Integrating Innovation in Service Delivery and Research to Connect - - PowerPoint PPT Presentation

Integrating Innovation in Service Delivery and Research to Connect Inner City Youth with Wellness

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

• Drs. Steve Mathias 1,2 and Chris Richardson 1,2,3

Lead Donor: CHÉOS

Centre for Health Evaluation and Outcome Sciences

www.innercityyouth.ca

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
• 12+ groups
• Evolving an integrated ICY research team
• “A Centre of REAL GOOD”

http://www.coastmentalhealth.com/youth-services

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

Family 5.3% Shelter 46% SRO 8.5% Supported 7.5% Independently 9.9% Street/Couch Surfing 9.9% Other 3.2%

Housing at Intake

Anxiety Disorders – 34.6%

PTSD – 10.7%

Generalized Anxiety Disorder – 3.8% Social Phobia – 6.1%

Panic Disorder – 3.6%

OCD – 3.8% Anxiety Disorder NOS – 11.9%

Mental Health Diagnoses at Intake

• 84% were diagnosed with a mental illness
• 56% diagnosed with both mental illness and substance

abuse/dependence

Mood Disorders –48%

Major Depressive Disorder – 12.8% Bipolar II – 8.1% Bipolar NOS – 6.3% Dysthymic Disorder – 1.8% Depressive Disorder NOS – 5.7% Bipolar I – 3.6% Mood Disorder NOS – 11.1%

Psychotic Disorders –20.4%

Schizophrenia – 5.1%

Substance-induced psychosis – 1.6%

Schizoaffective – 1.6%

Psychosis NOS – 13.8%

ADHD & FAS

ADHD – 15.4% FAS – 12.1%

Substance Abuse/Dependence

Alcohol Abuse – 10.9% Cannabis Abuse – 10.9% Alcohol Dependence – 13.0% Cannabis Dependence – 21.7%

Substance Abuse/Dependence

Amphetamine Abuse – 2.0% Cocaine Abuse – 5.7% Amphetamine Dependence – 12.4% Cocaine Dependence – 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

25 youth housed with ICY 4 move outs to market rental 2 moves to

• ther SROs

2 moves to

• ther supported

housing 1 transfer to treatment 1 move to CLBC

2013-2014 Housing Snapshot

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% 14% 38% 6% 12% 13% 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