Supporting Continuity through Interprofessional Care planning in Acute Child and Adolescent Mental Health (ACAMH): An Evidence Informed Practice Innovation at Interior Health Carla Mantie, RPN, MA, IH; Heather Owens, RPN, IH; Michelle Padley, BSN, IH; Amanda Pogany, BSN, IH; Cheryl Zawaduk, BSN, MSc, EdD., TRU
Background The ACAMH inpatient unit at Kamloops’ Royal Inland Hospital (Interior Health) provides crisis stabilization 9-17 year olds (mean= 14 years). About half of the annual number of hospitalization via ER (n=62) are stress reaction adjustment disorder presenting with suicide attempt. An interprofessional (IP) case management team provides follow-up care 30 days post discharge at Parkview, a community based facility. A 2012 Patient Journey Mapping (Scott) exercise recommended quality improvement, education, improved protocols and resources, and communication as strategies needed to enhance service delivery. Responding to these recommendations and staff desire for enhanced collaboration, this project draws on Kutcher and Mcluckie’s (2010) values of collaboration, continuity and community. The project was initiated through the Evidence Informed Practice Innovations Action Research Study and is supported by the TRU School of Nursing.
Goals To pilot a collaborative assessment tool to support client experience of continuity and improve communication and collaborative care planning across the IP team and with families. Ultimately, this project is intended to improve access to services for families and clients experiencing crisis.
Methods & Process
Winter 2013
KT & Informing Practice with Evidence • Engagement of IP team in participatory action research (Spring 2012-Dec 2013) • CANS-MH training • E-Poster presentation • Paper poster at RIH • IHA Newsletter Brief (Fall 2013) • Healthcare Education and Research Rounds (HEARR) webinar (Feb 2014) • Anticipate publication in Mental Health Journal (Spring 2014)
Literature Review Collaborative Care Planning Spring 2013
Tool Selection Child Adolescent Needs & Strength Mental Health (CANS-MH)
Progress & Early Observations
IP Team CANS Training Ethics Review Summer 2013
6-month Pilot CANS-MH on admission or presentation to ER and at 30 days post-discharge Fall 2013
Evaluate with Exploratory Descriptive Design Surveys, Interviews, Secondary Data Winter 2013/14
Semi-structured interviews with primary caregivers (parent, foster parents, or designated adult to be completed within 3 months of discharge). Survey offered to the IP team to explore influence on evidence informed practice.
The CANS-MH (Lyons, 2010) tool was refined for local use with active participation. The research team observes a high level of commitment of IP staff to improving services. Even at the early stages of piloting the tool, staff are finding that the admission assessment processes are streamlined. Communimetrics: a communication tool that incorporates communication theory into the assessment of children and families in mental health crisis. Early observations include increased communication among IP team about goals of patient care and quality of assessments. IP staff are re-examining current assessment practices.
Acknowledgements & References Thank you to Katrina Plamondon (Nursing Research Facilitator, IH); the MSFHR for funding the Interior Health Scholarly Practice Challenge; the support of the TRU School of Nursing; and the RIH ACAMH IP team. British Columbia. Representative for Children and Youth. (2013). Still waiting: First-hand experiences with youth mental health services in B.C. http://www.rcybc.ca/Images/PDFs/Reports/RCYCYMHreport-Apr2013.pdf Kutcher, S. & McLuckie, A. for the Child and Youth Advisory Committee, Mental Health Commission of Canada (2010). Evergreen: A child and youth mental health framework for Canada. Calgary, AB: Mental Health Commission of Canada. Lyons, J. (2010). Child/Youth and Adolescent Needs and Strengths. Copyright © 2013 Praed Foundation Collaborative Training Website / Learner Nation LLC All rights reserved. http://canstraining.com/jlyons/cans-mental-health-mh/node/printable-copy-of-the-manual Scott, Samantha. (2013). Kamloops patient journey mapping report: Child and Youth Mental Health, 26 November 2012. https://www.divisionsbc.ca/thompson/CYMH PJM picture; used with the permission of the Thompson Division of Family Practice, Practice Support Program and www.drawingoutideas.ca
Some implementation challenges include changes in staff and inconsistencies in training materials.
Connect 2013 Heath Services Research at Work: Using evidence to transform care 16 September 2013 Coast Plaza Hotel & Suites, Vancouver BC