jacques esterhuizen - the acute community intervention team
DESCRIPTION
A presentation given by Jacques Esterhuizen at The Journey, CHA Conference 2012, in the 'Innovations in mental Health Care for Children & Young People'TRANSCRIPT
THE ACUTE COMMUNITY INTERVENTION TEAM
Jacques Esterhuizen
Acute Services Directorate
CAMHS
Child and Adolescent Health Services
Perth
Western Australia
“It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change”
CHARLES DARWIN (1809-1892)
Presentation Layout of WA CAMHS services Development of ACIT Progress Reform of inpatient units Future directions
CAMHS Organisational Chart
Total clinical FTE – 101
CAMHS inpatient beds: 28 beds for under 18 yo for WA’s 2.4 million population
CAMHS area Ages (years) Number
of beds
PMH Ward 4H under 16 8
Bentley Adolescent Unit
12 to under 18 12
Families at Work
(sub-acute)
6 – 12 8
Acute CAMHSPMH Ward 4H
Client group Type of service
Providing:
Up to 16 years Those who cannot be managed in the community due to acuity or complexity of problems
Statewide specialised voluntary in-patient service
Acute careCrisis admissionCan be followed by assessment for stabilisation, diagnosis and planning for dischargeShort interventions where indicated
Acute CAMHSBentley Adolescent Unit
Client group Type of service Providing:
Up to 18 years oldThose who cannot be managed in the community due to high level of acuity and risk
State-wide acute inpatient serviceOnly Authorised mental health inpatient unit in WA for under 18’s
Assessments and treatments by a multidisciplinary team focusing on containment and safety for young people
Acute CAMHSTransition Unit
Client group Type of service
Providing:
Adolescents aged 13 to under 18 yearsTransitioning between BAU and home and/or into other services.
Step-down facility
Intensive recovery focused programDay Therapy program accessed by both inpatients and outpatients Intensive group based work
Peel, 9.5fteRockingham,
8.2fte
Fremantle, 11fte
Shenton, 5.1fte
Hillarys, 5.3fte
Clarkson, 6.5fteSwan Valley / Kalamunda 9.6fte
Armadale, 11fte
Community CAMHS
Bentley Family Clinic, 12.7fte
Warwick, 9.3fte
Total clinical FTE – 88.2
Locations of CAMHS (WACHS)
3.6 FTE West Kimberley
1.6 FTE East Kimberley
1.5 FTE West Pilbara
3.5 FTE East Pilbara
4 FTE Geraldton
6.8 FTE Wheatbelt
4.5 Upper SW
3 FTE Lower SW
2 FTE Kalgoorlie
2 FTE Esperance
2 FTE CUGS
2.6 FTE LGS
11
State demographics
500,000 (24%) children aged 0-17yrs (ABS 2006 census)
74% - Metro; 26% - Rural and remote Mental health problem
16.6% of young people (Child Health Survey)
21% Aboriginal children (Aboriginal Child Health
Survey, age 12-17)
Severe mental disorder 5% young people (Child Health Survey)
11% Aboriginal children (Aboriginal Child Health Survey,
age 12-17)
12
State demographics
Risk of clinically significant emotional difficulties, age 4-17 (WA Mental Health towards 2020)
15% non-Aboriginal children 24% Aboriginal children
5% children (with mental disorder in clinical range and parental
need for help) needed hosp dept psychiatric help (National Survey of Mental Health and Well-being – 2000)
Admissions 11/12: 680 (2.7% of severe mental disorder category - WA Child Health Survey)
Acute CAMHS Assertive Community Intervention
Began with the introduction of ACIT Following on with the Acute Response Team (ART)
Funded by MHC and NPA Responding to consumer and carer requests for
emergency assessments in community, thereby
avoiding emergency department attendance
Rapid response and comprehensive assessments Identifies, manages and stabilises the most high risk
children and adolescents in the community alternative to inpatient admission acute high risk phase following discharge
Acute CAMHS Assertive Community Intervention
Client group
Type of service Providing:
ACIT High riskUnder 18s
Admission diversionIntensive outreach support Business hours
8 week interventionAlternative, complementary multidisciplinary model of care to inpatient treatment.Preventing admission where possible
ART Under 18s
Emergency Dept diversion7 days a week/24 hours a day
Single point of patient flow coordinationTelephone consultation for crisis management & advice In-reach to PMH & all metro emergency departmentsCommunity visits in metro area
IN(CON)CEPTION TO BIRTH – Dob 01/08/08
Funding from PMH Gaps in Service Initiative
MDT = Psychiatrist, Psychologist, Senior Social Worker, MH Nurses, Ed Liaison Officer, Multi-cultural MH worker (5.5FTE)
Training Networking (CAMHS and NGO) and
workshops
INFANCY – 1st yearACIT Referrals by Age May 08-April 09
0% 9%
59%
32%
0-4
5-9
10-14
15-19
ACIT REFERRALS May 08 - April 09
9
3
14
21
18
22 22
8
10
21
18
14
0
5
10
15
20
25
May-08
Jun-08
Jul-08
Aug-08
Sep-08
Oct-08
Nov-08
Dec-08
Jan-09
Feb-09
Mar-09
Apr-09
CHILDHOOD – Model of Care
Referral Daily intake meeting (weekdays), ED and
ward referrals Initial assessment
Co-worker model Contact within 24 hours of referral Holistic, systemic based assessment
approach involving client and relevant family members / guardians or care provider.
CHILDHOOD – Model of Care (cont)
Management Development of crisis plan Provide family with supportive contacts Multi-disciplinary assessment and treatment MDT clinical reviews
Discharge / Outcome 8 week intervention Identification of onward service
CHILDHOOD - change in bed classificationWard 4H (Sep 2009)
Assessment bed (minimum of 2 beds daily) 24 hour admission. Intensive assessment and development of
management plan. Aim to return to community
Therapeutic bed (maximum 6 beds) Need for continued inpatient care Care coordinator model of care Goal directed treatment planning
CHILDHOOD - Development of ART
Acute Response Team (ART) Rapid response team to assess overnight
admissions to ward 4H, medical wards and ED. Members: Registrar on duty, PLN, Duty Officer,
ACIT clinician, Consultant Psychiatrist. Optional members: Level 1 and 2 nurses Linkage with ward 4H and ACIT. Training environment for junior staff.
CHILDHOOD - Benefits of overnight admission
Provide containment of situational crisis Partial resolution of crisis Stabilisation of risk Assessment and case discussion by MDT Allows office hours consultation and liaison Allows transfer to appropriate facility during
office hours
CHILDHOOD - ART bed data
ART outcome. Sep '09 - Jun'10
61%
28%
33%
39%
Cont Admit Discharge ACIT Other
CHILDHOOD - ART bed dataART Outcome (FY 10/11)
20%
32%
52%48%
Cont Admit Discharge ACIT Other
24
ADOLESCENCE
Restructure of Metro CAMHS – Feb 2011 ACIT expanded in Jan 2012 (NPA funding for
extra 5FTE) Servicing 16-18 age group
Adult emergency departments and Bentley Adolescent inpatient unit (12 beds, age
12-18) 10.2 FTE
Nursing ; SSW; Specialist Clinical Psychologist; Multicultural worker; OT
Case load = 79 (~ 8FTE = 10 clients per FTE)
ACIT - ReferralsACIT - Referrals per month (linear regression)
Jul'08 - Jun'12
0
5
10
15
20
25
30
35
40
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
Linear (11-12) Linear (10-11) Linear (09-10) Linear (08-09)
ADULTHOOD – Reform of Acute Services
Development of ART November 2012
ED diversion program MHC funding = $1.6M Assertive community based Ax; 24/7 PLN
role; Metro ED Ax; 24 hour bed flow/triage position
13.6 FTE Nursing; SSW
BENEFITS
Many more options for disposal from ED An alternative to admission Reduced length of stay No bed blockage Least restrictive care “Hospital in the home” Closing the gap between Hospital and
Community mental health services