Optimizing Transitions: Addictions and Mental Health Presentation Objectives 1. To review emerging practices for developmentally appropriate care for TAY 2.
Download ReportTranscript Optimizing Transitions: Addictions and Mental Health Presentation Objectives 1. To review emerging practices for developmentally appropriate care for TAY 2.
Slide 1
Optimizing Transitions: Addictions and Mental Health
2015
Slide 2
Presentation Objectives
1. To review emerging practices for
developmentally appropriate care for TAY
2. To describe the components of a successful
program for TAY
3. To describe key elements in optimizing transitions
for TAY from hospital to community services
4. To describe an evaluation framework used by the
LOFT, Sickkids, and CAMH partnership
5. To share preliminary results
Slide 3
Some facts about TAY with MH and
Substance Use Problems
Youth experience more disconnection and are therefore
less likely to receive appropriate support services in the
transition to adulthood (Brown and Wilderson, 2010)
For more than 70% of adults living with mental health
problems, symptoms developed when they were young.
“Identifying youth at risk and intervening as early as
possible improves their life trajectories, their
productivity as Canadians and reduces the prevalence
of mental health problems in adulthood.” (Mental
Health Commission of Canada, Youth Council, 2010)
Slide 4
Challenges for Transitional Age Youth
with MHA
Access and
Navigating
Services
Delivery of
Services
System Issues
Characteristic
of the
Population
Transitional
Age Youth
Service
Offerings
Slide 5
Developmentally-informed Practice
5
Consider sex & gender, trauma, culture
Without support, youth with serious mental health
and substance use concerns face significant
challenges in achieving developmental milestones
Younger youth - school success, social skill
development
Older youth – vocational success, developing
intimate relationships
With support and/or early achievement, positive
outcomes are more likely
Slide 6
Considerations in working with TAY
6
Need clinical services PLUS services that
promote independent living AND coordinated
care
Need services that address needs directly
AND processes that reflect the needs of TAY
Need to consider youth goals re: adulthood
Slide 7
7
Services for older youth to promote
independence
Employment
Education
Housing
Community involvement (social/recreational activities)
and social support
Money management
Training on basic living skills (cooking, shopping, etc.),
problem-solving and informed decision-making’
What exists in your community?
Slide 8
Key attributes of service delivery
8
Informal
Flexible
Individualized, youth involvement in goal setting
Involve supports
Build on strengths
Prepare youth for transition, across services and
sectors
Support youth through transitions
Slide 9
Parallel with MI principles
9
Youth input
Active listening
Non-judgmental
Avoid lecturing
Express empathy
Offer assistance
Encourage, offer descriptive praise, express
enthusiasm
Slide 10
Developmentally-specific services
10
Developmentally-specific services are targeted to
meet the needs of youth considering their
developmental stage (not, chronological age)
For example, developmentally-specific groups,
services, residential programs, within
child/adolescent and adult services
Slide 11
Transitions: Challenges/Issues/Barriers
11
Lack of experience/difficulties addressing parental
issues
Youth/family reluctance
Lack of institutional support
Lack of planning
Lack of developmentally-informed adult services
Lack of two-way communication
Confidentiality & consent issues
Brodie, Goldman & Clapton (2011), Davidson, S. & Cappelli, M. (2011), Singh, S. et al. (2008)
Slide 12
Transitions: Challenges/Issues/Barriers
12
Time/Resources/high workload, staffing shortages, long
wait lists
Training
Differing perspectives (youth, family, providers)
Attitudes/Discomfort/lack of confidence of providers
Limited applicability of services
Difficulty accessing resources
Poor intra-agency & inter-agency coordination
Individual vs. family approaches
Developmental vs. diagnostic approaches
Lack of flexibility
Protective vs. responsibility approach
Brodie, Goldman & Clapton (2011), Davidson, S. & Cappelli, M. (2011), Singh, S. et al. (2008)
Slide 13
Transitions: Challenges/Issues/Barriers
13
Limited specific research regarding how to prepare
youth and family for transition – greater focus on
policy & procedure, less focus on clinical practice
Inconsistent documentation/information
systems/transfer systems
Organizational culture differences
Lack of shared information about service structures
Different thresholds & eligibility criteria for service
Lack of off-hours services
Brodie, Goldman & Clapton (2011), Davidson, S. & Cappelli, M. (2011), Singh, S. et al. (2008)
Slide 14
Recommendations from the evidence
14
Youth and family perspectives should be considered in service
planning generally & for their own care
Developmentally appropriate communication and information
for youth
Accessible communication and information for families
Worker support, co-located & multi-agency services
Accessible & flexible services dedicated to youth (i.e.
community-based, friendly, informal, flexible venues, hours of
service, types of service, & dealing with missed appointments)
Well-trained practitioners, advocacy, mentoring
Brodie, Goldman & Clapton (2011), Davidson, S. & Cappelli, M. (2011), Singh, S. et al. (2008)
Slide 15
Transition to Independence Process
(TIP)
Example: A model of care for TAY
Slide 16
“Discovery
rather than
Recovery”
16
Slide 17
TIP Overview
17
TIP is a promising practice for:
Transitional aged youth with emotional/behavioural
difficulties
Appropriate for youth 14-29 years old
Applicable across multiple services and sectors in
community-based settings
Model operationalized through seven guidelines &
core practices
Clark et al. (1995)
Slide 18
TIP Transition Domains
18
Slide 19
Key Facts about TIP
19
Cross sectoral applicability
Rooted in evidence based approaches such as
Motivational Interviewing and Cognitive
Behavioural Therapy
Can integrate into existing work
o
TIP used intentionally and purposefully
Role of supervisor important to maintain fidelity
Slide 20
TRACK
Example: A model for transitions of care for TAY
Slide 21
TRACK Criteria for Optimal Transition
21
Continuity of care – engaged with AMHS for 3 months or
appropriately discharged (long-term continuity)
Period of parallel care – period of time when involved with
both CAMHS & AMHS (relational continuity)
At least one transition planning meeting – meeting to discuss
transition; involve youth, family, and key SPs, before transfer
(cross-boundary/team continuity)
Optimal information transfer – referral letter, summary of
services, current assessment (informational continuity)
Slide 22
TRACK: Improving the Transition
22
Alignment
Attitudinal adjustment to promote view of services as complementary
Map all services available to youth/TAY
Interagency development of care pathways
Preparation of service users before transition
Information/what to expect
Differences re: services/confidentiality/parental involvement
Slide 23
TRACK: Improving the Transition
23
Transition process
Flexibility
“Age windows”
Planned and occur at times of relative stability
Crisis is a contra-indication
Improving info transfer
Specific protocol for information transfer
Detailed info should go with youth
Slide 24
TRACK: Improving the Transition
24
Improve liaison between the Child and Adolescent Mental
Health System (CAMHS) and the Adult Mental Health System
(AMHS)
Improved knowledge, communication & understanding between CAMHS
& AMHS
Joint training, continuous professional development re: transition
Changes to service structures & functioning
Supervision, clinical accountability
Designated transition workers
Slide 25
What Youth Like! (YSSR, 2010-2014)
25
Positive relationships with service providers
Incentives
Flexibility
Support for autonomy
Addressing reasons for using
Non-judgmental treatment
(YSSR, 2010-2014)
Slide 26
Essentials to building bridges with
hospital (Heather’s perspective)
1. Align community practices to best
practice/research
2. learn language and roles
3. know common client and need
4. build trust
5. formal MOU
6. lead a summit
7. learn together!
Slide 27
Complimentary services
Barrier free admission: GAIN Short Screener to screen
for possible diagnosis
On the ground service coordination works: Taking youth
to appointments, connecting them to primary care, crisis
plans, finding and maintaining housing, etc.
Peer power: peer support workers, drop-in, groups,
and opportunities for social connection
Crisis support– that is how young people re-engage
with supports if they disengaged
Staff send on average 2500 texts/month
Supportive housing
Slide 28
TAY TXT
I’m just so nervous for the interview. I really want to get
into this program.
Being nervous is a normal part of the process.
You are very passionate about your career, I think
that will show during your interview.
But how do I tell them that I really want this
opportunity and I will wake up at 5am every morning if
I have to?
Simple. The same way you just told me.
Slide 29
Community and Peers
Peer support is a vital part of the program (paid vs unpaid)
Exploring new ways to have fun and learn: ex. Art therapy,
visiting new places
Pathways to Recovery groups
Slide 30
Components of LOFT’s TAY MH and
Addiction program
Weekly
psychiatrist
Supportive
Housing- low,
med , high
support
Focus on tight
referral
pathways
Staffing MonFri 9am-9pm
Sat: 1-9pm
Trained peer
mentors
Specialized
Addiction
program
Focus on engagement
Priority referral source is hospital
On the ground support
Evaluation framework (CAMH): GAIN SS
Formal partnerships with 3 hospitals
Research: Sean Kidd
Groups and
recreational
activities
Monthly
psychologist
staff consult
Care
coordination
pilot through
Health Links
Crisis
phone/text
24/7
MCYS ,
TCLHIN
and donor
funded
Slide 31
ACT Community Treatment project
Funded in 2013
For Transitional age youth (age 16-25) with
addictions (from harm reduction perspective)
Partners: CAMH, HSC and LOFT
Focus on optimizing transitions from hospital
Team launch included people across partners
Education provided across sectors
Offered in sites across Toronto
Slide 32
Optimizing transitions
Primary referral source is hospital (2 formal MOUsHospital for Sick Children and CAMH)
Robust evaluation framework
Service gaps come at critical time when first onset of
mental health issues may occur; we use standard tools to
start mental health care coordination
Partnership with Urgent Care clinic (CAMH) and psychiatry
Slide 33
Appreciative Inquiry: An exercise
Think of a time that you had the most amazing
experience of either making a referral, receiving a
referral or being referred.
Please talk about that experience in detail using the
worksheets.
You will be asked to report back to the group what
your partner said
Slide 34
What works in building bridges?
Appreciative inquiry exercise: Make it fun!
Client or patient– who cares? Get it done.
Pulled out principles of how we will work together
Contact list and intake flow chart in a drop box
ACT training together
Regular team meetings to touch base and open
door to feedback
Slide 35
Slide 36
Slide 37
Our team!
Slide 38
Slide 39
Objectives to be evaluated
Improved access to evidence-based community
addictions treatment for youth
Improved transitions from hospital to community, and
from youth into adult care systems
Improved outcomes for youth with addictions issues
Slide 40
Components of our Evaluation
Framework
Contemplation ladder (every meeting)
GAIN Short Screener every 12 weeks
Self-efficacy tool (every 12 weeks)
Determinants of Health Outcomes (intake, 1 month,
3 month, 6 month, exit/discharge).
Focus group annually
Client satisfaction questionnaire annually
Binder kept at program to keep anecdotal
feedback/comments
Slide 41
GAIN-SS
41
brief screening tool for clients age 10+
identifies difficulties in 4 dimensions:
internalizing disorders (e.g. depression, anxiety)
externalizing disorders (e.g. ADHD)
substance use problems
crime and violence
CAMH-version of GAIN-SS includes 7 additional items to
screen for:
eating-related issues
trauma-related distress
disordered thinking
gambling, gaming and internet misuse
*GAIN-SS was developed by Chestnut Health Systems, Copyright © 2005
Slide 42
www.chestnut.org
Slide 43
Evaluation results Nov 2014
43
Total # of surveys collected to date = 231
Domains assessed:
Mental health (GAIN-SS Revised)
Internalizing Disorders
Externalizing Disorders
Substance Use
Crime/Violence Screener
Additional questions assessing disordered eating, traumatic distress, disordered thinking,
gambling, gaming, internet misuse
Social determinants of health (Transitional Age Youth Program
Measure)
Motivation (Contemplation Ladder)
Self-Efficacy (General Self-Efficacy Scale)
Service User Feedback
Slide 44
Transitional Age Youth Program Measures
44
64.7% male; mean age = 21.7
Scale 1 = Excellent, 2=Good, 3=Fair, 4 =Poor
higher scores = more difficulty in that domain
POORER STATUS
Means at Program Intake
4
3.5
3
2.5
2
1.5
1
0.5
0
Slide 45
45
GAIN Short-Screener: Summary
Percentage of youth endorsing severe problems in each
domain (score of 3+)
Internalizing
Disorders = 87.9%
Externalizing Disorders = 75.7%
Substance Use = 44.6%
Crime/Violence = 15%
Slide 46
Motivation – Contemplation Ladder
46
Pre-contemplation = 1 – 3
Contemplation = 4 – 6
Preparation = 7,8
Action and Maintenance = 9,10
Slide 47
Motivation – Contemplation Ladder
47
LOFT mean Ladder score = 8.5
Typical items youth selected
“I have made a plan to change my substance use, and have begun
to make some of those changes”
“I have changed my substance use, but still worry about slipping
back. I need to keep working on the changes I’ve made”
LOFT Importance score:
“How important is it for you to change your substance use?”
Scale 1 (not at all important) – 4 (very important)
Importance mean = 2.7
Slide 48
Self-Efficacy
48
General Self-Efficacy
N=43
Scale: 1 (not true at all) – 4 (exactly true)
Total scale: 10 (very low SE) to 40 (very high SE)
LOFT
“I can solve most problems if I invest the necessary
effort”
Youth mean = 28.1
90% selected true or somewhat true)
100
80
60
40
20
0
“I can remain calm when facing difficulties because I can
60
50
rely on my coping abilities”
57% selected true or somewhat true
True/Somewhat Not true/hardly
True
true
40
30
20
10
0
True/Somewhat Not true/hardly
True
true
Slide 49
Service User Feedback
49
4-point scale
1 (Strongly Disagree) to 4 (Strongly Agree)
Total LOFT mean = 37.7, N= 24
Program offered opportunities to get involved
Could work if given opportunity
Can influence MH/Social service system
My opinions/ideas count
Recommend program to others
Agree
Happy with living situation
Disagree
Staff interested in my improvement
Know where to go if services not good
Have right to approve services
Services relevant to needs
Satisfied with support from staff
0
10
20
30
40
50
60
70
80
90
100
Slide 50
Summary - Risk
50
LOFT youth
Present with many social, health (mental and physical),
employment, and housing challenges (i.e., social
determinants of health)
High internalizing problems (e.g., depression) and
externalizing problems (e.g., difficulty paying attention)
Distressing memories/dreams about past
Eating disturbances
Substance use issues
Slide 51
Summary - Resilience
51
HOWEVER, LOFT youth are also:
Highly
motivated to change problematic substance use
and maintain those changes
Have a sense of self-efficacy to handle
challenges/stressors in their lives
And, importantly, LOFT youth report moderate to
high satisfaction in most domains
Slide 52
Thank-you for your time
Gloria Chaim, MSW, RSW
Associate Director, Child Youth and Family Services
Centre for Addiction and Mental Health
[email protected]
Heather McDonald, MSW
Director of Adult and Youth Services
LOFT Community Services
[email protected]
Optimizing Transitions: Addictions and Mental Health
2015
Slide 2
Presentation Objectives
1. To review emerging practices for
developmentally appropriate care for TAY
2. To describe the components of a successful
program for TAY
3. To describe key elements in optimizing transitions
for TAY from hospital to community services
4. To describe an evaluation framework used by the
LOFT, Sickkids, and CAMH partnership
5. To share preliminary results
Slide 3
Some facts about TAY with MH and
Substance Use Problems
Youth experience more disconnection and are therefore
less likely to receive appropriate support services in the
transition to adulthood (Brown and Wilderson, 2010)
For more than 70% of adults living with mental health
problems, symptoms developed when they were young.
“Identifying youth at risk and intervening as early as
possible improves their life trajectories, their
productivity as Canadians and reduces the prevalence
of mental health problems in adulthood.” (Mental
Health Commission of Canada, Youth Council, 2010)
Slide 4
Challenges for Transitional Age Youth
with MHA
Access and
Navigating
Services
Delivery of
Services
System Issues
Characteristic
of the
Population
Transitional
Age Youth
Service
Offerings
Slide 5
Developmentally-informed Practice
5
Consider sex & gender, trauma, culture
Without support, youth with serious mental health
and substance use concerns face significant
challenges in achieving developmental milestones
Younger youth - school success, social skill
development
Older youth – vocational success, developing
intimate relationships
With support and/or early achievement, positive
outcomes are more likely
Slide 6
Considerations in working with TAY
6
Need clinical services PLUS services that
promote independent living AND coordinated
care
Need services that address needs directly
AND processes that reflect the needs of TAY
Need to consider youth goals re: adulthood
Slide 7
7
Services for older youth to promote
independence
Employment
Education
Housing
Community involvement (social/recreational activities)
and social support
Money management
Training on basic living skills (cooking, shopping, etc.),
problem-solving and informed decision-making’
What exists in your community?
Slide 8
Key attributes of service delivery
8
Informal
Flexible
Individualized, youth involvement in goal setting
Involve supports
Build on strengths
Prepare youth for transition, across services and
sectors
Support youth through transitions
Slide 9
Parallel with MI principles
9
Youth input
Active listening
Non-judgmental
Avoid lecturing
Express empathy
Offer assistance
Encourage, offer descriptive praise, express
enthusiasm
Slide 10
Developmentally-specific services
10
Developmentally-specific services are targeted to
meet the needs of youth considering their
developmental stage (not, chronological age)
For example, developmentally-specific groups,
services, residential programs, within
child/adolescent and adult services
Slide 11
Transitions: Challenges/Issues/Barriers
11
Lack of experience/difficulties addressing parental
issues
Youth/family reluctance
Lack of institutional support
Lack of planning
Lack of developmentally-informed adult services
Lack of two-way communication
Confidentiality & consent issues
Brodie, Goldman & Clapton (2011), Davidson, S. & Cappelli, M. (2011), Singh, S. et al. (2008)
Slide 12
Transitions: Challenges/Issues/Barriers
12
Time/Resources/high workload, staffing shortages, long
wait lists
Training
Differing perspectives (youth, family, providers)
Attitudes/Discomfort/lack of confidence of providers
Limited applicability of services
Difficulty accessing resources
Poor intra-agency & inter-agency coordination
Individual vs. family approaches
Developmental vs. diagnostic approaches
Lack of flexibility
Protective vs. responsibility approach
Brodie, Goldman & Clapton (2011), Davidson, S. & Cappelli, M. (2011), Singh, S. et al. (2008)
Slide 13
Transitions: Challenges/Issues/Barriers
13
Limited specific research regarding how to prepare
youth and family for transition – greater focus on
policy & procedure, less focus on clinical practice
Inconsistent documentation/information
systems/transfer systems
Organizational culture differences
Lack of shared information about service structures
Different thresholds & eligibility criteria for service
Lack of off-hours services
Brodie, Goldman & Clapton (2011), Davidson, S. & Cappelli, M. (2011), Singh, S. et al. (2008)
Slide 14
Recommendations from the evidence
14
Youth and family perspectives should be considered in service
planning generally & for their own care
Developmentally appropriate communication and information
for youth
Accessible communication and information for families
Worker support, co-located & multi-agency services
Accessible & flexible services dedicated to youth (i.e.
community-based, friendly, informal, flexible venues, hours of
service, types of service, & dealing with missed appointments)
Well-trained practitioners, advocacy, mentoring
Brodie, Goldman & Clapton (2011), Davidson, S. & Cappelli, M. (2011), Singh, S. et al. (2008)
Slide 15
Transition to Independence Process
(TIP)
Example: A model of care for TAY
Slide 16
“Discovery
rather than
Recovery”
16
Slide 17
TIP Overview
17
TIP is a promising practice for:
Transitional aged youth with emotional/behavioural
difficulties
Appropriate for youth 14-29 years old
Applicable across multiple services and sectors in
community-based settings
Model operationalized through seven guidelines &
core practices
Clark et al. (1995)
Slide 18
TIP Transition Domains
18
Slide 19
Key Facts about TIP
19
Cross sectoral applicability
Rooted in evidence based approaches such as
Motivational Interviewing and Cognitive
Behavioural Therapy
Can integrate into existing work
o
TIP used intentionally and purposefully
Role of supervisor important to maintain fidelity
Slide 20
TRACK
Example: A model for transitions of care for TAY
Slide 21
TRACK Criteria for Optimal Transition
21
Continuity of care – engaged with AMHS for 3 months or
appropriately discharged (long-term continuity)
Period of parallel care – period of time when involved with
both CAMHS & AMHS (relational continuity)
At least one transition planning meeting – meeting to discuss
transition; involve youth, family, and key SPs, before transfer
(cross-boundary/team continuity)
Optimal information transfer – referral letter, summary of
services, current assessment (informational continuity)
Slide 22
TRACK: Improving the Transition
22
Alignment
Attitudinal adjustment to promote view of services as complementary
Map all services available to youth/TAY
Interagency development of care pathways
Preparation of service users before transition
Information/what to expect
Differences re: services/confidentiality/parental involvement
Slide 23
TRACK: Improving the Transition
23
Transition process
Flexibility
“Age windows”
Planned and occur at times of relative stability
Crisis is a contra-indication
Improving info transfer
Specific protocol for information transfer
Detailed info should go with youth
Slide 24
TRACK: Improving the Transition
24
Improve liaison between the Child and Adolescent Mental
Health System (CAMHS) and the Adult Mental Health System
(AMHS)
Improved knowledge, communication & understanding between CAMHS
& AMHS
Joint training, continuous professional development re: transition
Changes to service structures & functioning
Supervision, clinical accountability
Designated transition workers
Slide 25
What Youth Like! (YSSR, 2010-2014)
25
Positive relationships with service providers
Incentives
Flexibility
Support for autonomy
Addressing reasons for using
Non-judgmental treatment
(YSSR, 2010-2014)
Slide 26
Essentials to building bridges with
hospital (Heather’s perspective)
1. Align community practices to best
practice/research
2. learn language and roles
3. know common client and need
4. build trust
5. formal MOU
6. lead a summit
7. learn together!
Slide 27
Complimentary services
Barrier free admission: GAIN Short Screener to screen
for possible diagnosis
On the ground service coordination works: Taking youth
to appointments, connecting them to primary care, crisis
plans, finding and maintaining housing, etc.
Peer power: peer support workers, drop-in, groups,
and opportunities for social connection
Crisis support– that is how young people re-engage
with supports if they disengaged
Staff send on average 2500 texts/month
Supportive housing
Slide 28
TAY TXT
I’m just so nervous for the interview. I really want to get
into this program.
Being nervous is a normal part of the process.
You are very passionate about your career, I think
that will show during your interview.
But how do I tell them that I really want this
opportunity and I will wake up at 5am every morning if
I have to?
Simple. The same way you just told me.
Slide 29
Community and Peers
Peer support is a vital part of the program (paid vs unpaid)
Exploring new ways to have fun and learn: ex. Art therapy,
visiting new places
Pathways to Recovery groups
Slide 30
Components of LOFT’s TAY MH and
Addiction program
Weekly
psychiatrist
Supportive
Housing- low,
med , high
support
Focus on tight
referral
pathways
Staffing MonFri 9am-9pm
Sat: 1-9pm
Trained peer
mentors
Specialized
Addiction
program
Focus on engagement
Priority referral source is hospital
On the ground support
Evaluation framework (CAMH): GAIN SS
Formal partnerships with 3 hospitals
Research: Sean Kidd
Groups and
recreational
activities
Monthly
psychologist
staff consult
Care
coordination
pilot through
Health Links
Crisis
phone/text
24/7
MCYS ,
TCLHIN
and donor
funded
Slide 31
ACT Community Treatment project
Funded in 2013
For Transitional age youth (age 16-25) with
addictions (from harm reduction perspective)
Partners: CAMH, HSC and LOFT
Focus on optimizing transitions from hospital
Team launch included people across partners
Education provided across sectors
Offered in sites across Toronto
Slide 32
Optimizing transitions
Primary referral source is hospital (2 formal MOUsHospital for Sick Children and CAMH)
Robust evaluation framework
Service gaps come at critical time when first onset of
mental health issues may occur; we use standard tools to
start mental health care coordination
Partnership with Urgent Care clinic (CAMH) and psychiatry
Slide 33
Appreciative Inquiry: An exercise
Think of a time that you had the most amazing
experience of either making a referral, receiving a
referral or being referred.
Please talk about that experience in detail using the
worksheets.
You will be asked to report back to the group what
your partner said
Slide 34
What works in building bridges?
Appreciative inquiry exercise: Make it fun!
Client or patient– who cares? Get it done.
Pulled out principles of how we will work together
Contact list and intake flow chart in a drop box
ACT training together
Regular team meetings to touch base and open
door to feedback
Slide 35
Slide 36
Slide 37
Our team!
Slide 38
Slide 39
Objectives to be evaluated
Improved access to evidence-based community
addictions treatment for youth
Improved transitions from hospital to community, and
from youth into adult care systems
Improved outcomes for youth with addictions issues
Slide 40
Components of our Evaluation
Framework
Contemplation ladder (every meeting)
GAIN Short Screener every 12 weeks
Self-efficacy tool (every 12 weeks)
Determinants of Health Outcomes (intake, 1 month,
3 month, 6 month, exit/discharge).
Focus group annually
Client satisfaction questionnaire annually
Binder kept at program to keep anecdotal
feedback/comments
Slide 41
GAIN-SS
41
brief screening tool for clients age 10+
identifies difficulties in 4 dimensions:
internalizing disorders (e.g. depression, anxiety)
externalizing disorders (e.g. ADHD)
substance use problems
crime and violence
CAMH-version of GAIN-SS includes 7 additional items to
screen for:
eating-related issues
trauma-related distress
disordered thinking
gambling, gaming and internet misuse
*GAIN-SS was developed by Chestnut Health Systems, Copyright © 2005
Slide 42
www.chestnut.org
Slide 43
Evaluation results Nov 2014
43
Total # of surveys collected to date = 231
Domains assessed:
Mental health (GAIN-SS Revised)
Internalizing Disorders
Externalizing Disorders
Substance Use
Crime/Violence Screener
Additional questions assessing disordered eating, traumatic distress, disordered thinking,
gambling, gaming, internet misuse
Social determinants of health (Transitional Age Youth Program
Measure)
Motivation (Contemplation Ladder)
Self-Efficacy (General Self-Efficacy Scale)
Service User Feedback
Slide 44
Transitional Age Youth Program Measures
44
64.7% male; mean age = 21.7
Scale 1 = Excellent, 2=Good, 3=Fair, 4 =Poor
higher scores = more difficulty in that domain
POORER STATUS
Means at Program Intake
4
3.5
3
2.5
2
1.5
1
0.5
0
Slide 45
45
GAIN Short-Screener: Summary
Percentage of youth endorsing severe problems in each
domain (score of 3+)
Internalizing
Disorders = 87.9%
Externalizing Disorders = 75.7%
Substance Use = 44.6%
Crime/Violence = 15%
Slide 46
Motivation – Contemplation Ladder
46
Pre-contemplation = 1 – 3
Contemplation = 4 – 6
Preparation = 7,8
Action and Maintenance = 9,10
Slide 47
Motivation – Contemplation Ladder
47
LOFT mean Ladder score = 8.5
Typical items youth selected
“I have made a plan to change my substance use, and have begun
to make some of those changes”
“I have changed my substance use, but still worry about slipping
back. I need to keep working on the changes I’ve made”
LOFT Importance score:
“How important is it for you to change your substance use?”
Scale 1 (not at all important) – 4 (very important)
Importance mean = 2.7
Slide 48
Self-Efficacy
48
General Self-Efficacy
N=43
Scale: 1 (not true at all) – 4 (exactly true)
Total scale: 10 (very low SE) to 40 (very high SE)
LOFT
“I can solve most problems if I invest the necessary
effort”
Youth mean = 28.1
90% selected true or somewhat true)
100
80
60
40
20
0
“I can remain calm when facing difficulties because I can
60
50
rely on my coping abilities”
57% selected true or somewhat true
True/Somewhat Not true/hardly
True
true
40
30
20
10
0
True/Somewhat Not true/hardly
True
true
Slide 49
Service User Feedback
49
4-point scale
1 (Strongly Disagree) to 4 (Strongly Agree)
Total LOFT mean = 37.7, N= 24
Program offered opportunities to get involved
Could work if given opportunity
Can influence MH/Social service system
My opinions/ideas count
Recommend program to others
Agree
Happy with living situation
Disagree
Staff interested in my improvement
Know where to go if services not good
Have right to approve services
Services relevant to needs
Satisfied with support from staff
0
10
20
30
40
50
60
70
80
90
100
Slide 50
Summary - Risk
50
LOFT youth
Present with many social, health (mental and physical),
employment, and housing challenges (i.e., social
determinants of health)
High internalizing problems (e.g., depression) and
externalizing problems (e.g., difficulty paying attention)
Distressing memories/dreams about past
Eating disturbances
Substance use issues
Slide 51
Summary - Resilience
51
HOWEVER, LOFT youth are also:
Highly
motivated to change problematic substance use
and maintain those changes
Have a sense of self-efficacy to handle
challenges/stressors in their lives
And, importantly, LOFT youth report moderate to
high satisfaction in most domains
Slide 52
Thank-you for your time
Gloria Chaim, MSW, RSW
Associate Director, Child Youth and Family Services
Centre for Addiction and Mental Health
[email protected]
Heather McDonald, MSW
Director of Adult and Youth Services
LOFT Community Services
[email protected]