Barrett adolescent strategy

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)




responsivetothis.

Accesstoacommunityresidentialservicerequirestheyoung

persontobeactivelyparticipatinginaprogramwithCYMHS.

Tier3:

Level6StatewideInpatientExtendedTreatmentand

RehabilitationService(24h/7d)




responsivetothis.

YoungpeoplemaybedischargedfromthisServicetoaDay

Programintheirlocalcommunity.

StaffingProfile

Tier2a:

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Level5DayProgramServices(MonFribusinesshours)

Multidisciplinary,clinical.

Plusstaffingfromcommunitysector.

DETE.

Tier2b:

CommunityResidentialService(24h/7d)


Plusstaffingfromcommunitysector.

Tier3:

Level6StatewideInpatientExtendedTreatmentand

RehabilitationService(24h/7d)


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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Barrett Adolescent Strategy Expert Clinical Reference GroupExpert Clinical Reference Group

v5EndorsedbyECRG08.05.2013

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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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Page5of6

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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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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Documents

Barrett adolescent strategy