Providing access and early intervention for people with mental health concerns
Jan 05, 2015, By: Sandy Harper-Jaques, RN, MN, RMFT, Jacqueline Simms, RN, BN, MN
In many parts of Canada, timely access to mental health services continues to be a challenge. Single session walk-in (SSWI) therapy is a model of service delivery that improves access to care and ensures that people can obtain services when they need them most.
Our community-based SSWI service, located at the South Calgary Health Centre, is one of a small number that Alberta Health Services offers across the province. The model is designed for individuals, couples and families, who can simply walk in, fill out two forms and be seen by a qualified therapist (a master’s- or doctoral-prepared nurse, social worker or psychologist) for an hour of therapy structured to meet their needs. The session is suited to those who have limited time and who are seeking help.
At the outset, the client identifies one or two issues to focus on. The therapist quickly engages with the client, explores the client’s ideas about solutions and change, and works with the client toward new options. Clients are often given information about other agencies. Most of the time, however, no followup is necessary. If the therapist deems it necessary, clients are linked to other resources before the session ends.
Our service, launched in 2004, has seen a steady increase in demand, with people learning about us by word of mouth. In the 2012-2013 fiscal year alone, we assessed and treated more than a thousand clients. Most are self-referred; the rest are referred by health-care professionals and school counsellors. There are no exclusion criteria or age restrictions, and appointments are not necessary. The service is offered four evenings and one morning per week.
Our clinical team consists of nurses, social workers and psychologists, who have various theoretical approaches to therapy. Nurses contribute a biopsychosocial perspective to the team. Because the team members agree that two heads are better than one, they review the client’s forms before the session begins and consult with one another before the client leaves.
On each shift, one therapist is assigned a shift coordinator (SC) role. The SC supports the other therapists and facilitates the flow of clinical activities. The clinical lead is a clinical nurse specialist. She facilitates an orientation process for new team members that includes a literature review, a seminar, observation sessions and an introduction to the SC role. Clinical issues and administrative concerns are discussed at regularly scheduled meetings, which provide opportunities for the clinical team to enhance their practice.
As a service, we seek feedback from clients by measuring their level of distress before and after the session and asking them to complete satisfaction surveys at the end of the session. From September 2011 to February 2012, the team conducted a formal study using four client self-report instruments. They collected information from consenting clients before the session and at the end, and again one month later. The results showed that clients were generally satisfied and felt they had developed greater confidence in managing the problem that they sought help for. Forty per cent of the clients indicated that having a single therapy session was sufficient.
We believe the SSWI model reduces the pressure on other services that are more complex and expensive. In feedback we received during the 2013-2014 fiscal year, for example, 66.5 per cent of clients told us they would have sought services elsewhere if our service had not been available. Specifically, 7.5 per cent would have presented to an emergency department or urgent care and 4.6 per cent would have sought physician care.
We will continue to seek feedback from clients about how best to serve them and to review best practices from similar services to help us continue to improve. Areas worth further examination include understanding the characteristics and needs of the 30 per cent of clients who return to see us more than once and evaluating the overall cost-effectiveness of our service. We are eager to share the SSWI model with other health-care providers. We invite our nursing colleagues and other health-care providers in the Calgary area to visit us. No appointment necessary, no referral required. You can walk right in.
A success story
During a parent-teacher interview, the father of eight-year-old Patrick was shown three drawings his son had made during art class. One drawing showed an unhappy boy in a playground, standing a long way from the other children. In the second drawing, the little boy was crying; in the third, he was holding a rope. The teacher had tried to talk to Patrick about his drawings, but the child would not talk. The teacher asked the father for his interpretation of the drawings. At the end of the interview, the teacher recommended our service to him.
When they arrived at the centre later that day, the father completed forms in the waiting room about the situation he and Patrick wanted help with. After a short wait, the two were seen by a therapist. During the session, Patrick talked about his troubles with other children at school and how lonely he felt. The father responded by telling his son about some challenges he had with peers when he was a boy and how he overcame them. Together, father and son began to develop a plan to help Patrick with his problems at school. At the end of the session, the therapist recommended two children’s books about making friends the two could read together, and she acknowledged the father’s role modelling. A few weeks later, the father spoke with the teacher. She told him that Patrick was happier at school and that his art projects no longer had pictures of a sad boy.
Sandy Harper-Jaques, RN, MN, RMFT, is a therapy specialist at the Northwest Community Mental health Centre. Until July 2014, she was Clinical Nurse Specialist and Clinical Supervisor at the Adult Mental Health and walk-in clinics, South Calgary Health Centre, Calgary.
Jacqueline Simms, RN, BN, MN, is Clinical Operations Manager, Adult Mental Health and walk-in clinics, South Calgary Health Centre.