Hong Kong Hospital Authority Convention 2013

Multidisciplinary Case Management Model for People

with Severe Mental Illness 15 May 2013

Jolene Mui

Nurse Consultant

Community Psychiatry

The role of Nurse Consultant (NC) represents a new and dynamic area of advanced nursing

practice in contemporary Hong Kong health care.

Scope of Nurse Consultant Practice Hospital Authority, Hong Kong

In collaboration with multidisciplinary team, NC is responsible for: 1. Strategic planning and service development, 2. Development of care delivery model, care pathway/guidelines, risk

identification and stratification; 3. Ensure service quality and staff competency; 4. Monitor standards and outcome; 5. Direct care and management of complex and high risk cases; 6. Facilitate primary care development and community networking; and 7. Provide consultation service.

4

Improve clinical care

Helping people to stay healthy

毒 如 蛇 蠍

影 片 Experience sharing in Community Psychiatric Service

Problems with inadequately funded

CPS/unplanned closure of beds Service provision could only geared towards risk aversion Patients with SMI were often cycled rapidly between psychiatric

emergency services, inpatient psychiatric hospital units and a return to the

community without adequate provision for aftercare.

Recovery

Service

Risk Aversion

Strategic planning and service development :

The vision of the future is of a person-centred service

based on effective treatment and the recovery of the

individual

Hospital Authority Mental Health Service Plan for Adults2010- 2015

Hospital Authority Mental Health Service Plan for Adults2010- 2015

Strategic planning and service development

Set the stage

To develop unique care delivery model to meet patient `s

needs effectively.

3 – tiered multidisciplinary Case Management Model in CPS

Multidisciplinary approach to meet the multiple needs of patients.

One single point of entry to improve the accessibility of service consumers

Immediate risk

• In relapsed

• In acute state

High risk

• Poor drug compliance

• Intense emotional problems

• SMI with young children

Low risk

• Stable cases with chronicity of illness

• Multiple functional disabilities

High intensity short term care package

A. Crisis Resolution

B. Assertive community out-reach ( pre-crisis intervention)

Complicated care package

• Psycho-therapeutic intervention :

• -symptom management.

• -counseling

• -cognitive behavioral therapy

• -family therapy

Medium

High

Low

Complexity of formulation Risks & Needs stratification Complexity of intervention

Low intensity care package

-Maintenance therapy

-Peer support

Objective exchange rate of case load among the 3 tiers :

(1) High: (2)Medium : (3) Low

Risk

Pathfinder Risk assessment

Needs

Camberwell Needs Assessment

•The stratification is an essential process to ensure appropriate workload distribution among case managers. •The case allocation with references to patients` needs and matching with case managers` expertise allows the care delivery to be more focused and this is essential to drive for quality.

Stratify patients into 3 tiers complexities: high, medium low.

The uniform assessments and outcome measures ensure standard

Service provision

Service development and clinical leadership

-

To build a streamlined and coordinated workforce for

community psychiatric care of General Adults.

.

Integration all community psychiatric service of General Adult,

EASY & Forensic under the same Team in year 2010

Leading the whole Team towards the same vision

Continuous Quality Improvement

Formulation of fidelity scales.

To ensure service quality

Creation of the New model with service protocol/ risk & needs

stratification /care package/ care pathway.

Uniform Assessment

Clinical Guidelines

Data Management

Evidence-Based, Best Practice

Levels of Care

Outcomes Fidelity

Develop Fidelity Assessment Determining whether the intervention is conducted as planned and is consistent with

service elements delineated including structures & goals.

Develop Fidelity Assessment

• Components

a. Team structure: case load/staff capacity

b. Team process : guideline/procedure

c. Diagnostic and Treatment intervention:

ISP/care package Community care

d. Organization: admission & discharge

criteria

e. Monitoring: outcome

Clinical practice and consultancy

-

To provide clinical consultancy service across multidisciplinary groups/community partners.

.

On going supervision to case managers from a variety of backgrounds ( nurse, OT, social worker )

Working directly with clients of having high risk /complex needs

Ensure service quality and staff competency

-

Continuous review, organize & deliver training to

multidisciplinary staff working in Community Psychiatric

Service as well as CPNS of HK

.

Design the training packages in different tiers under the new model.

Arrange training to multidisciplinary staff working in CPS.

Develop training programs for case managers.

3 tiers Case Management Model

Immediate risk

• Active psychosis which

affects patient's ADL

• Immediate risk to self

and others

Medium risk • Doubtful drug compliance

• Fluctuating mental state

• Intense emotional problems

• SMI with young children

Low risk

• Stable cases with chronicity of illness

• Multiple functional disabilities

High intensity short term care package

A. Crisis Resolution /pre-crisis intervention

B. Assertive out-reach

Intensive care package

Psycho-therapeutic intervention :

-symptom management.

-counseling

-cognitive behavioral therapy

-family therapy

Medium

High

Low

Complexity of formulation Risks & Needs stratification Complexity of intervention

Standard care package • Maintenance therapy

• Close collaboration with

community partners.

• Enhance patient self care and

• functional ability

Enhanced community networking

-

To build strategic partnership

Formalized network with all relevant community partners . Joint projects to link up professional staff; people from

different strata of society (e.g. community agencies / volunteers / carers / business enterprise / families ) to provide share care to clients/families/carers /public.

To provide consultation to community partners.

Research & evidence based practice

-

To improve service outcome through evidence-based

practice

Conduct research

s

Bressington, D. T., Mui, J., Cheung, E. F. C., Petch, J., Clark, A. B.,

& Gray, R. (2013). The prevalence of metabolic syndrome

amongst patients with severe mental illness in the community in

Hong Kong – A cross sectional study. BMC Psychiatry, 13, 87.

doi:10.1186/1471-244X-13-87

Bressington, D., Mui, J., & Gray, R. (in press). The effects of

medication-management training on clinicians’ understanding

and clinical practice in Hong Kong. Nurse Education Today.

doi:10.1016/j.nedt.2012.10.021

Bressington D., Mui, J., & Gray, R. (2013). Factors associated

with antipsychotic medication adherence in community-based

patients with schizophrenia in Hong Kong: A cross sectional

study. International Journal of Mental Health Nursing, 22, 35-

46. doi:10.1111/j.1447-0349.2012.00830.x

Chui, W. W. H., Mui, J. H. C., Cheng, K. M., & Cheung, E. F. C.

(2012).

Community psychiatric service in Hong Kong: Moving towards

recovery-oriented personalized care. Asia-Pacific Psychiatry, 4,

155-159. doi:10.1111/j.1758-5872.2012.00206.x

Cheng, K. M., Chan, C., Wong, R., Leung, K. T., Mui, J., Chui, W.,

& Cheung, E. (2012). Integrated care pathway for the

personalized care programme for patients with severe mental

illness in Hong Kong. International Journal of Care Pathways, 16,

72-75. doi:10.1258/jicp.2012.012006

Chan, S., Mui, J., Shing, K. C., Chien, W. T., Chan, A., Chan, D., &

Ip, W. Y. (2011). “Growing in Happiness”: Pilot study of a

mental health promotion programme for children with

Chui, W. W. H., Mui, J. H. C., Cheng, K. M., & Cheung, E. F. C.

(2012).

Community psychiatric service in Hong Kong: Moving towards

recovery-oriented personalized care. Asia-Pacific Psychiatry, 4,

155-159. doi:10.1111/j.1758-5872.2012.00206.x

s

Chan, S., Mui, J., Shing, K. C., Chien, W. T., Chan, A., Chan,

D., & Ip, W. Y. (2011). “Growing in Happiness”: Pilot

study of a mental health promotion programme for

children with mentally ill parents. Hong Kong Journal of

Mental Health, 37(1), 22-30.

Yeung, C. L., Kwok, S. K., & Mui, H. C. (2011). An

investigation of an RFID-based Patient-Tracking and

Mobile Alert System. International Journal of Engineering

Business Management, 3(1), 50-56.

Mui, J. (2011, June). Keynote address: Clinical practice

innovation. Paper presented at the 5th Hong Kong

International Nursing Forum, Hong Kong SAR, China.

Cheng, K. M., Mui, J., Wong, R., Leung, K. T Chui, W., &

Cheung, E. (2012). Integrated care pathway for the

personalized care programme for patients with severe

mental illness in Hong Kong. International Journal of Care

Pathways, 16, 72-75. doi:10.1258/jicp.2012.012006

Mui, J., Fong, S. Y., Lin, K., & Chan, E.. (2011, September). Meaning of

recovery from people with severe mental illness. Paper presented at

2011 Institute of Mental Health Conference, Hong Kong SAR, China

Mui, J. (2012, August). Advanced nursing practice: Global vision – global reality

Paper presented at the 7th International Nurse Practitioner/Advanced Practice

Nursing Network Conference, United Kingdom

Mui, J. (2010, December). Comprehensive management models. Paper

presented at the 2nd HK-UK Joint International Conference, Hong Kong SAR,

China.

Mui, J. (2009, November). Nurses’ contribution to contemporary disease

management. Paper presented at The Fourth Conference, Macau-Hong Kong

Nursing Conference. MacauSAR, China

Mui, J. (2009, August). 如何運用綜合能力及家庭參與提升病人成效. Paper presented at中華護理學會 一百週年庆 at Peking

s

This New Model sets

the stage for us to move

forward…..

STRUCTURE: Establish multidisciplinary case

management model

PROCESS : Formulate comprehensive assessment

tools

- Risk & Needs assessment

-Individual patient care plan

- Clinical Case Review

OUTCOME measures: Needs/risks/measurable

Mental/physical/psychological/social…

COMMUNITY PARTNERS:

Established local platform: SWD. NGO. Police.

Housing

Collaboration guideline with ICCMW

Brings in more

recovery elements

into the service model

Research:

Meaning of

RECOVERY

Draws on consumer perspectives

•Symptom amelioration • Enhancement of functional capability •Improvement of health.

Clinical (medical) Recovery

a meaningful, satisfying and valued life dignity

hope aspiration confidence

Self determination

Meaning of Recovery……two sides…

Clinical (medical) Recovery Practioner Defined recovery : symptom reduction health improvement; enhancement of functional capability;

Personal (life)

Recovery

Service user defined recovery

Meaningful, satisfying and valued life.

It was what have focused in the past

That is what we are planning to do more

Equally important

To actualize RECOVERY

We have to combine both the

`Clinical Recovery` & `Personal

Recovery

Employed the first peer specialist in

HK in 1st September 2011

Recovery-focused Practice

stigmatization

H.K. Connection (鏗鏘集)

我病了……但我會快樂

Strategy to overcome stigma

Youth Ambassador Program to increase the resilience of children of psychotic parents

Thank you