Child and Youth Mental Health Service - Service Framework ......mental health issues, in...

Child and Youth Mental Health Service

Service Framework

Acknowledgement ofTraditional Owners

Darling Downs Health respectfully acknowledges the Traditional Owners, both past and present, of the region we service.

If you have any questions regarding this document or if you have a suggestion for improvement, please refer to Director, Strategy and Planning or Executive Director, Mental Health Alcohol and Other Drugs, Darling Downs Hospital and Health Service.

www.health.qld.gov.au/darlingdowns

ABN 64 109 516 141

© Darling Downs Hospital and Health Service, State of Queensland, 2019 creativecommons.org/licenses/by/3.0/au

4370.V1 | 09/2019ABN 64 109 516 141 www.health.qld.gov.au/darlingdowns

Darling Downs Health Child and Youth Mental Health Service ................................ 2

Our framework ....................................................2

Our vision ............................................................2

Our mission .........................................................2

Effective, safe, high value care ................... 4

Model of Service .................................................5

Principles of care .................................................5

Coordinated and responsive ....................... 7

Criteria for Eligibility for Child and Youth Mental Health Services in Darling Downs Health: ............8

Access pathways .................................................9

Referral ............................................................. 10

After-hours access .............................................11

Individually tailored ..................................12

Individual support and treatment plans ............. 12

Case management............................................. 13

Involuntary care ................................................ 14

Hospital bed-based care ................................... 14

Specialised services .......................................... 14

Integrated and interconnected ..................16

Our service partners .......................................... 17

Recording mental health information................. 17

Working with families and other service providers ........................................................... 18

Rehabilitation and recovery focused ..........19

Promoting wellbeing and quality of life .............. 19

Discharge/transition of care .............................. 19

Re-entry to the mental health service ................ 19

Darling Downs Health 1

Darling Downs Health Child and Youth Mental Health Service

The Darling Downs Health Child and Youth Mental Health Service is a network of specialised mental health teams located across our region. They provide a comprehensive response to the varying needs of infants, children and adolescents (young people) with mental health problems or mental disorders and their families and caregivers in the community.

Our framework

This framework has been written to outline the services provided by Darling Downs Health Child and Youth Mental Health Service for individuals, carers, families and the general community.

The framework also offers general information to assist our health service partners and colleagues in understanding the services we provide.

Our vision

To improve mental health and wellbeing of infants, children, adolescents and their parents/guardians (young people) and carers to reduce the lifetime risk and burden of mental illnesses within our community.

Our mission

To deliver effective and comprehensive, developmentally and culturally sensitive, family-centred mental health care for infants, children and adolescents up to 18 years of age (young people) who are suffering from, or at risk of developing, severe, complex and enduring mental health issues, in collaboration with parents/guardians, families, care providers and our other key partners.

The Darling Downs Health Child and Youth Mental Health Service (CYMHS) delivers evidence-informed, specialised services for young people within the spectrum of integrated community treatment, community support, and hospital bed-based services.

Our work is guided by 5 core enablers which underpin how we operate.

Central to our service design is the provision of responsive, accessible and effective care, with young people and their families and caregivers at the centre of their own journey.

2 Child and Youth Mental Health Service - Service Framework


Darling Downs Health CYMHS Core Enablers:

Effective and Safe High Value Care

Rehabilitation and Recovery

Focused

Coordinated and

Responsive

Integrated and Interconnected

Individually Tailored

Responsive, accessible and effective care


Our service hubs support surrounding communities across the Darling Downs HHS region. In addition, our hospital bed-based unit based in Toowoomba also provides services for young people outside of the Darling Downs service boundaries when appropriate.

We employ a range of Medical, Nursing and Allied Health Clinicians who provide specialised child and youth mental health services. Our workforce is multidisciplinary, with staff from all disciplines working in partnership to develop and deliver individualised care to young people in need.

Darling Downs CYMHS Multidisciplinary teams typically include:

• Child and Adolescent Consultant Psychiatrists

• Registered Nurses

• Mental Health Workers

• Psychologists

• Aboriginal and Torres Strait Islander Health Workers

• Occupational Therapists

• Trainee Registrar Psychiatrists and other Doctors

• Dieticians

• Speech and Language Therapists

• Social workers

• Teachers and Guidance Counsellors

All team members have the support of locally based, specialised Clinical leaders, responsible for the operational and professional leadership, and who play a key role in ensuring our vital partnerships are fostered and enhanced.

Effective, safe, high value care

Darling Downs Health CYMHS delivers safe, effective and high-value care through Community and Hospital bed-based treatment and support services, delivered by local teams. Our community services are positioned in 6 locations across the Darling Downs:

» Toowoomba Community CYMHS

» South Burnett Community CYMHS, located in Kingaroy;

» Southern Downs Community CYMHS, located in Warwick and Goondiwindi;

» Western Downs Community CYMHS, located in Dalby and Chinchilla.

Toowoomba

Chinchilla

Kingaroy

Dalby

Warwick

Goondiwindi


Model of Service

Darling Downs Health CYMHS are guided by Queensland state-wide Models of Service, centrally managed and reviewed by the Queensland Mental Health Alcohol and other Drugs Branch. Within Darling Downs Health, as previously indicated, there is senior nursing/midwifery representation on many governance committees.

The models of service and frameworks that are applicable to our services are:

• Community Child and Youth Mental Health Model of Service

• Evolve Therapeutic Services

• Adolescent Acute Inpatient Model of Service

• Child and Adolescent Day Program Model of Service

• Assertive Mobile Youth Outreach Service Model of Service

Queensland Health Mental Health Practice Guidelines and the suite of state-wide standardised clinical documentation also support consistent practice across our services.

Treatments and specialised programs offered across Darling Downs Health Child and Youth Mental Health Services are continually evaluated and refreshed. This process allows clinicians in the field to have input in what programs and treatments will be of greatest benefit to the community and to raise ideas for consideration. All treatments and programs are supported with evidence and approved through the Darling Downs Health CYMHS leadership team before being endorsed for delivery in the region.

For Darling Downs Health CYMHS, protocols and guidelines are tailored to support local service delivery. Governance to ensure local guidelines, protocols, treatments and programs are evidence based, meet local need and maintain a contemporary focus occurs through Divisional Safety and Quality meetings held Quarterly. All the services we provide are tested against, and meet, the national standards in safe quality care.

Principles of care

All young people have the right to comprehensive and integrated mental health care that meets their individual needs and achieves the best possible outcome in terms of their recovery.

The Darling Downs Health Child and Youth Mental Health Service (CYMHS) incorporates guiding principles into service delivery to ensure individuals, carers and families have access to a range of programs that will support meaningful recovery.


We use evidence as a basis for treatment:We use a criteria-led approach to admission, treatment, referral and recoveryWe are assertive in identifying and managing high risk presentations as safely as possible for allOur treatment is regularly reviewed to ensure it is effective and usefulWe support a least-restrictive approach to treatment, in consideration of the young persons’ safety Agreed treatments have a scientific evidence base which is broadly endorsed across professionals and disciplinesWhen deciding on a therapeutic intervention, we are guided by shared formulation, diagnosis, the best available research evidence, and the young person and their parent/guardian choice.

We value continuity of care:We offer multi-level services to young people and families/caregivers which align to severity and level of impairment of the individual.

In keeping with a ‘stepped care’ approach, we support young people and their families to transition to more appropriate services when safe to do so.

We value our service partners and their role in supporting young people who require services at low-moderate intensity and complexity, or with emerging mental health problems, and nurture these relationships to ensure care is as streamlined as possible.

We are inclusive and individualised: Our approach to treatment and recovery considers a person’s life story or pathway that has led them to the current experience or predicament.

Our programs and treatments are relevant to the individual and designed with their input.

We are accountable for the services and treatments we offer and deliver and ensure follow up is appropriate.

We are considerate of the distress and trauma experienced by many parents, carers and persons experiencing mental health problems and approach our work with compassion.

We are collaborative:Our work with parents, caregivers and families is integral and, in some cases, the primary intervention recommended.

Our responsibility in shared partnerships sees us as one partner in the network of professionals involved care, including non- health partners when required.

Our treatments and programs are delivered by skilled professionals from many disciplines who are connected and who take a shared approach to care.

We link with young people and families and include them in decisions about treatment.

We take a community first approach:Wherever possible, young people receive care in the community setting.

If hospital admission is required, follow up care is planned and delivered in the community.

In keeping with our recovery orientation, we aim to enhance the capacity of young people and their carers to cope and thrive without ongoing need for professional assistance.

We meet our responsibility to provide service as close to home as possible in communities across our region; within our resource and funding limitations.

Our Principles are explained in the table below:



Coordinated and responsive

Being referred into mental health services can be a stressful time for individual, families and care providers. Darling Downs Health CYMHS offer responsive services to help young people and their parent/guardians and partners in health care to navigate the mental health service system and connect to the right service in a timely way.

Young people experiencing mental health issues have access to a range of services designed to support them appropriately at all levels of need. Darling Downs CYMHS works within the Commonwealth Department of Health Mental Health Reform Agenda ‘Stepped Care Approach’, where services are provided to people at different stages and in different environments, with a focus on the least intensive level of intervention possible.

In accordance with a stepped care approach, young people across the Darling Downs experiencing low to moderate mental health issues can access services in the primary health care sector (for example, through schools, General Practice or Community Organisations). Those experiencing severe and/or complex and emerging mental health issues can access services from Darling Downs Health CYMHS.

Our service is designed and funded to Provide mental health care for young people experiencing problems and disorders that are:

» Severe and /or complex

» Likely to represent emerging or diagnosable mental disorders

» Not responding to reasonable interventions at other levels of care

» Severely compromising quality of life and developmentally appropriate functioning

» Not amenable to treatment through alternative, equally appropriate, or more appropriate services

» Requiring coordination/ integration across multiple services

» Likely to benefit from the range of interventions our service offers.

The table below defines factors generally associated with young people living with severe and complex mental health needs and may assist in determining whether the signs a young person is demonstrating are consistent with our eligibility criteria.


Criteria for Eligibility for Child and Youth Mental Health Services in Darling Downs Health:

Factors that indicate Severe Mental Health Concerns or Problems in Young Person:

» High level of distress (individual, family/ carer, wider support systems)

» High level of developmentally appropriate functional impairment (e.g. social, leisure activities, scholastic)

» Greatly reduced quality of life

» Not responding or resistant to reasonable first line interventions

» Signs and symptoms suggestive of high risk to self or others (e.g. suicidal behaviours)

» Signs and symptoms suggestive of serious psychiatric diagnosis (e.g. psychosis, eating disorders)

» Signs and symptoms suggestive of severe attachment difficulties

Factors typically contributing to Complex needs for Young Person with Mental Health Problems:

» Multiple problems or multiple disorders (including developmental, physical and substance use disorders)

» Multiple professionals and/ or agencies involved/ concerned

» Personal or carer history of trauma, abuse, or neglect

» History or presence of carer mental illness, complexity or impairment

» Chronic physical illness or medically-unexplained physical symptoms

» Multi-problem family/ carer/ environmental context, including severe carer-child relational problems, homelessness and out-of-home care

» Forensic history


Access pathways

There are several ways for young people to access Child and Youth Mental Health:

Telephone

A medical referral from a GP or specialist emailed/faxed to CYMHS

In person

The map below provides detail for the typical pathways for young people experiencing mental health concerns to access Darling Downs CYMHS, which aligns to our stepped care approach:

Young person with mental health concerns

Headspace, community NGOs

General practice, Community medical

centre, private specialist and Allied

Health

Education and school supports -

teachers, guidance counsellors, school-based health nurse

Community networks, social media networks,

online support programs

Family supports - parents, carers, trusted friends or

family

EdLinq Coordinator

Child Safety Liaison

Officer (for children in

care)

Darling Downs Health Child and Youth Mental Health Services (for severe and complex mental health services)

In emergency situations, where young people are experiencing imminent risk to themselves or others, call 000 for Queensland Police and Ambulance Service assistance.

This may result in transfer to an emergency department for urgent assessment. In rural areas, this may result in transfer to Toowoomba Hospital.


Referral

When referring a young person to Darling Downs Health CCYMHS, the following information is preferred:

» Details of current General Practitioner (GP)

» Relevant History

» Other partners in care- for example specialists or allied health practitioners

» Any treatment or interventions provided

» Results of clinical or other assessments or recent investigations

» Consent by the young person

If a young person is receiving treatment from other specialists (for example a paediatrician), referral from that specialist to CYMHS is advisable. If providing a named referral, please refer to the Director of Clinical Services.

Mental Health clinicians are available to discuss referral pathways and informed consent matters directly with the young person or their parents or guardians if this is preferred.

All referrals to the Darling Downs Child and Youth Mental Health Services are triaged according to a nationally agreed triage scale which determines the timing and nature of our response.

Our primary aim is to determine where and how each young person and their parent/guardian can access the best possible and most appropriate assistance from the most appropriate service at the most appropriate time.


Darling Downs Health is supported by several health service providers and partners at national, State, and local levels.

The table below provides examples of pathways for a young person following referral to Darling Downs CYMHS services. Decisions around which pathway a young person may take to access service will always be based on comprehensive individual assessment and screening at the time of referral or presentation:

After-hours access

1300 MH CALL (1300 64 22 55) is a 24-hour, seven day centralised phone number for mental health referrals, crisis and support. This service will

advise an appropriate level of response based on the triage assessment.

Timely, responsive assessment and intervention - Darling Downs Health CYMHS

For young people attending a hospital Emergency Department outside of business hours across the Darling Downs, the Acute Care Team (ACT) will co-ordinate triage, assessment and clinical interventions to establish early recovery planning and relapse prevention. ACT staff have

established partnerships with other mental health service providers, emergency services and relevant external health and community service agencies involved in youth mental health and

notify local CYMHS teams of after-hours presentations.

Young person with severe and complex mental health needs

Comprehensive Mental Health Assessment

&Multidisciplinary

Team Review

CYMHS Community Clinic

Planned and scheduled assessment during

business hours

Referred to other service provider with

recommendations

Local Hospital Emergency Department

Admission and inpatient stay

Community CYMHS follow-up and

treatment

Crisis or Emergency Assessments 24 hours/day


Individually tailored

Following referral, triage and assessment, young people who are identified as meeting eligibility criteria are offered service within Darling Downs CYMHS. Individually tailored interventions to support and treat young people within CYMHS are designed following clinical interview and assessment with the young person.

Individual support and treatment plans

Working in partnership with the young person, and their care givers, Medical, Nursing and Allied Health Professionals develop an individualised treatment plan.

Treatment plans are designed to meet biological, psychological, social and cultural needs, and rely on evidence based, therapies and interventions, and consider many factors. Some of these include:

Circumstances

» clinical signs and symptoms

» current and past treatment

» social and cultural needs

Relationships

» personal and family strengths

» support systems

Individual factors

» risks to self or others

» barriers to improvement

» other needs


Case management

Darling Downs Community CYMHS uses a case management model to deliver services and support to young people living in the community. Our services follow these basic principles:

Multi-disciplinary

A combination of medical, nursing and allied health clinicians with specialised skills in providing care to children and young people, both within and outside the CYMHS service.

Person-centred

The young person and their family are equal partners in planning and developing treatment and support interventions.

Recovery-oriented

A foundation belief that people can, and do recover from mental illness.

Strengths-based

Using the young persons’ strengths, building resilience and enhancing opportunities for social and school inclusion.

Key features of case management include:

» Assessment and clinical intervention, individually tailored and designed to minimise the impact of mental illness on young people, their family and significant others, who are living in the community;

» Partnership with families and care providers to develop skills, knowledge and support systems to enable the young person to participate fully in their communities and schools;

» Identification of a Principle Service Provider (PSP) as a single point of coordination;

» Assisting to access to a broad range of clinical and non-clinical services to enable young people to establish, re-establish or reclaim a meaningful life;

» Partnership with non-government organisations, primary care and other services connected to the young person, including reaching out to organisations and services of benefit to the young person;

» Enabling access to early intervention and focus on the principles of recovery.


Involuntary care

Involuntary assessment and treatment only occur if all least-restrictive options have been exhausted in situations of high risk and lack of capacity. The Guide to the Mental Health Act 2016 provides detail on the involuntary assessment and treatment of persons with mental illness and ensures the protection of the persons rights. Involuntary treatment can be provided in a hospital or community setting. Independent Patient Rights Advisors (IPRAs) are available to speak with young people and their parent/guardian to provide information about patient rights and the Mental Health Act.

Hospital bed-based care

In some situations, hospital admission is required. In the Darling Downs Health Service Region, we have one specialised Adolescent Inpatient Unit located at Toowoomba Hospital. Yannanda is an 8-bed unit, where structured, highly supervised and supportive care is provided to young people, typically aged between 12-18 yrs. Yannanda is an environment for acute assessment and treatment, which cannot be delivered safely in the community or in alternative settings. Children under the age of 12 requiring inpatient admission may be referred to the Queensland Children’s Hospital or admitted to a local Paediatric Unit under the care of a Paediatricians, with consultation liaison Psychiatry services provided by CYMHS.

During admission, young people, their parents/guardians and care providers are supported to engage with the multidisciplinary treating team to facilitate treatment and transition back to their primary care providers (e.g. General Practitioner, school, community networks).

Admission to our specialised adolescent inpatient unit occurs following consultation and review by a Psychiatrist/Psychiatric Registrar, either on arrival or transfer to the hospital Emergency Department, or as a component of community CYMHS Specialist care and assessment. For the safety and wellbeing of young people, and in accordance with statewide guidelines, Yannanda is a restricted access unit- where entry and exit requires assistance from staff.

Specialised services

In addition to community and inpatient care, we offer specialised services. These include Adolescent Day Program, Acute Mobile Youth Outreach Services (AMYOS), and other individual and group programs, which occur following comprehensive assessment, multidisciplinary team review, and discussion with parents or guardians, and is offered when it is identified that such services are appropriate and would be of benefit to the young person.

Our individually tailored care includes the provision of responsive, specialised services. Examples of CYMHS specialised services for eligible young people include:


Yannanda Day Program

A community-based program, operating centrally from the Yannanda acute adolescent unit.

» Delivers a range of immediate, short term and longer-term interventions to support the young persons’ journey to recovery.

» Individual and Group program activities are planned in partnership with the young person and endorsed by specialised allied health and clinical leaders through the CYMHS local governance committee.

» Caters for young people aged 12-18.

Ed-LinQ

A coordination service between the education sector, primary care, community and mental health sectors.

» Focus is on improving linkages and service integration.

» Supports early detection and collaborative care of school-aged young people at risk of, or experiencing, mental health problems or mental illness.

» Ed-LinQ Co-ordinators operate from the Toowoomba Hospital and Kingaroy Hospital campuses.

Assertive Mobile Outreach Service (AMYOS)

A community-based program operating in Toowoomba and immediate surrounding suburbs and localities.

» Designed for young people aged 12-18 with complex trauma and attachment histories, high risk of self-harm, vulnerabilities and barriers to engaging with health services.

» Clinicians work with young people and families, and primary care agencies community. This program is designed for longer term support up to two years, based on individual need.

Hospital Education Program

The Hospital Education Program is an integral companion to the Yannanda Day Program and based in Toowoomba.

» A part of the Queensland Children’s Hospital School

» Available to young people with complex mental health conditions who are at risk of, or have become disengaged from school or other education programs

» Provides specialised and appropriate educational support to young people at all stages of their illness

» Delivered by specialised Teachers and Guidance Counsellors.

Evolve Therapeutic Services (ETS)

Provides education and learning support groups for foster-parents and other carers, and education for professionals on the specific and complex needs of young people in out-of-home care. The service aims to improve emotional wellbeing and foster skills development. Evolve services are based in Toowoomba, Kingaroy and Warwick and operate across the Darling Downs as a part of an interagency partnership between Queensland Health, Department of Child Safety, Youth and Women; Department of Communities, Disability Services and Seniors and the Department of Education, Training and Employment.


16 Consumer and Community Engagement Strategy

Integrated and interconnected

As an integrated service focused on providing person centred care, Darling Downs Health CYMHS ensures connection and integration of the services provided to young people.

Young peoples’ needs are met through the coordinated and collaborative efforts of all health providers, both internal and external to the public Health Service. We recognize the importance of effective partnerships in ensuring access to and provision of comprehensive, integrated, person centred care.

The table below provides an example of how the multi-disciplinary team works within and across teams within Darling Downs CYMHS to ensure care is individualised and interconnected for each young person accessing services, and designed with a focus on recovery:

Recovery and return to primary support services

Liaison officers:Indigenous

GuardianshipChild safety

Consumer feedbackAmbulance/police

Other community

mental health agents

Schools and partners in education

Crisis and out of home care services

Day program and education

program

Medicaltherapy

Connecting partners in care

Psycho-education, skills training

Group therapy

Individual psychotherapy

Other community supports

Medical specialists

Allied Health providers

GPs

Com

preh

en

sive Assessment

Case managem

entTreatment plannin

g

Young person Family/carer

Multidisciplinary review

Medical review

s

Clinic appointments

Hom

e vi

sits


Darling Downs Mental Health services are leading contributors to the local Mental Health Professionals Network (MHPN), operating centrally in Toowoomba. The network is a national initiative and encourages mental health professionals from across all agencies to connect and build on partnerships to enhance quality care. Specialised CYMHS staff regularly attend and contribute.

Recording mental health information

Darling Downs Child and Youth Mental Health services collect mental health information using a state- wide application called Consumer Integrated Mental Health Application (CIMHA). This information is confidential and may only be shared with others through a strict process of consent when there is a clinical or legislated requirement to share information.

The program allows de-identified information to be collected and reported as key performance indicators (KPIS). KPIs which are mandatory for us to review include those that provide details of effective, appropriate, efficient, accessible, timely, safe and sustainable care delivery.

Our service partners

In our region, we identify and work with multiple key partners in care for young people experiencing mental health issues and illness. Most commonly these include:

» General Practitioners and Specialist Doctors

» Private Allied Health Professionals

» Headspace

» Early Intervention and Prevention Service – Toowoomba Hospital

» Department Child Safety, Youth and Women

» Family and Child Connect – Mercy Services

» Child Protection Liaison Officers – Toowoomba Hospital

» National Disability Insurance Scheme (NDIS) funded supports

» Addiction Services – non-government and Toowoomba Hospital

» Child Youth Community Forensic Outreach Service

» Eating Disorders Outreach Service

» Perinatal and Infant Mental Health Service

» Education Queensland

» Toowoomba Catholic Diocese

» Independent Schools (multiple across Darling Downs)

» Emergency Services- QLD Police and Queensland Ambulance

» Primary Health Network


Strong relationships with other partners in the care of the young person, including providers of primary health care, are identified, maintained and where needed, initiated. This close collaboration ensures we best meet individual needs of young people and their family.

We contribute to this process through clear communication with partners in care and families and guardians throughout all phases of care. In some instances, formal agreements (e.g. memorandums of understanding) are developed to ensure our partnership can be smooth and as supportive as possible.

As the primary medical provider involved in the ongoing care of the young person, the General Practitioner/Specialist Doctors will receive comprehensive reports and a summary of services provided by Darling Downs CYMHS.

Working with families and other service providers

The involvement of families and care providers is integral to achieving successful outcomes for the young people accessing our services, therefore, their involvement is encouraged and valued in all aspects of care.


Rehabilitation and recovery focused

Promoting wellbeing and quality of lifeDarling Downs Health CYMHS supports positive outcomes for young people and their parents/guardians and care providers. It is anticipated that a young person may benefit from our services in some of the following ways:

» Decrease in psychological distress

» Improvement in some symptoms (mood, thoughts, deliberate self-harm, disruptive behaviour etc.)

» Reduction of risk or vulnerability

» Re-engagement with school or transition to employment

» Improved understanding about mental health problems

» Development of strategies to cope with persistent symptoms, to promote resilience, reduce the likelihood of future recurrence and maximize psychological growth and development

» Increased access to mental health care in the primary care setting

» Increased knowledge of community supports that are available

» Improved quality of life and developmentally appropriate functioning (e.g. school, friendships, parent-child relationships).

Discharge/transition of careDischarge occurs when the young person no longer requires our service and has support in place to manage outside of Darling Downs CYMHS. A comprehensive handover with all service partners involved in ongoing care of the individual is arranged by CYMHS case managers and includes the young person and their family.

Recovery planning, strategies to prevent relapse, crisis management plans and clearly articulated re-entry processes are agreed during transition of care. This is also the case when transferring or relocating to other CYMH or alternative mental health services.

Re-entry to the mental health serviceWe acknowledge that mental health issues can be episodic in nature and changes to the young person’s circumstances may influence their ability to manage their mental health during these times. Re-referral to our services may be necessary to reassess current needs and establish whether specialised treatment is required.


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