Transitional age youth telepsychiatry consultation service

Youth who are 16 to 24 years old go through big changes as they move into adulthood. This can sometimes lead to, or put the youth at risk for, having mental health problems.

Prevention and early treatment can make a meaningful difference to these youth. Early, community-based interventions can help them avoid crisis situations, emergency room visits, and psychiatric hospitalizations.

Service providers at the Waypoint Centre for Mental Health Care, in Midland/ Penetanguishene, recognized the need for a service that focused on early intervention for transitional-age youth in their community. Their solution was to provide these youth psychiatric consultations using videoconferencing.

In this edition of the Promising Practices series, EENet’s Alexandra Harrison looks at Waypoint’s telepsychiatry consultation service for transitional-age youth. Click below to read the full story.

Promising Practices profiles innovative practices and initiatives from around Ontario.

Read it below or download the PDF.

Background

Shaunna Brady, Coordinator and
Dr. Sharon Zickman, Consulting
Psychiatrist 

Youth who are 16 to 24 years old go through big changes in their development related to school, relationships, jobs, and living situation as they move into adulthood. This can sometimes lead to, or put the youth at risk for, having mental health problems. 

Prevention and early treatment can make a meaningful difference to these youth. Early, community-based interventions can help them avoid crisis situations, emergency room visits, and psychiatric hospitalizations. 

Service providers at the Waypoint Centre for Mental Health Care, located in Midland/ Penetanguishene, recognized the need for a service that focused both on early intervention and transitional-age youth within their community. Their solution was to provide these youth psychiatric consultations using videoconferencing. 

Telepsychiatry has been shown to be effective to help youth get connected early on to a psychiatrist when one is not available locally. It decreases wait times and allows local service providers to give youth and their families information about early intervention and treatment options. 

About the Transitional Age Youth Telepsychiatry Consultation Service:

The Transitional Age Youth Telepsychiatry Consultation Service offers one-time consultation to youth 16 to 24 years old who have, or are at risk of having, mental health problems. The aim of the service is to make it easier for adolescents to access a psychiatrist early on to support early interventions. Youth are typically referred by their local primary care provider. The service is not intended for youth in crisis or with complex mental illness.

This initiative got started in the spring of 2011 and the service was up and running in the Midland/Penetanguishene area by September 2011.  In the fall of 2013, the service expanded to include youth living in the Muskoka District. Originally piloted at four days per month, the team now typically conducts two consultations every week and four every other week. Each consultation ranges from 40 to 120 minutes. By the end of 2013, the team had received referrals or inquires from 324 youth and completed 129 consultations (67% female and 33% male). 

The service uses the Ontario Telemedicine Network (OTN) so that psychiatrists can provide consultations remotely and the youth do not have to leave their communities. Similar to other telepsychiatry initiatives, like the program at the Hospital for Sick Children in Toronto, the consulting psychiatrist can offer local primary care providers treatment recommendations or help the youth connect to community-based or online resources.  

Youth can typically get appointments within two to three weeks after the service team receives the referral and the necessary client information, including the youth’s self-report. The self-report aims to engage the client and capture their perceptions, expectations, needs, and story before the consultation. The youth is included every step of way and the information is available to all members of the team, as well as o the client and their support person. 

The consultation service team is made up of:

  • Coordinator, 
  • Social Worker, 
  • Community Team Assistant
  • Two consulting psychiatrists (Dr. Sharon Zickman in Toronto and Dr. Anjana Chawla in Orillia)

Shaunna Brady and Katy Pattulo, Wellness
Fair Event (May 2012)

Both psychiatrists provide consultations from their own offices, while the youth and the consultation service team are in Midland at the Waypoint Outpatient Services Program.  For youth living in Muskoka, the team partners with Muskoka-based services to connect youth with the consulting psychiatrists.

The one-time consultation includes any supports the youth chooses to include at the session – such as family, school support person, or youth worker– and the youth’s consent is required for anyone to be present during their consultation. 

The youth’s engagement is a critical part of the consultation process. Before the consultation, the youth has the opportunity to meet with a member of the team to discuss their needs and to complete the self-report. 

After the consultation, the youth and the service team review the psychiatrist’s recommendations and discuss any barriers to follow-up support as well as community-based agencies or groups, or online resources, that the youth can access.

Any recommendations made during the consultation are sent to the referring care provider and include diagnostic assistance, treatment advice, and recommended follow-up. Youth may request a copy of their consultation to use to get supports at school or from other helping services. 

If necessary, the youth may return for a follow-up consultation, particularly if they are not receiving other youth services. Although this is a one-time service focused on supporting primary care providers, connecting the youth with available resources in an important part of the process. 

Lessons Learned

One of the key elements of the service is engaging the youth in the consultation process. To ensure the consultation has a successful outcome, the youth must choose to participate in the process. Giving the youth the option to bring support persons of their choosing and to voice their reasons for attending the consultation makes them the central focus of the process. This is not always without its challenges, as the youth may not be interested in taking part in the consultation, but ultimately this decision is up to them. 

The service team also noticed that the community needed mental health resources for youth. Many calls that came into the service were about referrals to care, rather than for consultations. To respond to this need, the team put together a number of resource sheets on a variety of diagnoses, as well as topics including: 

  • pregnancy/parenting, 
  • lesbian, gay, bisexual, transgender, and queer (LGBTQ) issues, 
  • bereavement support, 
  • education, recreation and social opportunities, 
  • financial support. 

They also try to connect youth to youth-friendly provincial resources, like Kids Help Phone (www.kidshelpphone.ca), the Jack Project (thejackproject.org), and mindyourmind.ca.
Partnering with helping services, encouraging families, and advocating for the needs of transitional-age youth in the Simcoe-Muskoka community are all important parts of the service.

The team has a relationship with local school boards and community-based agencies. Taking part in community-based and school events has been an important way to promote the service.

The need for the service has also demonstrated the importance of this age group. Waypoint staff organized a working group to bring together staff working with transitional-age youth to look at specific issues, needs, and treatment approaches. This is particularly relevant to Waypoint, where youth are often required to be treated in the adult setting if they need to be hospitalized. Many of the staff working with youth have been trained in the Transition to Independence Process (TIP) Model, an evidence-based model for working with youth that focuses on their strengths and on planning for their future goals.  

The team is also involved in other local initiatives, including: 

  • A pilot project for youth using Photovoice to document their experiences with mental health and addictions in Simcoe-Muskoka; 
  • Promotion of a local LGBTQ youth film festival; 
  • Involvement on the High Risk Suicide Protocol Group for Adolescents; and 
  • System navigation work with Community Partners with Schools (COMPASS).  

Participation in the Simcoe-Muskoka Transition Age Youth System of Support Partnership, a community-led initiative dedicated to creating an integrated system of supports for youth and their families as they transition to adulthood.

As the community’s need for prevention and early intervention increases or changes, the service will continue to respond and advocate for this important service and an overall system for transition-age youth. 

For more information contact:
Shaunna Brady, Coordinator
Tracy Wilson, Social Work Clinician
Ashley Shepherd, Community Team Assistant
tay [at] waypointcentre [dot] ca
Waypoint Centre

Author: Alexandra Harrison

 

 

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