link connecting patients and families with mental health and addictions services in rural areas. kristen barnes

© Provincial Health Services Authority

Link: Connecting Patients and

Families with Mental Health

Resources

Shawna Wilwand (BCMHSUS)

Kristen Barnes (PHSA imPROVE)


BC Mental Health and Substance Use Services

• Provincial specialized services for children, youth and their

families

• Inpatient units

• Outpatient clinics

• Supported by PHSA imPROVE to implement lean thinking

and tools

• One tool used is the Rapid Process Improvement

Workshop (RPIW)


Context: BC Children’s Hospital Emergency

Department

• Mental Health patients – approximately 900 visits a year

• 66% are discharged directly from Emergency

• Where the patient is referred upon discharge depends on

a number of factors and is a complex process

http://www.bcchildrens.ca/NR/rdonlyres/47824BCA-4E34-47F2-8804-4270FA1D3CA4/25334/IMG_2496.jpg

http://www.bcchildrens.ca/NR/rdonlyres/47824BCA-4E34-47F2-8804-4270FA1D3CA4/25334/IMG_2496.jpg


Current State Emergency Physician Feedback


Problem

• 40% of families with mental health concerns discharged

from BC Children’s Hospital Emergency did not receive

services in a timely manner after discharge.


Contributing Factors

• 25% of referrals did not go to the right service

• Quality of referrals

• Access to community services

• Inequity in Service: Psychiatric Liaison Nurse position only

available to patients during working hours-37.5

hours/week. Only 15% of patients presenting with mental health concerns received follow up.


Intervention-BCCH Emergency Department

• Created one standardized crisis referral form (down from 11)

• Created an information handout for patients and families to access community

supports

• Psychiatry and Emergency Physicians collaborated on a standardized

assessment tool

• Created an algorithm for disposition in Emergency


Measurement: ED Outcomes

• 99% of families directed to the correct service

(compared to 75% before interventions)

• Equity in Service: All patients with mental health

concerns presenting to the emergency

department who require follow up receive follow

up


Intervention-BCMHSUS Link

• New service to help connect families with community

mental health resources.

• Provides mental health assessment, medication initiation

and management, and resource consultation.

• Link can provide a maximum of 4 follow up sessions.

• Without adding new resources, Link is expected to provide

services to an estimated 300 families in it’s first year


Who is LINK?

• Link is a team of Mental Health professionals including:– Nurse Clinician- Shawna Wilwand

– Nurse Practitioner- Ardelle Komaryk

– Social Worker- Karen Cooper

– Psychiatrist- Dr. Jennifer Russel


Measurement: Services Provided by Link

• Received 108 referrals – accepted 91% others already

connected and the patient’s care provider notified.

• Since August 15th, 2014 Link has provided services for 98

families

• Contact patient/family within 2 business days 99% of the time

• Services provided• 88% connected with nurse clinician

• 13% connected with social worker

• 5% connected with nurse practitioner

• 11 patients (11%) urgent non-emergent psychiatric assessment


Measurement: Patient Experience

• Feedback from families and the community has been

overwhelmingly positive. When asked about their experience

with Link’s over the phone services:

• Patients and families said:

• Community partners said:

“We felt safe,

helped and

supported”

Link is a great

program, I am

thankful for

the follow-up

call

Helpful, glad

someone

followed up

Always good…to

communicate with

community and all partners

– clients often present in the

emergency department and

we are not aware

Thank you for

everything you did

getting us support. Son

is doing better now and

what you did really

made a difference

“Amazing

you

helped my

child so

much”


Patient Experience Survey (n=5)

• 100% of patients/families responded “definitely” when

asked if Link had helped

• 100% strongly agreed/agreed:– Told about resources

– Understood purpose of service

– Knew who to contact

– Comfortable asking questions

– Given answers I could understand

– Felt respected


Key Messages

• Without increased cost and assigning new resources, we created a service that has increased the quality of patient care and follow up for mental health presentations to the emergency

• This process involved working across organizations, regions, and sectors of care. To overcome this challenge, members of the BC Children’s Hospital Emergency Department, BC Mental Health, community partners and families worked collaboratively to design the new process.


Contact Information

Shawna Wilwand

Link Nurse Clinician

Email:[email protected]

Phone: 604-875-2345 Ext 4948

Kristen Barnes

imPROVE Facilitator

Email: [email protected]

Phone: 604-813-7682

Healthcare

link connecting patients and families with mental health and addictions services in rural areas. kristen barnes