A presentation given by Jacques Esterhuizen at The Journey, CHA Conference 2012, in the 'Innovations in mental Health Care for Children & Young People'

1. THE ACUTE COMMUNITY
INTERVENTION TEAM
Jacques Esterhuizen
Acute Services Directorate
CAMHS
Child and Adolescent Health Services
Perth
Western Australia

2. “It is not the strongest of the species that survive, nor
the most intelligent, but the one most responsive to
change”
CHARLES DARWIN (1809-1892)
 Presentation
 Layout of WA CAMHS services
 Development of ACIT
 Progress
 Reform of inpatient units
 Future directions

3. CAMHS Organisational Chart

4. Total clinical
FTE – 101

5. CAMHS inpatient beds: 28 beds for under 18
yo for WA’s 2.4 million population
CAMHS area Ages (years) Number
of beds
PMH Ward 4H under 16 8
Bentley 12 to under 18 12
Adolescent Unit
Families at Work 6 – 12 8
(sub-acute)

6. Acute CAMHS
PMH Ward 4H
Client group Type of Providing:
service
Up to 16 years Statewide Acute care
Those who specialised Crisis admission
cannot be voluntary Can be followed by
managed in the in-patient assessment for
community due service stabilisation, diagnosis
to acuity or and planning for
complexity of discharge
problems Short interventions
where indicated

7. Acute CAMHS
Bentley Adolescent Unit
Client group Type of service Providing:
Up to 18 years State-wide Assessments
old acute inpatient and treatments by
Those who service a multidisciplinary
cannot be Only team focusing on
managed in the Authorised containment and
community due to mental health safety for young
high level of acuity inpatient unit in people
and risk WA for under
18’s

8. Acute CAMHS
Transition Unit
Client group Type of Providing:
service
Adolescents aged Step-down Intensive recovery
13 to under 18 years facility focused program
Transitioning Day Therapy
between BAU and program accessed by
home and/or into both inpatients and
other services. outpatients
Intensive group
based work

9. Community
CAMHS
Clarkson, 6.5fte
Swan Valley /
Kalamunda
Hillarys,
9.6fte
5.3fte
Warwick, Bentley Family
9.3fte Clinic, 12.7fte
Shenton,
Armadale,
5.1fte
11fte
Fremantle,
11fte
Peel,
Rockingham, 9.5fte
8.2fte
Total clinical
FTE – 88.2

10. Locations of CAMHS (WACHS)
1.5 FTE West Pilbara
3.6 FTE West Kimberley
3.5 FTE East Pilbara
1.6 FTE East Kimberley
4 FTE Geraldton
2 FTE Kalgoorlie
2 FTE Esperance
6.8 FTE Wheatbelt
2 FTE CUGS
2.6 FTE LGS
4.5 Upper SW
3 FTE Lower SW

11. State demographics
 500,000 (24%) children aged 0-17yrs
(ABS 2006 census)
 74% - Metro; 26% - Rural and remote
 Mental health problem
 16.6% of young people (Child Health Survey)
 21% Aboriginal children (Aboriginal Child Health
Survey, age 12-17)
 Severe mental disorder
 5% young people (Child Health Survey)
 11% Aboriginal children (Aboriginal Child Health Survey,
age 12-17)
11

12. State demographics
 Risk of clinically significant emotional
difficulties, age 4-17 (WA Mental Health towards 2020)
 15% non-Aboriginal children
 24% Aboriginal children
 5% children (with mental disorder in clinical range and parental
need for help) needed hosp dept psychiatric
help (National Survey of Mental Health and Well-being – 2000)
 Admissions 11/12: 680 (2.7% of severe mental disorder
category - WA Child Health Survey)
12

13. Acute CAMHS
Assertive Community Intervention
 Began with the introduction of ACIT
 Following on with the Acute Response Team (ART)
 Funded by MHC and NPA
 Responding to consumer and carer requests for
emergency assessments in community, thereby
avoiding emergency department attendance
Rapid response and comprehensive assessments
 Identifies, manages and stabilises the most high risk
children and adolescents in the community
 alternative to inpatient admission
 acute high risk phase following discharge

14. Acute CAMHS
Assertive Community Intervention
Client Type of service Providing:
group
ACIT High Admission diversion 8 week intervention
risk Intensive outreach Alternative, complementary
Under support multidisciplinary model of care to
18s Business hours inpatient treatment.
Preventing admission where
possible
ART Under Emergency Dept Single point of patient flow
18s diversion coordination
7 days a week/24 Telephone consultation for crisis
hours a day management & advice
In-reach to PMH & all metro
emergency departments
Community visits in metro area

15. IN(CON)CEPTION TO BIRTH – Dob 01/08/08
 Funding from PMH Gaps in Service
Initiative
 MDT = Psychiatrist, Psychologist, Senior
Social Worker, MH Nurses, Ed Liaison
Officer, Multi-cultural MH worker (5.5FTE)
 Training
 Networking (CAMHS and NGO) and
workshops

16. INFANCY – 1st year
ACIT Referrals by Age May 08-April 09
0% 9%
32%
0-4
5-9
10-14
15-19
59%
ACIT REFERRALS May 08 - April 09
25
22 22
21 21
20
18 18
15
14 14
10 10
9
8
5
3
Nov-08
May-08
Aug-08
Sep-08
Dec-08
Jan-09
Jun-08
Feb-09
Mar-09
Oct-08
Apr-09
Jul-08
0

17. CHILDHOOD – Model of Care
 Referral
 Daily intake meeting (weekdays), ED and
ward referrals
 Initial assessment
 Co-worker model
 Contact within 24 hours of referral
 Holistic, systemic based assessment
approach involving client and relevant family
members / guardians or care provider.

18. CHILDHOOD – Model of Care (cont)
 Management
 Development of crisis plan
 Provide family with supportive contacts
 Multi-disciplinary assessment and treatment
 MDT clinical reviews
 Discharge / Outcome
 8 week intervention
 Identification of onward service

19. CHILDHOOD - change in bed classification
Ward 4H (Sep 2009)
 Assessment bed (minimum of 2 beds daily)
 24 hour admission.
 Intensive assessment and development of
management plan.
 Aim to return to community
 Therapeutic bed (maximum 6 beds)
 Need for continued inpatient care
 Care coordinator model of care
 Goal directed treatment planning

20. CHILDHOOD - Development of ART
 Acute Response Team (ART)
 Rapid response team to assess overnight
admissions to ward 4H, medical wards and ED.
 Members: Registrar on duty, PLN, Duty Officer,
ACIT clinician, Consultant Psychiatrist.
 Optional members: Level 1 and 2 nurses
 Linkage with ward 4H and ACIT.
 Training environment for junior staff.

21. CHILDHOOD - Benefits of overnight admission
 Provide containment of situational crisis
 Partial resolution of crisis
 Stabilisation of risk
 Assessment and case discussion by MDT
 Allows office hours consultation and liaison
 Allows transfer to appropriate facility during
office hours

22. CHILDHOOD - ART bed data
ART outcome. Sep '09 - Jun'10
28%
39% 61%
33%
Cont Admit Discharge ACIT Other

23. CHILDHOOD - ART bed data
ART Outcome (FY 10/11)
20%
48% 52%
32%
Cont Admit Discharge ACIT Other

24. ADOLESCENCE
 Restructure of Metro CAMHS – Feb 2011
 ACIT expanded in Jan 2012 (NPA funding
for extra 5FTE)
 Servicing 16-18 age group
 Adult emergency departments and
 Bentley Adolescent inpatient unit (12 beds,
age 12-18)
 10.2 FTE
 Nursing ; SSW; Specialist Clinical
Psychologist; Multicultural worker; OT
 Case load = 79 (~ 8FTE = 10 clients per
FTE)
24

25. ACIT - Referrals
ACIT - Referrals per month (linear regression)
Jul'08 - Jun'12
40
35
30
25
20
15
10
5
0
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
Linear (11-12) Linear (10-11) Linear (09-10) Linear (08-09)

26. ADULTHOOD – Reform of Acute Services
 Development of ART
 November 2012
 ED diversion program
 MHC funding = $1.6M
 Assertive community based Ax; 24/7 PLN
role; Metro ED Ax; 24 hour bed flow/triage
position
 13.6 FTE
 Nursing; SSW

27. BENEFITS
 Many more options for disposal from ED
 An alternative to admission
 Reduced length of stay
 No bed blockage
 Least restrictive care
 “Hospital in the home”
 Closing the gap between Hospital and
Community mental health services