CHIRP Project Update Child Health Integrated Response Pathways
December 2023
For all Tamariki and their whānau, who have behavioural, neurodevelopmental and associated mental health concerns to experience timely, responsive and integrated care that matters to them. In September 2021 Hauora a Toi Specialist Services set out to work together differently. At the time it was unclear as to what this might look like, but the services knew they had to work differently to respond to growing demand, overwhelming wait-times for assessment, fragmented inconclusive and drawn out assessment experience for whānau, frequent declines and bouncing between services. In addition to the above, Māori experienced longer wait-times and were overrepresented in the clients the services failed to reach.
project, and the solutions arose from a willingness among clinicians, specialists and services to collaborate, share resources and expertise, and reconfigure the resources within all three services to maximise efficiency and consumer experience.
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and Australia.
This ongoing commitment to a collaborative approach to problems and solutions, which actively breaks down system driven siloed ways of working has been CHIRPS greatest challenge and greatest success, receiving it awards and acknowledgments in New Zealand
Golden Moments
• Increasing access to assessment & halving waittimes to diagnosis • Establishing a single point of entry for ease of access • Capturing and addressing inequities of access • Reducing declines & bouncing between services • Reducing unnecessary waiting
Te Waka Aorangi – Child Wellness Centre
Opening in July – Sep 2024. The top floor will provide an open plan collaborative working space for Child Development Service, Developmental Paediatrics and Child Mental Health. Downstairs will be purposely fitted out to provide a welcoming, calm therapeutic space, specific to the needs of the Tamariki and Whānau we serve. Outside of office hours the building will be utilised by community, parent, and support groups. Project Manager: Jim Robb
• Testing collaborative assessment pathways for children with complex needs • Working better together has enabled a more effective and cohesive relationship with Education, Kohanga Reo, Mental Health in schools, Primary care and Hauora and Community Services • Introducing cross-service collaborative practice and peer review • Te Ara Pa Harakeke • Te Waka Aorangi - Child Wellness Centre • Te Kaumoana O Ruamano
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The Tauranga CHIRP Triage Team CHIRP offers a Triage service - a single point of referral to enable equity and ease of access. Who we serve: Children aged 14yrs and younger with developmental, attentional and/or behavioural concerns, that are of clinical significance, impact on the Nadia Du Plessis child’s functioning across home and CHIRP Integrated educational settings and may be due Operations Lead to an underlying neurodevelopmental condition including autism, ADHD and/or intellectual disability. Who we are: The CHIRP triage team is made up of registered health professionals who will review referrals with a multidisciplinary and multi-service lens. CHIRP Triage team may gather further information from whānau, school/ preschool and any other services involved with the child.
What we do: With representation from Child Mental Health, Child Development Service, Paediatrics and Education, the team will then identify a pathway for assessment and support that best meets the needs of the young person and their whānau. Where appropriate this may lead to an integrated response from more than one service.
Te Ara Pā Harakeke – CHIRP Māori Pathway 2024
We are very excited to welcome Des Willison, Lisa Herewini and Tina Witehira onto the CHIRP project team and into the CHIRP development space from January 2024. They will join Te Paea Muir who has provided a strong voice for Māori on the CHIRP Project Team since the beginning of 2022 and has advocated for a collectivist framework in this space. All four clinicians are experienced social workers currently working with children and whānau in our Child Health Services. Te Paea is employed with CDS, and Des, Lisa and Tina provide specialised and tailored in-home support to parents and caregivers attending Incredible Years Programmes around Tauranga Moana with MICAMHS.
Additionally, they bring with them a wealth of knowledge and experience of Tauranga Moana networks, Te Ao Maori, Te reo Māori me ona tikanga, and extensive experience in cultural leadership roles. Mana motuhake for Te Ara Pā Harakeke is to develop and strengthen CHIRP Pathways to support, awhi and manaaki tamariki and their whānau Māori. To provide a Te Ao Māori lens, Māori concepts and advocacy to the clinical space and to explore, and design Māori models and pathways of care for strategic endorsement and development.
Eastern Bay Development Eastern Bay Update: Hayley Evemy and Nadia Du Plessis have been working closely with specialist child health services, and with Education and the Primary Health Alliance to develop a single point of referral and a coordinated response in the Eastern Bay. They are delighted to introduce Mel Hammond, as the CHIRP triage coordinator for the Eastern Bay who commenced 20th November, and joins Annette White, the CHIRP Administrator. The Eastern Bay Teams Have been trialling the process with referrals redirected internally and plan to launch the single point of referral form from 1st February 2024. • Te Whanau a Irakewa has endorsed the CHIRP project and offered Te Pou Kokiri support. • CHIRP representatives have been incorporated into the
Tautiaki Education led Panel and trialling WHIP (Whakatane Health integrated Pathway) of taking referrals from the panel. CHIRP will look to join the new Putauaki Panel in 2024.
Mel Hammond
• Presentation to Whakatane cluster of schools Principals, LSC, SENCOs planned for 29 November. • Voyagers and CDS co-locate at Te Kaumoana O Ruamano (106 Commerce Street, Whakatane) from 1st of December enabling ongoing opportunities for Integrated practice and service delivery. Eastern Bay Project Delivery Team: Glenda Gillgren, John
McLoughlin, Rebecca Maltby, Debs McPherson, Mel Hammond, Annette White, Kathleen Sanft, Nadia Du Plessis, Hayley Evemy.
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QBCheck comes to New Zealand! Within Te Whatu Ora current demand for specialist ADHD assessment outstrips the specialist resources available and we are under pressure to adapt current pathways and adopt new innovative tools to streamline this process for both service users and clinicians. Dr Sarah Moll and Anja Theron have worked with Qbtech UK, to secure a trial of the QBCheck product in a New Zealand context. QbCheck is an online ADHD test that supports early identification, assessment and treatment of ADHD, for individuals aged 6-60 years old. It is a computer-based test that objectively measures the core signs of ADHD: Hyperactivity, Impulsivity and Inattention. The QbCheck was recently appraised by the National Institute of Clinical Excellence (NICE) and identified as beneficial in the following: 1. QbTest saves clinician time and NHS money with no loss of accuracy in assessing for ADHD.
2. Clinicians have greater confidence in their diagnostic decisions. 3. It can mitigate gender bias (Reh, et al. 2015) The tool is being trialled in Hauora a Toi currently, in conjunction with usual diagnostic tools, and will be audited over the next five weeks by our medical student, Chloe Malone. Particular consideration will be given to impact on Māori, and the potential of the tool to address inequities. For more information on QbCheck please contact I & I Project Manager, Haidee Barrow Haidee.Barrow@bopdhb.govt.nz Project Team: Dr Sarah Moll, Anja Theron, Dr Julia Reid, Dr Katharine Blackman, Haidee Barrow, Kim Blair
Forms Go Live
From 1st February 2024 Information about CHIRP and the Triage team will be available on Health Point and Te Whatu Ora website. This will include electronic links to parent and teacher questionnaires, and Vanderbilt screener, enabling referrers to more easily support whānau to access specialist assessment services. Online CONNERS will also be available for use from February 2024, supported through IT mechanisms to ensure data safety and anonymisation.
Integrated & Collaborative Diagnostic Assessment Pathways
From left - Anja Theron Transformation Director, Child Wellbeing Services, Kim Blair CHIRP Project Manager.
CHIRP wins awards in Australia and New Zealand. In May 2023 CHIRP placed 2nd overall of a total of 64 innovations presented at the Health Round table in Melbourne and also won the People’s Choice Award as the innovation considered to have the most impact on their community in the patient access category. In November 2023 CHIRP placed first equal at the National Health Quality Improvement Scientific Symposium “Whole-systems quality: Better together”
CHIRP continues to explore cross service integrated and collaborative pathway assessments to avoid a young person being referred onto another service (and waitlist) for an assessment to be completed. Where possible, CHIRP psychologists and allied health professionals are working alongside paediatricians and psychiatrists to provide a multi-disciplinary approach for those young people with both ADHD and ASD under consideration, in many cases reducing wait-times by twelve months and providing a more holistic and conclusive experience for whānau. This is not easy with current siloed funding and geographical challenges, and continues to be driven by good will, flexibility and opportunity. Sustainable system change to deliver whānau centred care remains the long-term goal of CHIRP.
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Referrals into CHIRP Tauranga into CHIRP Tauranga Referrals into CHIRPReferrals Tauranga
20 0
Mar-23 Mar-23 May-23 May-23 Jul-23Jul-23 Sep-23 Sep-23
Jan-23 May-22 Sep-22 Jul-23Jul-22 Mar-23 Nov-22 May-23 Sep-23Sep-22 Jul-23 Nov-22 Jan-23 Sep-23 Jan-23
180 160 140 120Referrals into CHIRP Tauranga 100 80 60 40 20 0
Mar-21 May-21 Jul-21 Sep-21 Jan-21 Jan-21 Nov-21 Mar-21 Mar-21 Jan-22 May-21 May-21 Jul-21 Mar-22Jan-21 Jul-21 Sep-21 May-22 Mar-21 Nov-21 Sep-21 May-21 Jul-22 Jan-22 Nov-21Jul-21 Sep-22 Mar-22 Jan-22 May-22 Nov-22Sep-21 Nov-21 Mar-22 Jul-22 Jan-23 Jan-22 Sep-22 May-22 Mar-23 Mar-22 Nov-22 Jul-22 May-23
180 160 140 120 180 100 160 80 140 120 60 100 40 80 2060 040
Average days waiting from referral to CHIRP to MDM 300
Oct-23
Sep-23
15 months
Aug-23
Jul-23
Jun-23
Nov 2023
Oct-23
Sep-23
Aug-23
0
11 months
Whānau, schools and community report less declines and bouncing around between services, clearer communication and expectation. More children are receiving an assessment but wait Ave days waiting for all Ave days waiting for Maori Target wait time time to diagnosis remain long. The volume of children referred for diagnosis is significantly increased, and as yet no requests for Ave days waiting for all Ave days waiting for Maori Target wait time additional fte /resource to respond to growing demand has been approved.
Jul-23
50
0
Jan 2023
Oct-23
100
0
Sep-23
50
50
Jun-23 Oct-23
100 150
100
Aug-23 May-23 May-23 Sep-23
200 150
Jul-23 Apr-23
200
Average time from request for help to diagnosis – For Tamariki and whānau across services.
Jan 2022 (Start of Project) 27 months
150
Apr-23 Aug-23
250
200
Mar-23
250
Aug-22 May-22 May-22 Sep-22 Jun-22 Jun-22 Oct-22 Jul-22 Jul-22 May-22 Nov-22 Aug-22 Aug-22 Sep-22 Jun-22 Dec-22 Sep-22 Oct-22 Jul-22 Jan-23 Aug-22 Oct-22 Nov-22 Feb-23 Dec-22 Sep-22 Nov-22 Mar-23 Jan-23 Oct-22 Dec-22 Feb-23 Nov-22 Apr-23 Jan-23 Mar-23 Dec-22 May-23 Apr-23 Jan-23 Feb-23 Jun-23 May-23 Feb-23 Mar-23 Jul-23 Jun-23
300
300
Jul-22
Jun-22
Average days waiting from referral to CHIRP to MDM Average days waiting from referral to CHIRP to Average days waiting from referral toMDM CHIRP to MDM 250
ve days waiting for all Ave days waiting for Maori Target wait time Ave days waiting for all Ave daysOnward waiting forreferrals Maori Target wait time from CHIRP Tauranga 70 70
60
60
50
60 50 40 30 20 10 0
Onward referrals from CHIRP Tauranga 40 Onward referrals from CHIRP Tauranga
When external service is indicated it means external service only 40 30 and no onward link to 70 30 20 specialist services. The 2060 data doesn’t capture 10 a combination of the 10 50 0 two which is the most 0 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 common scenario. (we 40 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 began Capturing this Paeds CDS External service MICAMHS Paeds CDS External service MICAMHS data in Jun 23) 30 50
70
Onward referrals from CHIRP Tauranga
20
4
4
10 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 0 Paeds Jan-23 CDS Feb-23 ExternalMar-23 service Apr-23 MICAMHS Nov-22 Dec-22 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Paeds
CDS
External service
MICAMHS
4
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Acknowledgements
It is with great sadness that we acknowledge the recent passing of Chloe Wright, a passionate ambassador for the wellbeing of women and children, whose foundation generously contributed to the advancement of Te Waka Aorangi and it’s vision for Tamariki and whānau in Hauora a Toi. We also acknowledge Beth Hughes, CHIRP Steering group consumer advocate, who sadly lost her son Tomos this year. Beth has tirelessly advocated for improved services for young people with disabilities and their whānau, and Tomos has always been a huge inspiration behind this and a catalyst for starting CHIRP.
Thank you to past and current members:
Chirp Project Delivery Group: Anja Theron, Chris McAlpine, Dr Evelyn Aranas, Fiona Putty, Glenda Gillgren Hayley Evemy, Heather Stewart, Judie Smith, Dr Katharine Blackman, Kim Blair, Dr Michael Gudex, Nadia Du Plessis, Nicola Chadwick, Dr Rebecca Maltby, Dr Sarah Moll, Te Paea Muir, Victoria Collinge. CHIRP Steering Group: Beth Hughes, Dr David Jones, Dr Dianne Lees, Erika Harvey, Henri Katz, Joanne Burch, Dr Justin Wilde, Kerry Taylor, Kim Blair, Michelle Meyer, Nathan Toms, Nicola Chadwick, Rozi Pukepuke, Dr Sarah L Mitchell, Stewart Ngatai, Timothy Slow, Anja Theron Report prepared by CHIRP Project Manager – Kim Blair, November 2023 kim.blair@bopdhb.govt.nz
Members of the CHIRP Project and Steering Group who were able to come together in person for our final meeting of 2023 – missing some of our members and our Eastern Bay representatives.
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