Wellness Centre Model and Strategic Development

1. 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 Joel Sadavoy & KC Chan

2. Conflict of Interest Disclosure • At this point, we have no conflict of interest to disclose in relation to the subject matter of this presentation. Joel Sadavoy & KC Chan

3. Background Joel Sadavoy & KC Chan

4. 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.) Joel Sadavoy & KC Chan

5. 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) Joel Sadavoy & KC Chan

6. 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 Joel Sadavoy & KC Chan

7. 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) Joel Sadavoy & KC Chan

8. 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 Joel Sadavoy & KC Chan

9. Philosophy • Health is a continuum ranging from optimal health to critically ill & severe functional impairment Wellness Tipping Point Illness/Deterioration Optimal Health Critically Ill & SevereF(x) impairment At risk / Sub-syndromal Early Phase of Illness Joel Sadavoy & KC Chan

10. 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 Joel Sadavoy & KC Chan

11. 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 Joel Sadavoy & KC Chan

12. 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 Joel Sadavoy & KC Chan

13. The Centre’s 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 Joel Sadavoy & KC Chan

14. Scope of Services • Individualized Care • Assessment • Formulation • Therapeutic Intervention • Early Identification / Detection • Education • Wellness and MH • Health promotion Joel Sadavoy & KC Chan

15. Early Identification /Detection • Improving access • Client-centered engagement taking into account client’s 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) Joel Sadavoy & KC Chan

16. 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 The Centre’s Health and Wellness Strategies Joel Sadavoy & KC Chan

17. Individualized Care – Assessment • Clinical Assessment • Symptoms / Mental Status / Cognitive Capacity • Diagnosis • Functional Assessment • ADL + IADL • Social / Interpersonal • Patient/family’s Perception of Problems and Situation • Evaluation of patient/family’s Beliefs and view of Possibilities Joel Sadavoy & KC Chan

18. 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 Joel Sadavoy & KC Chan

19. Treatment Plan / Options No Treatment Referred Elsewhere Evidence-based Care + Perception/Belief-based Programs Evidence-based Care Perception/Belief-based Programs Individualized Care - Intervention Joel Sadavoy & KC Chan

20. Partner 1 Outreach, Wellness Programs, Case mgmt, peer support, caregiver support/training, and Social club Collaborating Community Agency A Collaborating Community Agency B FP GP FP Dept. of Psychiatry, MSH Training,, Education and Research 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 Joel Sadavoy & KC Chan

21. 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 Joel Sadavoy & KC Chan

22. 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)– researchProposal 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 Joel Sadavoy & KC Chan

23. 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 • > 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 Joel Sadavoy & KC Chan

24. 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 Joel Sadavoy & KC Chan

25. 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) Joel Sadavoy & KC Chan