jacques esterhuizen - the acute community intervention team

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