Presenting Telelink Mental Health Services/Service de santé mentale Telelink
The following video was produced by AboutKidsHealth and associated leaders in pediatric care. Sickkids has made a strategic commitment to enhancing child health systems, systems of care, the access to care, the standards of care for kids. Telelink is a phenomenally visonary way of reaching out to the communities who don’t particularly have access to children’s mental health services in their direct community. “Kind of like anorexia?” People don’t generally consider the significance of mental health services until someone in their family or community tries to access help. This is especially true for the 1 in 3 Canadians who live in either rural or extremely remote communities, far away from specialists who are often located in major city centers. We want to introduce you to an innovative program at the Hospital for Sick Children, that is providing a variety of mental health services to pediatric populations and their families. We call it Telelink Mental Health. “Hi!” “Hi, Tony!” It’s a comprehensive program that brings into these communities the expertise of over 75 child and adolescent psychiatrists and other mental health specialists using live interactive teleconferencing and other technologies. “Constance?” A lot of people on the other side of the TV screen… so, schools, sometimes a pediatrician, sometimes children’s aid, the family, the parents, the foster parents, in some cases will all be sitting in the room at the other end. If there’s disagreements in how the various agencies are
working together we can begin to look at that with the clients present. “I like that.” It allows the support network that we have developed in our local community to be with us. A major component of TeleLink is our Telepsychiatry Program. “When was the first time you took any kind of that medication?” Since 2000 the Ministry of Children & Youth Services has funded thousands of clinical consultations — and a variety of education initiatives. This has helped the workers in children’s mental health agencies across Ontario build their skill set and comfort level in working with children, youth, and families who are dealing with mental health problems. “You’re good with animals are you?” “I guess so… yeah.” Often agencies like ours will complain about what governments don’t get right. It’s absolutely one of the things that the government did get right in terms of connecting us with SickKids Hospital in this particular project. Could it be expanded? I would hope so! We also provide support for families, physicians, and other mental health professionals through a variety of locally-run programs and hospitals in remote regions. The technology lets us connect. I can see a blush or a watery eye. Because our consultants are not from the communities who are referring families to us, we collaborate first with the local children’s mental health workers who educate us about
the specific needs and cultures of their communities. The military initiative that we have which we call operation peace of mind… “You know the one where we sit and we talk to Toronto–” “Oh Tony, yeah, umhm…” As you try to sort out what it’s like for a young person that gets moved around time over time over time, what happens when their mom or dad leaves for deployment? What happens when one of them is either injured or killed? “His e-mail address is right there.” People in remote and rural areas, I mean, if you don’t have this kind of service you end up with practitioners not being guided. Families are very complicated and to have a consultation with somebody, it just enriches your practice. And if you don’t have that service in a remote area –if you don’t have Telelink– then you are at such a disadvantage. We want to understand the needs of our clients before we connect them with a suitable specialist. “Tell me what’s good about it… and why do you…” Working with the professionals in children’s mental health, be it social workers, psychologists, psychiatrists, is sometimes challenging but it can be very rewarding. They all come with their areas of specialization and expertise, and what we’ve been able to do is match that expertise with the challenges of the community. “What grade in school are you in?” Every time a child comes to see us, that child is bringing their family and we recognize that when somebody in the family is having a difficulty, the whole family has been affected. “Grade 8?” So we want to get the parents away from the idea that it’s the kid’s problem. It’s not the kid’s problem. You know, many of the disorders that we deal with are genetically based. “Can you cite a study that would be useful to share with parents?” The center we actually provide to our Northern community partners focus on evidence-based strategies. And the most distinctive aspect of our consultations is that often teachers, principals and local physicians will join social workers and parents in a child session. This means that every consultation becomes a learning experience for everyone involved. We anticipate that this initiative will continue to be important, because the reality is that rural Canadians are so vastly underserviced, they live in communities where few–if any–psychiatrists can be found. For this reason we believe it’s important to expose psychiatry residents and other mental health trainees to our work with children in rural, remote and aboriginal communities. There’s actually a curriculum requirement for psychiatric residence at the University of Toronto to participate in our program. “Is that actually based on evidence?” The cases that I saw were just incredible in terms of their complexity. We want future psychiatrists to be comfortable using this technology because it helps connect kids and their care givers with the experts who would otherwise not be available to them. It is now possible to bring together at the table people from a community mental health agency that is sponsored by a particular ministry, physicians that are paid from a completely different pocket, and even teachers, who, of course, are supported through a completely different mechanism. So geography is no longer a limitation. We’re able to connect and provide high-level psychiatric care, high-level mental health practice, high level psychology expertise, to children everywhere in the province of Ontario, perhaps the country. In the future it might possibly be a very normal way of seeing patients. As this technology moves forward and makes its way into more communities, we need to find innovative ways of incorporating it into day-to-day practices. While telelink’s psychiatry consultations focus on mental health issues, the emphasis for psychology assesements is more on learning and development, and how these are influenced by a child’s behaviour. Unfortunately, there are also very few psychology resources available to many communities in Ontario. So by using this technology, a registered psychologist at the Hospital for Sick Children can supervise a psychometrist from a distance while they are
giving tests, and interview and observe the child while they are working. Down the road, we also hope to play a role in advancing the training of community psychometrists and other professionals to build the expertise locally. It’s really neat, especially for people who can’t travel. We actually measure the effectiveness of telelink programs on an ongoing basis, and we are constantly updating the telelink team about our findings. It’s about revolutionizing the way we conduct our intervention. We do this by systematically evaluating, measuring, and updating our strategies, and our research involves our stakeholders in a meaningful way. So we’ve consulted with not only the people delivering the program but also the family members and service providers in rural communities about what they’d like the research to reflect. We don’t ask people to rate our services on a scale from 1-10. We solicit detailed and richly textured feedback from everyone on the recieving end. From the service providers, the parents, and most importantly the children themselves. This truly is one of the most distinguishing features of our program. “Peter, I’m sure you’ve got some thoughts that are bringing in the other community perspective and the aboriginal perspective.” “I think we’re effective cross-culturally.” We are working very hard to create real and trusted relationships in the north. One of the most important pieces of forging long-distance ties is learning about existing community strengths, then facilitating the development of community-based resources and resiliencies. Some communities, for a lot of good reasons, can be hesitant to engage. So we recognize that we need to be educated first about the unique context of each of the communities we partner with. What surprises people about this model of service delivery is that isolated communities actually get specialist appointments and attention more quickly than people who live in urban centers like Toronto or Vancouver, and that really is remarkable. Our goal is to create a seamless, collaborative approach working with people inside and outside the medical field, not just doctors and nurses, but with social workers, teachers, and elders. This is the future of effective mental health service delivery in Canada. Telelink is essential. And I believe it’s essential because every child is entitled to a healthy life, and unfortunately some of the communities throughout the world do not have the benefit of this kind of expertise that we are able to bring to them over the medium of the technology.