Wellness Centre Model and Strategic Development

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Wellness CentreModel and Strategic Development

• Wellness Centre
• A Mount Sinai Hospital Community Program
• in partnership with
• Hong Fook Mental Health Association
• Yee Hong Centre for Geriatric Care
• May 28, 2007

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Conflict of Interest Disclosure

• At this point, we have no conflict of interest to
  disclose in relation to the subject matter of
  this presentation.

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Background
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Barriers in Accessing Mental Health Care

• Fears of stigmatization
• Lack of knowledge about available resources
• Culturally determined attempts to manage problems
  within the family 
• Language and Cultural barriers
• (Sadavoy J, Meier R, Ong AYM. Barriers to access
  to mental health services for ethnic seniors the
  Toronto study. Can J Psychiatry 2004 49
  192-199.)

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Other Barriers

• Lack of alternatives and dominance of drug
  therapy may discourage members of ethnocultural
  group to access care (Li, Logan, Yee Ng, 1999)
• Perceptions of symptoms as somatic rather than
  psychiatric in origin (Ng, 1997 Li, Logan, Yee
  Ng, 1999)
• Difference in conceptions of mental health (Ng,
  1997)
• Long waiting list (Lai et.al, 2003 Health
  Quality Council, 2004)
• Failure to detect MH problems by primary care
  physicians (Health Quality Council, 2004)

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Barriers for Chinese Seniors

• Transportation
• Reliance on families in MH detection, choice of
  help-seeking and continuation of care
• Fear of burden to family and children
• Relatively low literacy and educational skills
• Misinterpret MH problems as part of process of
  normal aging

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The Use of the Wellness Model to engage the
ethnocultural community to access care

• Culturally relevant wellness concepts which are
  both familiar and acceptable to the target
  community
• The Wellness concepts guiding the program closely
  fit the culturally derived determinants of mental
  health
• Mental health is closely allied to physical
  health and exercise
• Self-help and the active pursuit of body-mind
  alternatives foster better mental health and
  relieve patients from possible stigma
• Mental health must be pursued by individuals
  rather than purely relying on health
  services/professionals
• (to be continued)

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The Use of the Wellness Model to engage the
ethnocultural community to access care

• (continued)
• Culturally relevant wellness programs and
  activities serve as the interface to a continuum
  of more individualized mental health services
  that incorporates conventional psychiatric care
• Wellness activities and the environment of the
  Centre help to destigmatize the process of
  seeking mental health care

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Philosophy

• Health is a continuum ranging from optimal health
  to critically ill severe functional impairment

Tipping Point
Wellness
Illness/Deterioration
Optimal Health
Critically Ill Severe F(x) impairment
At risk / Sub-syndromal
Early Phase of Illness
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The Wellness Centre Philosophy

• The Centre is a culturally-competent mental
  health access point for Chinese seniors and older
  adults to
• mainstream clinical care and assessment,
  complemented by non-conventional holistic care
  options
• MH and wellness education that focus on
  culturally relevant determinants of health

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The Wellness Centre Philosophy2

• Focus on early identification and intervention
• Familiar, accessible, destigmatizing environment
• community-based portal of entry
• continuum of care including social supportive
  services
• clinical and educational outreach
• family-orientation model
• An academic program incorporating teaching
  clinical care, education and research

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Target Population / Community

• Chinese Community (GTA)
• Elderly and Older Adults (55)
• Living in the community
• Families and Caregivers in need of individualized
  emotional and educational support for the care of
  an elderly at home

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The Centres Engagement Model

• To facilitate access through enhancing
  engagement the model includes built-in
  mechanisms to positively address or accommodate
• linguistic and cultural needs staff bicultural,
  bilingual
• conceptualization of determinants of mental
  health
• individual readiness to accept psychiatric care
  and drug therapy
• Interpretation of their own problems
• Input on their own health and wellness needs

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Scope of Services

• Individualized Care
• Assessment
• Formulation
• Therapeutic Intervention
• Early Identification / Detection
• Education
• Wellness and MH
• Health promotion

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Early Identification /Detection

• Improving access
• Client-centered engagement taking into account
  clients readiness to seek psychiatric care
• Focusing on risk factors and stressors rather
  than the conventional emphasis on meeting
  diagnostic criteria
• Identifying at risk or sub-syndromal population
  and motivating individuals to start intervention
  at early stage
• Educating front-line staff and volunteers about
  early signs of Major MH disorders
• Systematic MH screening for at-risk or isolated
  seniors (in process)

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The Centres Health and Wellness Strategies

• Culturally relevant health practices
• Healthy lifestyle
• Healthy diet / nutrition
• Health maintenance methods exercise
• Self-help, coping mechanism, and chronic disease
  self management
• Alternative / holistic care (include TCM)

• Conventional medical care
• pharmacotherapy
• Psychotherapies /counselling
• Hospital/ institutional care
• Supportive care
• Care coordination

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Individualized Care Assessment

• Clinical Assessment
• Symptoms / Mental Status / Cognitive Capacity
• Diagnosis
• Functional Assessment
• ADL IADL
• Social / Interpersonal
• Patient/familys Perception of Problems and
  Situation
• Evaluation of patient/familys Beliefs and view
  of Possibilities

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Individualized Care - Formulation

• Analysis and incorporation of information from
  the Wellness/cultural and medical domains of
  assessment
• Formulation shapes the intervention defines the
  combination of strategies
• Intervention will encompass patients agreed
  direction of wellness

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Individualized Care - Intervention
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Partner 1 Outreach, Wellness Programs, Case
mgmt, peer support, caregiver support/training,
and Social club
Collaborating Community Agency A
Collaborating Community Agency B
FP
Dept. of Psychiatry, MSH Training,, Education and
Research
GP
FP
Collaborating Seniors Org. F (Host Agency)
Wellness Centre (Assessment, Dx, Rx Consultation
Treatment)
Collaborating Senior Org. C (Host Agency)
Primary Care attached to WC
GP
FP
FP
Shared care Referral Referral, Consultation
Follow-up Referral, Resource Backup,
Integrated service program
FP
Partner 2 Case mgmt, Caregiver support
Collaborating Community Senior Service Agency E
Collaborating Community Senior Service Agency D
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Educational Outreach

• Psychogeriatic Training and Consultation to
  front-line workers of community senior services
  agencies
• may offer basic training to volunteers of
  Friendly Visiting programs isolated seniors
• Invited MH and Wellness Education for other
  senior organization/service agencies
• Caregiver Workshop and group co-organized with
  Yee Hong

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Outreach to At-risk Seniors

• Clinical Outreach Home-visits when necessary,
  feasible, and meeting clients need
• Systematic MH screening for at-risk seniors
  (proposed research/feasibility study) research
  Proposal completed (Yee Hong CD groups )
• may extend to clients of Supportive Housing
  Programs frail and isolated seniors
• may extend to other agencies at subsequent
  development phrase

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Engagement with FPs

• Collaborative Mental Health Care Network (CMHCN)
  established in December 2005 1st of its kind
  targeting FPs serving primarily the Chinese
  community
• Mentored by Joel Sadavoy and Danny Yeung
• 12 Chinese physicians registered
• Meet regularly for consultation and training
• gt 1/3 of the doctors referrals from FPs from
  this CMCHN
• Closely link with FPs affiliated with Yee Hong
  Medical Centre
• Service brochures and introduction mailed to
  Chinese FPs
• In future, if resources permit, more outreach to
  and engagement of FP will be done

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Programs for Families and Caregivers

• Individualized support to Families and Caregivers
  by WC or YH
• Group and self-help support offered by YH
• Supportive and wellness programs for families and
  caregivers can be offered by YH or WC or in
  collaboration

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Partners Roles and Contributions

• Co-ordinated Intake and Inquiry Response among
  partners (a template and working protocol was
  developed in 2005)
• Yee Hong
• Referral Services
• Family and Caregiver Support
• Supportive Care and Wellness Programs
• Outreach to isolated seniors
• Hong Fook
• Peer Leader Training for seniors
• Community MH education to elderly immigrants (in
  collaboration)