CHEO and the Royal shrink wait times for mental health services

CHEO and the Royal shrink wait times for mental health services

By: Ryan Tumilty Metro

New approach puts patients at centre of decision making.

Wait times for children with mental problems plummeted last year as a new one-size-doesn’t-fit-all approach has shrunk waits from months to mere weeks.

In a recently released report, CHEO and the Royal Ottawa Hospital both revealed that the wait times for children referred for mental health problems have dropped.

At CHEO, a wait that averaged 200 days in 2014 has been cut down to 22 days. Meanwhile, at the Royal the wait has fallen from 450 days to 20.

CHEO’s chief of psychiatry Dr. Kathleen Pajer, said the change has come because children are no longer being put through an upfront assessment before they get treatment.

She said prior to implementing the Choice and Partnership Approach (CAPA), patients had to wait to see only a handful of specialists and complete an assessment that involved school records and hours of interviews.

“That assessment, depending on the person, can take anywhere from one to six hours over a couple of days,” said Pajer. “That leads to basically a bottleneck in the system. That is the only way to get into the system.”

She said when they talked to patients about how to make improvements, they were told to do away with the assessments.

“Patient after patient, parent after parent said ‘Stop assessing us so much and start treating us,’” she said.

Pajer said patients are now offered a much quicker initial interview and are then directed to someone – who could be a social worker, psychologist or psychiatrist – for treatment.

She said they ask the patient and family what the biggest issue is and also ask how best to solve it. She said they ask the family as well about how much change they can handle so real improvement can actually take place.

“We can write all sorts of glorious behavioural or psychological prescriptions and a family may not be able to actually do them,” she said. “We’re focused on what the family thinks is the primary problem and that actually gets you more clinical yield.”

The changes have lead to increases in the amount of referrals with a slight increase this year at CHEO and a 33 per cent jump at the Royal.

“The flow through the system is much faster so we can handle more kids.”

Pajer said this year has been about reducing the wait list .

“The first task we have over the next three or four years is to make sure we keep the wait list down,” she said.

Part of that involves making sure that patients are involved in the process and that everyone is working towards getting them better.

“You don’t take somebody on without having clear goals for what they are seeing you for and monitoring those goals on a regular basis and then discharging them when the goals have been met.”

She said to do that they are working on better scheduling for patients and centralizing physicians calendars.

They are also taking what they learned during the last year to determine what sorts of physicians they should hire and train.

“What we have discovered with that is we have holes in the treatment that our patients clinically needs.”

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