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
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!).
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
• 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
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
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
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.
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.
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
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
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
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
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:
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: