Well Fort Annie Nurse Practitioner Karla Nurse Practitioner

Well. Fort Annie – Nurse Practitioner Karla – Nurse Practitioner Natasha- Social Worker Tapo- Clinical Counsellor Cohort 13 March 2 2018 IDEAS Applied Learning Project www. ideasontario. ca

What are you trying to accomplish? System Aim: As a system we are striving to integrate clients into the CHC and we are working towards building accessibility of services for clients. This requires that we optimize on the resources available. Project AIM statement: Enhancing client driven care: By March 2, 2018, 50% of female clients (18 -65) will see a reduction in their PHQ 9 score by 50% www. ideasontario. ca 2

Quality Standards Addressed & Challenges 1. Monitoring for treatment adherence and response Challenge(s): Client follow up / pre-booked appointments / appointment reminders 2. Treatment after initial diagnosis Challenge(s): Client follow up / medication adherence / cost / psychiatry access / stigma 3. Shared decision making Challenge(s): Client/clinician relationship dynamics www. ideasontario. ca 3

Changes – – – Regular collection of PHQ-9 scores in person and telephone Design and implement a Depression Flow Sheet Implementation of Psychosocial group Client interviews exploring the experiences of participants Role clarification in interdisciplinary practice Standardizing processes and procedures in treatment to increase access to resources – Pre-booking follow up appointments for client starting on new antidepressants – Encouraging the use of the Wellness Passport as a self-care tool www. ideasontario. ca 4

STATS…. www. ideasontario. ca 5

Quantitative Results/Impact Results: • - This graph shows an average of 9% reduction in PHQ 9 score for all clients comparing baseline to their most recent score • - For some, this occurred in their 4 th follow up visit, for others it was in their third follow up visit. • -We ghosted two values in this chart #7 and #19 because these clients were not engaged in their treatment plan. Reasons included language barriers; lack of resources (transport etc). www. ideasontario. ca 6

Were we able to prove our theory? Our theory was that by making resources more accessible, and by meeting regularly with clients, clients would be more aware of what is available to them and how they can be co-designers of their treatment. YES • PHQ-9 score- (increase vs decreases) • There was an increase in rate of return for follow-ups • Standardizing practice resulted in a marked improvement in engagement for clients with the mental health team. Working as team with a standardized approach to care resulted in increased client satisfaction, follow ups, goal setting and better managed depression. NO • Self-care strategies did not increase with use of wellness passports • Clients reported becoming “tired” of answering PHQ-9 questions, which led to doubts about the efficacy of PHQ-9 scores as an accurate measure. www. ideasontario. ca 7

Qualitative Results/Impact - Client regularly report frequent PHQ 9 assessment as meaningless - Those who accessed other supports in the centre (e. g. physio, social work, counselling, etc. ) reported these services as beneficial to their wellbeing - Clients and clinicians report difficulty with access to prebooked appointments - Reminder calls helped with follow ups and consequently with adherence - Clients most often did not utilize wellness passport tool www. ideasontario. ca 8

Questions and Responses • Care experience • Environment • Effectiveness • • “The providers always have suggestions on how to deal with situations, how I can go about making my day a little better”. “The sessions have worked; I’m a bit more settled”. • Strategies • Communication • Tools/resources • One participant mentioned exploring other questions on the questionnaire that measure depression so progress of participants are accurately measured as opposed to the routine questions in which responses may be memorized. www. ideasontario. ca 9

Lessons Learned Enablers • Clients who willingly participated in project • Colleagues who helped with data collection, scheduling conflicts, and other things • Teamwork Challenges • • • Same day appointments Long psychiatry wait times Repeated use of the p. HQ-9, which clients reported was tedious Inconsistencies between scores and client reports Making time to do IDEAS data collection **Conducting and collecting PHQ-9 scores over the phone allowed for flexibility for clients who could not come in regularly. Following some education about the tool we found clients were open to using the tool as a self-care tool. www. ideasontario. ca 10

Next Steps to Progress Improvement • We have kept the rest of Well. Fort informed on our change ideas. • Implementation of Depression Flowsheet across organization and get feedback on the usability of this tool for larger team • Make PHQ-9 forms available to clients as a self-assessment tool. • Run psychosocial groups that focus on specific mental health disorders more regularly. (Starting with a Mindfulness CBT group for clients with diagnoses of MDD and Anxiety). • Explore adding a social worker to this team (ongoing) • Team now has access to regular psychiatrist which has improved wait times for assessment and follow up www. ideasontario. ca 11