PROMISING PRACTICES
A Podcast about Mental Health and Addictions

Episode 11: New Brunswick

Episode 11: Clinical Framework Model from the Acadian Peninsula (NB)

June 2, 2021 – New Brunswick’s award-winning Clinical Framework Model helps to provide better mental health services to young people with complex needs. It allows for a strategic approach where the intention is to identify the clinical interventions that best meet the needs of the young person and their family.

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Loretta O’Connor: Welcome back to Promising Practices, a podcast on mental health and addictions brought to you by Canada’s Premiers. This is our eleventh episode of sharing promising practices that are underway in each province and territory.

My name is Loretta O’Connor. I’m the Executive Director of the Council of the Federation Secretariat, an organization that supports the work of Canada’s Premiers.

Today we visit the Acadian peninsula, a largely rural area in northeastern New Brunswick, named after the large Acadian population located there. Acadians are a vibrant minority Francophone culture known for their unique music and art, their delicious food, and their deep sense of community.

Let’s welcome the Premier of New Brunswick, Blaine Higgs, to introduce the Acadian peninsula’s success with the Clinical Framework Model developed to support child and youth mental health.

Premier Blaine Higgs: Hi, I'm Blaine Higgs, Premier of New Brunswick, and I'm pleased to join Canada's Premiers in the Council of the Federation's podcast series on mental health and addictions, alongside my Minister of Health, Dorothy Shephard, and our Department of Health’s Addictions and Mental Health Team. This podcast episode is unique as it features New Brunswickers, who have either played a role or have received support from our Clinical Framework Model in the Acadian peninsula. The Clinical Framework Model helps to provide better services to young people with complex needs by offering better supervision and optimal support to parents and adults who care for them on a daily basis. It allows for a strategic approach where the intention is to identify the clinical interventions that best meet the needs of the young person and their family.

New Brunswick has recently had occurrences regarding mental health crisis care in the province, and the Clinical Framework Model is a step in the right direction to improving population health, access and intervention supports in our province. From 2014 to 2016 compared to 2017 to 2018, we've seen strides in harm reduction and intervention since the implementation of this model. Some key indicators include a decrease of 65% in police environment of youth residing in group homes in the region. Youth with complex needs involvement with justice court proceedings is down 50%. Ambulatory transport due to risk of self-harm or harm to others is down 82%. And hospitalization for psychiatric concerns are down 65%.

In today's podcast, you will hear from our clinical team members, care partners and families who have been involved in the program. I'm proud to share this insight and valuable information about New Brunswick’s Clinical Framework Model and how it's making a positive impact in our communities.

Loretta O’Connor: Thank you Premier Higgs for highlighting how the Clinical Framework Model is supporting child and youth mental health in New Brunswick.

I would like to remind everyone listening that if you or someone you know is struggling, help is available. You can call New Brunswick’s CHIMO helpline at 1-800-667-5005 or visit www.chimohelpline.ca.  You can also call Kids Help Phone at 1-800-668-6868 or the Canada Suicide Prevention Service at 1-833-456-4566.

Next, we’ll hear from a number of people in the Acadian Peninsula who play key roles in developing and utilizing this model. From social workers to psychologists to family members impacted by the program – taken together, their voices and their stories provide a unique and compelling picture of this promising practice.

Danièle Loubier: Hello, my name is Danièle Loubier. I am a psychologist in mental health, and on the Child and Youth Team in Tracadie for the Vitalité Health Network. I also have the role of clinical consultant with Le Passage Therapeutic Facility. The development of the Clinical Framework Model was made possible by integrated service delivery, ISD, which fosters the necessary cooperation between the departments and the partners. We began to think about the best way of responding to the complex and costly needs of some of our children and youth. These were the ones who sometimes had to be sent to resources outside New Brunswick, or far from their communities, their support network, their school, and professionals with whom they had developed ties of trust. Workers in residential facilities and foster parents often had to support children and youth without the appropriate structure. We knew that if we were able to take up the challenge, our youth and children with complex needs could benefit from placements and resources in their communities, staying close to their networks and all their support persons. The idea of having work teams surrounding these children and youth, customized for each one of them, was born.

To draft the model, a partnership then went further, between Social Development – Stéphane Noel, psychologist, and Sonia Ferguson, senior social worker – and I from the Mental Health Sector and the Child and Youth Team. The work first developed from ideas that came from previous work with Le Passage / Le Complexe Savoie. The Clinical Framework Model for children and youth with complex needs then took shape. With time, other partners gave us their trust – Therapeutic Foster Families, Le Gouvernail, Maison Ted, etc.

What we dreamed of achieving was a clinical framework model in which parents would feel essential to understanding needs and in decisions. Children and youth would be able to discuss their ideas and opinions every time they felt able to, by participating in team discussions. The partners at all levels would be able to sustain each other in relation to all the stages of support. The strengths of children, their families, their network and their community would be part of the solutions. We would provide ourselves with the means to be strategic at all levels, which would include responding to crisis situations. We could focus on complex needs and dynamics rather than human beings – a child, youth or family. The idea of a customized team for every child and youth had already come to us in our work with Le Passage / Le Complexe Savoie.

The clinical consultation teams, CCT, have become one of the ways of making the model operational. As soon as it is set up in a therapeutic facility, a CCT is customized for the child or youth, and he or she will be part of it, along with the parents and informal support as needed. The frequency of the CCT’s meetings is determined by the team members in terms of the intensity of the needs, or if an emergency situation occurs. The CCT has become the ideal means of planning for the child or youth’ s return to their community after having had access to an assessment or treatment resource outside of their area. The CCT plays a role of the successes of all transitions, whether from one resource to another, one service to another, or the transition to a new stage of life, a youth turning 19 for example. The CCT makes it possible to develop an adequate knowledge of the needs and characteristics of the child or youth and their living environment.

When the model is applied in compliance with its deep-seated values, it has the power to change the placement experience for all of those concerned. It is essential to give management of the model all the human resources required. The results that my colleagues will present to you are proportionate to the respect given to the whole process of the model. Children and youth for whom life has been so hard and distressing deserve an organized response that is commensurate with their great needs at the present time. Our society awards itself by giving these young people a chance to become citizens, and perhaps also parents themselves, able to achieve their potential, feeling safe, and with a better quality of life than fate meted out to them originally.

Roland Landry: Well, hello, I'm Roland Landry. I'm a social worker at the centre. I've been working at the center for over 30 years. I'm also the manager of the Le Passage program. Le Passage is a residential environment for children who are registered with the Department of Social Development. We take children with complex needs and major challenges. We take children who may have fetal alcohol syndrome, who may have Tourette's Syndrome, autism with Asperger's Syndrome, and some who we have often supported with numerous diagnoses with intellectual delays. We work a lot with the Hart model from the Center of Excellence where they work a lot with children who have attachment problems and who have experienced trauma, because we know that most of our children have experienced a lot of trauma in childhood and in relation to mental health.

Of course, Le Passage has been there for about 35 years. As I was just saying now, I've been involved for 31 years. At the very beginning, we set up a structure, a framework. At Le Passage, it is something that fills a great need in the children and they can make progress. But we work hard, but we had a few tools and means of working with the children with respect to the therapeutic aspect. The advent of clinical consultation teams – our famous CCTs – really changed the face of the direction of Le Passage in connection with the total improvement with respect to the children's therapeutic needs, and the needs of the natural families who support the children.

The CCT model programs, you know that the majority of our children are registered with Social Development, but they have so many complex needs that they are also supported by Mental Health. So, in the past, Mental Health, we really worked more in silos. Mental Health, the psychologists, or workers who follow the child – my workers – we try to make the therapeutic plan, but it was not in conjunction with Mental Health. The schools, as best they could, decided that their child would go to school for two hours, one hour, half an hour – everyone made decisions on their own.

The advent of the CCTs, for me, with the experience I have acquired over the years, it is the best of the models that we could have in support to help the children. Not just to give them a structure, a framework for a living, it is to be able to help them cure their wounds, to be able to help them put the tools and means in place that can help them on their therapeutic path. The usual procedure we do in relation to ICT, the members of this team must make sure that the interpretations and directions adopted will be continually questioned to adjust to the reactions of the children or the parents to the events that they are faced with, both in their regressive and progressive movement or to adjust to new theoretical and clinical knowledge. The team must learn to deal with the uncertainty that accompanies constant change.

Of course, before that, we had a tendency to want to take the child, so that he or she would adapt to our environment. Now we must adapt our environment to the child. And in our clinical consultation teams, the members, we have the opportunity to have the psychologist in Mental Health supporting us, who is there to help us in the clinical orientation of the case. We can also have the psychologist who is followed by Social Development and who can be incorporated too. We have other members of Mental Health as workers. These members often help us a lot to have access to the psychiatrist. The psychiatrist often follows our children; we have more access to the psychiatrist. With the members, when we experience a problem with the child, every three weeks we hold our CCT meetings, and often the workers may have much more direct connection and take reports to the psychiatrist who can make the addition and the adjustment to the children's medication.

We also have counselors who attend these clinical meetings. We can have a social worker from Social Development; we can have, especially if it's important, the child, the parents, we can also have the extended family, maybe the grandparents, any significant family members, members of the extended family, other members of the community can participate in our meetings. We have members of the CNY teams who make a common plan. I find that the common plan is extremely relevant because there are a lot of us. There could be seven, eight, ten, twelve of us around the table discussing and revising the child's therapeutic plan. The common plan defines each person's role. Mental Health, if the psychologist has to conduct his meetings, may say what has worked with the child. If the occupational therapist is involved, they may tell us what stage they are at. How we can work and continue putting the occupational therapists, the therapeutic tools in our home; we can develop alliances and therapeutic pathways that are developed from all the resources we have access to, and we put them all together.

The duration of these meetings is between one and a half and two and a half hours. Usually the first hour, there will be a discussion between the workers to obviously define the plan and the direction. In the second hour, we will invite the family, the child, to really define the direction of what we think therapeutically and then have the parents’ opinion. The therapeutic aspect of that with respect to our children, with the major challenges they have, helps us enormously.

Our little loves, the little children we are responsible for, have so many big challenges. In the 1990s we worked with hyperactivity and it was problematic for us. Now, we don't talk about it anymore. It is the small gain that our children can make with these symptoms or live with hyperactivity disorder.  We have much bigger problems with attachment disorders and trauma that children experience that it is so complex that it takes a whole big team around these children to be able to help them add the tools to calm them down, to be able to heal certain wounds of these children, and to be able to direct and equip them for their future, to give them the means and tools so that they may grow and heal some of their wounds.

The parents often, when we can get them, most of the time when we can get the natural family or extended family or foster family, we want to have them with us for our ICT meetings. Number one: clinically, we can also support the family. Second, but it's that everyone has the same language to work with the child. And that is at the clinical level, at the therapeutic level. That is deemed essential for us, for everyone, that we all know what our roles are. We know what we're working on. We're not duplicating services, so that we're saving an enormous amount of time. The school – sometimes we can't even our workers will get involved, they will go work directly at the school. Sometimes it may happen that they don't have a worker who can support the child at recess or things like that. So, the collaborative work with the community and the other community resources, including the school, can be done and it is done in a really positive way with our children in the support we must provide.

So, for me what I'm doing and what I recommend is certainly that the therapeutic aspect of the clinical consultation teams is extremely important. Sometimes people complain that it can take a long time. No, we are saving a lot of time. We saved a lot when we did assessments using the clinical supervision model, the impact the CCT teams had on our hospitalizations. With respect to psychiatry, taking our children to other resources outside our region, we saved a whole lot of time and mobilized other resources because we are all working in partnership to meet the needs of our children.

So, to summarize a little, it's sort of like that, that we had to chat about in relation to the clinical consultation teams and we also have the opportunity to go to the ICT teams where we are going to meet with the integrated teams. Excuse me, I missed a little section on the integrated teams where they can also lead us in much more advanced clinical directions or other resources, if we want to respond to all the needs of our children. But working in partnership between the resources is the best thing we could do to help our children in the community therapeutically and clinically once again.

Sonia Ferguson: Hi, my name is Sonia Ferguson. I'm a social worker at the Department of Social Development. I'm part of the clinical team and one of the creators of the Clinical Framework Model for children and youth presenting complex needs. I am the clinical consultant for foster family and natural parents when the young person transitions toward their natural family in their community.

In January 2019, there was an evaluation of the performance of the Clinical Framework Model by the Vitalité Health Network. Here are some of the quantitative results of the evaluation. In total 49 youth with complex needs were the subject for this study for a period of four years. The data collection represents the journey of these children and youth before and after the rollout of the clinical framework. The quantitative result of the evaluation indicates that youth with complex needs, once supported by the model, begin to demonstrate a reduction in the number of police involvements, reduction in the number of youth in the system, reduction in the number of transportations by ambulance, and reduction in the number of psychiatric hospitalizations.

Several types of placements are available for youth and children with complex needs in the Acadian Peninsula. We're working in collaboration to provide a resource that meets the needs of the youth and that can also represent the lower intensity of placement. In parallel to the study, the team also observed academic improvement, decreased medication and better social skills. The evaluation of the performance pushed us to think and define more clearly the definition of success. The success of the placement process and the related clinical framework is defined not by the return of a child to their natural family. Sometimes this objectivity is impossible to achieve but by the restoration of healthy relationships between the youth and their natural family or a network of significant people.

Success is also demonstrated with the youth that develop the ability to engage in an effective academic learning process that matches their potential when the adaptive functioning has improved, when they demonstrate a better capacity for self-regulation and appropriate behavior profiles for their developmental level. When the success is developing a healthy capacity for attachment, when they feel sufficiently secure to resume the course of their developmental stage, like language, motor skills, etc.

The clinical framework for children who represent complex needs and the CCT wrap-around approach to care represent the ideal vehicle when it comes to implementing a collaborative, strength-based trauma response approach to care for youth and their family like art training, attachment, regulation and competency for children who have suffered trauma. The CCT facility, the transfer of learning, is an important investment in complex situations, to those who will remain involved in the long-term with the children or the youth.

A great emphasis is placed on reducing long-term placement and returning the youth or the child in the family as quickly as possible. The model attaches an importance to the support that is necessary for the successful transition period between the group home and the return of the child or the youth in their foster family or in their biological family. This approach is carried out by the maintenance by the CCT in the transition, and the composition of the team being adjusted according to the new context of the youth and the child. The clinical consultation team supports family and the youth to reduce anxiety regarding the transition, the CCT assures rigorous follow up, and the voice of the child and the family are heard in the common plan. Thank you.

Gisèle Breau: My name is Gisèle Breau, and I have been the Executive Director of Le Foyer Le Gouvernail Inc. and the Maison Ted in Shippagan for 26 years. For years, the lack of consultation between various sectors such as Education, Mental Health, Public Safety, the Department of Social Development, and our resources has played an important role in the emotional and mental instability of some of our young people in our resources and their families. The lack of a clinical framework in the past has done a lot of damage to our young people and their families, because their responsibilities were not adequately defined and taken into consideration. This ambiguity has caused great distress for certain and young people, resulting in recurrent admissions to a psychiatric unit or to hospital, not to mention certain police interventions owing to a lack of understanding of the same distress. When violence directed at oneself or others becomes the only way for our youth, we must recognize that our system is no longer adequate, and that changes need to be made. The clinical supervision model for children and youth has been bridged naturally to Le Gouvernail and the Maison Ted since 2016 with the addition of a clinical psychologist from the Department of Social Development.

Educators may want to make a big difference in the lives of the young people entrusted to them, but to do so they must be able to get the resources needed to attain their objectives, which was not always the case in the past. Since the implementation of clinical consultation teams, we have observed a significant improvement and a recognition of other sectors with respect to the expertise of frontline workers, that is our educators. Our employees are able to talk about their successes or challenges and get the resources needed to better focus on the needs of young people. The fact that voices of young people become a priority when it is a matter of responding to their needs, makes it easier to build the case of a solid pyramid that begins with the need to feel safe. There are times when you need to know how to adapt to prevent situations from deteriorating. Often, it is enough to temporarily add an extra employee to better supervise a young person and make them feel secure. These preventive interventions have had positive results on the number of hospitalizations and police interventions. In the past seven years, no run-aways or hospitalizations were reported. The fact that our teams are heard, and relationships of trust have been built between us, with the common goal of helping children to reconstruct the foundations of their identities, and to find a sufficient attachment capacity to continue their development in a family, is very reassuring to me with respect to the importance of these clinical consultation teams. This same team makes it possible to build a more solid safety net around young people and their families. The needs of young people admitted to Le Gouvernail, the Maison Ted, or to our apartments are increasingly complex. Yet, our success rates have been greater since the involvement of the clinical consultation teams.

The success of our interventions begins with the recognition of the needs of all participants around the same table, and if we need to change our usual paths to come to the assistance of a family, we must continue to do so without hesitation. These same teams are increasingly cognizant of the importance of having an exit plan from the beginning of the placement, because it is essential for the young person and their family to know that there is a beginning and an end to any service, and that we are only there to support them in that process. We have confidence in the future. You must know where you are going in order to continue to move forward. That is one of the foundations of the evolution of human beings. The teams now have a common language when talking about mental health traumas or attachment disorders, or even neurological challenges arising from a diagnosis of autism spectrum disorder. These challenges are no longer the responsibility of a single person, but of a benevolent team seeking to find solutions to ease the suffering and distress experienced by some young people and their families.

Stéphane Noël: Hello, my name is Stéphane Noël, a psychologist with the Department of Social Development, and I was involved in the development and drafting of the clinical supervision model for children and youth. I am currently the clinical consultant for the Foyer Le Gouvernail and the Maison Ted. I also perform full psychological assessments, or assessments complimentary to existing ones, as needed for youth who are supported by our Department of Social Development.

The members of the clinical supervision model team are assembled to discuss the model and its success. We've established some common factors that in our view, are the cornerstone of the model’s success. First, with time, it turns out that that model has contributed to the effectiveness of clinical support and strengthening of the environment’s ability to meet the needs in complex situations. Also, the main stakeholders can intervene more independently. Subsequently, each discipline and field of knowledge receives equivalent consideration. No discipline or expertise gets an advantage over the other, which means that the CCT facilitates work synergy. In other words, the concerns and opinions of all those involved in the CCT are respected, including those of the youth and parents.

Before the model was implemented, the complexity of the cases meant that the workers became exhausted from the burden of the task they felt they were carrying on their shoulders alone. In the past few years, the workers have said they have been more motivated to remain involved more continuously in complex cases. This feeling of responsibility is now effectively distributed among the primary workers on the CCT. Also, the foster families and natural parents tell the clinical consultants that they feel they are more a part of the process, that they feel supported, respected and revalued in their roles. Lastly, all the partners are more able to recognize the value of the work of each person involved. In short, the multi-disciplinary work leads to an effective combination of efforts to attain a better result.

With respect to the therapeutic approach, it is important to point out that all primary workers on the team receive training to improve youth services. Also, the CCT meetings represent opportunities for ongoing training in relation to the specific challenges of each young person. With respect to continuity of follow up, everyone present who shares the young person's environment, parents, workers, etc. at the CCT meetings has the opportunity to provide good feedback on the situation, and in relation to observations and reflections. The CCTs are therefore very inclusive for parents, regardless of the child's status, and always in the child's best interest.

The clinical supervision model facilitates the survival of the presence of the informal network of these young people to which they might often choose to return when they reach the age of majority. Because their parents have been welcomed into the CCT, they've had the chance to improve their knowledge and have had the necessary support to adjust to their children's needs. In some cases, the parents were supported to accept services for themselves.

The commitment to and the cooperation of all stakeholders in the clinical supervision model are maintained by the pace of the regular meetings of the CCT. For example, sometimes the staff of the therapeutic facilities, including foster parents, go home to resolve a crisis situation that occurred during a visit. This procedure was made possible by the clinical support existing in the Acadian Peninsula, which is a contrast from a previous method in which a young person was accompanied to the therapeutic facility if he or she had a meltdown at home. This new method brings several positive results. The parents and the young person experience the crisis situation, its resolution, and a return to calmness in an environment made safe by the staff of the therapeutic facilities, having gone to their home at their request. Each one in turn, parents and youth, find some learning to do and evolves in their development and achievement of their potential.

The CCT is concerned with being as transparent as possible toward parents and members of the extended family involved, while prioritizing the best interests of the child or youth. In addition, the supervision provided by the model makes it possible to keep these young people in therapeutic facilities in their community near their formal network, thus facilitating a gentler transition to the best family environment for them in their area. The clinical supervision model truly enables young people to be admitted less often and for shorter periods to very costly resources far away from their original living environment.

In conclusion, I want to emphasize that the implementation of this clinical supervision model could not have been achieved without the leadership and unconditional support of Reno LeBouthillier and André Gionet, our managers at the DSD and Mental Health Services.

Pierrette Desfonds: Hello, let me introduce myself, Pierrette Desfonds, foster parent for 30 years now. I'm going to tell you about my personal experience with one of my youth who has been living with us for seven and a half years. When he arrived, he was 10 years old. He had been living in a group home, Le Passage, for two years. After a two-year placement under constant supervision, his functioning was stable enough for him to be transferred to a foster home. The youth wanted to have a family. His parents were involved and kept hoping they'd be able to get him back, but they were unable to offer him the supervision, structure and consistency he needed.

The foster care social worker approached us to explore the possibility of our taking him in. After reading over his file and the reports outlining his various diagnoses, i.e., attention deficit disorder with impulsivity, oppositional disorder with provocation, conduct disorder, mood disorder and learning disorder, we nonetheless decided to go ahead and provide him with a family. During the first month, not going to school and also being in the honeymoon period, the youth integrated well into the family despite a few hiccups. Everything changed when he started school. He exhibited violent and aggressive behavior at school, on the school bus and at home. He even ran away a few times.

We lived with his periods of instability for three years. We tried to find solutions with the Social Development social worker, who was responsible for the youth, but we were unable to stabilize him. After we requested an appointment with a psychiatrist in Bathurst to have his medication adjusted, the situation got even worse. He tried to throw himself out of the car, and he even said he might harm me because he wanted to go to jail. I had to promise him that I would take him to visit the jail so he would calm down in the car. I should mention that this is a two-hour drive from my home to the psychiatrist's office. I had to keep calm for the duration of the drive. Once back home, he became even more violent. I had to call 911 and they took him to the psychiatric unit at the Bathurst Hospital. He was hospitalized for seven days to have his medication adjusted.

Back home, it was still not easy. Tantrums, no schoolwork, no return to school. The Social Development social worker responsible for my youth explained to me that they were going to set up a clinical consultation team because we needed to find solutions. His placement with us was becoming increasingly fragile. We wanted some help, so he could continue to live with us and so we could have a better quality of life. The social worker told me we were going to be the first foster family to have a clinical consultation team or CCT. So, they set up a clinical consultation team.

At the first meeting, when I saw all those people around the table – the youth social worker, the psychologist, and the social worker from the Department of Social Development, the mental health social worker, a teacher and a member of the school administration, I thought I'd missed the boat with my youth, but they quickly reassured me and put me at ease. And that's when everything changed. We discussed the youth’s behavior point by point and they came up with strategies to help us help him. After listening to the views of all the partners and discussing the family situation, we decided to have two clinical consultation teams, one for school because several adjustments were needed, and the other to make the adjustments at home. This meant two reviews of the common plan per month. We were certainly taking it one problem at a time. But after a year, with two CCTs every month, the youth gradually returned to school on a part-time basis. There were fewer tantrums at home and there was more stability. The CCTs allowed for better coordination of services and interventions.

Over the months, still with the help of the CCT, my youth’s school time increased to halftime, but he could not take the bus in the morning. At the time he was in elementary school. My big fear was high school entry, but again with the help of the CCT, an independent study program was put in place at school to modify his learning. He was still going on half-time basis, and that was still working quite well. In 2016, it was decided to combine the two common plans into a single plan. We could address the needs of both sectors, i.e., school and home. The clinical consultation team still met every month.

Since he's been with us, contacts with his parents have been maintained. Frequency is determined on the basis of my youth’s reactions after the visits, and the decision is made by the CCT. We are very aware that these contacts are important to him. With the CCT we find strategies to maintain family ties. Without ever stopping our monthly meetings, my youth has continued to improve. He is now in grade 11, attending school full time, and taking the bus. He has two friends and this is very important for him because he didn't have any before. There's still some violent behavior, but he's able to withdraw, reflect, and come back and talk to us about it. At home, he's respectful even if he doesn't always understand, but he's trying to improve and wants to stay with us. The mental health social worker has been critical to my mental health, as she remained involved to offer support and advice even though my youth didn't want to see her. Her interventions helped me with him without his knowing it when there were small differences between us. That allowed me to have a moment to myself to vent without judgment.

Also, his medication has decreased and he's happier. There have been no admissions to the psychiatric unit and no police intervention. The attending psychiatrist is very impressed by the progress the youth has made. He never thought he would adjust to family life. We have even been able to reduce the frequency of our meetings with the CCT and fewer people are involved. We now have a common plan every three months.

In closing, my youth is now stable, and without this team, I don't know where he'd be. I'm convinced that he'd be in jail or in a psychiatric ward. I believe they saved his life, and he can now look to the future even with his delays and challenges. I read this story to him and he had tears in his eyes and told me it was beautiful. I have the same service with my other youth and things are going very well. Having been a foster parent for 30 years, and receiving services from the teams for five years, I can see the difference in the interventions and the speed in finding solutions. They can finally achieve happiness.

Shannon Haché: The clinical consultation team is a very important partner for the school system. Most of the kids that benefit from that rigorous follow up have complex needs and particularities. For them to be able to function well in the school environment, it is often necessary to put in place individualized interventions that take their specific needs into consideration. The scholar intervenors are part of the clinical consultation teams, and they have the chance to collaborate as members of the team for the implementation of these interventions. The expertise of the different members of the team is essential and well used. We have the chance to consult, amongst others, of psychologists who can answer our question, but mostly help us to understand every child's particularities. As a result, we can elaborate plans more easily, all while having a better understanding of the child.

The team members coming from the group homes also bring us a great support. It is a direct communication with the intervenors. We can therefore ensure cohesiveness in the interventions being used. Having the chance to discuss about the interventions, which ones work better and why, can sometimes make a big difference. To give you an example, we had a kid that was looking to have control over loss of things, but the recommendations of the professionals cited that he could not have such control for now because some teaching had to be done beforehand. While discussing at a CCT meeting, we realized that the kid often ate an additional breakfast at school. We then managed to find an effective way to communicate about the nutritional needs of the kid.

For another child, we had created a social story to try to eliminate a specific problematic behavior that happened in school but also at the group home. The school team personalize that social story to adapt it to the group home reality to ensure a cohesive intervention in all environments. The problematic behavior of the child stopped soon after.

At the clinical consultation team meetings, we also discussed how to limit the impact of changes for the kids. Many of our kids, especially those who are on the autism spectrum, have difficulties handling changes. Their plans often include gradual increases of the visits at home, of the time spent at school, of the number of academic demands made etc. Even if those plans are well thought of and validated in teams meeting, if they all increase at the same time, they can become an anxiety factor for the child. So, in the meetings, the team can discuss and determine which changes will be prioritized and how we are going to ensure that this transition goes well. For the schools, the district support resource teacher takes some data and analyzes it so we can then measure the impact of the changes. The school intervenors being part of the CCT is one of the initiatives that contributes to the fact that there are a lot fewer kids that are withdrawn from the school establishments. With back-to-school continuums and individualized intervention plans, we can make sure these kids have success all while respecting their actual capacities and allowing them to develop their potential.

Julie Gionet: Hello. We are parents of two children, a 20-year-old girl and a 17-year-old boy with autism spectrum disorder. Our son has lived at Le Passage therapeutic facility since he was 14 years old. His departure from home to Le Passage was not easy, but the situation at home, at school, in the neighborhood, and with friends had become very difficult. My husband had to stop working during the day to work at night, so that I could work during the day and be home at night, as our son was requiring too much attention to leave him with a babysitter.

It was during a lunch organized with our children at school that the situation worsened. My husband had to come home with our son and I stayed to talk to the principal. She proposed meeting with a Social Development resource for help. We already had an autism counselor in school who didn't give advice and tips at home. Experts from Fredericton even came to the school to put together a plan to make it work better, but nothing was working. The social worker then convinced me to accept their help because we were at the end of our rope.

From then on, two people from the Department of Social Development took care of us. There were home visits, visits to their office and reports written on our son's needs. It was agreed that Maison Ted would be the appropriate place for him. A visit was organized to introduce us to the staff and to visit the home with our children. Later on, we took our son there for a night and we picked him up the next morning. There was an incident during the night stay that changed the plans. Our son required too much supervision for Maison Ted. The social workers informed us that Le Passage was an option and that as soon as a place was available, our son could go there. Social workers supported us throughout this process.

The day he left we had to come up with a lie to convince him to get into the car with us. We told him that his dad was going to meet a man for a mechanic's job, and since this is a subject he loves very much, we had no difficulty in taking him. His luggage had been packed the day before and placed in the trunk of the car without him noticing. We were expected at Le Passage at 2 pm. I remember that day as if it were yesterday. I was like a robot: nervous, unable to think or speak. But Le Passage counselors took matters into their own hands as soon as we arrived explaining to us and to our son that he was going to have to stay with them for a while. It wasn't easy to leave and come home without him.

After that, clinical consultation team or CCT meetings were scheduled every three weeks, and the workers who participated all had a specific role to play, all in the interest of the well-being of our son and those around him. In the meantime, we could phone the residence if we were worried to ask for his news. As the meetings progressed, things had to be changed and tighter security also had to be put in place. We were made aware of his challenges and successes during the CCT meetings. A tragedy followed during the weekend visit home by our son. An emergency CCT meeting was held. The people around the table made decisions, we consented, we trusted them. Other problems arose. He was out of control, and he had to remain in isolation at the Caraquet hospital. We were with him at night and the Passage counselors came during the day. The situation improved and we went back to Le Passage. But things went off the rails again and he spent some time at the Bathurst hospital. There was an incident at the hospital and the doctor wanted the police to intervene.

Throughout the incidents, the workers, ourselves and the members of the clinical consultation team were aware of what was going on. An emergency meeting was organized again and they managed to convince the doctor of another option, as it was just impossible to envision a young person with autism being sent to prison. He was therefore admitted to the special youth unit at the Moncton Hospital for a stay of almost two weeks. We went there on weekends so we could see and spend time with him. His behavior improved and he was able to return to the residence. Then there were psychological assessments at the Campbellton hospital, court appearances, and he finally ended up with one year of probation. Everything was in place so that the year of probation could go well and that was the case –- a total success.

Everything that was put in place around our son was exceptional. The people who took care of him are good people. You see him, you realize that. He is in good hands and that is why it is okay for us his parents to accept that he is no longer with us. We have visits organized to see him – lunches, outings, etc. He calls us every night. They are all good, positive time spent with him, thanks to the guidance and support he receives. We can't imagine going through these trials without the support of this great team. The good cooperation we have had with Le Passage and CCT employees over the past three years is invaluable. They're almost our second family. I don't even want to think about what might have happened if they hadn't been there to support us through all of these trials. We have nothing but thanks and gratitude for them. And we certainly think that the same system should be put in place in other regions of New Brunswick. This would only bring positive things to younger people in difficulty and their families.

Loretta O’Connor: Thank you to Danièle Loubier, Roland Landry, Sonia Ferguson, Gisèle Breau, Stéphane Noël, Pierrette Desfonds, Shannon Haché and Julie Gionet for their testimonies on the success of the Clinical Framework Model. Your contributions as social workers, psychologists, and parents have been invaluable in providing mental health care for children and youth in New Brunswick. Here with us to provide closing remarks on the recognized success of the Clinical Framework Model is New Brunswick’s Minister of Health, Dorothy Shephard.

Minister Dorothy Shephard: As the Minister of Health for New Brunswick, I first want to personally thank everyone involved, who helped us develop and put into practice this unique model. The stakeholders, clinicians, clients and their families, and everyone else who shared their stories and feedback. Thank you.

This model has confirmed that all partners can recognize the value of each other's work. Multi-disciplinarian work leads to an effective combination of efforts to achieve a better result. The Acadian Peninsula Clinical Framework Model Team has received various awards and recognition over the past three years, including the Award of Excellence Social Development, from the senior officials of the New Brunswick Department of Social Development in November 2018. In May 2019, the Graham Beck Foundation invited the Acadian Peninsula team to present the model to various stakeholder groups from across the country. And in April 2020, the Clinical Framework Model developed in the Acadian Peninsula was awarded the Merck Patient First Prize.

It takes out of the box and innovative thinking to be able to develop programs such as the Clinical Framework Model, and it strengthens the capacity of the setting to respond to the needs arising from complex situations. To the members of the team who've worked so hard in bringing the model to life, thank you.

Improving population health, access and intervention are key priorities when it comes to addictions and mental health services and supports in our province. With the release of our latest Intergovernmental Addiction and Mental Health Five-year Plan, our government is committed to ensuring New Brunswickers, including our children and youth, can access and easily navigate additional and mental health services. With the exceptional outcomes from the Clinical Framework Model, our government looks forward to expanding the model into more of our communities, and to increase access to higher intensity supports, when required, by care teams, children, youth and their families.

Loretta O’Connor: Thank you Minister Shephard for your comments showcasing how the Clinical Framework Model is supporting New Brunswick youth with complex mental health needs. This is an excellent example for other jurisdictions who are facing similar challenges.

Join us again next week when we’ll hear about the award-winning initiative developed in Newfoundland and Labrador. Called “Bridge the gapp”, this online tool provides helpful resources and local connections to those looking for guidance and support related to mental wellness and substance use.

Thank you for listening!

 

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