2 Years & Thriving!

Presented by:

Martha Nystrom, BSP, MBA, Program Manager, SCPCN

Patrick Griffin, MS, RSW, Clinical Supervisor – Time to Talk

Faculty/Presenter Disclosure

Relationships with commercial interests:

Potential for conflicts of interest

None to disclose

SCPCN

Quick Facts

o Began operations February 1, 2006

o Geography includes Calgary

population south of Anderson Road

o Projected to grow 4% annually with 4

new communities planned

Physician Demographics

2015 218 Member Physicians

2013 182 Member Physicians

2006 47 Member Physicians

2013

237,433 Residents

160,009 (67%) Attached Patients

2015

256,000 Residents

190,835 (76%) Attached Patients

Patient Demographics

2006

150,000 Residents

75,000 (50%) Attached Patients

Calgary Zone Primary Care Action Plan

Guiding Principles (2011)

Access

Comprehensiveness

Continuity

Coordination

Most responsible family physician and team

Demonstrated value to patients, providers, system and funder

Model of Care:

Centralized

vs.

Decentralized

SCPCN Philosophy

Providing access to

a range of basic

health services

including:Primary Care

Women’s Health

Chronic Disease

Management

Mental Health

Promotion

Seniors’ Health

The World Health Organization says

‘There is…..

- Toward Recovery & Wellbeing:

A Framework for a Mental health Strategy for Canada

What needs to be done?

“Provide access to the right combination of services,

treatments and supports, when and where peopleneed them”.

Mental Health

Commission of

Canada

(stats from 2011)

1 in 5 Canadians are affected annually

by mental health conditions

That’s approx 40,000 – 50, 000

people within SCPCN’s boundaries

Principles

Support the SCPCN physicians practice

Complement the BHC model

Expand the model of care to meet diverse mental health needs

After Hours Access

Unattached and Attached Patients

For All ages and stages

Increase communication with referring physicians

MH services closer to the medical home

Goals

Improve Access

Mental Health interventions

Coordination with relevant

systems

Internal communication

Data collection

Sustainability

Centralized service: T2T

o 7 Clinics (28 Physicians)

Decentralized service: Behavioural

Health Consultants (BHC)

o 14 Clinics (73 Physicians)

T2T Pilot Team

TEAM

Program Manager

Medical

Office

Assistants

Consulting Clinical

Supervisor

2 Full Time

Therapists

3Part Time Contract Therapists

Jan – Apr 2014 =

62 hours/month

May 2014 – Mar 31,2015 =

109 hours/month

T2T

Referral Process

T2T Brief Therapy Model

We use a Feedback Informed Model of Treatment (FIT)

o Assessment: 60 minutes

Biopsychosocial with provisional DSM 5 diagnosis

Treatment recommendations

T2T Brief Therapy Model

o Treatment 5 – 50 minute follow up appointments

CBT, SFT, Brief Dynamic Models

Goal focused

Timely on-going communication with Family Physician

Refer to SW or community partner

o Discharge Summary report to Family Physician

Treatment recommendations

Referrals (as indicated)

Statistics

27 physicians

provided 709referrals

598 unique

patients & 1445patient visits

Anxiety and depression (60%)

Average TTTN =

18.5 days

Utilization Pattern

0

20

40

60

80

100

120

140

160

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Attended

DNS

<24 Hours

Total Booked

Referred

Life Stressors

Psychiatric Symptoms

Participant Satisfaction:

Session Rating Scale (SRS)™Revised V2.1

4.99

4.98

4.94

4.874.85 4.85

4.80

4.76 4.75 4.75

4.60

4.65

4.70

4.75

4.80

4.85

4.90

4.95

5.00

Respect

Honesty&Sincerity

Acceptance

Understanding

Helpfulness,Usefulness

AgreementonTasks

Agreementontreatment

Ideasaboutchange

AgreementonGoals

Hope

SRS is a trademark tool used by

our T2T team

© 2000, Lynn D Johnson, Ph.D,

Scott D. Miller, Ph.D and Barry L.

Duncan, Psy.D

PHQ9 and GAD7 Scores

Adapted from: PHQ9 = Patient Health Questionnaire and GAD7 = Generalized Anxiety Disorder

T2T taught me that opening

up isn’t a bad thing and

that you can’t solve

problems on your own.- T2T Patient Quote

Integrated

Centralized

Model

April 2015 and

Beyond

T2T Current Team

TEAM

Program Manager

Medical

Office

Assistants

Clinical Supervisor/Therapist

2.4 Full Time

Therapists

2

Social

Workers

2 Part time

Contract Therapists

o 114 hrs/week

Our Current

T2T Team

Utilization

Stats

Days to Discharge

Average =

176 days

Patient Life Stressors

Psychiatric Symptoms

ation

AHS

Behavioural

Health Consultants

3 BHC’s work in 18 SCPCN

clinics

Average = 7.75

patients/day

6.2% No Show Rate

Happiness Basics

facilitators

ACE Research Project

QUICK

STATS:

Mental Wellness

Recovery Group

Help to recover from

DEPRESSION

& ANXIETY

Mental Wellness Recovery Group

Evaluation

Participants reported a 54% increase in

ability, knowledge & understanding

of areas proven to be key to successful

recovery.

Participants reported a 70%increase in

their understanding of the importance of

setting personal goals to recovery.

Happiness Basics

Your Guide to Being

HAPPIER!

CLASS

STATS 9 facilitators trained by RDPCN*

4 Seasons (Fall 2014, Winter, Spring, Summer 2015)

11 groups

269 registered

140 graduated

*Happiness Basics was developed by Red Deer Primary Care Network

Happiness Basics Evaluation

EQ5DL EQ-5D – European quality of life in 5 dimensions – acknowledge source

0

1.4

1.1

1.7

2

2.2

1.3

1

1.5

1.8 1.8

0

0.5

1

1.5

2

2.5

Mobility Self-care Usual Activities Pain Anxiety/Dep

EQ

5D

5L

Sc

ale

EQ-5D at class 1 and 6

Before After

USA (English) © 2009 EuroQol Group. EQ-5D™ is a trade mark of the EuroQol Group

Happiness Basics Evaluation

Happiness Scale

*Results compiled

from first 2 sessions

(2014/2015)

Medical Neighbourhood

Addiction & Mental Health Services

Access Mental Health

Child/Adolescent Mental Health

South Health Campus

AHS Providers (eg) Community Providers (eg)

Calgary Counselling Centre

Sheriff King

CASA (Calgarians Against

Sexual Assault) Catholic Family Services

Service Improvement Plans

Build capacity to increase patient access

Clinical Supervisor – Full Time

Clinical Consultant/Mentorship

Group and Individual Supervision

Professional Development

Standardized Operational Practices

Ethical Consultation

Assessment Tools

Documentation Practice Audits/Quality Assurance

Complex referral triage

Monthly AuditPatients seen >4 times

Prepare patient for discharge

Conversation with clinical supervisor

Re-referral

Goal to keep number of appointments to < or = 6 sessions

BHC Expansion

Additional BHC – Oct 2015

6 more clinics

Total:

4 BHC’s

24 clinics

114 Physicians

Scheduling of providers

TTTN (Time to third next) = 30 days

Initial to follow-up visit ratio – 1:2

Schedule templates developed

Real time charting

Implement Nov 2015

Social Work Role Optimized

Social Work Referrals

Addiction Resources

Finances

Food

Housing

Income resources

Lack of supports

Legal issues

Loss of job

Parenting resources

Estimate 25% of current referrals

directed to Social Work.

Annual Physician Survey

How familiar

are you with

these SCPCN

services that

are available

to you and

your

patients?

I know and

use it

Know;

but not

used it

Don’t

know;

interested

Not

interested

Total

Time to Talk (T2T) 25 (21.6%) 35 (30.2%) 51 (44.0%) 5 (4.3%) 116

Behavioural Health 57 (47.9%) 32 (26.9%) 28 (23.5%) 2 (1.7%) 119

Happiness Basics 26 (22.0%) 43 (36.4%) 44 (37.3%) 5 (4.2%) 118

Mental Wellness

Recovery Group

11 (9.1%) 26 (21.5%) 78 (64.5%) 6 (5.0%) 121

Annual Physician Survey

Please rate

your

satisfaction

with the

quality of

service?

Very

satisfied

Somewhat

satisfied

Neither Somewhat

dissatisfied

Very

satisfied

Ttl

Time to Talk (T2T) 12

(44.4%)

10

(37.0%)

4

(14.8%)

1 (3.7%) 0

(0.0%)

27

Behavioural health 38

(77.6%)

7 (14.3%) 3 (6.1%) 1 (2.0%) 0

(0.0%)

49

Happiness Basics 7 (33.3%) 5 (23.8%) 9

(42.9%)

0 (0.0%) 0

(0.0%)

21

Mental Wellness

Recovery Group

2 (15.4%) 5 (38.5%) 6

(46.2%)

0 (0.0%) 0

(0.0%)

13

Mental Health Supports Suggested

o Increased number of

therapists

oGeriatric community

based services

o Teen mental health

support

o Psychiatrist access

o Eating disorder support

group

oADHD Clinic

oChronic Pain

Management

o Faster access for MH

support

Communication

& Marketing

Strategy

o Launch revised referral form

o Website updates

o Meetings with referring

physicians

o Review T2T services – Therapist,

Social Worker

o Complimentary programs

available

New SCPCN

Consolidated Clinic

Space

T2T Therapist Growth following move to new space

Adding2 FTE

Evolution of Services

Examples

Skills Groups (Coping with…)

Mindfulness Sessions

Psychiatry Access

Student

Practicum Site

Building capacity

Developing affiliation

with academic setting

Professional

development

opportunity

Pan PCN Networking opportunity

for PCN mental health providers

o Adaptive

o Collaborative

o Creative

We need our team to be:

o Flexible

o Patient Centered

o Integrated

To keep the plane in the air

moving forward…

martha.nystrom@scpcn.ca

patrick.griffin@scpcn.ca

CONTACT: