Faculty and Resident Orientation Manual Division of Child & Adolescent Psychiatry
Faculty and Resident Orientation Manual Division of Child & Adolescent Psychiatry The University of Western Ontario Schulich School of Medicine and Dentistry Department of Psychiatry TABLE OF CONTENTS WELCOME ...................................................................................................................................................................... 4 ORIENTATION FOR POSTGRADUATE RESIDENTS ............................................................................................................ 5 POSTGRADUATE EDUCATION ............................................................................................................................................ 5 EDUCATIONAL OPPORTUNITIES ........................................................................................................................................ 6 OTHER EDUCATIONAL OPPORTUNITIES FOR RESIDENTS ................................................................................................... 6 ADMINISTRATIVE ASPECTS OF THE UNIVERSITY OF WESTERN ONTARIO DIVISION OF CHILD AND ADOLESCENT PSYCHIATRY ....................................................................................................................................................................... 7 LONDON HEALTH SCIENCES CENTRE – CHILD AND ADOLESCENT MENTAL HEALTH CARE PROGRAM ............................... 8 PSYCHIATRISTS AT LONDON HEALTH SCIENCES CENTRE ................................................................................................... 8 COMMUNITY BASED CAP PSYCHIATRISTS IN SOUTHWESTERN ONTARIO ....................................................................... 10 LHSC PROGRAMS ......................................................................................................................................................... 11 DAY TREATMENT PROGRAM ........................................................................................................................................... 11 INPATIENT MENTAL HEALTH CARE PROGRAM ................................................................................................................ 13 THE OUTPATIENT PROGRAM ........................................................................................................................................... 14 EATING DISORDERS PROGRAM........................................................................................................................................ 15 QUICK RESPONSE CLINIC.................................................................................................................................................. 17 MATERNAL CHILD MENTAL HEALTH PROGRAM .............................................................................................................. 18 TRANSITION AGE PROGRAM............................................................................................................................................ 19 CATCHMENT AREAS ......................................................................................................................................................... 19 REGIONAL MENTAL HEALTH CARE – LONDON (ST. JOSEPH’S HEALTH CARE) ................................................................ 25 THE CHILD AND PARENT RESOURCE INSTITUTE (CPRI) ................................................................................................. 25 VANIER CHILDREN’S SERVICES ..................................................................................................................................... 27 RESIDENCY TRAINING SITES IN WINDSOR .................................................................................................................... 28 CHILDREN FIRST (WWW.CHILDREN-FIRST.CA)......................................................................................................................... 28 SUMMIT CENTRE (WWW.SUMMITCENTRE.ORG) .................................................................................................................... 29 GLENGARDA CHILD AND FAMILY SERVICES (WWW.GLENGARDA.ON.CA) .............................................................................. 29 WINDSOR REGIONAL CHILDREN’S CENTRE (WWW.WRCHILDRENSCENTRE.ORG)..................................................................... 30 MARYVALE ADOLESCENT AND FAMILY SERVICES ............................................................................................................ 31 TEEN HEALTH CENTRE (WWW.TEENHEALTHCENTRE.COM) ...................................................................................................... 32 EMERGENCY GUIDELINES ............................................................................................................................................. 33 OTHER COMMUNITY AGENCIES ................................................................................................................................... 40 1. LHSC – VICTORIA HOSPITAL.......................................................................................................................................... 40 2. LHSC – UNIVERSITY HOSPITAL ...................................................................................................................................... 40 3. ST. JOSEPH’S HEALTH CARE .......................................................................................................................................... 40 4. ST. JOSEPH’S HEALTH CARE – REGIONAL MENTAL HEALTH CARE – LONDON SITE – ADOLESCENT UNIT ...................... 40 5. CPRI * - CHILD AND PARENT RESOURCE INSTITUTE ...................................................................................................... 40 6. MERRYMOUNT CHILDREN’S CENTRE ........................................................................................................................... 41 7. HARDY GEDDES HOUSE ................................................................................................................................................ 41 8. WESTERN AREA YOUTH SERVICES (WAYS) * ................................................................................................................ 41 2 9. CRAIGWOOD YOUTH SERVICES * ................................................................................................................................. 41 10. VANIER CHILDREN’S SERVICES ................................................................................................................................... 42 11. CHILDREN’S AID SOCIETY, LONDON AND MIDDLESEX ................................................................................................ 42 12. CRISIS-INTAKE TEAM (CIT) .......................................................................................................................................... 42 13. CENTRE FOR CHILDREN AND FAMILIES IN THE JUSTICE SYSTEM * ............................................................................. 42 14. FAMILY SERVICE LONDON .......................................................................................................................................... 42 15. GENEST DETENTION CENTRE FOR YOUTH (YOUTH 12-15) ......................................................................................... 43 16. KING STREET DETENTION CENTRE FOR YOUTH (YOUTH 12-15) ................................................................................. 43 17. GUNN STREET GIRLS HOME ....................................................................................................................................... 43 18. MAITLAND STREET GROUP HOME ............................................................................................................................. 43 19. OXFORD AND ELGIN CHILD AND YOUTH CENTRE * .................................................................................................... 43 20. HURON-PERTH CENTRE (HPC) * ................................................................................................................................. 43 21. GREY BRUCE CHILDREN’S SERVICES *......................................................................................................................... 43 22. ANAGO GROUP HOME * ............................................................................................................................................ 44 23. SCIP (SCHOOL COMMUNITY INTERVENTION PROGRAM) .......................................................................................... 44 24. CHILDREN’S SERVICES COORDINATING NETWORK (CSCN) ........................................................................................ 44 ONTARIO CHILD AND YOUTH TELEPSYCHIATRY PROGRAM – WESTERN HUB ............................................................... 45 3 WELCOME The Residents, Faculty and Staff of the Division of Child and Adolescent Psychiatry welcome you to London, and hope you will take some time to review our programs and give serious consideration to the excellent educational opportunities available in our Division. There are a number of sites in the London and Southwestern Ontario mental health community, offering experiences in a variety of specialties. We offer the chance to explore areas new to you by taking elective rotations, dictated primarily by your interests and career goals. Your rotation in Child and Adolescent Psychiatry will offer the opportunity to gain exposure and expertise in inpatient, day treatment, outpatient or residential areas; and provide you with experience with patients ranging from toddlers to young adults. You may spend time in several sites within the city of London; or take advantage of placements in Windsor, Chatham, or in other communities in Southwestern Ontario. Telepsychiatry is embedded within the core training of Child and Adolescent Psychiatry. Various treatment modalities are available including family therapy, play therapy, supportive therapy, insight-oriented therapy, cognitive-behavioural therapy, interpersonal psychotherapy, and dialectical-behavioural therapy. The Division of Child and Adolescent Psychiatry offers training for both General Adult Psychiatry residents and residents specializing in Child and Adolescent Psychiatry. Your education in the Division of Child and Adolescent Psychiatry will provide the opportunity to work with an exceptional group of residents from across North America and around the world. The residents here enjoy a convivial and collegial relationship, both professionally and socially. You will reap the benefits of the support of a dedicated and committed peer group, and will have the chance to participate in social events organized by and for this diverse group. We hope this provides information about how our programs can best meet your needs and objectives. We invite you to contact our Division Chair, Dr. Sandra Fisman, or the Postgraduate Education Director, Dr. Patricia Hall, to talk about the career and educational opportunities in London and area. Child and Parent Resource Institute (CPRI) Centre for Children and Families in the Justice System Children’s Aid Society London District Catholic School Board London Health Sciences Centre Vanier Children’s Services Residency Training Site in Windsor St. Joseph’s Regional Mental Health Care Thames Valley District School Board Western Hub Telepsychiatry Program Clinics in Community 4 ORIENTATION FOR POSTGRADUATE RESIDENTS POSTGRADU ATE EDUCATION PGY 1 General Adult Psychiatry Residents All postgraduate year one psychiatry residents do one block of child and adolescent psychiatry. The rotation will occur on the Inpatient Unit (B8200) of the Child and Adolescent Mental Health Care Program at London Health Sciences Centre (LHSC). You will be notified of what month your rotation is by the program coordinator, Eva Adams. PGY 3 General Adult Psychiatry Residents All residents in postgraduate year three do a mandatory six blocks of training in Child and Adolescent Psychiatry (CAP). Residents must complete this experience in both inpatient\residential and outpatient settings. The resident could complete all six blocks in one placement if they had exposure to inpatient\residential and outpatient\community settings simultaneously or the resident could spend three of the six blocks in inpatient\residential programs and three blocks in an outpatient\community setting. Inpatient program refers to a hospital-based program in an acute care or tertiary care hospital. A residential program refers to a setting where children and adolescents with mental health problems are assessed and treated therapeutically under the supervision of a child and adolescent psychiatrist. During the six blocks of training in Child and Adolescent Psychiatry, a two week rotation in Developmental Disabilities is required. Residents will meet with the Postgraduate Education Coordinator in the Division of Child and Adolescent Psychiatry in the Postgraduate year 2 to arrange their rotations. Residents should also arrange to do one telepsychiatry consultation with the Western Hub. Please see Core Training Objectives which follow in this section. PGY 5 and PGY6 Child and Adolescent Psychiatry Residents Twenty for months of approved residency in Child and Adolescent Psychiatry which must include: At Least 18 months of clinical training in Child and Adolescent Psychiatry including Inpatient, Ambulatory (Outpatient clinics, day treatment program, provision of consultation liaison to pediatric services, provision of direct or indirect patient or program consultation to schools, correctional programs, and community mental health services), and at least 6 months of this training must occur in the final year of experience. Clinical selectives up to 6 months within the clinical training period may be comprised of rotations in approved programs outside of, but related to the practice of Child and Adolescent Psychiatry. Each of these rotations must be one month in duration and may include Neurology, Neuroimaging, Pediatrics, Adolescent Medicine, Developmental Disabilities, Addictions, and Forensic Psychiatry. Regular opportunity for and experience in emergency/urgent assessment and care of children and youth in a minimum longitudinal experience equivalent to one month’s duration. Up to the equivalent of 6 months of advanced knowledge and skill straining relevant to Scholar and/or Manager and is undertaken utilizing a horizontal or longitudinal experience 5 in a special area of interest in at least one of the following domains, Health care delivery, Research, Teaching, Educational Scholarship, Administration. Please contact Tracy Henebry, Program Coordinator by email Tracy.Henebry@lhsc.on.ca for more specific information regarding the Child and Adolescent Psychiatry Subspecialty Program. All residents are to do family therapy during their training in Psychiatry. Please meet with the Psychotherapy Coordinator of the Department of Psychiatry to discuss meeting your psychotherapy requirements. The department of psychiatry is actively developing Family Therapy experiences across the lifespan. The Division of Child and Adolescent Psychiatry offers several modalities of family therapy training at various locations. EDUCATIONAL OPPORTUNITIES Child and Adolescent Psychiatry Teaching Rounds occur the third Thursday of each of the following months: September, October, November, December, January, February, April, and May; they occur from 830 to 1000; they are usually held at LHSC-Victoria Hospital in room# B2-119 residents are to organize the rounds one month prior to your rounds please send title and three objectives to the administrative assistant for the University of Western Ontario Division of Child and Adolescent Psychiatry. PGY3 Module Lecture Series occur Thursday afternoons during the year. schedules are provided by the Department of Psychiatry PGME office. Child and Adolescent Psychiatry Complex Case Rounds and Journal Club occur on the second Wednesday of every month from 12:15 to 1:15; they are usually held at LHSC-Victoria Hospital in room# B8-035. PGY5 and PGY6 Child and Adolescent Psychiatry Subspecialty Curriculum occur Thursday afternoons during the year. Schedules are provided by the Child and Adolescent Psychiatry PGME office. OTHER EDUCATIONAL OPPORTUNITIES FOR RESIDENTS Continuing Medical Education (CME) Rounds child\adolescent psychiatry has CME rounds the second Thursday in June- the rounds occur between 08:30 and 10:30; a resident usually presents a case; a local or invited speaker gives a one hour talk; and one member of the Division of Child and Adolescent Psychiatry moderates the session 6 Semi-Annual Division of Child and Adolescent Psychiatry Meeting consists of a short business meeting followed by an invited guest speaker and dinner. Annual Division of Child and Adolescent Psychiatry Meeting consists of a business meeting and is followed by an invited guest speaker and dinner. Annual UWO Division of Child and Adolescent Psychiatry Conference Usually occurs on the last Thursday in April of each year; a whole day; usually one or two speakers ADMINISTRATIVE ASPECTS OF THE UNIVERSITY OF WESTERN ONTARIO DIVISION OF CHILD AND ADOLESCENT PSYCHI ATRY Advisory Committee of the UWO Division of Child and Adolescent Psychiatry members include the Division Chair, Undergraduate Education Coordinator, Postgraduate Education Manager, CME Education Director, representative from the Thames Valley District School Board, representative from the London and District Catholic School Board, Research Director, Resident Representative, Southwestern Ontario Medical Education Network (SWOMEN), Community Member, Faculty of Education at Western, Children’s Aid Society Member this committee meets four times per year Undergraduate Education Coordinator Dr. Ben Loveday, RMHC-London, coordinates the clinical clerkship; he coordinates elective medical students; he sits on the monthly Undergraduate Education Committee of the Department of Psychiatry Postgraduate Education Manager Dr. Patricia Hall coordinates the PGY3 psychiatry residents for their child\adolescent psychiatry rotations Coordinates the PGY3 module lecture series sits on the Resident Training Committee Child and Adolescent Psychiatry Subspecialty Program Director Dr. Patricia Hall is responsible for developing and maintaining the specific standards of accreditation by the Royal College of Physicians and Surgeons of Canada. The Postgraduate Director is involved in multiple committees including chairing the RTC. Family Therapy Program The psychotherapy coordinator for the Department of Psychiatry coordinates family therapy experiences for residents 7 Research Director Dr. Jeff Carter, Vanier Children’s Services, will meet with each career child/adolescent psychiatry resident to discuss their plans for research to fulfill diploma requirements. LONDON HE ALTH SCIENCES CENTRE – CHILD AND ADOLESCENT MENTAL HE ALTH CARE PROGRAM Outpatient Program Day Treatment Program Eating Disorders Program Inpatient Unit Intake Department PSYCHI ATRISTS AT LONDON HE ALTH SCIENCES CENTRE Outpatient Department Dr. Sandra Fisman Dr. Margaret Steele Dr. Heidi Haensel Dr. Patricia Hall Dr. Michelle Ngo Dr. Javeed Sukhera Day Treatment Program Dr. Naveed Rizvi – two full days per week Eating Disorder Program Dr. Alexandra Nowicki Dr. Liga Stare - pediatrician works two days per week Inpatient Program Dr. Kamran Kizilbash Dr. Javeed Sukhera First Episode Mood and Anxiety Program Dr. Sarah Armstrong – two days per week Dr. Michelle Ngo – four days per week 8 Telepsychiatry Dr. Naveed Rizvi – Physician Lead Telepsychiatry service is known as the Western Hub. It is situated primarily at CPRI but LHSC, St. Joseph’s Health Center – Regional Mental Health Care – London (SJHC-RMHC-L), Windsor Regional Hospital (WRH) and the UWO Division of Child and Adolescent Psychiatry are all partners. You may be asked to do some telepsychiatry consultations. Rhonda Persichilli is the intake coordinator and is based at CPRI. All referrals to the Child and Adolescent Mental Health Care Program (with the exception of child and adolescent psychiatry emergency consultations) will be directed to the intake department. For those referrals for inpatients, the referral should be directed to Inpatient Child and Adolescent Psychiatrists Dr. Javeed Sukhera and Dr. Kamran Kizilbash. For outpatient consultations, intake will work with the outpatient Child and Adolescent Psychiatrists and their secretaries to book these appointments. Telepsychiatry consultations go to Rhonda Persichilli at CPRI. Psychiatrists at CPRI Dr. Al Brown – full time, psychiatrist for residential unit for patients with Developmental Disabilities and sees outpatients with emotional disorders Dr. Rida Mirza – three days a week, sees general outpatients Dr. Rob Nicolson – Chair of the Developmental Disabilities Division; pervasive developmental disorders; developmental disabilities; (he also has a research office at LHSC), three days a week at CPRI, sees children with PDD Dr. Ajit Ninan – full time, Medical Director for CPRI, psychiatrist for the short-term assessment unit for 6-12 year olds Dr. Naveed Rizvi – three days per week, psychiatrist for Mood Disorders Clinic and Physician Lead for Telepsychiatry Dr. Sohail Makhdoom – full time, sees outpatients with developmental disabilities and pervasive developmental disorder Dr. Nevena Dourova – full time, psychiatrist for the residential unit for adolescent girls and general outpatients and consults to Selective Mutism Clinic Dr. Sarah Armstrong – three days a week, sees outpatients through Mood Disorders Clinic and Brake Shop (Tic Disorders Clinic) and general outpatients Dr. Simran Ahluwalia- full time, psychiatrist for residential unit for developmentally disabled patients under 12 and consults to ACES (Attachment disorders clinic) and Telepsychiatry and Complex Special Needs Dr. Tim Beal – full time, psychiatrist for residential unit for adolescent boys, telepsychiatry, forensic work, Psychiatry Discipline Lead Dr. Jose Mejia – one day a week, psychiatrist with Sexual Behavior’s Team and telepsychiatry Dr. Linda Plowright – two days a week, Dual Diagnosis Program 9 Psychiatrists at St. Joseph’s Hospital – Regional Mental Health Care Program – London Site – Adolescent Unit Dr. Ben Loveday – Inpatient unit Dr. Sandra Fisman – Physician Lead for the entire program at SJHC-RMHC-London adolescent unit and outreach program and provides consultation for the outreach program Children’s Aid Society Dr. Krystyna Wojakowski COMMUNITY BAS ED CAP PSYCHI ATRISTS IN SOUTHWESTERN ONTARIO a list of community based child and adolescent psychiatrists in Southwestern Ontario is available through the Division Chair’s office. 10 LHSC PROGRAMS Mandate The Child and Adolescent Mental Health Care Program is a regional provider of primary, secondary, and tertiary child and adolescent mental health services with four components: Inpatient, Outpatient, Eating Disorders, and Day Treatment. The Child and Adolescent Mental Health Care Program serves children and adolescents who present with mental health difficulties, such as: Mood Disorders including Depression, Bipolar Disorder and suicidal behaviours, Anxiety Disorders, Schizophrenia, Psychotic Disorders, Eating Disorders, Post Traumatic Stress Disorder, Psychosomatic Disorders, as well as acute symptoms of distress related to family or personal crisis, abusive experiences, and/or experiencing or witnessing traumatic events and changes within the family. Please note that the Child and Adolescent Mental Health Care Program does not serve children and adolescents whose needs are better addressed by other agencies due to such primary presenting concerns as: behavioural problems, attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, substance abuse, pervasive developmental disorders, learning disabilities, marked intellectual impairment and physical illness without an associated mental health problem. We also do not accept referrals to conduct Custody and Access Evaluations, Child Welfare Assessments or Young Offender Assessments. DAY TRE ATMENT PROGRAM The Child and Adolescent Mental Health Care Day Treatment Program offers a two week assessment of children and adolescents, between 10 and 17 years of age, who require more intensive services than available through the Outpatient program, but who do not require hospitalization. The anticipated length of stay is 2 to 16 weeks. Assessment and treatment are provided by an interdisciplinary team which includes various disciplines including psychiatry, psychology, social work, child and youth counseling and nursing, and special education. During the first two weeks, a comprehensive interdisciplinary assessment is completed. The program team works closely with youths and families to identify treatment goals and individualized treatment plans. According to the needs of the youths and the families, the day treatment program offers individual psychotherapy, group therapy, family therapy and/or pharmacotherapy in a structured therapeutic environment. Children and adolescents also participate in the W.D. Sutton school component of the program. The program team works in close collaboration with the community care providers and the schools to promote a timely return of youths to their community. After discharge youths are offered outreach support to prevent early relapse. 11 Education The Child and Adolescent Centre offers a workshop on a yearly basis. Some of the topics have included: Conduct Disorder Attention Deficit with Hyperactivity Disorder Attachment Self-Harm Behaviours Treating Child and Adolescent Depression Children’s Mental Health at School Understanding and Treating Trauma: Biological, Social, Psychological, and Legal Perspectives Psychopharmacology Update Child Maltreatment: Prevention and Intervention Eating Disorders in Adolescents Psychosis: From Childhood to Adulthood Speakers are available to community agencies and groups on a variety of subjects, such as the assessment and treatment of children and adolescents presenting with Eating Disorders, Mood and Anxiety Disorders, Post Traumatic Stress Disorder, and other mental health difficulties. Presentations can also be provided on child and adolescent development, family therapy, pharmacotherapy, among other possibilities. Research The Child and Adolescent Mental Health Care Program has a commitment to scientific practice in the broadest sense, with ongoing evaluation of clinical programs and participation in clinical research related to etiology, epidemiology, assessment and intervention. How To Reach Us Referrals for all services are accepted from family members, community physicians, mental health practitioners, schools, social agencies, and other mental health facilities. For psychiatric consultation a physician's referral letter is mandatory. Child and Adolescent Mental Health Care Program 8th Floor, B Zone Children's Hospital, LHSC 800 Commissioners Road London, Ontario Tel: (519) 667-6640 Fax: (519) 667-6814 12 INP ATIENT MENTAL HE ALTH CARE PROGRAM Who We Serve We serve children and adolescents under age 18 requiring short term inpatient admissions for crisis stabilization. Child and Adolescent Inpatients is a regional provider of children’s mental health services in Southwestern Ontario. Crisis and urgent assessment and treatment for children, adolescents, and their families is the dominant focus of service delivery. The program serves children and adolescents who present with mental health difficulties such as: mood disorders, depression, suicidal behavior, anxiety disorders, schizophrenia, psychotic disorders, eating disorders, and acute symptoms of distress related to family or personal crisis, abusive experiences, experiencing or witnessing traumatic events and changes within the family. Services Provided The Child and Adolescent Centre offers assessment, stabilization and treatment. The inpatient service offers short-term stabilization admissions, inpatient assessments of urgent mental health problems presenting in crisis, and coordination with community resources for follow-up treatment planning. Inpatient Services are delivered by an interdisciplinary team consisting of psychiatrists, social workers, family therapists, psychologists, nurses, child and youth counsellors, medical consultants, teachers, and office support staff. Education The Child and Adolescent Centre offers a workshop on a yearly basis. Some of the topics have included: Treating Child and Adolescent Depression Children’s Mental Health at School Understanding and Treating Trauma: Biological, Social, Psychological, and Legal Perspectives Psychopharmacology Update Child Maltreatment: Prevention and Intervention Eating Disorders in Adolescents Psychosis: From Childhood to Adulthood Speakers are available to community agencies and groups on a variety of subjects, such as the assessment and treatment of children and adolescents presenting with Eating Disorders, Mood and Anxiety Disorders, Post Traumatic Stress Disorder, and other mental health difficulties. Presentations can also be provided on child and adolescent development, family therapy, pharmacotherapy, among other possibilities. 13 THE OUTP ATIENT PROGRAM Crisis and urgent assessment and treatment for children and adolescents with mental health difficulties of an internalizing nature, and their families, is a dominant focus of service delivery. The Outpatient Program of the Child and Adolescent Centre offers assessment and treatment children and adolescents who are 15 years of age or younger. Recommendations for treatment will be made at the time of the assessment. If ongoing services are to be provided at the Outpatient Program, this may include family therapy, individual therapy, group therapy and/or pharmacotherapy. However, there may not be further involvement after the initial assessment. Services are delivered by an interdisciplinary team consisting of psychiatrists, social workers, family therapists, and psychologists. Education The Child and Adolescent Centre offers a workshop on a yearly basis. Some of the topics have included: Conduct Disorder Attention Deficit with Hyperactivity Disorder Attachment Self-Harm Behaviours Treating Child and Adolescent Depression Children’s Mental Health at School Understanding and Treating Trauma: Biological, Social, Psychological, and Legal Perspectives Psychopharmacology Update Child Maltreatment: Prevention and Intervention Eating Disorders in the Young Psychosis: From Childhood to Adulthood Speakers are available to community agencies and groups on a variety of subjects, such as the assessment and treatment of children and adolescents presenting with Eating Disorders, Mood and Anxiety Disorders, Post Traumatic Stress Disorder, and other mental health difficulties. Presentations can also be provided on child and adolescent development, family therapy, pharmacotherapy, among other possibilities. 14 E ATING DISORDERS PROGRAM Who We Serve For clients up to age 18 who are experiencing eating problems, including restricting, bingeing, purging, excessive exercising and related preoccupations with food, shape, and weight. Clients may be experiencing physical symptoms related to low body weight or purging behaviour. Eating problems must be the primary area of concern but comorbidities are also addressed. Services Provided Intake and screening of those up to age 18. Assessments. Consultations with physicians and practitioners in the community. Inpatient stays for those in need of medical stabilization. Four beds available. Day Treatment for those between age 13 and 18 years with serious eating problems. Eight spots are available. Day Treatment is for those who require intensive treatment but are medically stable. Patients and their families must be motivated to participate within the Program. The Program runs from 8 am to 6 pm, Monday through Thursday. There is also a weekly evening group for patients and their families. During the school year, a qualified teacher provides an academic Program in the mornings. Afternoons include a variety of group-oriented treatments. Patients receive meal support therapy, consisting of meals and snacks, provided within a supervised setting. Outpatient psychoeducational groups for clients and their family. Outreach workers are available in six areas (Chatham, Sarnia, Stratford, Owen Sound, Goderich, and Woodstock) offering limited services, including screening, psychoeducational groups, and/or therapy. A specialized multi-disciplinary team consisting of psychiatry, psychology, nutrition, social work, child and youth work, and nursing. Education Eating Disorders Speakers are available to community agencies and groups on a variety of subjects, such as the assessment and treatment of children and adolescents with eating disorder symptoms and illnesses such as anorexia, bulimia nervosa, and other disorders related to these illnesses. Presentations can also be provided on child and adolescent development, family therapy, pharmacotherapy, among other possibilities. Opportunities for practicum students and interns in medicine(Psychiatry, Pediatrics and Family Medicine in particular) and other , psychology, nutrition, and social work. Research The Child and Adolescent Mental Health Care Program has a commitment to scientific practice in the broadest sense, with ongoing evaluation of clinical programs and clinical research related to etiology, epidemiology, assessment and intervention. Program evaluation in conjunction with Ontario Community Outreach Program for Eating Disorders. 15 How to Reach Us Referrals to the Eating Disorders Program must be made by a physician. As part of the referral process, documentation of recent medical evaluation must be included (e.g. physical examination and laboratory investigations within the past two weeks). Once a physician’s referral has been received a full assessment is conducted with the client and family and treatment recommendations are made. If one of the programs can meet the needs of the client s/he will be invited to attend the Program. Intake Department, Child and Adolescent Mental Health Care Program 8th Floor, B Zone, Children's Hospital, LHSC 800 Commissioners Road London, Ontario Tel: (519) 667-6640 Fax: (519) 667-6814 Outpatient Program Mainly Group Intervention Eating Attitudes Group (Why Weight Manual) Parent Support Group Duration is 8 - 10 weeks Age range generally is 13 - 18 years of age Limited Individual/Family Therapy Designated Outreach Workers - Groups may vary Day Treatment Program Least Intrusive Intervention Model Continuum of Care Regional Accessibility Group Process Age range is between 13 - 18 years of age Accommodates 8 patients Average length of stay is 6 months Program runs Monday to Thursday 8:00 a.m. to 4:00 p.m. Treatment Goal Normalized Eating Weight Restoration Half Day of School (W.D. Sutton) Inpatient Program Accommodates 4 patients Medical stabilization with some weight restoration 16 Average length of stay is 2 - 3 months Up to age 18 Pediatric consultation available Outreach Program 6 regions with approximately 2 days per week - Chatham, Goderich, Owen Sound, Sarnia, Stratford, Woodstock Each area has individual demands and expertise Primarily Outpatient Groups Limited Individual/Family Therapy Intake Screening Provide ongoing linkage for full assessment by Treatment Team Referral Process Eating Disorder Program's referral form completed by Physician Documentation of recent medical evaluations within last two weeks including physical exam and laboratory investigations Imminent medical complications, Physician to Eating Disorders Program Physician contact Outreach representatives are main community contact and intake referral process Upon referral, full assessment by Treatment Team and treatment recommendations will occur Refer to attached Outpatient Treatment Program and Outpatient Follow Up Protocol QUICK RESPONSE CLINIC Please Note: The QRC is a pilot project and information in this document may change. Who We Serve: The Child and Adolescent Mental Health QRC clinic accepts referrals from the Paediatric Emergency Department in cases where the ER physician has deemed the case as urgent but not requiring an immediate emergency psychiatric referral. Currently only patients that are in Middlesex County can be referred to this clinic. Services Provided: The service provides a telephone assessment by a mental healthcare professional within 2 business days. After the telephone interview, the patient will be given recommendations about the appropriate services in the community that would best suit the patient needs. The mental health professional may feel an additional consultation of a psychiatrist is needed. In this case, the patient will be seen by a psychiatrist at the Child and Adolescent Mental Healthcare Program, for a one time consultation. The psychiatrist may ask that the patient receive short term crisis therapy, which would be provided through the QRC clinic. Referrals for the QRC clinic are only accepted from the Emergency Department, Children’s Hospital, London Health Sciences Centre. Please be aware that if the QRC does not offer treatment and is a 17 consultation service only with some very limited follow up capability (3 sessions maximum). For questions about the QRC please contact: Child and Adolescent Mental Health Care Program 8th Floor, B Zone Children's Hospital, LHSC 800 Commissioners Road London, Ontario Tel: (519) 667-6640 Fax: (519) 667-6814 MATERNAL CHILD MENTAL HE ALTH PROGRAM Who We Serve The Perinatal Mental Health Care Program offers services to women with mental health issues who are contemplating pregnancy, are pregnant, or up to one year post-partum. The attachment relationship of the mother-child dyad is emphasized in our interdisciplinary clinic. The catchment area is the same as that of the Women’s Care program at London Health Sciences Centre. Services Provided One full day clinic with an interdisciplinary team is offered, as well as a half day clinic which is focused on diagnosis and medication-based treatment. In the interdisciplinary clinic, assessments are performed by a team which consists of a psychiatrist, social worker and clinical nurse specialist. Medication management, psychotherapy, birth planning and connection with community resources are all part of the treatment modalities offered. A prenatal education workshop on attachment for expectant mothers with mental health issues is also offered through this clinic. Depending on the needs of the patient, service can range from one-time consult to ongoing follow-up up to one year post-partum. Education Speakers are available to community agencies and groups on a variety of subjects related to mental health in pregnancy and postpartum, attachment relationships, and the mental health needs of the mother-child dyad. Research The Perinatal Mental Health Care Program has a commitment to scientific practice in the broadest sense, with ongoing evaluation of clinical programs and participation in clinical research related to etiology, epidemiology, assessment and intervention. 18 How To Reach Us Referrals are accepted from obstetrical and midwifery care providers, community physicians, mental health practitioners, and public health care providers. For psychiatric consultation a physician's referral is preferred. A referral form can be made available by contacting the program. Perinatal Mental Health Care Program London Health Sciences Centre 800 Commissioners Road London, Ontario Tel: (519) 667-6673 Fax: (519) 685-8595 TRANSITION AGE PROGRAM A Transition Age Program is currently in the process of being developed. CATCHMENT AREAS Outpatients London and Middlesex Wards of the London and Middlesex Children’s Aid Society (CAS) should access psychiatric consultations within that agency. Some exceptions may apply if crisis situation and there is a long wait at CAS Referrals from other counties are deferred to their local Children’s Mental Health agency Crisis and urgent cases from Oxford and Elgin counties requiring a psychiatric consultation may be seen on an exceptional basis, however, ongoing services are expected to be completed at the local community level Inpatients London and Middlesex Elgin Oxford Exceptions may occur involving the admission of patients from other counties on occasion If patients are from out of the catchment area, referrent should be advised that for youth: Ages 13-17 years – they should contact St. Joseph’s Health Care Centre, Regional Mental Health Care London – Adolescent Unit; and For children under 13 years – they should contact CPRI 19 Day Treatment London and Middlesex Elgin Oxford Exceptions may apply if transportation to the program can be arranged by the family and/or guardian Eating Disorders London and Middlesex Elgin Oxford Huron Perth Lambton Kent Grey Bruce Essex PLEASE SEE ATTACHED REFERRAL FOR 20 REFERRAL FORM Child and Adolescent Mental Health Care Program Intake Office Phone Number: (519) 667-6640 Please Fax Referral to: (519) 667-6814 Total # of pages (including this page): Age criteria: Outpatients ages 15 and under, Inpatients 8-15 yrs., Day Treatment 10-17 yrs, Eating Disorders - consultation and treatment for ages 17 yrs and under For referrals regarding EATING DISORDERS: please contact our office and we will fax an eating disorders referral form. Name of child/adolescent: Date of Birth: Sex: M Age: F Health Card Number: __________________ *Name of parent/guardian (please provide this information): ______________________________________ Phone number(s)-Home: ________________________ Work: _________________________________ Mailing Address: _____________________________________________________________________ ___________________________________________________________________________________ Has the parent/guardian been informed of the referral? Yes No If not, please do so before submitting this referral. Referral Agent: Role with child/family: ___________________ Phone Number: FAX Number: _________________________ Mailing Address: ____________________________________________________________________ __________________________________________________________________________________ Detailed reason for referral: ____________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Intensity of service sought (circle only one): Inpatient Outpatient Day Treatment Date/Completed by: ________________________________________________________ Child & Adolescent Mental Health Care Program Eating Disorders Today’s Date: ____________________________ Health Card # ________________________________ Patient’s Name: ___________________________________________ DOB: ______/_______/_______ Day Month Year Address: ______________________________________________ Postal Code: ___________________ Parent/Guardian Names: ________________________________________________________________ Phone #(Res) _______________________ (Bus)_______________________(Cell)__________________ Email Address: ________________________________________________________________________ Who does patient reside with? Who has custody of patient: Both parents Joint Mother Mother Father Father Guardians Guardians Ward of CAS Step-Parent(s) Name: __________________________________________________________________ Phone #(Res) _______________________ (Bus)________________________ (Cell)________________ Referring Physician: ____________________________________________ (Specialty)_______________ Address: _____________________________________________________________________________ Phone #____________________________________________ FAX #____________________________ Email Address ___________________________________ Physician Referring #____________________ Family Doctor/Paediatrician: _____________________________________________________________ Please note: Please print or type all information legibly. Please complete all sections. Your referral will not be processed until all information is received. ************************************************************************************ COMMENTS: _________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Clinical Urgency Please circle one Please return entire form by fax to: Crisis Urgent Semi-Urgent Elective Child & Adolescent Mental Health Care Program Eating Disorders Attention: Intake Office Phone: (519) 667-6640 Fax: (519) 667-6814 22 PRESENTING PROBLEM(S): DIAGNOSIS: 1. 2. 3. WEIGHT & HEIGHT: PLEASE PROVIDE A GROWTH CHART OR COMPLETE GROWTH HISTORY IN ADDITION TO BELOW Please record Current Weight Date taken: Kg Please record Current Height Date taken: Lbs. Cm Previous Weights: Ft/In Previous Weights: Lowest Weight Loss Date of lowest wt: kg/lbs Highest kg/lbs Onset Precipitating Factors Duration Date of highest wt: WEIGHT CONTROL METHODS FREQUENCY No Yes Per Day Per Week Food Restriction Binge Vomiting Laxatives Diuretics Ipecac Diet Pills Exercise MENSES: Menarche: _____________________________________________________________ Usual Cycle: ____________________________________________________________ Last Menstrual Period: ____________________________________________________ Last Normal Menstrual Period: ______________________________________________ 1 amenorrhea: _________________________________________________________ 2 amenorrhea / length: __________________________________________________ 23 LAB WORK: Please have the following lab work completed and faxed to us at time of referral Sodium Potassium Chloride Glucose Urea Calcium Phosphate ALT Total Protein AST CBC, Diff., Platelets ESR Electrocardiogram (ECG) completed date: _____________________________________ MEDICAL STABILITY: **VERY IMPORTANT…PLEASE FILL OUT COMPLETELY WITH CURRENT INFORMATION** Blood Pressure lying standing Date taken Heart Rate lying standing Date taken Oral Temperature Hydration F poor fair C good Date taken very good Date taken MEDICATIONS: Prescribed: Name(s) & dose(s) Non-prescribed: Name(s) & dose(s) PRIOR MEDICAL DIAGNOSES AND/OR TREATMENT FOR THIS CONDITION AND/OR OTHER CONDITIONS Previous Treatment for an Eating Disorder: Yes No If yes, when & where _________________________________________________________________ ___________________________________________________________________________________ Name of healthcare provider and tel. #: ___________________________________________________ Other medical diagnoses: _______________________________________________________________ PRIOR PSYCHIATRIC DIAGNOSES AND/OR TREATMENT: Suicidal behaviour Suicidal ideation OCD Depression Anxiety Disorder Self Harm Behaviours _____________________________ History of CAS involvement History of Abuse Sexual Physical Emotional History of Legal Trouble (police involvement) Substance Abuse ETOH Other __________________ Please provide a separate formal referral note. 24 REGIONAL MENTAL HEALTH CARE – LONDON (ST. JOSEPH’S HEALTH CARE) The Regional Mental Health Care – London, Adolescent Unit is an inpatient, tertiary care facility for ages 13 to 18 years old, with a psychiatric disorder. The average stay is between 4 and 6 weeks. We have an interdisciplinary team which includes a psychiatrist, clinical psychologist, two social workers, occupational therapist, recreational therapist, child and youth workers and nursing staff. The residents can be involved in numerous therapeutic modalities such as individual therapy, group therapy and family therapy. We have regular case conferences involving patients, their families and all other parties involved, such as Children’s Aid Society (CAS), group homes, and schools. THE CHILD AND PARENT RESOURCE INSTITUTE (CPRI) CPRI provides a range of highly specialized, interdisciplinary consultation, treatment, research and education services to children and youth from 0 to 18 years of age and their families across our 17 county catchment area. CPRI has staff with a wide range of clinical expertise, including the following: Child and Adolescent Psychiatrists Developmental Paediatricians General Paediatrician Psychologists Psychometrists Occupational Therapists Speech Pathologists Developmental Service Workers Dietician Child Care Workers Behaviour Consultants Social Workers Nurses (RPN’s and RN’s) Pharmacist 25 Library Technician Child Life Specialist Recreation Therapist We provide residential and outpatient services Residential clients and their families are provided intensive services in a residential unit at CPRI where they receive services required. There are 5 residential inpatient units at CPRI. Referral to these units is through Single Point Access Agencies. Children and youth who are most complex and have tried other outpatient mental health services come in to the inpatient units. Short term assessment and treatment stays and urgent response intervention are available. CPRI has an interdisciplinary approach to assessment and treatment including psychiatry, paediatrics, psychology, nursing, social work, speech and language pathologists, occupational therapy and behaviour consultants. Outpatient clients are seen by the clinicians on site at CPRI or may by receiving other services from CPRI in their home community e.g. behaviour consultants. The following are the programs/services we provide: Attachment Consultation and Education Service (ACES) - Consultation and assessment for children and youth (birth to 18 years) with a focus on disturbances of attachment or attachment disorders and a history of traumatic and/or disruptive life events. The child or youth may also be experiencing difficulties in relationships, behaviours and emotional well-being, potentially impacting his or her functioning in home, school, or community contexts. The clinical approach includes the Circle of Security. Education, in the form of workshops, resources, and system consultations is also available to the community. Mood Disorder Clinic- Assessment, treatment, consultation and education for children and youth (6-18 years) who are suspected of having early onset Bipolar Disorder. Brake Shop- Specialized assessment, treatment, consultation and community education for children and youth (6 to 18 years) with severe behavioural concerns or intermittent Explosive Disorder, with a co-morbid tic disorder. Dual Diagnosis- Assessment, consultation and treatment of children and youth 2- 18 years with developmental delays and complex emotional and behavioral difficulties. Intellectual Disabilities and Emotional disorders: Adaptive Strategies (IDEAS)- Assessment, diagnosis, consultation, treatment, education for children and youth (2-18 years) with a developmental delay and mood disorder, anxiety disorder or psychotic disorder. Home Visiting Program for Infants (HVPI) - Early intervention program (for the counties of Middlesex, Oxford, Elgin, Perth, and Huron only) for infants (up to 5 years) and their families who are at risk for or have developmental or physical disabilities. HVPI is staffed with speech pathologists, occupational therapists, nursing, physiotherapists and a psychologist. 26 Homeshare- Specialized placement program in which children and youth who are developmentally disabled, medically fragile/technologically dependent and/or dually diagnosed, are placed with families on a full-time and long-term basis in London and surrounding counties. Homeshare is staffed with Social Workers and other disciplines. Autism Spectrum Disorders (ASD ) Program- Assessment, treatment, and consultation for children and youth up to the age of 18 years with a diagnosis of ASD. Selective Mutism- Assessment and consultation for children and youth (3 to 18 years) who have restricted speech in one or more settings for at least two months and have demonstrated capacity for speech. Sexual Behaviours- Comprehensive assessment and consultation concerning sexual behaviours of children and youth (can include trauma assessment). General Clinical Services – This program provides mental health services to children who present with significant behavioural concerns that do not fit within the aforementioned specialty programs. For more information you can visit our website at www.cpri.ca VANIER CHILDREN’S SERVICES Vanier Children’s Services (Vanier) is a licensed and accredited children’s mental health centre recognized as a leader in helping children and youth age 0 to 14 with emotional and behavioural issues, and their families. For over 40 years, we have served London and surrounding communities in southwestern Ontario with compassionate, best-practice and innovative programs and services. (www.vanier.com) We work with families, professionals and our community to create a caring, emotionally healthy and supportive environment where all children, including the most vulnerable, reach their full potential to lead safe, productive and independent lives. Vanier is an accredited Children's Mental Health Centre primarily funded by the Ontario Ministry of Children and Youth Services. Who we help Parents are our partners. Together, we provide supports to children to increase the likelihood that they will reach their full potential. Vanier works with the whole family's unique strengths, needs and culture. Many of the children we help are reacting to overwhelming stresses within their lives like death, divorce, violence, neglect, or parents with mental health or substance abuse problems. Some are coping with genetic conditions and problems resulting from parenting. 27 What we do Vanier serves children age 0 to 14 who have serious emotional, mental illness and behavioural problems, and their families. Our programs and services are flexible and responsive to the specific needs of each family. We offer Crisis intervention Residential services Day treatment Early years programming and various attachment therapies Individual, family, and group counseling Community outreach Psychiatric and psychological services Limited francophone intake and counseling services In home support services RESIDENCY TRAINING SITES IN WINDSOR CHILDREN FIRST (www.children-first.ca) 3295 Quality Way, Suite 102, Windsor, On. N8T 3R9 (519) -250-1850 Population Served 0-6 Services Out-patient services provided to families with children who have special needs, developmental and/or social-emotional/ behavioral. Children and families are visited by a child and family consultant in the home and /or community child care centres. Needs are identified and a service plan is developed which can address learning, communication, movement, feeding, social-emotional health, and behavior, in those settings. Specialty staff include resource teachers, occupational therapist, physiotherapist, social workers, speech and language pathologists, and psychologist. A consulting psychiatrist is also available. When deemed appropriate by the child and family consultant and the family, the child can be referred to these consultants for specific assessment/intervention. 28 SUMMIT CENTRE (www.summitcentre.org) 3735 King Street, Windsor, On. (519) 255-1195 Population Served preschoolers diagnosed with autism who would be no older than 48 months of age at the time of admission to the program Services Provision of early intensive behavioral intervention to preschool children with autism. Children initially receive one-on-one applied behavior analysis treatment (ABA) each week, year round. Treatment is provided both at home and the Summit Centre. Treatment is aimed at enhancing language and communication, social skills and play, and independent living skills. When children turn six, Summit Centre works with schools and other agencies to provide a smooth transition. Summit Centre also provides parent training groups and promotes research into autism (affiliated with the University of Windsor, Department of Psychology). Modest user fees are based on a family’s ability to pay. GLENG ARDA CHILD AND FAMILY SERVICES (www.glengarda.on.ca) 1453 Prince Rd., Windsor, On. N9C 3Z4 (519) 257-5106 Population 6-14 Services All programs include a multi-disciplinary team consisting of child and youth workers, special education teachers, and social workers. Consultants in psychology and Child and Adolescent Psychiatry are available when appropriate. In addition to the overall therapeutic milieu, the program offers individual, family, and group counseling for children, siblings, parents, and families. Day Treatment – including assessment, counseling, service coordination, special education, behavior management, life skills, and home support Community Support Program – treatment team consisting of a special education teacher, social worker, and child and youth worker provide support programs in community school and/or the home, as well as counseling to the family. Supervised Access Program Prevention and Early Intervention Program – treatment team composed of a child and youth worker and social worker provide classroom social skills programs, group and individual counseling, and home support services utilizing a team approach with community school staff. 29 WINDSOR REGIONAL CHILDREN’S CENTRE (www.wrchildrenscentre.org) 3901 Connaught St., Windsor, On. N9C 4H4 (519) 257-5215 Population 6-17 Services Specialized Services Autism and Related Disorders – assessment, diagnosis, intervention and training/education resource services Developmental Program – developmental disabilities assessment, diagnosis, intervention and consultation with parents, therapists, and school personnel; assist children and adolescents with significant long-term limitations in intellectual, sensory, or motor functioning combined with significant limitations in adaptive functioning. Neuropsychological Assessment and Consultation- neuropsychological assessment, diagnosis, and consultation with parents, therapists, and school personnel; referrals accepted only from children’s mental health program coordinators who are providing service to the child and family. Community Services Outpatient Services – on-site and community-based programs for children aged 6-17 and their families; social workers and child and youth workers provide the primary intervention with access to psychology and psychiatry as deemed necessary during the course of treatment. Services may take place in-centre, in –home, or in the community. Individual, group, parental, and family therapy are available as well as in-home and specialized parent training and education. Additional treatment services that may be available include the activity-based social skills development group for adolescents and other groups designed to address issues such as depression, anxiety, and bullying. Youth Mental Health Court Services Youth Criminal Justice Program – provides an array of multi-disciplinary services for youth in conflict with the law, including psychological and psychiatric consultation between the ages of 12-18; referred by the Youth Court or Probation Services. Interventions provided include individual, group, and family counseling Adolescent Sexual Offender Outpatient Program – treatment group designed for adolescents who have sexually offended; referrals accepted from individuals, police services probation, and Windsor-Essex Children’ Aid Society Youth Mental Health Court Service – program works with justice system to divert youth (16+) with mental health needs out of the formal justice system where appropriate. Diversion services include access to a multi-disciplinary team at WRCC. 30 Crisis Response Services Walk-in Clinic – targets children and families aged 0-18 with a variety of social, emotional, or behavioral problem; mental health and/or psychiatric disorders, suicidality, etc. Immediate assessment, short-term counseling / intervention and referral to appropriate community resources provided. Clinic hours are 12-6 p.m. Monday, Tuesday, and Thursday Emergency Crisis Response Service – provides a social worker available to hospital emergency room M-F, 8 a.m.-11 p.m. Social worker provides assessment of children and youth, up to age 16, who present in crisis. Emergency Crisis Response Worker will determine, in consultation with the Director and Psychiatrist on call whether admission to WRCC’ s crisis bed or to a Child and Adolescent bed at Maryvale, is warranted. If child is admitted to either bed, social worker is involved in discharge planning. If child is not admitted, social worker will develop an intervention plan for those families. Intensive Family Services (Family Learning Place – FLP) This is a 4-month milieu residential program for children aged 6-12; 5 residential spaces, 8 spaces from 8a.m.- 8 p.m., 1 crisis stabilization bed (30 days) . A wide menu of services are provided by FLP, including play therapy, family therapy, group therapy, parent counseling, onsite parent training, in-home parent training, parent seminars, in-school consultation, psychological assessment and consultation, psychiatric assessment and consultation, recreation therapy, etc. MARYV ALE ADOLESCENT AND FAMILY SERVICES 3640 Wells St. Windsor, On. N9C 1T9 (519) -258-0484 Population Served 11-17 Services: Multidisciplinary team includes child and youth workers, special education teachers, social workers, nurses, psychologist, consulting psychiatrist. Music, art, and recreational therapy are also available. Various programs offer milieu treatment, individual, family, and group counseling, recreational activities, and an on-campus school operated in conjunction with the Greater Essex County District School Board. Day Treatment Program – Services for adolescents aged 11-17 who are unable to be maintained in community school and are typically experiencing problems at home and in the community. 31 Stabilization and Discharge Planning Program – short term stabilization and discharge planning for those 11-15 who are in crisis. Admission is for up to 21 days. Multi-disciplinary assessment is conducted and a plan is formulated to address and stabilize the situation and provide continuing support. Out-patient follow-up is typically provided by Windsor Regional Children’s Centre. Child and Adolescent Acute Care Mental Health Program – acute care hospital bed program for those 11-15 experiencing significant mental health difficulties. Program is administered by Windsor Regional Hospital and located at Maryvale. Access occurs through the E.R. at Windsor Regional Hospital. Length of stay normally not exceeding 7 days. A multidisciplinary team provides an in-depth assessment of the adolescent after which a follow-up plan is developed with community services for ongoing treatment after discharge. Assessment and Receiving Program – short-term residential and assessment services for adolescents 11-17 who have come into the care of the Children’s Aid Society. Admission for up to 90 days to provide assessment and recommendations for longer term treatment and living arrangements Intensive Residential Treatment – 24 hour residential treatment as needed for adolescents age 11-17 McIsaac residence – supervised housing and teaching of life skills for more independent living for 5 teenage boys, aged 15-18 TEEN HE ALTH CENTRE (www.teenhealthcentre.com) 1585 Ouellette Ave., Windsor, On. N8X 1K5 (519) 253-8481 Population Served ages 12-24 Services A wide variety of out-patient programs including Medical and Nursing Services, Counseling Programs, Street Health program, Self-Esteem Groups, Anger Management, Parent Support, Nutrition Services, etc. Coverage 32 EMERGENCY GUIDELINES Child and Adolescent Psychiatry Consultations are available for children and youth up to the age of 17 with mental health problems (e.g., eating disorders, psychosis, severe depression, suicidality, sudden and impairing deterioration in functioning, etc.). Referred patients have been triaged by ER staff as requiring an emergency psychiatric consultation rather than being discharged and referred to resources in the community or to the Quick Response Clinic. Only one exception may apply: When the Child and Adolescent Psychiatrist on call has directed a patient to ER following a phone consultation with specified Ministry of Child and Youth Services (MCYS). Weekdays from 09:00 to 17:00, consultations occur in conjunction with assessments provided by clinicians of the Child and Adolescent Mental Health Care Program at CH/LHSC. After hours and on weekends, the Child and Adolescent Psychiatrist on call will work with the Residents in Psychiatry. Summary of consultation process When a consultation is deemed necessary by the ER physician the following occurs: The Child and Adolescent Psychiatrist on call is contacted first at pager 13385 between 09:00 to 17:00. The consultant then calls the assigned clinician if the call is received between 09:00 to 16:30. A decision will be made to either discharge or admit the patient. For calls received later than 16:30 or on weekends, the (Psychiatrist) ER Physician will contact the CEPS team via the resident pager. Phone consultations to MCYS agencies Ministry of Child and Youth Services (MCYS) designated agencies in London-Middlesex, Elgin, Oxford, Grey-Bruce, and Huron Perth can access a direct telephone consultation with the Child and Adolescent Psychiatrist on call, for youth, up to the age of 18, who are their active patients. If the youth requires assessment in ER they will be directed to CH. It is the responsibility of the Child and Adolescent Psychiatrist on-call or the delegated resident, to notify the ER Triage Nurse of the patient’s direct referral to Psychiatry. Community services to consider when discharging from ER Child and Adolescent Mental Health Care Program – Outpatients Children and adolescents, up to the age of 17, with mental health difficulties of an internalizing nature, such as: Mood disorders including depression and bipolar disorder Suicidal behaviours Anxiety disorders, including obsessive-compulsive disorder 33 Schizophrenia and psychotic disorders Post-traumatic stress disorder Psychosomatic disorders Acute symptoms of distress related to family or personal crisis, abusive experiences, and/or experiencing or witnessing of traumatic events Referrals for patients with eating disorders (i.e. anorexia nervosa, bulimia or eating disorder not otherwise specified), up to the age of 17, must be completed by a physician who is prepared to take on the role of most responsible physician until the case is assessed by the Eating Disorders team. These referrals are made to Child and Adolescent - Intake using a specific form with recent lab work and ECG results Process Telephone: 519-667-6640 Mail the Emergency Contact Sheet to Child and Adolescent Intake, Victoria Hospital, or fax to 76814. Please ensure copy is legible The Child and Adolescent Psychiatrist on call or delegate should call Child and Adolescent Intake advising that a referral is being made to ensure that Intake is able to follow up promptly in processing the referral Family will be contacted once the referral is received, but it is recommended that they follow up if they have not been contacted in 3 working days As waiting lists can vary widely, families should not be told a specific time for the appointment. An intake phone interview will be completed to determine appropriateness and urgency of service Crisis-Intake Team (C-IT) – 519-433-0334 Children and youth up to the age of 17 with such mental health difficulties as: Services offered include Disruptive behaviors Substance abuse Families and youth in conflict Youth in crisis due to psychosocial stressors Crisis support After hours service Intake and triage to one of three agencies, including Vanier, Craigwood, and Western Area Youth Services (WAYS) An intake interview will be completed to determine appropriateness and urgency of service Process Provide families with the C-IT number to refer themselves directly. 34 Children’s Aid Society (CAS) - 519 -455-9000 Children and adolescents in need of protection. Process Consult with ER staff if sexual or physical abuse is suspected so that ER abuse protocol can be completed. If no immediate danger anticipated but past abuse suspected, call CAS directly. Faculty and Residents – On Call Scheduling The Administrative Assistant for the Division Chair will contact the faculty for on call availability 2 months in advance. During the week the Psychiatrist on call provides coverage starting at 9:00 am for 24 hours except on Fridays when coverage starts at 9:00 am for 8 hours ending at 5:00 pm. Weekend coverage is provided by one psychiatrist who starts on the Friday at 5:00 pm and provides coverage until the Monday morning at 9:00 am. Residents in the Child and Adolescent Psychiatry Subspecialty Program are required to provide coverage for one weekend day per month. This coverage will start either Saturday or Sunday at 9:00 am for a 24 hour period. The Program Coordinator for the Child and Adolescent Psychiatry Subspecialty Program will contact the residents to confirm their availability. *See attached flowcharts for details about ER assessments for children and youth and admission procedures and EPC Psychiatrists Reporting Form 35 36 Child Psychiatry Day Call ER Assessment Flowchart #1 (Clinician, Resident and Psychiatrist on call) Referral made to the Child and Adolescent Psychiatrist On-call Psychiatrists calls clinician on call to inform them of the referral Clinician calls resident on call to discuss referral and will decide with the resident who will complete the initial assessment based on flow in the Adult ER. If no resident on call please see flowchart #2. Clinician or resident (or both if resident is new to service and would benefit from watching clinician interview patient) proceed to the ER to assess the patient Chart and any other notes available reviewed Assessment process: o o o o o o o Inform patient of clinician/resident role in assessment process and others involved (ie. resident and/or Psychiatrist) Explain purpose of ER assessment – to explore and understand what has brought the patient to the ER and to develop a plan for the management of acute needs Explain the process of the assessment Explain the boundaries of confidentiality Complete the history and gather any necessary collateral information Interview patient and care-giver separately Complete the child psychiatry ER contact 37 If initial assessment completed by clinician If initial assessment completed by resident or resident and clinician together Clinician calls resident to inform them that the assessment has been completed Resident calls the Psychiatrist oncall and reviews the case over the telephone Resident proceeds to the Child ER, and reviews case with the clinician in person Resident may choose to call clinician as well to discuss case and gather more information about community resources Resident sees the patient and accompanying adults to review pertinent points of the history and ask any additional questions they deem necessary- the clinician may choose to join the resident during this process Psychiatrist, resident, and possibly clinician collaborate in making the decision to admit or discharge the patient Resident calls the Psychiatrist on-call and reviews the case over the telephone Resident discusses the admission or discharge plan with the patient and accompanying adults Psychiatrist, resident, and clinician collaborate in making the decision to admit or discharge the patient Resident completes the diagnosis section and adds information as necessary on the Child ER contact sheet Resident and possibly clinician discuss the admission or discharge plan with the patient and accompanying adults Resident completes the diagnosis section and add information as necessary on the Child ER contact sheet 38 If patient is to be admitted If patient is to be discharged Resident or clinician will call Child and Adolescent Psychiatry Inpatients (52091) to inform nursing staff of the admission. If no bed available on D6-200 Psychiatrist on call will assist in obtaining a bed at RMHC-L, Paediatrics, or Adult Psychiatry Resident completes the discharge orders on the ER patient chart. Resident also signs the hospital emergency front sheet. Resident or clinician obtains two addressograph stickers, the yellow ER chart copy and the pink copy of the Child Psychiatry ER contact sheet (if the patient is being referred to, or is a patient of, the Child and Adolescent Center) and places them in the ER consult binder in CEPS office Resident performs a physical exam and records findings on the physical exam form If patient has been or needs to be placed on a Form 1 the resident completes/checks the forms and ensures that the Form 42 has been completed and given to the patient Resident or clinician will call admitting to inform them of the admission Resident will complete the admission orders and inform ER nurses that the patient is being admitted. Resident completes the Medication Reconciliation Form and the Allergy Form. Resident or clinician obtains two addressograph stickers and the yellow ER chart copy and places them in the ER consult binder in CEPS office 39 OTHER COMMUNITY AGENCIES PLEASE NOTE THAT THE NUMBERS CORRESPOND TO THE NUMBERS ON YOUR MAPS OF LONDON 1. LHSC – VICTORI A HOSPITAL 800 Commissioners Road East (corner of Commissioners and Wellington) B Tower, 8th Floor Child & Adolescent Programs Inpatient Unit Eating Disorders Program Day Treatment Program 2. LHSC – UNIVERSITY HOSPITAL 339 Windermere Road (corner of Windermere and Western Road) 3. ST. JOSEPH’S HE ALTH CARE 268 Grosvenor Street (corner of Grosvenor and Richmond Street) 4. ST. JOSEPH’S HE ALTH CARE – REGIONAL MENTAL HE ALTH CARE – LONDON SITE – ADOLESCENT UNIT 850 Highbury Avenue, between Dundas and Oxford, on Highbury 12 bed inpatient unit for youth between 13 and 17 years chronic mental health problems longer stay admissions have 4 day treatment spots outreach program for London\Middlesex area accept transfers from LHSC MCYS and MOHLTC funded agency larger catchment area than LHSC 5. CPRI * - CHILD AND P ARENT RESOURCE INS TITUTE 600 Sanatorium Road, between Boler and Oxford Street 40 provides outpatient and residential treatment for children and adolescents (up to 17 years) with severe emotional and behavioral problems, major psychiatric disorders with comorbid behavioral difficulties, bipolar disorders clinic, pervasive developmental disorders, Tourette’s disorder, attachment disorders clinic and developmental disabilities urgent response unit and short term assessment unit for 6 to 12 years old (these have to be accessed through the Children’s Services Coordinating Network (CSCN)) MCYS funded agency larger catchment area than LHSC 6. MERRYMOUNT CHILDREN’S CENTRE 1064 Colborne Street, corner of Huron and Colborne Street an agency that provides a wide array of services for children and their families it offers emergency care for children whose parents need some respite there are some beds utilized by the Children’s Aid Society has parenting groups 7. HARDY GEDDES HOUSE 507 Queens Avenue, corner of Queens and Maitland group home for boys between the ages of 14 and 18 years 8. WESTERN AREA YOUTH SERVICES (W AYS) * 714 York Street, corner of York and Lyle Street group homes for male and female youth up to 17 years provide some groups for youth in the community MCYS funded agency 9. CRAIGWOOD YOUTH SERVICES * 520 Hamilton Road, corner of Hamilton Road and Chesley outpatient, residential and in-home family preservation programs for adolescents (13 to 17 years) who have significant behavior problems offer parenting groups offer anger management groups for youth MCYS funded agency 41 10. V ANIER CHILDREN’S SERVICES 871 Trafalgar Street at Dillabough provide residential and in-home family preservation treatment have 0-6 years program treat children and youth with behavioral difficulties MCYS funded agency London\Middlesex catchment area 11. CHILDREN’S AID SOCIETY, LONDON AND MIDDLESEX 1680 Oxford Street East, London 12. CRISIS-INTAKE TE AM (CIT) 714 York Street, London an excellent Crisis – Intake – Team (CIT), which is a 24 hour a day service, offers up to 3 or 4 sessions for children and youth with behavioral crises It is a joint service between Madame Vanier Children’s Services, Craigwood and WAYS They co-lead a discharge planning group with D62 called KITES Also provides information about community groups 13. CENTRE FOR CHILDREN AND FAMILIES IN THE JUSTICE SYSTEM * 245 Pall Mall Street, Suite 200, corner of Pall Mall and Richmond they have a Child Witness program they do court assessments for children and youth they do custody and access assessments they have a community based team providing service to youth in detention centers and residential settings Dr. Rida Mirza consults to the community-based team two days per week 14. FAMILY SERVICE LONDON 125 Woodward Avenue, between Oxford/Riverside and Woodward St. provides counseling for children, youth, adults and families 42 15. GENEST DETENTION CENTRE FOR YOUTH (YOUTH 12 -15) 1670 Oxford Street East 16. KING STREET DETENTION CENTRE FOR YOUTH (YOUTH 12-15) 583 King Street 17. GUNN STREET GIRLS HOME 53 Gunn Street a group home run by the Children’s Aid Society 18. MAITLAND STREET GROUP HOME 372 Maitland Street (near Princess) a group home for females between the ages of 14 and 18 years 19. OXFORD AND ELGIN CHILD AND YOUTH CENTRE * outpatient and limited in-home family preservation for children and youth up to 17 years in Oxford County offices in Ingersoll, Woodstock , St. Thomas and Tillsonburg Dr. Ralyea consults to this agency MCYS funded agency they receive telepsychiatry from the Western Hub 20. HURON-PERTH CENTRE (HPC) * outpatients for children and youth up to 17 years offices in Clinton, Stratford and Listowel MCYS funded agency they receive telepsychiatry from the Western Hub 21. GREY BRUCE CHILDREN’S SERVICES * children and youth mental health agency for youth up to age 18 years 43 office in Kincardine MCYS funded agency they can access child\adolescent psychiatry emergency service they receive telepsychiatry from the Hospital for Sick Children in Toronto 22. ANAGO GROUP HOME * a group home for adolescent females located in Parkhill they also have 4 beds for youth with developmental disabilities they can access child\adolescent psychiatry emergency service 23. SCIP (SCHOOL COMMUNITY INTERVENTION PROGRAM ) a partnership between MVCS, LHSC, Merrymount, the Thames Valley District School Board, and the London\District Catholic School Board has recently expanded to Elgin County schools for children and youth between 7 and 14 years who have an externalizing behavior problem the program is accessed through the school boards it provides pediatric consultation it provides group therapy for parents and children 24. CHILDREN’S SERVICES COORDINATING NETWORK (CSCN) an agency which deals with hard to serve children and youth children and youth for whom you have suggested residential treatment, day treatment at Madame Vanier Children’s Services, Wraparound services and in-home family preservation must be referred to CSCN they are also the agency to arrange for a patient of CPRI to have an urgent bed members of different community agencies sit on teams to determine if the child and youth need residential treatment (Tier One) if it is decided the child needs residential treatment another team meets about 10 days later to determine where the child will be placed in residential treatment (Tier Two) PLEASE NOTE: THE CHILDREN’S AID SOCIETY IS NOT PART OF THE CHILD AND ADOLESCENT PSYCHIATRY EMERGENCY SERVICE; IF THEY CONTACT THE CHILD\ADOLESCENT PSYCHIATRIST ON CALL THEY SHOULD BE ADVISED TO GO TO THEIR LOCAL EMERGENCY DEPARTMENT * designates agencies that can utilize the child and adolescent psychiatry emergency service 44 ONTARIO CHILD AND YOUTH TELEPSYCHIATRY PROGRAM – WESTERN HUB Telepsychiatry – Western Hub of the Ontario Child and Youth Telepsychiatry Program. Dr. Naveed Rizvi – Medical Director Western Hub (WH) is located at the Child and Parent Resource Institute (CPRI) and operates in partnership with The Division of Child and Adolescent Psychiatry, Schulich School of Medicine and Dentistry, Western University, Child and Parent Resource Institute (CPRI), London Health Sciences Centre (LHSC), St. Joseph’s Health Care London (SJHC), and the Windsor Regional Hospital (WRH). Using Ontario Telemedicine Network (OTN), Western Hub child and adolescent psychiatrists can provides Telepsychiatry Clinical consultations, Program consultations and Professional to Professional consultations from CPRI, LHSC, SJHC-London or WRH to Child and Adolescent Mental Health Agencies located in the rural communities of South Western Ontario. As a member of the Division of Child and Adolescent Psychiatry, you may also be requested to do some Telepsychiatry consultations for Western Hub. Rhonda Persichilli is the WH coordinator and will contact you to arrange, coordinate and to provide you the relevant information regarding the consultation. If you have any questions or want more information about the Telepsychiatry Program at Western Hub, please contact Dr. Naveed Rizvi, Medical Director, Western Hub at Syed.Rizvi@ontario.ca (519-858-2774 x 2919) or Rhonda Persichilli at Rhonda.persichilli@ontario.ca (519) 858-9603. 45
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