By Dr. Christopher Kowalski, MA (Cantab), MBBS, MRCPsych, FHEA
Dr. Christopher Kowalski is a child and adolescent psychiatrist from the U.K. who is undertaking a simulation fellowship at the Medical Psychiatry Alliance. In particular, he is working with the simulation team at CAMH to explore new and exciting ways to use interprofessional simulation to educate health care professionals who work with clients who have mental health needs.
The Medical Psychiatry Alliance’s goal is to transform the delivery of mental health services for patients who suffer from physical and psychiatric illness or medically unexplained symptoms. It is a collaborative health partnership between CAMH, The Hospital for Sick Children, Trillium Health Partners, and the University of Toronto, as well as the Ontario Ministry of Health and Long-Term Care and an anonymous donor.
Last June, I had the pleasure of working with the Medical Psychiatry Alliance’s (MPA) simulation team at the Centre for Addiction and Mental Health (CAMH), to adapt a training course that I had developed in the U.K. for a Canadian audience. My original course, which had the somewhat unattractive name of SWAMPI-CYP (Simulation Workshop at the Mental-Physical Interface—Child and Young People), was designed to help those working with young people who have both physical and mental health needs to feel more capable of doing this kind of work. It was a unique course in that it was designed to replicate interprofessional working around such cases, as well as replicating the cases themselves.
What is simulation?
For those not familiar with simulation, it is the re-creation of clinical events in a safe manner for the purposes of education or training. It involves using special suites or centres that resemble clinical spaces and, in the case of simulation for mental health education, having actors portray patients and/or relatives. Difficult clinical scenarios are followed by an in-depth debrief that draws out learning for all those involved or observing.
To do this in an interprofessional manner means bringing together a number of professionals from different clinical backgrounds and specialities so that these individuals can learn with, from and about each other. In this way, we can seek to address some of the barriers to effective health care, namely poor collaboration between health care teams and across health care systems.
Developing the course for the Canadian health care system
The team at Maudsley Simulation, where SWAMPI-CYP was developed, has had a lot of success with the course in the U.K. so I was optimistic about how the ideas would translate to the Canadian context. When I arrived in Canada, I was pleased to find that the CAMH Simulation team and their MPA collaborators at The Hospital for Sick Children and Trillium Health Partners had embraced the course and were making it their own. Whilst it can be difficult to let go of a course you have spent considerable time developing and nurturing, it made absolute sense for those working on the project to adapt the original SWAMPI-CYP to fit the needs of the MPA, and so I was more than happy to give them my blessing.
The resulting course was christened ISPEACC-CY: Interprofessional Simulation Experiences across the Care Continuum—Child and Youth. Whilst ISPEACC-CY has the same broad objectives as SWAMPI-CYP, it differs in a significant way. By adopting a unique approach to course design, the developers have been able to re-create some of the difficulties faced when clients are seen across a number of health care settings throughout their journey. This is achieved by having scenarios featuring the same client set in different organizations.
We know that fragmented health care systems have a significant impact on health outcomes, especially when clients require both physical and mental health care input, and by designing the course in this manner, we were able to draw out these issues and work with the participants to generate solutions.
Delivering the course
Course delivery day was an extremely pleasurable and educational experience. As a fairly competent simulation debriefer, I was more than happy to be involved in the running of the course on the day. In particular, I found the discussions in the scenario debriefs fascinating, in part due to my not being overly familiar with Ontario’s health care system yet.
Many of the difficulties encountered in day-to-day practice—around team-working, cross-organizational communication and clinical responsibility—were highlighted and participants genuinely seemed to find the course engaging and useful. Having a number of physicians, nurses and social workers around the table made for rich and detailed discussion, and it was clear that each individual was learning new things about the others.
The scenarios themselves were particularly unique and included:
- A young person attending a family health team at Trillium Health Partners with symptoms of anxiety who is later found to be suffering with an eating disorder on attendance of the SickKids emergency department.
- A young person with Type 1 diabetes and cannabis use disorder attending a Trillium community diabetes clinic with poor glycaemic control, who is later found to be having a diabetic ketoacidotic crisis whilst on the CAMH youth concurrent disorders unit.
- A young person presenting to the outpatient pain clinic at SickKids who is found to be self-harming, the context of which is later explained during a visit to the CAMH emergency department.
These are particular complex scenarios to pull off and our actors, following rigorous preparation, did a sterling job.
What’s next for ISPEACC?
The next steps for ISPEACC is to roll out the course so that it can reach more health care professionals across Toronto and Ontario. This will start with a second date at SickKids in the fall and then more course dates across each of the MPA partner sites in the near future. I am very much looking forward to seeing how the course develops and, based on the success of the first delivery date, am confident that it will have a significant impact on improving the care of young people with complex physical and mental health needs.
If you would like more information about the ISPEACC course or the CAMH Simulation Team, please contact: firstname.lastname@example.org.
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