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Data drives two SickKids mental health care innovations in hospital and the community

10/3/2019
 


Christina Bartha (left) and Dr. Suneeta Monga are constantly assessing their programs to make sure children and youth are getting the mental health care they need.

By Jane Kitchen

To assess the mental health needs of children and youth, The Hospital for Sick Children (SickKids) in Toronto is introducing a more integrated and evidence-informed clinical model at both its hospital and community sites.

“We are aligning our data collection processes across the hospital and community sites,” says Christina Bartha, Executive Director, Brain and Mental Health program, SickKids, and SickKids Centre for Community Mental Health (SickKids CCMH). “We are starting to link our services to create a more seamless continuum from hospital to community, in order to achieve greater impact and quality between the two. For our Mental Health Consultation Liaison Service at SickKids and our redesign of our intensive services at SickKids CCMH, we used data to assess the effectiveness of the mental health care we provide, shaping the care we are offering.”

SickKids: Connecting mental health and medical care needs

Since 2014, SickKids has offered a Mental Health Consultation Liaison (CL) Service for patients. The service provides psychiatric assessment, evaluation, and treatment planning for medical and surgical patients who also have a concurrent mental health concern.  The need for this integrated and collaborative approach was amplified by findings from the Medical Psychiatry Alliance project (2015-2020) which evaluated the effectiveness of this model in a paediatric setting. 

“We see many different connections between physical and mental health among patients on our medical and surgical units,” says Dr. Suneeta Monga, Associate Chief of Psychiatry, SickKids. “Children with pre-existing mental health conditions or whose mental health conditions are caused or exacerbated by their physical illness; or those who develop mental health conditions from dealing with their physical illness, such as a chronically ill child who develops depression once they realize how different their life is from their peers.”

The Mental Health CL Service improved staff awareness of these issues leading to better identification of patients who needed to be seen by this service.  As a result, referrals more than doubled in a three-year period, from just over 200 in 2015/16 to 450 in 2018/19. The team complement now includes paediatric mental health nurse practitioners, a behaviour analyst and psychiatrists.

“We are doing a better job of flagging mental health concerns and responding to the needs of patients and families in an area that was previously under-recognized,” says Monga.

SickKids CCMH: Re-designing services to respond to changing client needs

In 2017, the goals of the SickKids integration with the former Hincks-Dellcrest Centre was to improve access to mental health care for children and youth, particularly those with complex mental health needs. In the last two years, the new SickKids CCMH has focused on improving its clinical processes to provide more efficient access to outpatient services (OPS). Wait times to OPS have been reduced by 40 per cent, achieved through process improvement and the introduction of new service lines offering more options to families. Even with these changes, however, there remained a gap in capacity for intensive day-based services.   

“We learned from an analysis of our residential services data that we were offering a rural treatment plan no longer aligned with what families and youth wanted,” says Bartha. “Rather than having a child live away from home, families are asking for day-based intensive services that are community-integrated and offer support for transition to school and other services at the end of treatment.”

This finding has led to an overhaul of the intensive services model provided at SickKids CCMH, specifically the residential services stream. Over the past year, SickKids CCMH decommissioned their rural residential program known as “the Farm” and is now investing these resources into expanded day-based services at their two city sites; city-based residential care is still available when needed. At full implementation, these changes will increase service capacity by as much as 40 per cent.

Working together to increase access to care options

With the growing numbers of children and youth with mental health concerns presenting at SickKids (a 66 per cent increase in mental health presentations to the Emergency Department alone  between 2016 and 2018) and the relatively recent relationship with SickKids CCMH, there are many opportunities for care to be bridged between the two organizations. Historically, community-based mental health agencies have been challenged to manage clients with concurrent complex physical and mental health diagnoses. Through this innovative integration, the hospital and community sites are working toward integrated service lines that will allow these children to receive mental health care in the community, with the confidence that specialized medical care is available if and when they need it.

Jane Kitchen is a Communications Advisor at The Hospital for Sick Children.