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8/10/2019 Barrett adolescent strategy
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Barrett Adolescent Strategy Expert Clinical Reference Gro
Expert Clinical Reference Group
v5EndorsedbyECRG03/11/2014
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ProposedServiceModelElements
AdolescentExtended
Treatment
and
Rehabilitation
Services
(AETRS)
Attribute Details
ServiceDelivered Theaimofthisplatformofservicesistoprovidemediumterm,
recoveryorientedtreatmentandrehabilitationforyoungpeople
aged1317yearswithsevereandpersistentmentalhealth
problems,whichsignificantlyinterferewithsocial,emotional,
behaviouralandpsychologicalfunctioninganddevelopment.
TheAETRS
continuum
is
offered
across
arange
of
environments
tailoredtotheindividualneedsoftheyoungpersonwithregard
tosafety,security,structure,therapy,communityparticipation,
autonomyandfamilycapacitytoprovidecarefortheyoung
person.
TheAETRSfunctionsaspartofthebroader,integrated
continuumofcareprovidedforyoungQueenslanders,that
includesacuteinpatient,dayprogramandcommunitymental
healthservices(public,privateandothercommunitybased
providers).
OverarchingPrinciplesThedeliveryofanAdolescentExtendedTreatmentand
RehabilitationServicecontinuumwill:
develop/maintainstablenetworks
promotewellnessandhelpyoungpeopleandtheirfamilies
inayouthorientedenvironment
provideserviceseitherin,orascloseto,theyoungpersons
localcommunity
collaboratewith
the
young
person
and
their
family
and
supportpeopletodeveloparecoverybasedtreatmentplan
thatpromotesholisticwellbeing
collaboratewithotherexternalservicestooffercontinuityof
careandseamlessservicedelivery,enablingtheyoung
personandtheirfamilytotransitiontotheircommunityand
serviceswithease
integratewithChildandYouthMentalHealthServices
(CYMHS),andasrequired,AdultMentalHealthServices
recognisethatyoungpeopleneedhelpwithavarietyof
issuesand
not
just
illness
utiliseandaccesscommunitybasedsupportsandservices
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wheretheyexist,ratherthanrecreateallsupportsand
serviceswithinthementalhealthsetting
treatconsumers
and
their
families/carers
in
asupportive
therapeuticenvironmentprovidedbyamultidisciplinary
teamofcliniciansandcommunitybasedstaff
provideflexibleandtargetedprogramsthatcanbedelivered
acrossarangeofcontextsandenvironments
havethecapacitytodeliverservicesinatherapeuticmilieu
withfamilymembers;supportandworkwiththefamilyin
theirownenvironment;andkeepthefamilyengagedwith
theyoungpersonandthementalhealthproblemstheyface
havecapacitytoofferintensivefamilytherapyandfamily
support
haveflexibleoptionsfrom24hourinpatientcaretopartial
hospitalisationanddaytreatmentwithambulant
approaches;stepup/stepdown
acknowledgetheessentialrolethateducational/vocational
activitiesandnetworkshaveontherecoveryprocessofa
youngperson
engagewitharangeofeducationalorvocationalsupport
servicesappropriatetotheneedsoftheyoungpersonand
therequirementsoftheirtreatmentenvironment,and
encourageengagement/reengagement
of
positive
and
supportivesocial,family,educationalandvocational
connections.
KeyDistinguishing
FeaturesofanAETRS
Servicesareaccessedviaatiered,leastrestrictiveapproach,and
mayinvolvecombinationsofservicetypesacrossthetiers.
Tier1:
PublicCommunityMentalHealthServices(Sessional)
ExistingLocations:AllHospitalandHealthServices(HHSs).
Accessambulatory
care
at
apublic
community
based
mental
healthservice,withinthelocalarea.
Interventionsshouldconsidersharedcareoptionswith
communitybasedserviceproviders,e.g.General
Practitionersandheadspace.
Tier2a:Level5CSCF.
DayProgramServices(MonFribusinesshours).
ExistingLocations:Townsville(nearcompletion),Mater,
Toowoomba,BarrettAdolescentCentre(BAC).
PossibleNew
Locations:
Gold
Coast,
Royal
Childrens
Hospital
CYMHScatchment,SunshineCoast.Fundsfromexisting
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operationalfundsofBACandRedlandsFacility. Final
locationsandbudgettobedeterminedthroughaformal
planningprocess.
Individual,familyandgrouptherapy,andrehabilitation
programsoperatingthroughout(butnotlimitedto)school
terms.
Coreeducationalcomponentforeachyoungperson
partnershipwithEducationQueenslandandvocational
servicesrequired.Thismaybeprovidedattheyoungpersons
school/vocationalsetting,orfromthedayprogramsite.
Flexibleandtargetedprogramswithattendanceupto5days
(duringbusinesshours)aweek,incombinationwith
integrationinto
school,
community
and/or
vocational
programs.
IntegratedwithlocalCYMHS(acuteinpatientandpublic
communitymentalhealthteams).
Programsaredeliveredinatherapeuticmilieu(fromarange
ofsettingsincludingdayprogramservicelocation,thefamily
home,schoolsettingetc.).
Programswillsupportandworkwiththefamily,keeping
themengagedwiththeyoungperson'srecovery.
Consumers
may
require
admission
to
Adolescent
Acute
InpatientUnit(andattendtheDayProgramduringbusiness
hours).
Proposalof12 15programplacesperDayProgram(final
placesandbudgetshouldbedeterminedaspartofformal
planningprocess).
Tier2b:1CommunityResidentialService(24h/7d).
ExistingLocations:Nilservicescurrently.Note:CairnsTime
OutHouse
Initiative
for
18y+.
PossibleNewLocations:SiteswhereDayProgramsare
currentlydelivered;Townsvilleidentifiedasapriorityinorder
tomeettheneedsofNorthQueenslandfamilies.Funding
fromexistingoperationalfundsofBACandRedlandsFacility.
Finallocationsandbudgettobedeterminedthroughaformal
1Note:TheDepartmentofHealthtakesaprovideragnosticviewindeterminingnonclinicalsupport
andaccommodationservices.Decisionstocontractserviceproviderswillbedeterminedbyservice
merit,consumerneedandformalplanningandprocurementprocesses.
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planningprocess.
DayProgramattendanceasinTier2aduringbusinesshours.
Thistierincorporatesabedbasedresidentialandrespite
serviceforadolescentsafterhoursandonweekends(inthe
community).
Thereispotentialforoneormoreoftheseservicesto
providefamilyrooms,thatwilltemporarilyaccommodate
familymemberswhiletheiryoungpersonattendstheDay
ProgramortheAdolescentAcuteInpatientUnit(for
example,inTownsville).
IntegratedwithlocalCYMHS(acuteinpatient,dayprogram
andpublic
community
mental
health
teams).
Residentialtobeapartnershipmodelforservicedelivery
betweenacommunitybasedserviceproviderandQH
multidisciplinarystaffingprofileincludingclinical(Day
Program)andcommunitysupportstaff(communitybased
provider).Partnershiptoincludeclinicalgovernance,training
andinreachbyCYMHS.
Residentialcomponentonlyprovidesaccommodation;itis
nottheinterventionserviceproviderbutwillworkclosely
withtheinterventionserviceprovidertomaintain
consistencyin
the
therapeutic
relationship
with
the
young
person.
OnsiteextendedhoursvisitingservicefromCYMHSDay
Programstaff.
Tier3:Level6CSCF.
StatewideInpatientExtendedTreatmentandRehabilitation
Service(24h/7d)2.
PossibleLocation:S.E.Qld.Sourceofcapitalfundingand
potential
site
not
available
at
current
time
3
.
Acknowledge
2TheDepartmentofHealthacknowledgesthededicatedschoolandexpertiseprovidedbythe
DepartmentofEducationTrainingandEmployment(DETE).TheDepartmentofHealthvaluesand
supportspartnershipwithDETEtoensurethatadolescentshaveaccesstoappropriate
educationalandvocationaloptionstomeettheireducational/vocational needs.3UntilfundingandlocationisavailableforTier3,allyoungpeoplerequiringextendedtreatment
andrehabilitationwillreceiveservicesthroughTiers1and2a/b(i.e.,utilisingexistingCYMHS
communitymentalhealth,DayProgramsandAcuteInpatientUnitsuntilthenewDayPrograms
andresidentialserviceprovidersareestablished).Itisemphasisedthatthisisnotproposedtobe
aclinicallypreferredoroptimalsolution,andsignificantrisksareassociatedwiththisinterim
measure.4Theprovisionofeducationatthislevelrequiresfocusedconsideration; anonsiteschooland
educationprogramisproposedasapriority.
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accessibilityissuesforyoungpeopleoutsideS.E.Qld.
ForyoungpeoplewhoseneedscouldnotbemetbyTiers1
and2above,
due
to
risk,
severity
or
need
for
inpatient
extendedtreatmentandcare.Theseyoungpeoplesneeds
arenotabletobemetinanacutesetting.
Inpatienttherapeuticmilieu,withcapacityforfamily/carer
admissions(i.e.familyrooms).
Allotherappropriateandlessrestrictiveinterventions
considered/testedfirst.
Proposalforapproximately15bedsthisrequiresformal
planningprocesses.
Mediumtermadmissions(approximatelyupto12months;
however,length
of
stay
will
be
guided
by
individual
consumer
needandwillthereforevary).
DeliversintegratedcarewiththelocalCYMHSoftheyoung
person.
Individualised,familyandgrouprehabilitationprograms
deliveredthroughdayandeveningsessions,available7
days/week.Thesemustincludeactivitybasedprogramsthat
enhancetheselfesteemandselfefficacyofyoungpeopleto
aidintheirrehabilitation.Assymptomsreduce,thereisa
focusonassistingyoungpeopletoreturntoatypical
developmentaltrajectory.
Consumerswillonlyaccessthedaysessions(i.e.DayProgram
components)oftheserviceiftheyareanadmittedconsumer.
Programsmaintainfamilyengagementwiththeyoung
person,andwhereverpossibleadolescentswillremain
closelyconnectedwiththeirfamiliesandtheirown
community.
Youngpeoplewillhaveaccesstoarangeofeducationalor
vocationalsupportservicesdeliveredbyonsiteschool
teachersandwillbeabletocontinuetheircurrenteducation
option4.There
is
an
intentional
goal
that
young
people
are
integratedbacktomainstreamcommunityand
educational/vocationalactivities.
Flexibleandtargetedprogramswillbedeliveredacrossa
rangeofcontextsincludingindividual,school,community,
groupandfamily.
Servicespecificationsandotherdescriptorstoillustrateserviceelements
TargetAge 13 17years,withflexibilityinupperagelimitdependingon
presentingissue
and
developmental
(as
opposed
to
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chronological)age.
DiagnosticProfile
Severeandpersistentmentalhealthproblemsthat
significantlyinterferewithsocial,emotional,behaviouraland
psychologicalfunctioninganddevelopment.
Treatmentrefractory/nonresponsivetotreatment havenot
beenabletoremediatewithmultidisciplinarycommunity,
dayprogramoracuteinpatienttreatment.
Mentalillnessispersistentandtheconsumerisariskto
themselvesand/orothers.
Mediumtohighlevelofacuityrequiringextendedtreatment
andrehabilitation.
Suggestedmodellingattributes
Averagedurationof
treatmentTier2a:
Level5DayProgramServices(MonFribusinesshours)
Upto12months;flexibilitywillbeessential.
Therewillbewidevariationinindividualconsumerneedand
theirtreatmentprogram;lengthofstaywillneedtobe
responsivetothis.
Tier2b:
CommunityResidential(24h/7d)
Upto12months;flexibilitywillbeessential.
Therewillbewidevariationinindividualconsumerneedand
theirtreatmentprogram;lengthofstaywillneedtobe
responsivetothis.
Accesstoacommunityresidentialservicerequirestheyoung
persontobeactivelyparticipatinginaprogramwithCYMHS.
Tier3:
Level6StatewideInpatientExtendedTreatmentand
RehabilitationService(24h/7d)
Upto12months;flexibilitywillbeessential.
Therewillbewidevariationinindividualconsumerneedand
theirtreatmentprogram;lengthofstaywillneedtobe
responsivetothis.
YoungpeoplemaybedischargedfromthisServicetoaDay
Programintheirlocalcommunity.
StaffingProfile
Tier2a:
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Level5DayProgramServices(MonFribusinesshours)
Multidisciplinary,clinical.
Plusstaffingfromcommunitysector.
DETE.
Tier2b:
CommunityResidentialService(24h/7d)
Multidisciplinary,clinical.
Plusstaffingfromcommunitysector.
Tier3:
Level6StatewideInpatientExtendedTreatmentand
RehabilitationService(24h/7d)
Multidisciplinary,clinical.
DETE.
Additionalnotes
ReferralSourcesand
PathwaysWhileserviceprovisionacrossallTiersofthisAETRScontinuumis
basedoninterdisciplinarycollaborationandcrossagency
contribution,areferraltoTiers2a,2band/or3willrequirea
CYMHSassessment
(i.e.,
single
point
of
entry).
IncreasedaccessibilitytoAETRSforconsumersandtheirfamilies
acrosstheStateisakeypriority.
TheTier3statewideservicewillestablishaStatewideClinical
ReferralPanel.Allreferralswillbereceivedandassessedbythe
Panel,whichhasstatewiderepresentationfrommultidisciplinary
mentalhealthcliniciansandthecommunitysector.
Complexitiesof
Presentation
Voluntaryandinvoluntarymentalhealthconsumers.
The
highest
level
of
risk
and
complexity.
ThisdocumentwasendorsedbytheExpertClinicalReferenceGroupoftheBarrett
AdolescentStrategyon8May2013.
Pleasereadinconjunctionwiththev5Preamble.
___________________________
DrLeanneGeppert
Chair,Expert
Clinical
Reference
Group
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ProposedServiceModelElements
Adolescent
Extended
Treatment
and
Rehabilitation
Services
(AETRS)
Preamble
Mentalhealthdisordersarethemostprevalentillnessesaffectingadolescentstoday.Ofparticular
noteistheconsiderableevidencethatadolescentswithpersistingandseveresymptomatologyare
thosemost likely tocarry thegreatestburdenof illness intoadult life.Despite this, funding for
adolescent(andchild)mentalhealthservicesisnotproportionaltotheidentifiedneedandburden
ofdiseasethatexists.
Inthe
past
25
years,
agrowing
range
of
child
and
youth
mental
health
services
have
been
established by Queensland Health (and other service providers) to address the mental health
needs of children and adolescents. These services deliver mental health assessment and
treatment interventions across the spectrum of mental illness and need, and as a service
continuum, provide care options 24 hours a day, seven days a week. No matter where an
adolescentandtheirfamily live inQueensland,theyareabletoaccessaChildandYouthMental
Health Service (CYMHS) community clinic or clinician (either via direct access through their
HospitalandHealthService,orthroughtelehealthfacilities). DayProgramshavebeenestablished
for adolescents in South Brisbane, Toowoomba and Townsville. Acutemental health inpatient
units for adolescents are located in North Brisbane, Logan, Robina, South Brisbane and
Toowoomba,
and
soon
in
Townsville
(May/June
2013).
A
statewide
specialist
multidisciplinary
assessment,andintegratedtreatmentandrehabilitationprogram(TheBarrettAdolescentCentre
[BAC]) is currently delivered at The Park Centre for Mental Health (TPCMH) for adolescents
between13and17yearsofagewithsevere,persistentmental illness.Thisservicealsooffersan
adolescentDayProgram forBACconsumersandnonBACconsumersofWestMoretonHospital
andHealthService.
Consistentwithstateandnationalmentalhealthreforms,thedecentralisationofservices,andthe
reformofTPCMHsite toofferonlyadult forensicandsecurementalhealthservices, theBAC is
unable to continue operating in its current form at TPCMH. Further to this, the current BAC
building has been identified as needing substantial refurbishment. This situation necessitates
carefulconsiderationofoptions for theprovisionofmentalhealthservices foradolescents (and
their families/carers) requiring extended treatment and rehabilitation in Queensland.
Consequently, an Expert Clinical Reference Group (ECRG) of child and youth mental health
clinicians,aconsumerrepresentative,acarerrepresentative,andkeystakeholderswasconvened
by the Barrett Adolescent Strategy Planning Group to explore and identify alternative service
optionsforthistargetgroup.
Between1December2012and24April2013theECRGmetregularlytodefinethetargetgroup
and theirneeds, conduct a service gap analysis, consider communityand sector feedback, and
reviewarangeofcontemporary,evidencebasedmodelsofcareandservicetypes.This included
thepotential
for
an
expanded
range
of
day
programs
across
Queensland
and
community
mental
healthservicemodelsdeliveredbynongovernmentand/orprivateserviceproviders. TheECRG
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haveconsideredevidenceanddatafromthefield,nationalandinternationalbenchmarks,clinical
expertiseandexperience,andconsumerandcarerfeedbacktodevelopaservicemodelelements
documentfor
Adolescent
Extended
Treatment
and
Rehabilitation
Services
in
Queensland.
This
elementsdocumentisnotamodelofserviceitisaconceptualdocumentthatdelineatesthekey
components of a service continuum type for the identified target group. As a service model
elementsdocument,itwillnotdefinehowthekeycomponentswillfunctionataservicedelivery
level,anddoesnotincorporatefundingandimplementationplanningprocesses.
The servicemodel elements document proposes four tiers of service provision for adolescents
requiringextendedmentalhealthtreatmentandrehabilitation:
Tier1PublicCommunityChildandYouthMentalHealthServices(existing);
Tier2aAdolescentDayProgramServices(existing+new);
Tier2b
Adolescent
Community
Residential
Service/s
(new);
and
Tier3StatewideAdolescentInpatientExtendedTreatmentandRehabilitationService(new).
Thefinalservicemodelelementsdocumentproducedwascognisantofconstraintsassociatedwith
fundingandother resources (e.g., there isnocapital fundingavailable tobuildBAConanother
site). The ECRGwas alsomindful of the currentpolicy context anddirection formentalhealth
servicesasinformedbytheNationalMentalHealthPolicy(2008)whicharticulatesthatnonacute
bedbasedservicesshouldbecommunitybasedwhereverpossible. Akeyprinciple forchildand
youth mental health services,which is supported by all members of the ECRG, is that young
people are treated in the least restrictiveenvironmentpossible, andonewhich recognises the
needfor
safety
and
cultural
sensitivity,
with
the
minimum
possible
disruption
to
family,
educational,socialandcommunitynetworks.
TheECRG comprisedof consumerand carer representatives,anddistinguished childand youth
mentalhealthcliniciansacrossQueenslandandNewSouthWaleswhowerenominatedbytheir
peersasleadersinthefield.TheECRGwouldliketoacknowledgeanddrawattentiontotheinput
oftheconsumerandcarerrepresentatives.Theyhighlightedtheessentialrolethataservicesuch
asBACplaysinrecoveryandrehabilitation,andthestaffskillandexpertisethatisinherenttothis
particular service type.While therewasalsovalidationofotherCYMHS service types, including
community mental health clinics, day programs and acute inpatient units, it was strongly
articulatedthat
these
other
service
types
are
not
as
effective
in
providing
safe,
medium
term
extendedcareandrehabilitationtothetargetgroupfocussedonhere.ItisunderstoodthatBAC
cannotcontinue in itscurrent formatTPCMH.However, it istheviewoftheECRGthat likethe
Community Care Units within the adult mental health service stream, a designspecific and
clinically staffed bedbased service is essential for adolescents who require mediumterm
extendedcareandrehabilitation.Thistypeofcareandrehabilitationprogram isconsidered life
savingforyoungpeople,andisavailablecurrentlyinbothQueenslandandNewSouthWales(e.g.,
TheWalkerUnit).
The service model elements document (attached) has been proposed by the ECRG as a way
forwardfor
adolescent
extended
treatment
and
rehabilitation
services
in
Queensland.
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There are seven keymessages and associated recommendations from the ECRG that need to
underpinthereadingofthedocument:
1. Broaderconsultationand formalplanningprocessesareessential inguidingthenextsteps
required for service development, acknowledging that services need to align with the
NationalMentalHealthServicePlanningFramework
Theproposed servicemodelelementsdocument isa conceptualdocument,notamodelof
service.Formalconsultationandplanningprocesseshavenotbeencompletedaspartofthe
ECRGcourseofaction.
Inthisconceptproposal,Tier2mapstotheClinicalServicesCapabilityFrameworkforPublic
andLicensed
Private
Health
Facilities
Version
3.1
(CSCF)
Level
5and
Tier
3maps
to
CSCF
Level
6.
Recommendations:
a) Furtherworkwillberequiredatastatewideleveltotranslatetheseconceptsintoamodel
ofserviceandtodevelopimplementationandfundingplans.
b) Formalplanningincludingconsultationwithstakeholdergroupswillberequired.
2. Inpatient extended treatment and rehabilitation care (Tier 3) is an essential service
component
Itisunderstoodthatthecombinationofdayprogramcare,residentialcommunitybasedcare
andacuteinpatientcarehasbeenidentifiedasapotentialalternativetothecurrentBACor
theproposedTier3inthefollowingservicemodelelementsdocument.
FromtheperspectiveoftheECRG,Tier3isanessentialcomponentoftheoverallconcept,as
thereisasmallgroupofyoungpeoplewhoseneedscannotbesafelyandeffectivelymet
throughalternativeservicetypes(asrepresentedbyTiers1and2).
Thetargetgroupischaracterisedbyseverityandpersistenceofillness,verylimitedorabsent
community
supports
and
engagement,
and
significant
risk
to
self
and/or
others.
Managing
these young people in acute inpatient units does not meet their clinical, therapeutic or
rehabilitationneeds.
Theriskofinstitutionalisationisconsideredgreateriftheyoungpersonreceivesmediumterm
careinanacuteunit(versusadesignspecificextendedcareunit).
Clinicalexperienceshowsthatprolongedadmissionsofsuchyoungpeopletoacuteunitscan
haveanadverseimpactonotheryoungpeopleadmittedforacutetreatment.
Managingthistargetgrouppredominantlyinthecommunityisassociatedwithcomplexitiesof
risktoselfandothers,andalsotheriskofdisengagingfromtherapeuticservices.
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Recommendation:
a)
ATier
3service
should
be
prioritised
to
provide
extended
treatment
and
rehabilitation
for
adolescentswithsevereandpersistentmentalillness.
3. InterimserviceprovisionifBACclosesandTier3isnotavailableisassociatedwithrisk
Interimarrangements(afterBACclosesandbeforeTier3isestablished)areatriskofoffering
suboptimalclinicalcareforthetargetgroup,andattentionshouldbegiventothetherapeutic
principlesofsafetyandtreatmentmatching,aswellasefficientuseofresources(e.g.,
inpatientbeds).
InthecaseofBACbeingclosed,andparticularly ifTier3 isnot immediatelyavailable,ahigh
priorityandconcernfortheECRGwasthetransitioningofcurrentBACconsumers,andthose
onthewaitinglist.
OfconcerntotheECRGisalsothedissipationandlossofspecialiststaffskillsandexpertisein
the area of adolescent extended care in Queensland if BAC closes and a Tier 3 is not
establishedinatimelymanner.Thisincludesbothclinicalstaffandeducationstaff.
Recommendations:
a) Safe,highqualityserviceprovisionforadolescentsrequiringextendedtreatmentand
rehabilitationrequiresaTier3servicealternativetobeavailableinatimelymannerifBAC
isclosed.
b)
InterimserviceprovisionforcurrentandwaitlistconsumersofBACwhileTier3service
optionsareestablishedmustprioritisetheneedsofeachoftheseindividualsandtheir
families/carers.Wraparoundcareforeachindividualwillbeessential.
c) BACstaff(clinicalandeducational)mustreceiveindividualcareandcasemanagementif
BACcloses,andtheirspecialistskillandknowledgemustberecognisedandmaintained.
4. Durationoftreatment
AliteraturesearchbytheECRGidentifiedaweakandvariableevidencebaseforthe
recommendedduration
of
treatment
for
inpatient
care
of
adolescents
requiring
mental
health
extendedtreatmentandrehabilitation.
Predominantly,durationoftreatmentshouldbedeterminedbyclinicalassessmentand
individualconsumerneed;thelengthofinterventionmostlikelytoachievelongterm
sustainableoutcomesshouldbeofferedtoyoungpeople.
Aswithallclinicalcare,durationofcareshouldalsobedetermined inconsultationwith the
youngpersonandtheirguardian.Rapportandengagementwithserviceprovidersispivotal.
Recommendation:
a)
Up
to
12
months
has
been
identified
by
the
ECRG
as
a
reasonable
duration
of
treatment,
butitwasnotedthatthisdependsontheavailabilityofeffectivestepdownservicesanda
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suitable community residence for the youngperson. It is important tonote that like all
mentalhealthserviceprovision,therewillbearangeinthedurationofadmission.
5. Educationresourceessential:onsiteschoolforTiers2and3
Comprehensiveeducationalsupportunderpinssocialrecoveryanddecreasesthelikelihoodof
the long term burden of illness. A specialised educational model and workforce is best
positionedtoengagewithandteachthistargetgroup.
Rehabilitation requires intervention to return to a normal developmental trajectory, and
successfuloutcomesaremeasuredinpsychosocialfunctioning,notjustabsenceofpsychiatric
symptoms.
Educationisanessentialpartoflifeforyoungpeople.Itisvitalthatyoungpeopleareableto
accesseffectiveeducationservicesthatunderstandandcanaccommodatetheirmentalhealth
needsthroughoutthecareepisode.
For young people requiring extended mental health treatment, themainstream education
system is frequently not able to meet their needs. Education is often a core part of the
interventionrequiredtoachieveapositiveprognosis.
Recommendations:
a) Accesstoonsiteschooling(includingsuitablyqualifiededucators), isconsideredessential
forTiers
2(day
programs)
and
3.
It
is
the
position
of
the
ECRG
that
aBand
7Specific
Purpose School (provided by Department of Education, Training and Employment) is
requiredforaTier3service.
b) As an aside, consideration should also be given to the establishment of a multisite,
statewideeducationserviceforchildren/adolescentsinacuteunits(hubandspokemodel).
6. Residential Service: Important for governance to bewith CYMHS; capacity and capability
requiresfurtherconsideration
There is no true precedent set inQueensland for theprovision of residential or bedbased
therapeuticcommunitycare (bynongovernmentorprivateproviders) foradolescents (agedupto18years)requiringextendedmentalhealthcare.
ThemajorityofECRGmembersidentifiedconcernswithregardtosimilarservicesavailablein
thechildsafetysector.Theseconcernswereassociatedwith:
Variablyskilled/trainedstaffwhooftenhadlimitedaccesstosupportandsupervision;
Highstaffturnover(impactingonconsumertrustandrapport);and
VariableengagementincollaborativepracticewithspecialistservicessuchasCYMHS.
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8/10/2019 Barrett adolescent strategy
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Barrett Adolescent Strategy Expert Clinical Reference GroupExpert Clinical Reference Group
v5EndorsedbyECRG08.05.2013
Page6of6
Recommendations:
a)
Itis
considered
vital
that
further
consultation
and
planning
is
conducted
on
the
best
servicemodelforadolescentnongovernment/privateresidentialandtherapeuticservices
incommunitymentalhealth.Apilotsiteisessential.
b) GovernanceshouldremainwiththelocalCYMHSortreatingmentalhealthteam.
c) It is essential that residential services are staffed adequately and that they have clear
serviceandconsumeroutcometargets.
7. EquitableaccesstoAETRSforalladolescentsandfamilies ishighpriority;needtoenhance
serviceprovisioninNorthQueensland(andregionalareas)
Equity of access for North Queensland consumers and their families is considered a high
prioritybytheECRG.
Recommendations:
a) LocalserviceprovisiontoNorthQueenslandshouldbeaddressedimmediatelybyensuring
a full range of CYMHS services are available in Townsville, including a residential
communitybasedservice.
b) Ifadecision ismadetocloseBAC,thisshouldnotbefinalisedbeforetherangeofservice
optionsinTownsvilleareopenedandavailabletoconsumersandtheirfamilies/carers.
Document No.13
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Recommended