October 23rd | 5:30 – 8:00 pm

2 Mainpro+ Credits

SCOPE = Seamless CareImproved Access to Specialist Directory, MSK

Support, Mental Health & Addictions Resources, and Pharmacy Consultation

Agenda

2

5:30 – 5:45 Dinner and Networking

5:45 – 5:55Welcome and Introductions

Dr. Pauline Pariser – Clinical Lead, Mid-West Sub-Region

5:55 – 6:25MSK - Rapid Access Clinic (RAC) Low Back Pain

Miriam Vanmeurs, Shama Umar – Toronto Central LHIN

6:25 – 6:55Pharmacy Consultation

Lisa McCarthy, Andrea Calvert, Kate Walsh – Toronto Central LHIN

6:55 – 7:15 Break-Out Session

7:15 – 7:30Specialist Directory

Jane Williams, Cynthia Djaja Putra – UHN Digital

7:30 – 7:50Mental Health & Addictions Resources

Hannah Matthews – Canadian Mental Health Association

7:50– 8:00Closing Remarks

Dr. Pauline Pariser

Welcome

Dr. Pauline Pariser

Clinical Lead, Mid-West Sub-Region

SCOPE Physician Lead

3

eVisit Primary

Care Initiative

Proof of Concept Model

@

Patient logs into

application, inputs

symptoms

Available physician can connect with patient

through a variety of modalities, provides diagnosis

and treatment; patient EMR updated with

encounter.

Physicians to respond within 2 business days.

Physician may provide follow-up in-person

care or order laboratory tests

Patient can view notes and

instructions

Same Day or

Next Day

1

2

3

Secure Video,

Messaging &

Voice/audio

Key Principles

6

Principles

Sustainability Within our publicly funded system

Quality Care Support continuity of primary care and importance of the patient-provider relationship

Discourages patients seeking outside use (walk-in clinics, Emergency) for primary care needs

Accessibility Patient centred care; supports “Patients First”

More convenient and timely access to same day/next day care

Measurable Evaluate the need and demand for the service

Can be evaluated against metrics and indicators to show efficacy and safety

Regional Regional coverage model

Strengthen professional relationships, trust and mentorship

Aligns with LHIN and sub-region Primary Care planning

Proof of concept – status update*

7 *September 17, 2018

4 LHINs are currently using eVisit Primary Care

Central West LHIN – Live Sept 2017 Waterloo Wellington LHIN – Live

Mar 2018

Central East LHIN – Live Jul 2018 Mississauga Halton LHIN – Live Aug

2018

43 providers enrolled

(Target 40 providers)

40 providers enrolled

(Target 75 providers)

13 providers enrolled

(Target 40 providers)

26 providers enrolled

(Target 40 providers)

1,887 patients invited 9,625 patients invited 510 patients invited 450 patients invited

894 eVisits completed 1,502 eVisits completed 20 eVisits completed 21 eVisits completed

Remuneration

8

Participation Clinical visit

$1800 for participation in pilots meeting the following criteria:

o Participation in clinical/program model development

o Enrol 200+ patients per participating physician

o Adopting and adjusting workflows as new models are

trialled and adjusted

o Pre- and post- demonstration survey

o Pre- and post- demonstration interview

o Data collection requirements

Billing codes:

o Phone/messaging – minor assessment - $15

o Phone/messaging – intermediate assessment – $21.70

o Video – minor assessment –$21.70 (A001 equivalent)

o Video – intermediate assessment –$33.70 (A007 equivalent)

Secure video is a two-way synchronous visit so it is billable at the same

rate as an in-person visit Intermediate

Secure messaging, voice and phone, is an asynchronous visit and there

are new fee codes for the pilot only

FHN/FHO physician visits (with

their own rostered patients)

BSM (i.e., FHT)

physician visits (with their own

rostered patients)

FHN/FHO/BSM physician visits with

patients not directly rostered to the

physician

FHG physician visits CCM/FFS physician

visits

Other

Shadow billing rate (15%) Shadow billing rate (15%) Full rate (100%) Full rate (100%) Full rate (100%) TBD based on individual

contract

Timelines and Targets

Minimum 40 physicians to participate

o Enrolled by November 2018

Each physician to invite minimum 200 patients

o Invited by December 2018

Physicians and patients will be onboarded until end of March 2019

o MOH LTC will then receive and review 3rd party evaluation report from WCH

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What impact is eVisit having on you?

“Benefit: some of patients who I normally see in office for f/u or managed by phone I can now do more efficiently by

eVisit, this is a big benefit.”

“Decrease back and forth with staff! Huge Increase in efficiency. Patients are happier to interact with doc not with

an admin. My admins are happier too “

“Ability to do it at my own time. I don’t feel like I am always connected. If I have time, I can quickly answer a question

during lunch. Having a text come in that I have a new visit is great, as I can check it and know if I need to respond or if it

can wait.” “I have so many examples. I think my

postpartum depression and my

support to her is a good one.

It also is good for follow up instead of

bringing patients back for their

results.”

“For patients it makes them feel that their needs

were addressed without the need to come down

to see me.”

What impact is eVisit having on your

patients?

“Instead of Coming in they have the ability

to get questions answered quickly and an

avenue to get to me. Nobody has abused it

thus far. Only had to f/u up with two

patients after an eVisit by phone as it was a

complex question and it was easier to talk

to them.”

“Patient say they Like the ability to reach

out to ask simple questions or have their

f/u appointment done this way. “

“Patient has two kids, both kids have

taken a pictures and tract over time. Had

a mole took a picture every week and it

was fine. This was great, as the patients

didn’t have to come into the office”

“I have 2 patients tell me

how much they love this. It is

more our generation, busy

and cannot come in and

their needs are minimal”

What Providers are saying about EAPC eVisit

Rapid Access Clinics for Low Back Pain

(RAC LBP)

October 23, 2018

Musculoskeletal Project: Toronto Central LHIN

• Evidence shows that the need to address access to care for patients with Musculoskeletal (MSK)

conditions is growing. Wait time data shows that patients with MSK conditions spend the most time

waiting to access health care services, such as MRI, even though they may not be the best options for

them.

• Rapid Access Clinics (RACs) for MSK conditions will allow patients to receive appropriate care sooner,

reducing unnecessary wait times and making the best use of existing resources.

• Specialists receive more appropriate referrals which allow for more predictable practice and improved

wait list management. Also, Ontario’s health system will become more sustainable, with improved access

to appropriate and high quality care.

12

Musculoskeletal Project: Evidence for Action

Prevalence:

• 1 in 3 adults are affected by MSK diseases (e.g. arthritis, repetitive strain injuries), which will only grow as the

population ages

Surgical Utilization:

• MSK surgeries account for 15% and represent the lowest % completed within target, of surgical procedures in

Ontario

Opioid Dependency:

• Timely access to appropriate MSK services reduces the incidence of unnecessary opioid prescriptions. Any opioid

prescription carries with it a risk of opioid dependence

Utilization:

• 3.1M Ontarians made 8M outpatient visits associated with MSK in 2013/14 (5.6M were primary care visits, 560K

ED visits)

• At least 37% of MRIs in the province are ordered for MSK conditions

Clinical Appropriateness:

• Evidence for sustained reductions in inappropriate utilization (e.g.. Low back pain pilot in three sites saw

$500K/year in costs avoided in reducing imaging)

• Aging population will continue to require procedures that are clinically appropriate

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The Transition from ISAEC to RAC LBP

• The Inter-professional Spine Assessment and Education Clinics (ISAEC) program was a pilot that has been in

place in the Toronto Central LHIN at University Health Network (UHN) since 2012.

• ISAEC Success Rates:

• 12 days is the average wait time for initial assessment

• Less than 6 weeks wait time to surgical assessment

• More than 96% of patients referred for consultation with a surgeon were surgically appropriate

• Less than 4% of ISAEC patients have gone on for specialist intervention

• Greater than 30% decrease in MRI utilization within the ISAEC network

• Less than 7% of patients have gone on to imaging or specialist intervention

• The ISAEC program is being expanded across the Toronto Central LHIN and will be referred to as Rapid

Access Clinics for Low Back Pain (RAC LBP) moving forward.

• Three additional hospitals that undertake spine surgery will receive referrals as part of the RAC LBP program:

1. Providence, St. Joseph’s and St. Michael’s Healthcare (St. Michael’s Hospital site)

2. Sunnybrook Health Sciences Centre

3. Michael Garron Hospital14

RAC LBP Pathway

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Benefits of the Model

Patients:

• Timely access to comprehensive assessment and

consultation (within 4 weeks)

• Individualized evidence-informed self-management

plans

• Follow ups for patients identified to be at higher

risk for persistent or recurrent low back pain

• Streamlined access to specialists when indicated

• Maintains Primary Care Provider and patient choice

of surgeon

Primary Care:

• One point of contact for referrals through

centralized intake

• Shared-care model with consistent patient

messaging and enhanced communication between

providers (inter-professional model)

• Primary Care Provider education and support in

low back pain assessment and management

• Patient- and Primary Care Provider-centered

resources

• Initial assessment conducted by specially trained

Advanced Practice Providers who execute the

standardized model of care

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Advanced Practice Providers (APPs)

• Skilled clinicians (Physiotherapists or Chiropractors) are the first and primary point of contact for consultation

and assessment of patients referred into RACs for LBP, and are responsible for delivering rapid patient

assessment and education for a specific population of low back pain patients, from their respective practice

location.

• They provide a defined program of care to the patient with an emphasis on education, self-management and

health promotion strategies.

• APPs will be connected to a Site Surgeon Sponsor (physician specialist) and Practice Leader (PL), based on

their location, who will provide clinical guidance and advanced LBP education

• APP practice locations can include: Community Health Centres; Family Health Teams; and other Health

Clinics within the Toronto Central LHIN

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Primary Care Providers (PCPs)

• PCPs who will be able to refer patients to RAC LBP are physicians and nurse practitioners.

• PCPs will refer their patients, who meet specific referral criteria and cannot be managed through primary

care, to the MSK Central Intake so they can be matched to an Advanced Practice Provider (APP) close to

home.

• This shared-care management model, emphasizes the benefits of on-going communication between PCPs

and APPs. Therefore, PCPs will be kept informed of the recommended course of treatment for

management and chronicity of LBP for each of their patients out of the LBP RACs.

• PCPs must be enrolled to the RAC LBP program in order to refer patients. This entails the completion of

a short online on-boarding and registration module.

• This module has been created to familiarize PCPs with both the ISAEC model of care, inclusion and

exclusion criteria, and the referral process. It will support education on MSK clinical pathways,

including initial assessment and management and includes information about red and yellow flags as

well as low back assessment. The module only takes approximately 15 minutes to complete.

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Primary Care Providers (PCPs)

• Once PCPs have completed the module they are enrolled into the program and will receive a RAC LBP

referral form.

• PCPs will receive communications once the RAC LBPs are ready to accept referrals in their sub-

region so they can enroll into the program. This will include a link to the online module. In addition,

they will also receive materials to support referral of their patients into the program.

• PCPs can expect to begin referring their patients into the RAC LBP in early 2019. This will likely begin

with the West and Mid-West sub-regions.

• PCPs who are interested in enrolling into the program are encouraged to join a waitlist via the ISAEC

website. Once the program is available in their sub-region these PCPs will be contacted directly with

enrollment details. To be added to the waitlist visit: http://www.isaec.org/how-do-i-obtain-referring-

privileges.html

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Contact Information

• Toronto Central LHIN Lead for LBP Pathway

• Shama Umar, Senior Consultant, Performance Management: shama.umar@tc.lhins.on.ca

• Visit the ISAEC website for additional program information and resources for both patients

and providers at www.isaec.org.

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SCOPE Pharmacy ServicesAccess to pharmacists’ drug therapy expertise for you and your patients

Disclosures

• Presenters: • Andrea Calvert, Lisa McCarthy, Kate Walsh

• Relationships with commercial interests:

• Grants/Research Support: N/A

• Speakers Bureau/Honoraria: Lisa McCarthy has received travel expenses for speaking on behalf of deprescribing.org

• Consulting Fees: N/A

• Other: N/A

Reduce serious medication-related harm by 50% in 5 years

Problematic Polypharmacy

• More medications than needed, or for which harm outweighs benefit

Extent of the Problem

• In 2016, ~2/3 Canadian adults aged > 65 yrstook 5 or more prescription medications

• 26.5% took 10 or more

• More drugs if: aged > 85 yrs, live in low-income or rural/remote neighbourhoods

• Each additional medication for an Ontario senior increases risk of hospitalization by 2-3% after controlling for health status and other confounders

Canadian Institute of Health Information 2018

Allin et al. Health Services Res 2017;52(4)

Potentially Inappropriate Prescribing

• Women > men

• In 2013:• $419 million spent ($75 per Senior)

• $1.4 billion in extra health system costs

• In 2016: • 49.4% of Canadian seniors had at least

one claim for a potentially risk drug (on the Beers list)

Morgan et al. CMAJ Open 2016

Canadian Institute of Health Information 2018

Rational Prescribing

• WHO Definition:• The situation in which patients receive medications

appropriate to their clinical needs, in doses that meet their own individual requirements for a sufficient length of time, with the lowest cost to them and their community

• Traditionally, emphasis has been on how to initiate therapy, less focus on when to stop or back off

De Vries TP et al. Guide to good prescribing. Geneva: World Health Organization, 1994

Deprescribing

The planned process of reducing or

stopping medications that may no

longer be of benefit or may be causing

harm.

The goal is to reduce medication

burden while improving quality of life.

Acknowledgement:

www.deprescribing.org

Deprescribing

Is part of good prescribing - backing off

when doses are too high, or stopping

medications that are no longer needed.

By necessity, deprescribing (and [by

extension] rational prescribing) involves

EVERYONE (people, caregivers, health

care providers, policy makers etc.)

Acknowledgement:

www.deprescribing.org

Start Local

•Opportunity!•Pharmacy Services for SCOPE

•Partners

SCOPE Pharmacy Services - Principles

1. Compliments, not duplicates, services offered by community pharmacists.

2. Prioritizes the primary care provider-person-community pharmacist relationship.

Potential Differences From Existing Community Pharmacy Services

• Liaise about but do not provide dispensing services• Compliments MedsCheck, Pharmaceutical Opinion programs and other services offered

• Time for a “deeper dive”• Pharmacists with advanced practice credentials and experience

• Links to other system resources e.g., advanced adherence support, supplies

• Offering home visits

Proposed Offerings

Medication

Information

Focused

Assessment

Comprehensive

Medication

Review

Comprehensive Medication Review

• GOAL: Right medication(s) with the right(s) dose at the right time(s)

• For each medication, pharmacists aim to ensure:

• a known and valid indication

• maximized efficacy

• safety

• optimized adherence

• Written recommendations to PCP and patient with discussion of implementation plan

Focused Assessments

• Patient-specific inquiries about a particular drug or disease state

• Examples:• Suspected adverse drug reactions

• Management of drug interactions

• Deprescribing and personalized tapering protocols

• Adherence reviews

• Medication-related causes of symptoms e.g., syncope, falls

• Pharmacogenomics

• Antibiotic recommendations

• Pain management

• Drug use in pregnancy and lactation

Medication Information

• Different from focused assessment in that usually not patient-specific

• Requires review of current evidence • Examples:

• Recommend a particular agent or administration schedule

• How does the new direct oral anticoagulant/antihyperglycemic/new agent compare to others in its class?

• Evaluate the risk of a theoretical drug interaction

• Quantify the incidence of an adverse drug reaction

• 89 year old female living alone

• Multiple comorbidities including CAD, newly diagnosed diabetes, sleep apnea, osteoarthritis

• Polypharmacy w/ many OTCs and supplements

• Rarely leaves the house due to pain and poor mobility

• Patient had concerns about her dependence on sleep aids, multiple medications

• Referral to assist with deprescribingCase 1

Photo by Bruno Aguirre on Unsplash

Interventions

• Developed oxazepam taper schedule, routine phone check-ins and follow up visits for monitoring and support

• Regular progress updates sent to primary care provider

• Worked with primary care provider to stop/ reduce several supplements

Patient outcomes

• Oxazepam stopped after 5 month taper, now starting acetaminophen-oxycocet taper

• Patient reports she is a new person: motivated, increased energy and mental clarity

• Reduced pill burdenCase 1

• 76 year old female living alone

• Multiple comorbidities including hemodialysis 3x/wk, carpal tunnel syndrome, osteoarthritis, insomnia

• Medications blister packed, regimen is QID

• Personal support worker (PSW) 14hr/wk

• Referral for medication adherence concerns (tablets on the floor, ‘stashes’ of loose tablets in containers, blister packs not finished)

Case 2

Photo by Jorge Fernández on Unsplash

Interventions

• Identified cause of adherence issues

• Trialed medication reminder device

• Worked with dialysis unit to reduce pill burden, provide updates on prn pain medication usage

• Worked with community pharmacy to pick up unused medication, simplify medication regimen in blister pack

• Joint home visit with PSW supervisor to develop care plan to assist client with blister pack

Patient outcomes

• Reduced pill burden

• Significantly improved medication adherence

• Maintained a level of independence with medication administrationCase 2

1. What medication-related issues would you like addressed so that you have time to more efficiently manage your patients?

2. Based on the potential service offerings we described…• Are there any that are more or less

appealing to you? Why?

3. With a patient in mind…• What information, resources, or

processes would you need to experience a seamless referral for SCOPE Pharmacy services?

Breakout Session

Breakout

42

RAC for Low Back Pain

1. Do you anticipate any push back from patients

when recommending that they be referred to this

program vs. directly for imaging/surgical consult? If

so, what would you need to support that

discussion?

2. What are the most important facts about the RAC

LBP program that should be highlighted when

informing and engaging primary care? Was there

any information that was lacking from this

presentation that you would have found more

helpful?

3. What would you find helpful to support a discussion

on RAC LBP with your colleagues? (e.g. one-pager, a

pamphlet, link to a website, FAQs, etc.)

43

1. What medication-related issues would you like

addressed so that you have time to more

efficiently manage your patients?

2. Based on the potential service offerings we

described, are there any that are more or less

appealing to you? Why?

3. With a patient in mind, what information,

resources, or processes would you need to

experience a seamless referral for SCOPE

Pharmacy services?

Pharmacy Consultation

Breakout Session

Specialists and Community Services DirectoryOctober 23, 2018

Prepared for: SCOPE meeting

Project Background

• The Specialists and Community Services Directory was created as a centralized and sustainable online directory to support PCPs in finding regularly updated and complete information on specialists and community services in the Toronto Central LHIN.

• The Directory went live on June 29, 2018, and is accessible by an early adopter group of 25 primary care providers and existing OTNHub members.

• Data Sources:

Data Provider Type of Data

eHealth Ontario’s Provincial Provider Registry (PPR)Specialists Data

Hospital data exports (CMaRS extracts)

Thehealthline.ca Information Network Community Services Data

What have we done since going live?1. Evaluate the Directory based on Early Adopters’ feedback and use outcomes to inform next steps2. Continue to enhance the Directory based on user feedback (e.g. data quality, usability)

45

7%

86%

7%

Neutral

Somewhat Useful or Very Useful

Somewhat Not Useful

Yes No

Recommend Directory to Colleagues

72%

7%

21%

Satisfied

Somewhat dissatisfied

Neutral

Overall Directory Satisfaction

Evaluation Outcome

To assess usability and readiness of the Directory for broader use

Goal

Survey Completion Rate

87% 80%

Usefulness of Information in the Directory

46

Early Feedback from Early Adopters

“It works well. Great job!”

“This is exciting!”

“The directory is intuitive and the community service section is good.”

“I think this is a great start. It will become more and more useful as extra providers are added”

“This is a great start; data accuracy will be key.”

“I think that word will spread as this is a very useful too that is much needed.”

“I like the layout, and navigation is straightforward.”

“Finally a team got it right and best piece of software I’ve seen delivered.”

# Early Adopters Feedback Category

1 Expand specialists and community services data beyond Toronto Central LHIN

Data Quality

2 Provide more accurate wait times information for all specialists

3 Obtain more fulsome contact information

4 Reduce duplication of specialties under guided search (e.g. hematology vs. haematology, pediatric vs paediatric, etc.)

5 Enable a more streamlined login and access (e.g. too many clicks to login)

Usability

6 Allow user to filter based on proximity/distance to an address for specialist search

7 Improve sorting of specialist profiles (e.g. alphabetically, wait times, etc.)

8 Default the type of service offered in guided search to “Office Referrals”

9 Integrate with other systems (e.g. EMR, referral system)

10 Enable directory to view location in Google Maps in a separate tab

11 Improve clarity of typeface (e.g. use more contrasting color)

Table below captures improvements or enhancements suggested by early adopters during evaluation.

Feedback on Improvements

48

Directory DemonstrationLink: https://directory.otn.ca/#/

49

1. Would you use the Directory in your daily practice?

2. Would you recommend the use of the Directory to your colleagues in its current state, knowing that it will continue to improve in terms of usability and data quality?

Discussion

50

Focus on improving quality of data in the Directory and preparing for the public view

Strategize on communicating the Directory to broader PCP group

Next Steps

51

Questions?

52

Big White Wall and BounceBack: Free psychotherapy services for adults and youth with mild to moderate depression and anxiety

Hannah MatthewsCanadian Mental Health AssociationOctober 2018

Funded by the Government of Ontario

Meet Sarah

• 30-year-old new mom• Has difficulty coping with motherhood• Reports sadness, low energy, anxiety, sleeping

problems to primary care provider at checkup• Is diagnosed with mild to moderate

depression• Is prescribed cognitive behavioural therapy

(CBT) without medication• Incurs long wait time to access in-person

counselling

Sound familiar?

Good news for more than 60,000 Ontarians

Primary Audience: Family Doctors and Nurse Practitioners in Ontario

These two self-help psychotherapy services are available now

Big White Wall (adults and youth 16+), an online peer support and self-management tool, coordinated by the Ontario Telemedicine Network (OTN) *Service available in English only

BounceBack® (adults and youth 15+), a telephone coaching program, managed by the Canadian Mental Health Association (CMHA) Ontario and CMHA York and South Simcoe

Client considerations forself-help psychotherapy services

• Client’s age• Level of depression or anxiety (must be in the

mild to moderate range)• Therapeutic treatment options• Client’s motivation level• Client’s profile

BounceBack

BounceBack:Background

• Developed by Dr. Chris Williams, a psychiatrist at the University of Glasgow in Scotland

• First adopted by CMHA British Columbia in 2008. Since then, more than 40,000 clients have been referred

• Two years ago, CMHA York and South Simcoe piloted the program in Ontario, with funding from the Central LHIN

• In October 2017, as part of the Government of Ontario’s investment in psychotherapy services, BounceBack was launched across Ontario

Developed by Dr. Chris Williams, psychiatrist, expert in cognitive behavioural therapy,Professor of Psychiatry at the University of Glasgow.

BounceBack:The approach

BounceBack:Offers two types of help

BounceBack telephone coaching and workbooks (referral required)

BounceBack Today online videos (no referral required)

1

2

BounceBack:Telephone coaching & workbooks

Telephone coaching using skill-building workbooks:

• Referral is primarily by family doctor, nurse practitioner, or psychiatrist

• Clients can also self-refer• Clients are called within 5 business days of referral being

submitted• Coaches conduct 3-6 sessions with clients using workbooks

chosen collaboratively and based on clients’ current needs• Popular workbooks: Being assertive; Changing extreme and

unhelpful thinking; Overcoming sleep problems• Coaching is available in more than 15 languages

BounceBack:Workbooks

BounceBack:Short format & youth booklets

Adapted content for youthShort format with less text

BounceBack:Telephone coaching & workbooks

• Coaches are not counsellors, but trained in educational and motivational coaching

• Coaches assist clients with skill development, provide motivation, and monitor progress

• Coaches are overseen by clinical psychologists• Coaches assess and monitor clients for risk of harming themselves or

others on every call• Primary care providers are clinically responsible for client care and are

kept informed of client progress

Initial Contact(within 5 business days of referral)

Session 1 Assessme

nt(within 2 weeks of

initial contact)

Close case, post-program scores, letters sent to participant and referrer (30 min)

Session 2(2-3 weeks

from S1)

Sessions3-6

(2-3 weeks between sessions)

Completion Session

(2-3 weeks from final session)

Booster Session

(within 6 months of completio

n)

Further support, reinforce skills (15-30 min)

Coaching, send next workbook(s) (15-20 min)

Coaching, send next workbook(s) (15-20 min)

Eligibility assessment & pre-program scores + send initial package including introductory workbooks or short format booklets & a short letter to referrer (45 min)

Establish contact & confirm contact details (If unreachable, letters sent to referrer and client)

BounceBack:Client journey

BounceBack:Online videos

BounceBack Today online video series:

• Offers practical tips on managing mood, sleeping better, building confidence, increasing activity, problem solving, healthy living

• Available in English, French, Mandarin, Cantonese, Punjabi, Arabic, and Farsi

Watch videos at:bouncebackvideo.ca(access code: bbtodayon)

BounceBack:Evidence-based benefits

Pilot program in CMHA York and South Simcoe with 461 clients who completed the program from August 2015 to December 2017 showed coaching-program effectiveness:

Depression and anxiety

decreased by almost 40%

11.610.6

7.2 6.5

0

2

4

6

8

10

12

14

Pre-BounceBack Post-BounceBack

Patient Health Questionnaire(PHQ-9; depressive mood)

Generalized Anxiety Disorder(GAD-7; assessment scale)

BounceBack:Benefits

Satisfaction survey conducted by CMHA York and South Simcoe with119 clients who completed BounceBack showed:

would recommend BounceBack to a friend or family member

92%found the CBT workbooks easy to read and helpful

94%liked receiving the service by telephone

95%

Referral form can be accessed or submitted online at: bouncebackontario.ca

Suitable for clients:• 15 years or older• With mild to moderate depression (PHQ-9) score

between 0-21 (with or without anxiety)• Not at risk to harm self or others• Not significantly misusing alcohol or drugs• With no personality disorder and no psychosis or manic

episodes within the past 6 months• With sufficient concentration and motivation to

engage in the program

For telephone coaching + workbooks (referral required)For online videos (referral not required)

BounceBack:How to refer

BounceBack:Who to contact

For more information on BounceBack or to access the referral form or resource materials:Visit: bouncebackontario.ca

Questions about telephone coaching or referral form:Contact BounceBack team at: 1 (866) 345-0224

Questions related to marketing opportunities:bounceback@ontario.cmha.ca

Big White Wall

Big White Wall: Origins

• Developed in the UK in 2007 by Psychiatrist Dr. Jenn Hyatt• Since 2007 has been offered in UK, USA, New Zealand and Canada (Ontario)• Over 60,000 members since 2007• Supported by multiple clinical trials, peer review journals and user survey results• Numerous awards including finalist in innovation mental health and best European

Union eHealth solution 2014

Big White Wall: Meaning

• “Big” recognizes the infinite nature of human

emotion;

• “White” conveys the blank canvas that the site

provides members to express themselves;

• “Wall” symbolizes shelter and support, as well as the

barriers we sometimes need to break through to

improve emotional health.

Big White Wall: What is it?

Self–register and Interact with a supportive

community where everyone’s voice counts

Freely express your thoughts and feelings with

unique creative outlets

Learn from smart programs and useful resources

that help you understand and feel more confident

Feel secure in an anonymous space where your

identity is completely private

Paid for by the Government of Ontario and

moderated 24/7 by mental health

professionals who ensure that members are

safe. Also supported by clinical analytics

Big White Wall is a 24/7 anonymous online

mental health service for mild to moderate

anxiety, depression and other related conditions

Big White Wall: Proven Effectiveness

Study conducted by Big White Wall revealed:

of clients saw improvement in at least one aspect of their well-being

70% 1 in 2clients reported sharing an issue for the first time

35%of clients experienced mental health-related absence from work; 51% of those clients reported that using Big White Wall reduced their time away from work

Big White Wall: Proven effectiveness

Clinical research study led by Women’s College Institute for Health Sciences and Virtual Care (WIHV) included participants from Lakeridge Health, the Ontario Shores Centre for Mental Health Sciences, and Women’s College Hospital revealed in some users who were consistent in using the solution:

A decrease in levels of reported depression and anxiety

An increase in perceived mental health recovery, which includes self-rated ability to self-manage

Client Consideration for Suitability

• 16 years and older with mild to moderate depression and anxiety

• low risk of suicidal ideations or self-harm

• Basic level of literacy and comprehension

• Access to a phone or computer with Internet

• Support clinicians/counsellors as an adjunct to face-to-face individual therapy

• Use as a bridge for wait times

• Clients looking for after-hours mental health support

• Newly Diagnosed Clients seeking support from a non-judgmental anonymous community

How to Refer

• Low staff intensity - provide leaflets & wallet cards to clients. Posters also available

• Clients self-register by visiting www.bigwhitewall.ca (enter email, user name and password)

• Any questions clients can email theteam@bigwhitewall.ca.

• Staff are not expected to deal with any questions related to sign up and use of BWW

Big White Wall: Who to contact

For more information on Big White Wall or to request resource materials:Email: bigwhitewall@otn.ca

Questions related to presenter opportunities:Contact Harriet Ekperigin at hekperigin@otn.ca

Thank you! Any questions?

Closing Remarks

Dr. Pauline Pariser

83

Thank You!