Program Design: Mental Health and Addiction Nurses in District School Board Program

Program Design: Mental Health and Addiction Nurses in District School Board Program

September 6, 2011

Table of Contents Program Design: Mental Health and Addiction Nurses in District School Boards Program Context 4 Program Goal 5 Guiding Principles for Mental Health and Addiction Nurses in District School Boards Program 6 Target Population: Students with Mild to Complex Mental Health and/or Substance Abuse Issues 7 Roles and Responsibilities 7 Program Accountabilities 8 Appendix A 10 Appendix B 11

Program Design: Mental Health and Addiction Nurses in District School Board Program Context Mental illnesses can affect anyone at any time. However, 70% of mental health problems and illnesses have their onset during childhood or adolescence. Studies suggest that between 15 and 21 percent of Ontario s children and youth have at least one mental health disorder. Schools are on the front lines of dealing with mental health and addictions problems among children and youth. An international survey of school principals and a scan of Ontario school boards indicate that educators rank mental health and substance abuse issues as critical issues for school systems. Furthermore: Mental illness affect school dropout rates: approximately 25% of males and females with a psychiatric disorder drop out of schools, accounting for 14.2% of all high school dropouts. Mental illness affect school attendance: it is estimated that in people with mental illness miss 40% more school days. Psychiatric disorders contribute to poor performance: it is estimated that from 30% to 58% of students with psychiatric disorders (depending on the disorder) will experience under achievement. As part of the Ontario government s 9,000 Nurses commitment, a key component of the province s health human resources strategy, a new program is being introduced into the Community Care Access Centres (CCACs): the Mental Health and Addictions Nurses in District School Boards (DSBs) Program. The fourteen CCACs in Ontario are being funded to recruit a total of 144 nurses [13 Nurse Leaders and 131 Registered Nurses (RNs)/Registered Practical Nurses (RPNs)] in 2011/12 and to annualize these positions as base in 2012/13 and out-years. The Mental Health and Addictions Nurses in DSB Program is also a key service investment that is part of Ontario s Comprehensive Mental Health and Addictions Strategy (http://www.health.gov.on.ca/english/public/pub/mental/pdf/open_minds_healthy_minds _en.pdf) (see pg 6 - Appendix A) and one of many deliverables for the initial three year action plan of the Strategy (see pg 7 - Appendix B) aimed at children and youth mental health. The program is linked to a suite of school-based initiatives being developed among the Ministries of Education, Children and Youth Services and Health and Long Term Care to support students with mental health and addictions issues, including: Health System Strategy and Policy Division September 6, 2011 4 of 12

Implementing Working Together for Kids Mental Health provincially, so that key adults in schools and in agencies will use effective tools for early identification and work collaboratively to meet the needs of kids and families. Amending the education curriculum to promote healthy development and mental health. Implementing a school mental health ASSIST program to help schools establish appropriate school-based delivery of mental health programs and services. Hiring Mental health Leaders in the 15 highest needs school boards, and providing support for mental health literacy training for all educators in the province. Development of a K-12 Resource Guide/Website which will provide teachers with information on the early signs of mental health issues and preventative actions they can take. Allocation of resources for hiring designated mental health workers in schools to address mental health needs, including needs at transition points such as elementary to secondary and to prevent youth suicides. The aim of the Mental Health and Addictions Nurses in DSBs Program is to help district school boards build capacity to recognize and respond to student mental health and addictions issues. Linked to the ASSIST program, which provides access to a group of mental health experts to help school boards build mental health capacity, the mental health and addictions nurses will become an integral part of an inter-disciplinary DSBbased team of mental health leaders, community mental health workers, and existing DSB staff that will work together to provide early identification and intervention services and supports to students who have mental health and addictions issues. Program Goal To provide mental health and addiction supports and services in an inter-disciplinary team with mental health leaders, mental health workers and existing DSB staff to children and youth, in Ontario s 72 publicly funded DSBs. Objectives: 1. To provide support to Ontario s DSBs to build capacity to recognize and appropriately respond to student mental health and addictions issues. 2. To work as part of an inter-disciplinary team and provide essential health related advice and support to the DSBs staff in developing comprehensive board plans to address a collaborative response to the mental health needs of students. 3. To reinforce the importance of positive mental health and introduce effective ways of coping with stress to students. Health System Strategy and Policy Division September 6, 2011 5 of 12

4. To advise school staff on potential side-effects of different classes of medications and provide medical consultation to school staff regarding issues such as medication management for individual students, particularly those with complex medical conditions concurrent with mental illness or addictions. 5. To provide students with mild to complex mental illness and substance abuse issues with support and access to services in the community as needed. Guiding Principles for Mental Health and Addictions Nurses in District School Boards Program Respect and understanding: Children and youth who are experiencing or have experienced a mental illness and/or addiction are valued members of their communities. They deserve to be treated with dignity and respect. Healthy development, hope and recovery: Individuals are resilient and have an inherent sense of hope for the future. Services will leverage personal strengths to help children and youth develop a sense of safety, self-worth and mastery over their future Person-directed services: Children, youth and their families must have a voice as essential partners in the provision of services and care; and they must have opportunity to make informed decisions about their personal care and support. Diversity, equity and social justice: Children and youth must be offered culturally relevant services that meet their needs at all ages and stages of life. They need equitable opportunities to receive those services, and participate in their communities free of stigma. Excellence and innovation: A commitment to continuous improvement with quality care that is person-directed, timely, accessible, effective, collaborative, and safe. Services strive for excellence and encourage best practices and innovation. Accountability: Providing education, supports and services to children, youth and families that are based on the best available evidence from lived experience, practice and research. Services must improve quality of life in a sustainable way; providers will be accountable for the value of the care they provide, and continually monitor results. Health System Strategy and Policy Division September 6, 2011 6 of 12

Target Population: Students with Mild to Complex Mental Health and/or Substance Abuse Issues The focus of the Mental Health and Addictions Nurses in DSB Program is students (and families where applicable) with mild to complex mental health and/or substance abuse issues. Students who are transitioning back to school from a hospital/institution because of a mental health and/or substance use issue, may be of particular focus for the program. The program will also focus on providing supports and services to students who are a witness to or are affected by a crisis situation such as suicide, violent behavior, etc. The program will also focus on providing education on good mental health promotion/resiliency building skills for the general student population where required/requested depending on the needs identified by the DSB. Roles and Responsibilities 1. Nurse Leaders a) Leadership Nurse Leaders will provide leadership and professional development through coaching and mentoring of RN s and RPN s. Nurse Leaders will be responsible for the development of the Mental Health and Addictions Nurses in DSBs programs in collaboration with DSBs and the CCAC. Nurse Leaders will be responsible for recruitment of the RNs and RPNs within their CCAC, scheduling, and oversight to ensure program alignment with MOHTLC goals. b) Managerial Nurse Leaders will have managerial responsibilities to include but not limited to: providing input to the development of a budget, supervising a team consisting of RNs and RPNs, and performance development and training. Nurse Leaders will lead report backs on program data collection to the Local Health Integration Networks and the MOHLTC and collaborate with DSBs on other data collection as needed. Nurse Leaders will provide oversight to ensure program consistency and communications across DSBs (many DSBs relate to multiple CCACs - e.g. Toronto DSB overlaps with four CCACs, one French board relates to 10 CCACs). c) Planner Nurse Leaders will provide essential health related advice and support to DSBs in their geographic area and contribute to the development of comprehensive board plans to ensure a collaborative response to the mental health and addiction needs of students. Coordinate and prioritize RN and RPN workload with DSB input. Health System Strategy and Policy Division September 6, 2011 7 of 12

2. RNs/RPNs with Mental Health and Addictions Expertise a) Direct Care and Coordination of Care Nurses with Mental Health and Addictions expertise will support early identification and intervention of students who may have potential mental health and/or addictions needs by performing assessments and draft plans of care. Support and/or refer students with complex issues such as refusal to attend treatment, self-harm, suicide, or violent behavior as required. Liaise with community (children and adult) mental health and addictions agencies, and family health care practitioners as required to help coordinate appropriate mental health and addictions care for students. Nurses will work with DSB staff to respond to crisis situations (e.g., suicide) to support students and educators. b) Advisory Role to Educators/Students/Parents Nurses will advise educators on potential side-effects of different classes of medications. Provide medical consultation to educators regarding issues such as medication management for individual students, particularly those with complex medical conditions concurrent with mental illness or addictions. Present information on good mental health /resiliency building skills for students and/or parent(s) to promote healthy development as required/requested by DSBs. c) Specialist on Interdisciplinary Team As part of an interdisciplinary team, nurses will provide the support of a health professional in helping students and/or parent(s) to access services such as family health care, community mental health and/or addictions agencies and provide education about options for treatment. Provide input to DSB staff in developing comprehensive board plans to address a collaborative response to the mental health needs of students. Program Accountabilities Funding Accountabilities This program is created through the 9,000 Nurses commitment and the associated funding responsibilities are tied to the number of nurse FTEs recruited for the Mental Health and Addictions Nurses in DSBs Program as outlined in the formal agreement between the Ministry and Local Health Integration Networks. Health System Strategy and Policy Division September 6, 2011 8 of 12

Performance Measures Performance measurement is the ongoing collection of performance data (indicators) to ensure that information is required to inform, track and assess the progress of the program. Performance measures are critical in a continuous quality improvement process as it provides the decision-makers with objective quality information to determine if the program is achieving the desired impact. Performance measures review and analysis permits the ongoing modification of the program to maximize its impact and ensure the program is delivering value to the overall health care system. Potential performance measures for the Mental Health and Addictions Nurses in DSB Program include: o Number of children and youth seen by nurse o Number of services provided by nurse o Fewer emergency department visits by children and youth for mental health and addiction issues There is an expectation that these measures will be collected, analyzed and used to continuously improve the Mental Health and Addictions Nurses in DSB Program and that this data and corresponding continuous quality improvement is reported to funders. Contact Information: Bobbi Clifton, Senior Policy Advisor Mental Health and Addictions Unit, Ministry of Health and Long-Term Care 416-327-7484 Bobbi.Clifton@ontario.ca Health System Strategy and Policy Division September 6, 2011 9 of 12

Appendix A Comprehensive Mental Health and Addictions Strategy Goals The long-term comprehensive strategy reinforces other key government initiatives such as The Poverty Reduction Strategy, Early Learning Strategy and the Long-Term Affordable Housing Strategy. Its key goals are as follows: 1. Improve mental health and well-being for all Ontarians Ontarians are happier, more resilient and more likely to succeed in school, work and life when they are able to cope with stress and manage the ups and downs in life. Programs will be available for all ages to help Ontarians develop the skills they need early in life to improve their mental well-being and to lead healthier lives. 2. Create healthy, resilient, inclusive communities We will help build inclusive, supportive communities. All Ontarians deserve access to the basic elements of a safe and healthy life education, employment, income and housing as well as opportunities to participate in meaningful ways in their community. Healthy communities help create a sense of belonging, which leads to better mental health. 3. Identify mental health and addictions problems early and intervene Acting early at the first signs of mental illness or problematic substance use and gambling can have a profound effect. It can help prevent addictions from taking over, and for those with a mental illness, it can shorten the journey to recovery. To intervene early, we must be able to identify and reach out to people with problems, wherever they are: in school, at work, in their doctor s office or in the justice system. This is particularly important for children and youth as symptoms of mental illness often first occur during childhood and adolescence. 4. Provide timely, high quality, integrated, person-directed health and other human services Ontarians with a mental illness and/or addictions need timely access to health and social services that meet their needs. These services should be integrated so people have easy access to the right mix of supports. Better coordination across health and other human services such as housing, income support, employment and the justice system will lead to better mental health. Health System Strategy and Policy Division September 6, 2011 10 of 12 10

Appendix B The Child and Youth Mental Health Strategy Three key child- and youth-centered priorities drive the first three years of the Comprehensive Strategy and contribute to its goals. The priorities will move the system forward rapidly and produce measurable results in the short term for children and youth, while laying the foundation for broader system changes. 1. Providing children, youth and families with fast access to high quality services It is critical that we monitor wait times and build capacity so that communitybased agencies are equipped to meet local demands. It also means creating links between and across education, health care and the community, and finding ways to link families with services. 2. Identifying and intervening in child and youth mental health issues early By equipping people who work with children and youth with the tools and knowledge they need, they will be better able to identify issues and handle them effectively. Communities must work to build a shared understanding of mental health issues, and ensure that there is strong regional and local leadership, particularly in community-based mental health agencies and schools. Providing services and supports early on will help to address problems sooner before they do too much harm. 3. Closing critical service gaps for vulnerable children and youth, children and youth at key transition points, and those in remote communities Currently, there are some groups of children that have even greater challenges accessing the care they need. To address this, we need to increase the availability of culturally-appropriate services to better serve more children and families, who are Aboriginal, or in high needs, or in underserved communities, who have complex mental health needs requiring specialized care, and/or who must navigate across key transition points. The goals will be accompanied by a thrust toward comprehensive reform of the child and youth community-based mental health system through a limited number of strategic investments: Consolidating efforts that already exist in the field for child and youth mental health by supporting initiatives that promote collaboration, efficiencies and consolidation. Health System Strategy and Policy Division September 6, 2011 11 of 12 11

Putting in place the quality standards, indicators, and tools necessary to measure outcomes. Health System Strategy and Policy Division September 6, 2011 12 of 12