Lead Donor: Integrating Innovation in Service Delivery and Research to Connect Inner City Youth with Wellness www.innercityyouth.ca Drs. Steve Mathias 1,2 and Chris Richardson 1,2,3 1 Inner City Youth Program, St. Paul’s Hospital, Providence Health Care 2 Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care 3 School of Population and Public Health, UBC CHÉOS Centre for Health Evaluation and Outcome Sciences
Disclosures Dr. Mathias Speaker Bureau: Janssen Ortho Advisor: Oksuka, Janssen Ortho Dr. Richardson Member: From Grief to Action
Inner City Youth Program: Lead Donor Silver Wheaton How did we begin? • Initially established in 2007 at St Paul’s Hospital • Now an Intensive Case Management Program • Case managers (nurses and social workers) • 16-20:1 ratio • Substance use and/or mental health • “Attachment informed” therapy • Stabilized housing is prioritized • Mental health goals are set by the youth
ICY Staffing- 2014 Expansion Our Intensive Case Management Team GREW! • Social Workers (3 ->6) • Nurses (1->6) • Clinical Supervisor (1) Our Rehab Team BLOSSOMED! • Occupational Therapist (1) • Rehab Assistants (1->2) • Peer support worker (0->3) • Recreation worker (0->1) Our Prescriber Team PRIMARIED! • Nurse Practitioner (1-> 3) • Psychiatrists (7) • Family Doctors (0->2)
ICY Housing Continuum What is the inter-relationship between health and social services? More than 90 housing units assigned to ICY youth in • collaboration with various partners • Low threshold- St Helen’s Hotels (25), Margherite Ford (20), Imuoto (16) • Medium threshold- Pacific Coast Apartments (15) and Burrard Building (20) 10 market rent housing subsidies • Nov. 3, 2014 -> Group home – 24/7 support, abstinence • based period of stabilization outside of DTES
ICY Access and Referral
Service Level • From 2007-2013: • Over 600 youth • 3000+ annual psychiatric appointments • 200+ contacts/week • 80+ youth in housing • Average wait time less than one month http://www.coastmentalhealth.com/youth-services • 12+ groups • Evolving an integrated ICY research team • “A Centre of REAL GOOD”
Chart review of ICY intake assessments conducted between Mar. 2007 and Dec. 2013 (n=494) What are the basic health needs of street involved youth? • Average age of 21 • 64% male, 35% female, 1% transgendered • Primarily Caucasian (57%) or Aboriginal (21%) • Education Completed: High school grad (11%), Grade 11/12 (30%), Grade 7-10 (42%) • 37% reported history of foster care • Income sources: 46% on IA, 20% working, 9% PWD
Housing at Intake Family Shelter SRO 5.3% 8.5% 46% Street/Couch Supported Independently Surfing 7.5% 9.9% 9.9% Other 3.2%
Mental Health Diagnoses at Intake • 84% were diagnosed with a mental illness • 56% diagnosed with both mental illness and substance abuse/dependence Anxiety Disorders – 34.6% Panic Generalized PTSD – Disorder – Anxiety 10.7% Disorder – 3.8% 3.6% Anxiety Social Phobia – OCD – 3.8% Disorder NOS – 6.1% 11.9%
Mood Disorders – 48% Major Depressive Dysthymic Depressive Bipolar I – Disorder Disorder – Disorder – 3.6% NOS – 1.8% 12.8% 5.7% Mood Bipolar Bipolar II Disorder NOS – – 8.1% NOS – 6.3% 11.1%
Psychotic Disorders – 20.4% Schizophrenia – Schizoaffective – 5.1% 1.6% Substance-induced Psychosis NOS – psychosis – 1.6% 13.8%
ADHD & FAS ADHD – FAS – 15.4% 12.1%
Substance Abuse/Dependence Alcohol Abuse – Alcohol Dependence 10.9% – 13.0% Cannabis Abuse – Cannabis 10.9% Dependence – 21.7%
Substance Abuse/Dependence Amphetamine Amphetamine Abuse – 2.0% Dependence – 12.4% Cocaine Abuse – Cocaine Dependence 5.7% – 12.3%
Substance Abuse/Dependence Opioid Abuse – 1.7% Opioid Dependence – 8.1%
History of Foster Care Among Youth Enrolled in ICY (2007-2013) 33.6% reported history of foster care – 30 fold over • representation compared to children and youth living in British Columbia. Youth with history of foster care were: • • More likely to be of Aboriginal heritage • Less likely to to have graduated from high school History of foster care was associated with: • • History of FASD • Cocaine abuse/dependence • Concurrent mental illness and cocaine abuse/dependence
2013-2014 Housing Snapshot 25 youth 4 move outs to 2 moves to housed with market rental other SROs ICY 2 moves to 1 transfer to other supported 1 move to CLBC treatment housing
So where did we land? What did we do to integrate health and social services? • Given the steady stream of youth with significant untreated mental health and substance use concerns… • Given the prevalence and acuity of mental illness in this population… • We opened a Centre…
Meet us at the G! www.innercityyouth.ca
Meet us at the G!
Primary Care and Integrated Services
Our Rehab team including the peeps
The burden of mental illness across the lifespan in the general population
Burden of mental illness by age and disorder
Why aren’t more youth ACCESSING mental health services? In the past 12 months, did you ever feel that you needed care for a mental health issue (like depression or anxiety), but you didn't use any services or get treatment? [BASUS Wave 6 n=1665 - > 270 (16.2%) said yes] 63% 49%M/37%F 27% 37% 38% 14% 13% 12% 6% 6%
Tablet-based waiting room survey • All youth complete a tablet based HEADSS assessment that includes the GAIN-SS • Secure, user friendly interface • A brief report is generated as a pdf which flags high risk items for clinician to check in initial interview • Full report includes all responses • Youth are connected to services
Report to practitioner
What we will be monitoring What are the health and psychosocial characteristics of youth using the clinic? Does the waiting room survey enhance the capacity of ICY to connect youth with wellness in terms of: • Improved physical/mental health and psychosocial development? • Reduced substance use? • Reduced initiation of hard drug use? • Based on large RCT using SURPS to target high risk youth 13yrs – 16 yrs to a 2- session group coping skills intervention, Conrod et al. found substantial reductions in risk of initiating cocaine use (OR=o.2) and other hard drugs (OR=0.50) as well as reductions in frequency of use. Conrod PJ, Castellanos-Ryan N, Strang J. Brief, Personality-Targeted Coping Skills Interventions and Survival as a Non – Drug User Over a 2-Year Period During Adolescence. Arch Gen Psychiatry. 2010;67(1):85-93.
Thanks to our donors… • Silver Wheaton • HSBC • Janssen Ortho • Variety The Children’s Charity of BC • St Paul’s Hospital Foundation Check us out at www.innercityyouth.ca
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