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CYMH Implementation Plan

Overriding Goal

To improve the quality of patient care available in non-specialized general practice for children and

youth dealing with mild to moderate anxiety and ADHD and youth with mild to moderate depression.

This will be measured by a change in function as measured by the CGI scale.

Learning Outcomes

By the end of the implementation, physicians will be able to…

1.

Utilize the CYMH EMR tools, hyperlinked algorithm and/or paper based binder to access all tools

2.

Apply screening and assessment tools to identify children and youth who may have anxiety,

depression, and ADHD with/without associated comorbidities.

3.

Use non pharmacological interventions (CBIS, Anxiety BC, DWD, Confident Parents) as first line

therapy for mild to moderate depression, anxiety, ADHD and behavioural issues

4.

Identify listening and hearing as valid treatment options

5.

Develop a care plan to address patients with anxiety, depression, and ADHD that utilizes CYMH

tools and resources

6.

Build a registry of all child-and-youth-aged patients with anxiety, depression, and ADHD

7.

Integrate CYMH tools and resources into an effective work flow

8.

Report increased confidence in providing appropriate management for child-and-youth-aged

patients with anxiety, depression, and ADHD

9.

Use appropriate tools to assess and plan a management strategy for X (TBD) child-and-youth-aged

patients with anxiety, depression, and ADHD

10.

Demonstrate knowledge of appropriate use of pharmacological treatment for management of condition.

11.

Develop a collaborative working relationship with a CYMH team and other community providers

(school counselors, specialists, community services, etc.)

12.

Identify appropriate community resources to support child-and-youth-aged patients with anxiety,

depression, ADHD, conduct disorders, substance use and psychosis

Key Messages in this program include…

1.

CYMH issues are typically under-identified or identified too late, early identification and

intervention is key, four out of five children and youth are not receiving treatment.

2.

The vast percentage (~80%) of mild to moderate CYMH issues can be effectively managed in

primary care.

3.

Take your time in the assessment so that you don’t miss something important or misidentify a

condition.

4.

Listening and hearing IS treatment. This is your greatest tool along with CBT skills to help

you if “stuff comes out”. Even if you have specialist access, there is typically a long wait until

that happens or between sessions. Other than PHQ9, GAD 7, no take home diagnostic tools

need to be used

(2)

5.

It’s not all up to you. CYMH problems may be chronic and may not be “fixable” but may be

managed more easily with shared responsibility, patient engagement and negotiation.

6.

Non-pharmacological management is the foundation upon which effective treatment is based

(pills don’t build skills!).

(3)

Instructional Plan for CYMH Implementation Program

Outcome

How to assess?

How to teach?

Resources needed?

1. Utilize the CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools

• Demonstrate in LS1 and review with GP in PV (AP1) in practice visit

• Pre LS1 embed into practice • Case based “scavenger

hunt”

• Participants are encouraged to follow along in the binder, turning to the page of the resource being covered, tabs are color coded, as our the corresponding PPT slide so they know where to turn, facilitators explain where to find it PC support at the table assists them to find the resources.

• Office computer

• Tools in the EMR • Lap top for LS1

• Module manual

• Case studies •

2.

Apply screening and

assessment tools to identify

children and youth who may

have anxiety, depression, and

ADHD with/without

associated comorbidities.

• KADS6, SCARED, SNAP IV, Demonstrate

administration to peer • Practice scoring assessment

tools

• Screening Questions: Demonstrate to peer • Post action plan case study

report??

• Report from coach

• Sharing experiences at next learning session

• Recorded on data sheet

• Lecture

• Paired activity

• Patient advocate • Lecture/video • Paired activity

• Case study with hidden info that requires elicitation

• Lecture

• Participants are encouraged to follow along in the binder,

• List of all tools • Copies of KADS6,

SCARED, SNAP IV • Copy of Screening

Questions

• Patient advocate (may be parent?)

• Internet access • Hidden info answers

• Laminated DSM5

Depression, Anxiety, ADHD definitions

(4)

• Demonstrate condition

confirmation in DSM5 turning to the page of the resource being covered, tabs are color coded, as are the corresponding PPT slide so they know where to turn, facilitators explain where to find it PC support at the table assists them to find the resources.

3. Use non pharmacological interventions (CBIS, Anxiety BC, DWD, Confident Parents) as first line therapy for mild to

moderate depression, anxiety, and ADHD

• Post action plan case study report??

• Report from coach

• Patient feedback

• Sharing experiences at next learning session

• Recorded on data sheet

• Youth CBIS: manual review,

demo/video paired activity with top 5 skills

• Other Resources: (TeFA, CFA, WRP, etc.) lecture • DWD: lecture/video

• List of all tools • Internet access??

4. Identify listening and hearing as

valid treatment options • Sharing experience at next learning session • Coach report

• Patient advocate (parent?) • Listening/paraphrasing

learning exercise in pairs

• Patient advocate • Facilitator guide for

exercise 5. Develop a care plan to address

patients with anxiety, depression, and ADHD that utilizes CYMH tools and resources

• demonstrate with peer

• Report from coach • Patient feedback

• Sharing experiences at next learning session

• Activity debrief

• CYMH Mental Health plan

demo • lecture

• Care plan handout

• Case studies?

6. Build a registry of all child-and-youth-aged patients with anxiety, depression, and ADHD

• Demonstrate on own EMR

or paper based tool

• Demonstration

• Physicians and staff work on own database with support

• Instruction sheets for each EMR on how to identify patients. 7. Integrate CYMH tools and

resources into an effective work flow

• GP report

• MOA report

• Report from coach

• Sharing experiences at next

• MOA coach discussion,

questions

• MOA breakout sessions

• Coach visits and problem

• EMR templates

• CYMH Manual

• Algorithm on computer

(5)

learning session solving sharing ideas during

action periods location

8. Report increased confidence in providing appropriate

management for child-and-youth-aged patients with anxiety, depression, and ADHD

• Sharing experiences at next learning sessions

• Pre/post surveys

• Paired and group activities during LSs, and real practice during action periods • Coach visits and problem

solving and sharing ideas during action periods • Coach reports describing

findings, solutions during action periods in next learning sessions

• Pre/post survey

9. Use appropriate tools to assess and plan a management strategy for X (TBD) child-and-youth-aged patients with anxiety, depression, and ADHD

• Sharing experiences at next learning sessions

• Report from coach • Completed data sheet • Pre/post surveys

• Action period planning with local groups

• Group discussion • Fee Discussion

• Action period forms • Fee case study?

10. Demonstrate knowledge of appropriate use of

pharmacological treatment for management of condition.

• Completed data sheet • Pre/post surveys

• Didactic lecture • Medication flow sheets

11. Develop a collaborative working relationship with a CYMH team and other stakeholders

• Sharing experiences at next learning sessions

• Report from coach

• Reports back from referrals

• Completed consent to

share information documents

• Action period planning with local groups

• Group discussion

(6)

12. Identify appropriate community resources to support child-and-youth-aged patients with anxiety, depression, ADHD, conduct disorders, substance use, and psychosis

• Sharing experiences at next learning sessions

• Report from coach • Report from PSP staff

• Action period planning with local groups

• Group discussion • Agency guest presenters

Lecture – rapid fire • Interactive referral case

study • Panel Q&A

• Tables for resources

• Action period forms • Representatives from

community resources • Information Tables for

(7)

First Learning Session (3.5 hrs)

Learning Objectives targeted:

Apply screening tools to

identify children and youth

who may have anxiety,

depression, ADHD and/or

conduct disorder

Utilize the CYMH hyperlinked

algorithm, EMR templates

and/or paper based manual

to access all tools

Use non pharmacological

interventions (WRP, TeFA,

CFA) as first line therapy for

mild to moderate depression,

anxiety, and ADHD

Identify listening and hearing

as valid treatment options

Develop a collaborative

working relationship with a

CYMH team and other

community providers (school

counselors, specialists,

community services, etc.)

Action Period 1

Learning Objectives targeted:

Apply screening tools to

identify children and youth

who may have anxiety,

depression, ADHD and/or

conduct disorder

Utilize the CYMH

hyperlinked algorithm,

EMR templates and/or

paper based manual to

access all tools

Apply listening and hearing

techniques as valid

treatment options

Second Learning Session (3.5hrs)

Learning Objectives targeted:

Use appropriate tools to assess

and plan a management

strategy for X (TBD)

child-and-youth-aged patients with

anxiety or depression

Use appropriate

pharmacological treatment for

management of children and

youth with anxiety and

depression

Develop a care plan to address

patients with anxiety and

depression that utilizes CYMH

tools and resources

Develop a collaborative

working relationship with a

CYMH team and other

community providers (school

counselors, specialists,

community services, etc.)

Identify appropriate

community resources to

support child-and-youth-aged

patients with anxiety,

depression, and ADHD

Action Period 2

Learning Objectives targeted:

Build a registry of all

child-and-youth-aged patients with

anxiety and depression

Apply screening and

assessment tools to identify

children and youth who may

have anxiety or depression

Apply non-pharmacological

interventions to manage

children and youth who may

have anxiety or depression

Where appropriate, develop

care plans to address patients

with anxiety and depression

that utilizes CYMH tools and

resources

Where appropriate, use

pharmacological treatment

for management of children

and youth with anxiety and

depression.

(8)

Learning Session Activities

1.

Introduction – context (45

min)

2.

Team roles and collaboration

3.

Statistics in community

4.

Confidentiality and consent

5.

Risk identification tables

6.

Screening tools to identify

children and youth who may

have anxiety, depression,

ADHD and/or conduct

disorders – four initial

questions

7.

CYMH hyperlinked algorithm,

EMR templates and/or paper

based manual to access all

tools

8.

Identify listening and hearing

as valid treatment options

9.

Specific Non Pharmacological

Interventions (WRP, TeFA,

CFA)

10.

Collaboration

11.

Resources

PDSA Action Period 1:

Trial workflow with EMR,

Electronic Algorithm and/or

paper binder

Use screening tools – 4

questions

Trial listening and hearing

techniques

Use non-pharm interventions

(WRP, TeFA, CFA)

Refer patients to general

resources

Learning Session Activities

1.

Case introductions

2.

Anxiety context

3.

Anxiety – identifying &

Screening

4.

Assessment – SCARED

5.

Depression context

6.

Depression – identifying &

Screening

7.

Assessment – KADS

8.

Suicide Risk assessment

9.

CGI

10.

Treatment & Management

Anxiety and Depression

11.

Medications

12.

Collaboration

13.

Resources

PDSA Action Period 2:

Build a registry of all

child-and-youth-aged patients with anxiety

and depression

Apply screening and assessment

tools to identify children and

youth who may have anxiety or

depression

Apply non-pharmacological

interventions to manage children

and youth who may have anxiety

or depression

Where appropriate, develop care

plans to address patients with

anxiety and depression that

utilizes CYMH tools and resources

Where appropriate, use

pharmacological treatment for

management of children and

youth with anxiety and

depression.

(9)

Third Learning Session (3.5 hrs)

Learning Objectives targeted:

Use appropriate tools to assess and plan

a management strategy for X (TBD)

child-and-youth-aged patients with

ADHD

Use appropriate pharmacological

treatment for management of children

and youth with ADHD.

Develop a care plan to address patients

with ADHD that utilizes CYMH tools and

resources

Develop a collaborative working

relationship with a CYMH team and

other community providers (school

counselors, specialists, community

services, etc.)

Identify appropriate community

resources to support

child-and-youth-aged patients with anxiety, depression,

and ADHD

Action Period 3

Learning Objectives targeted:

Build a registry of all child-and-youth-aged

patients with ADHD

Apply screening and assessment tools to

identify children and youth who may have

ADHD

Apply non-pharmacological interventions

to manage children and youth who may

have ADHD

Where appropriate, develop care plans to

address patients with ADHD that utilizes

CYMH tools and resources

Where appropriate, use pharmacological

treatment for management of children and

youth with ADHD

Fourth Learning Session (3.5hrs)

Learning Objectives targeted:

Integrate CYMH tools and resources into

an effective work flow

Report increased confidence in providing

appropriate management for

child-and-youth-aged patients with anxiety,

depression, and ADHD

(10)

Learning Session Activities

1.

Case introductions

2.

ADHD context

3.

ADHD – identifying & Screening

4.

Assessment – SNAP IV

5.

CGI

6.

Treatment & Management ADHD

7.

Medications

8.

Collaboration

PDSA Action Period 3:

Build a registry of all child-and-youth-aged

patients with ADHD

Apply screening and assessment tools to

identify children and youth who may have

ADHD

Apply non-pharmacological interventions

to manage children and youth who may

have ADHD

Where appropriate, develop care plans to

address patients with ADHD that utilizes

CYMH tools and resources

Where appropriate, use pharmacological

treatment for management of children and

youth with ADHD

Learning Session Activities

1.

Resources presentation

2.

Navigating the System – panel case study

3.

Care plans

(11)

First Learning Session (3.5 hrs) Learning Objectives:

• Apply screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorder

• Utilize the CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools • Use non pharmacological interventions (WRP, TeFA, CFA) as first line therapy for mild to moderate

depression, anxiety, and ADHD

• Identify listening and hearing as valid treatment options

• Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.)

Time Learning Session Activities

• Introduction – context (45 min)

• Physician, patient advocate perspective • Team roles and collaboration

• Statistics in community • Confidentiality and consent • Risk identification tables

• Screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorders – four initial questions

• CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools

• Identify listening and hearing as valid treatment options • Specific Non Pharmacological Interventions (WRP, TeFA, CFA) • Collaboration • Resources Delivery Format • Lecture/intro • Story telling • Facilitated Discussion • Presentation of stats and

validation

• Lecture

• Lecture

• Lecture

• Lecture & small group activity, activity debrief • Paired activity, discussion

of outcomes

• Lecture and facilitated discussion

• Facilitated discussion • Rapid Fire Presentation &

open tables at back 210 min

(12)

Second Learning Session (3.5hrs) Learning Objectives:

• Use appropriate tools to assess and plan a management strategy for X (TBD) child-and-youth-aged patients with anxiety or depression

• Use appropriate pharmacological treatment for management of children and youth with anxiety and depression

• Develop a care plan to address patients with anxiety and depression that utilizes CYMH tools and resources • Develop a collaborative working relationship with a CYMH team and other community providers (school

counselors, specialists, community services, etc.)

• Identify appropriate community resources to support child-and-youth-aged patients with anxiety, depression, and ADHD

Time Learning Session Activities

• Case introductions

• Anxiety context – including Screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorders – four initial questions

• Anxiety – identifying & Screening

• Assessment – SCARED

• Depression context

• Depression – identifying & Screening

• Assessment – KADS

• Suicide Risk assessment

• CGI

• Treatment & Management Anxiety and Depression

• Medications

• Collaboration

• Resources

Delivery Format • Story telling

• Lecture with feedback for validation

• Lecture

• Lecture with group discussion, paired activity • Lecture with feedback for

validation

• Lecture

• Lecture with group discussion, paired activity

• Lecture

• Lecture and group discussion with feedback • Lecture with group

discussion

• Lecture

• Facilitated discussion • Rapid Fire Presentation &

open tables at back 210 min

(13)

Third Learning Session (3.5hrs) Learning Objectives:

• Use appropriate tools to assess and plan a management strategy for X (TBD) child-and-youth-aged patients with ADHD

• Use appropriate pharmacological treatment for management of children and youth with ADHD. • Develop a care plan to address patients with ADHD that utilizes CYMH tools and resources

• Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.)

• Identify appropriate community resources to support child-and-youth-aged patients with anxiety, depression, and ADHD

Time Learning Session Activities

• Case introductions

• ADHD context - including Screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorders – four initial questions

• ADHD – identifying & Screening • Assessment – SNAP IV

• CGI

• Treatment & Management ADHD

• Medications

• Collaboration

Delivery Format • Story telling

• Lecture with feedback for validation

• Lecture

• Lecture with group discussion, paired activity • Group discussion

• Lecture with group discussion

• Lecture

• Facilitated discussion

210 min Assessment:

(14)

Fourth Learning Session (3.5 hrs) Learning Objectives:

• Integrate CYMH tools and resources into an effective work flow

• Report increased confidence in providing appropriate management for child-and-youth-aged patients with anxiety, depression, and ADHD

Time Learning Session Activities

• Sharing Experiences • Resources presentation

• Navigating the System – panel case study • Care plans

• Collaboration

• Sustainability and improvement tips

• Community Resource Café

• Sustainability plan • Wrap up, evaluations

Delivery Format • Story Telling and

facilitated discussion • Rapid Fire Presentation &

open tables at back • Storytelling, case

presentation, panel discussion with questions • Lecture and group

discussion, then paired activity

• Facilitated discussion

• Lecture

• Group activity • Small group activity

210 min Assessment:

References

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