT Comprehensive Programme Is client in the following priority group for intensive DBT treatment?

• a high service user, or likely to become so; AND/OR
• challenging to team, or likely to become so; AND/OR
• Likely to significantly benefit from therapy?

Continuing Care

• Key working and crisis care as per usual protocol.

Keyworker to discuss referral to DBT Programme with DBT clinician present at MDT, then complete referral to consult if appropriate Pursue treatment guided by above protocols and/or consider most appropriate community referral

No

Are treatment goals achieved?

Yes

• Ensure relapse prevention plan in

place

• Alert GP/referrer/family as appropriate
• Transition to appropriate community

follow-up Untreated Axis 1 Co-morbidity?

Does client have significant untreated co-morbid axis 1 problems?

Yes

Agreement on Diagnosis? (see note 1)

Does clinical MDT team agree that primary diagnosis could fit consideration for DBT Comprehensive programme? Is this noted in file?

• Review Diagnosis
• Consult appropriate pathway

No

Begin Indicated Axis I Treatments

• Commence appropriate treatments

as per appropriate pathway and/or refer to appropriate agency.

• See note 2 concerning relevance of

axis 1 treatments for BPD clients.

• Except for BPAD, treatment does

not need to be successful before continuing on this pathway.

Yes

Major Alcohol or Drug Problems? Treating Major A&D problems

• These treatments must commence

before client proceeds on the pathway.

• A&D treatments may be within

SORTED or at ancillary services

Yes

Incredible Years Specialist Service

Health and Wellness Coach referral pathway

Physical health/fitness need/goals identified High Priority Psychosis/Sorted Medium Priority Adolescent team Low Priority Child team Referral to Health and Wellness Coach Consult between Health and Wellness Coach and referring case manager Consult with Sorted Coordinator as needed Health and Wellness Coach contacts young person (& family as appropriate) for initial 1:1 Group work Individual work Ongoing consultation with referring case manager

SUGGESTIONS?