Transforming the delivery of child and adolescent mental health care in Northern Ontario: A comprehensive, multidisciplinary shared care model
Maternal, Child & Mental Health
The project exploring a change to a comprehensive, multidisciplinary shared care model for the delivery of child and adolescent mental health (C&A MH) in Northern Ontario has shown notable care delivery gains. There has been an effective reduction re-admission to inpatient hospital services following inpatient admission, a reduction in overall length of stay, and significantly increased access to mental health services for youth in the northeast region.
The main cause of presentation to C&A MH emergency departments in the region is related to personal safety concerns and currently available evidence base would indicate a time limited inpatient treatment focusing on skills development and providers operate within a consultation team model to be the most effective treatment available. Outcomes include reduction in length of stay in hospital, readmission rates and overall occupancy rate with increases in the total number of physician mental health assessments and outpatient follow up.
Evidence-based best practice recommendations suggest against prolonged children’s mental health inpatient admissions. A focus on outpatient care as a major predictor of recovery is continuing daily routines with prosocial engagement (most commonly attending school) to the largest extent possible. Dedicated efforts have been made to shift service delivery of child and adolescent mental health from a primarily inpatient model to primarily outpatient service delivery. To best facilitate care, new approaches to inpatient managed have been implemented with a focus on utilizing Dialectical Behavior Therapy (DBT) based skills training when appropriate. A presentation-based approach has been implemented within a shared care framework utilizing both subspecialty child and adolescent psychiatry and pediatrics to allow optimization of services across different phases of mental health illness settings including emergency department, general inpatient, and outpatient. The general hypothesis of this model was the expectation of fewer re-admissions to hospital, reduction in length of stay, and improved access to child and adolescent mental health services. Deidentified and aggregate data has been used to assess outcomes hypothesized, data was obtained directly from the hospital based Electronic Medical Record system. A significant reduction in re-admission (i.e. return to hospital after first admission and discharge) to hospital for mental health presentations has been noted since shifting the presentation model (43.6% in 2018 to 11.7% in 2022). Access and utilization of outpatient services (estimated through outpatient appointments) increased 315% after implementing the new model of care. Next steps could involve implementing resources to care coordination between inpatient and outpatient services, skills development and training for staff involved in the program and increased use of available technology to facilitate communication with youth involved in the program.