CYMH Implementation Plan

Overriding Goal CYMH Implementation Plan To improve the quality of patient care available in non-specialized general practice for children and youth dealing with mild to moderate anxiety and ADHD and youth with mild to moderate depression. This will be measured by a change in function as measured by the CGI scale. Learning Outcomes By the end of the implementation, physicians will be able to 1. Utilize the CYMH EMR tools, hyperlinked algorithm and/or paper based binder to access all tools 2. Apply screening and assessment tools to identify children and youth who may have anxiety, depression, and ADHD with/without associated comorbidities. 3. Use non pharmacological interventions (CBIS, Anxiety BC, DWD, Confident Parents) as first line therapy for mild to moderate depression, anxiety, ADHD and behavioural issues 4. Identify listening and hearing as valid treatment options 5. Develop a care plan to address patients with anxiety, depression, and ADHD that utilizes CYMH tools and resources 6. Build a registry of all child-and-youth-aged patients with anxiety, depression, and ADHD 7. Integrate CYMH tools and resources into an effective work flow 8. Report increased confidence in providing appropriate management for child-and-youth-aged patients with anxiety, depression, and ADHD 9. Use appropriate tools to assess and plan a management strategy for X (TBD) child-and-youth-aged patients with anxiety, depression, and ADHD 10. Demonstrate knowledge of appropriate use of pharmacological treatment for management of condition. 11. Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.) 12. Identify appropriate community resources to support child-and-youth-aged patients with anxiety, depression, ADHD, conduct disorders, substance use and psychosis Key Messages in this program include 1. CYMH issues are typically under-identified or identified too late, early identification and intervention is key, four out of five children and youth are not receiving treatment. 2. The vast percentage (~80%) of mild to moderate CYMH issues can be effectively managed in primary care. 3. Take your time in the assessment so that you don t miss something important or misidentify a condition. 4. Listening and hearing IS treatment. This is your greatest tool along with CBT skills to help you if stuff comes out. Even if you have specialist access, there is typically a long wait until that happens or between sessions. Other than PHQ9, GAD 7, no take home diagnostic tools need to be used

5. It s not all up to you. CYMH problems may be chronic and may not be fixable but may be managed more easily with shared responsibility, patient engagement and negotiation. 6. Non-pharmacological management is the foundation upon which effective treatment is based (pills don t build skills!). 7. A team-based approach to CYMH issues produces the best results.

Instructional Plan for CYMH Implementation Program Outcome How to assess? How to teach? Resources needed? 1. Utilize the CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools 2. Apply screening and assessment tools to identify children and youth who may have anxiety, depression, and ADHD with/without associated comorbidities. Demonstrate in LS1 and review with GP in PV (AP1) in practice visit KADS6, SCARED, SNAP IV, Demonstrate administration to peer Practice scoring assessment tools Screening Questions: Demonstrate to peer Post action plan case study report?? Report from coach learning session Recorded on data sheet Pre LS1 embed into practice Case based scavenger hunt Participants are encouraged to follow along in the binder, turning to the page of the resource being covered, tabs are color coded, as our the corresponding PPT slide so they know where to turn, facilitators explain where to find it PC support at the table assists them to find the resources. Paired activity Patient advocate /video Paired activity Case study with hidden info that requires elicitation Participants are encouraged to follow along in the binder, Office computer Tools in the EMR Lap top for LS1 Module manual Case studies List of all tools Copies of KADS6, SCARED, SNAP IV Copy of Screening Questions Patient advocate (may be parent?) Internet access Hidden info answers Laminated DSM5 Depression, Anxiety, ADHD definitions

3. Use non pharmacological interventions (CBIS, Anxiety BC, DWD, Confident Parents) as first line therapy for mild to moderate depression, anxiety, and ADHD 4. Identify listening and hearing as valid treatment options 5. Develop a care plan to address patients with anxiety, depression, and ADHD that utilizes CYMH tools and resources 6. Build a registry of all child-andyouth-aged patients with anxiety, depression, and ADHD Demonstrate condition confirmation in DSM5 Post action plan case study report?? Report from coach Patient feedback learning session Recorded on data sheet Sharing experience at next learning session Coach report demonstrate with peer Report from coach Patient feedback learning session Demonstrate on own EMR or paper based tool turning to the page of the resource being covered, tabs are color coded, as are the corresponding PPT slide so they know where to turn, facilitators explain where to find it PC support at the table assists them to find the resources. Youth CBIS: manual review, demo/video paired activity with top 5 skills Other Resources: (TeFA, CFA, WRP, etc.) lecture DWD: lecture/video Patient advocate (parent?) Listening/paraphrasing learning exercise in pairs Activity debrief CYMH Mental Health plan demo lecture Demonstration Physicians and staff work on own database with support List of all tools Internet access?? Patient advocate Facilitator guide for exercise Care plan handout Case studies? Instruction sheets for each EMR on how to identify patients. 7. Integrate CYMH tools and resources into an effective work flow GP report MOA report Report from coach MOA coach discussion, questions MOA breakout sessions Coach visits and problem EMR templates CYMH Manual Algorithm on computer in easily accessible

learning session solving sharing ideas during action periods location 8. Report increased confidence in providing appropriate management for child-andyouth-aged patients with anxiety, depression, and ADHD 9. Use appropriate tools to assess and plan a management strategy for X (TBD) child-andyouth-aged patients with anxiety, depression, and ADHD learning sessions Pre/post surveys learning sessions Report from coach Completed data sheet Pre/post surveys Paired and group activities during LSs, and real practice during action periods Coach visits and problem solving and sharing ideas during action periods Coach reports describing findings, solutions during action periods in next learning sessions Action period planning with local groups Group discussion Fee Discussion Pre/post survey Action period forms Fee case study? 10. Demonstrate knowledge of appropriate use of pharmacological treatment for management of condition. Completed data sheet Pre/post surveys Didactic lecture Medication flow sheets 11. Develop a collaborative working relationship with a CYMH team and other stakeholders learning sessions Report from coach Reports back from referrals Completed consent to share information documents Action period planning with local groups Group discussion Action period forms

12. Identify appropriate community resources to support child-andyouth-aged patients with anxiety, depression, ADHD, conduct disorders, substance use, and psychosis learning sessions Report from coach Report from PSP staff Action period planning with local groups Group discussion Agency guest presenters Lecture rapid fire Interactive referral case study Panel Q&A Tables for resources Action period forms Representatives from community resources Information Tables for resources to display

First Learning Session (3.5 hrs) Learning Objectives targeted: Apply screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorder Utilize the CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools Use non pharmacological interventions (WRP, TeFA, CFA) as first line therapy for mild to moderate depression, anxiety, and ADHD Identify listening and hearing as valid treatment options Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.) Action Period 1 Learning Objectives targeted: Apply screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorder Utilize the CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools Apply listening and hearing techniques as valid treatment options Second Learning Session (3.5hrs) Learning Objectives targeted: Use appropriate tools to assess and plan a management strategy for X (TBD) child-andyouth-aged patients with anxiety or depression Use appropriate pharmacological treatment for management of children and youth with anxiety and depression Develop a care plan to address patients with anxiety and depression that utilizes CYMH tools and resources Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.) Identify appropriate community resources to support child-and-youth-aged patients with anxiety, depression, and ADHD Action Period 2 Learning Objectives targeted: Build a registry of all childand-youth-aged patients with anxiety and depression Apply screening and assessment tools to identify children and youth who may have anxiety or depression Apply non-pharmacological interventions to manage children and youth who may have anxiety or depression Where appropriate, develop care plans to address patients with anxiety and depression that utilizes CYMH tools and resources Where appropriate, use pharmacological treatment for management of children and youth with anxiety and depression.

Learning Session Activities PDSA Action Period 1: Learning Session Activities PDSA Action Period 2: 1. Introduction context (45 min) 2. Team roles and collaboration 3. Statistics in community 4. Confidentiality and consent 5. Risk identification tables 6. Screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorders four initial questions 7. CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools 8. Identify listening and hearing as valid treatment options 9. Specific Non Pharmacological Interventions (WRP, TeFA, CFA) 10. Collaboration 11. Resources Trial workflow with EMR, Electronic Algorithm and/or paper binder Use screening tools 4 questions Trial listening and hearing techniques Use non-pharm interventions (WRP, TeFA, CFA) Refer patients to general resources 1. Case introductions 2. Anxiety context 3. Anxiety identifying & Screening 4. Assessment SCARED 5. Depression context 6. Depression identifying & Screening 7. Assessment KADS 8. Suicide Risk assessment 9. CGI 10. Treatment & Management Anxiety and Depression 11. Medications 12. Collaboration 13. Resources Build a registry of all child-andyouth-aged patients with anxiety and depression Apply screening and assessment tools to identify children and youth who may have anxiety or depression Apply non-pharmacological interventions to manage children and youth who may have anxiety or depression Where appropriate, develop care plans to address patients with anxiety and depression that utilizes CYMH tools and resources Where appropriate, use pharmacological treatment for management of children and youth with anxiety and depression.

Third Learning Session (3.5 hrs) Learning Objectives targeted: Use appropriate tools to assess and plan a management strategy for X (TBD) child-and-youth-aged patients with ADHD Use appropriate pharmacological treatment for management of children and youth with ADHD. Develop a care plan to address patients with ADHD that utilizes CYMH tools and resources Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.) Identify appropriate community resources to support child-and-youthaged patients with anxiety, depression, and ADHD Action Period 3 Learning Objectives targeted: Build a registry of all child-and-youth-aged patients with ADHD Apply screening and assessment tools to identify children and youth who may have ADHD Apply non-pharmacological interventions to manage children and youth who may have ADHD Where appropriate, develop care plans to address patients with ADHD that utilizes CYMH tools and resources Where appropriate, use pharmacological treatment for management of children and youth with ADHD Fourth Learning Session (3.5hrs) Learning Objectives targeted: Integrate CYMH tools and resources into an effective work flow Report increased confidence in providing appropriate management for child-andyouth-aged patients with anxiety, depression, and ADHD

Learning Session Activities 1. Case introductions 2. ADHD context 3. ADHD identifying & Screening 4. Assessment SNAP IV 5. CGI 6. Treatment & Management ADHD 7. Medications 8. Collaboration PDSA Action Period 3: Build a registry of all child-and-youth-aged patients with ADHD Apply screening and assessment tools to identify children and youth who may have ADHD Apply non-pharmacological interventions to manage children and youth who may have ADHD Where appropriate, develop care plans to address patients with ADHD that utilizes CYMH tools and resources Where appropriate, use pharmacological treatment for management of children and youth with ADHD Learning Session Activities 1. Resources presentation 2. Navigating the System panel case study 3. Care plans 4. collaboration

First Learning Session (3.5 hrs) Learning Objectives: Apply screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorder Utilize the CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools Use non pharmacological interventions (WRP, TeFA, CFA) as first line therapy for mild to moderate depression, anxiety, and ADHD Identify listening and hearing as valid treatment options Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.) Time Learning Session Activities Introduction context (45 min) Physician, patient advocate perspective Team roles and collaboration Statistics in community Confidentiality and consent Risk identification tables Screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorders four initial questions CYMH hyperlinked algorithm, EMR templates and/or paper based manual to access all tools Identify listening and hearing as valid treatment options Specific Non Pharmacological Interventions (WRP, TeFA, CFA) Collaboration Resources Delivery Format /intro Story telling Facilitated Discussion Presentation of stats and validation & small group activity, activity debrief Paired activity, discussion of outcomes and facilitated discussion Facilitated discussion Rapid Fire Presentation & open tables at back 210 min Assessment:

Second Learning Session (3.5hrs) Learning Objectives: Use appropriate tools to assess and plan a management strategy for X (TBD) child-and-youth-aged patients with anxiety or depression Use appropriate pharmacological treatment for management of children and youth with anxiety and depression Develop a care plan to address patients with anxiety and depression that utilizes CYMH tools and resources Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.) Identify appropriate community resources to support child-and-youth-aged patients with anxiety, depression, and ADHD Time 210 min Learning Session Activities Case introductions Anxiety context including Screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorders four initial questions Anxiety identifying & Screening Assessment SCARED Depression context Depression identifying & Screening Assessment KADS Suicide Risk assessment CGI Treatment & Management Anxiety and Depression Medications Collaboration Resources Delivery Format Story telling with feedback for validation with group discussion, paired activity with feedback for validation with group discussion, paired activity and group discussion with feedback with group discussion Facilitated discussion Rapid Fire Presentation & open tables at back Assessment:

Third Learning Session (3.5hrs) Learning Objectives: Use appropriate tools to assess and plan a management strategy for X (TBD) child-and-youth-aged patients with ADHD Use appropriate pharmacological treatment for management of children and youth with ADHD. Develop a care plan to address patients with ADHD that utilizes CYMH tools and resources Develop a collaborative working relationship with a CYMH team and other community providers (school counselors, specialists, community services, etc.) Identify appropriate community resources to support child-and-youth-aged patients with anxiety, depression, and ADHD Time Learning Session Activities Case introductions ADHD context - including Screening tools to identify children and youth who may have anxiety, depression, ADHD and/or conduct disorders four initial questions ADHD identifying & Screening Assessment SNAP IV CGI Treatment & Management ADHD Medications Collaboration Delivery Format Story telling with feedback for validation with group discussion, paired activity Group discussion with group discussion Facilitated discussion 210 min Assessment:

Fourth Learning Session (3.5 hrs) Learning Objectives: Integrate CYMH tools and resources into an effective work flow Report increased confidence in providing appropriate management for child-and-youth-aged patients with anxiety, depression, and ADHD Time Sharing Experiences Resources presentation Learning Session Activities Navigating the System panel case study Care plans Collaboration Sustainability and improvement tips Community Resource Café Sustainability plan Wrap up, evaluations Delivery Format Story Telling and facilitated discussion Rapid Fire Presentation & open tables at back Storytelling, case presentation, panel discussion with questions and group discussion, then paired activity Facilitated discussion Group activity Small group activity 210 min Assessment: