Forum Powerpoint_270422

Provider Forum 27 April 2022

Whakataka te Hau Karakia Timatanga (opening) Whakataka te hau ki te uru Whakataka te hau ki te tonga Kia mākinakina ki uta Kia mātaratara ki tai E hī ake ana te atakura He tio, he huka, he hau hū Tīhei mauri ora!

Cease the winds from the west Cease the winds from the south Let the breeze blow over the land Let the breeze blow over the ocean Let the red-tipped dawn come with a sharpened air A touch of frost, a promise of a glorious day

Agenda Speaker

Session

Lindsey Webber, CEO, WBoP PHO Dr Luke Bradford will facilitate the Open Forum

PHO Update including Afterhours Service Arrangements Open Forum 7 to 7.25 PM

Dr Diana Prizgintas, Consultant Clinical Psychologist, Gender Dynamix Michelle Meyer, Clinical Advisor, WBoP PHO Dr Luke Bradford, Chief Medical Officer, BOPDHB

Gender-Affirming Care & Current BOP Pathways 7.25 to 7.45 PM PHO Clinical Update, including Covid Update 7.45 to 7.55 PM

Adrian Toft, Dementia Implementation Lead Ruth Thomas, Clinical Lead Presbyterian Support Northern

Supporting People Living with Dementia to Live their Best Lives 7.55 to 8.15 PM

Emma Green, Allied Health Community Strategic Lead, BOPDHB

Latest innovation Rapid Response for Community Allied Health 8.15 to 8.30 PM

PHO Update

Lindsey Webber, CEO, Western Bay of Plenty Primary Health Organisation

Afterhours Service Arrangement Open Forum Facilitated by Dr Luke Bradford

Afterhours Service Arrangements Population growth and practice capacity issues has resulted in more people seeking care through Accident and Healthcare, creating the following issues: 1. Increased frequency of clinicians on-call being required to work, and for longer periods on each shift.

2. Increased volume of requests received each year for roster opt-off.

3. Frequency of GPs missing their rostered shifts.

4. The impact of Covid-19 over the last two years across the network, many clinicians are continually exhausted and stressed.

Suggested Options Options: Scenario 1 All opt-off arrangements are removed and every Practice is required to meet their responsibilities for the provision of afterhours services to their enrolled population.

Scenario 2 Opt-off arrangements are removed but exemption on medical grounds can be sought and endorsed, if supported by the Afterhours Committee.

Potential impact Will incur a levy of up to $1 per ESU

Scenario 3 A limited volume of opt-offs (up to 15) are retained to support approved exemptions (as per scenario 2 above) and a ballot arrangement to be conducted for the balance of opt-offs available.

May incur a levy of up to $1 per ESU

Will incur a levy of up to $1 per ESU

Gender-Affirming Care & Current BOP Pathways Dr Diana Prizgintas (she/her) Consultant Clinical Psychologist Clinical Lead at Gender Dynamix Aotearoa WPATH and PATHA member https://www.genderdynamix.org.nz/ diana@gdnz.org

• Māhū • Vakasalewalewa • Fa’afafine • Palopa • Akava’ine • Fakaleitī (Letī) • Fa’afafine • Kathoey • Whakawāhine • Takatāpui

Recent Rise of Trans* Media Exposure Laverne Cox -May 2014

Avery Jackson - Jan 2017

Elliot Page – March 2021

Minority Stress • Well documented chronically high levels of stress • Institutional disparities • High degree of prejudice • Chronic stress response • Poor physical and mental health outcomes

Welcoming Spaces The Power of Language and Environment

Forms • Is gender relevant to your application and or treatment process • Consider how you are going to use the data before you collect it • When writing reports, referrals or letters use the person’s identified pronouns and gender • Forms are an opportunity to demonstrate inclusivity

Creating Welcoming Spaces for All People

• Train all staff to avoid gender-specific language until they have asked a person for their name and pronouns.

• Offer “All-Gender” restrooms that are welcoming of all bodies.

• If changing bathroom signage is not an option, allow people to use restrooms most closely congruent with their gender identity.

• Ask for people’s names and pronouns routinely.

• Share information (including name and pronouns) with other staff members so that everyone can refer to people respectfully.

Creating Welcomin g Spaces for all people

• Be honest about your mistakes and demonstrate a willingness to learn • Open up space for people to discuss their gender identity and avoid an approach that assumes a gender binary • Be prepared to provide clients with resources or to connect them with other professionals who do • Take cues from clients about how to refer to them and their identity— use the language that they feel comfortable using • Subtle visual cues will be recognised

DSM-4TR – Gender Identity Disorder

Diagnosis

DSM-5 – Gender Dysphoria ICD-11 – Gender Incongruence

WPATH SoC 7

NZ Guidelines

The Golden Rule Treat everyone like you want to be treated.

BIG

The problem with the Golden Rule It treats everyone the same from your world view or perspective.

The Platinum Rule

Treat others like

they want to be treated

STATISTICS Discrimination Gender Identity: 67% , 44% last 12 months general population 17% vs 8% general population 57% TGNB did not disclose at work out of fear Mental Health 71% reported high or very high psychological distress 56% had seriously considered suicide last 12 months 37% had attempted suicide 17% last 12 months

Substance Use 37% used cannibis in the last 12 months vs 12% School 21% bullied at least 1x per week vs 5% Sport 14% involved in last 4 weeks vs 26% Sexual Violence 32% reported sex against their will since age 13 47% reported attempted rape

Counting Ourselves NZ study surveying the health and wellbeing of 1178 NGNB individuals in 2018

Clinical Presentation • Clear goal of addressing Gender Dysphoria • Exploring experience of gender • Not presenting issue • Gender identity is peripheral to main problem

Treatment Considerations • Age and maturity • Whanau and community support • Co-occurring conditions • Minority stress • Physical health • Socio-economic status • Spirituality • Risk

• Anxiety/Low Mood • Substance misuse • Self-harm • Eating disorders • Relationship difficulties • Neuro Diversity • Internalized Transphobia

•Non-Binary Identities • Fastest growing population • Fluid vs Static • Pronouns • Gendered language

Family Support • Huge predictor of mental health outcome • Can go through a period of grief • Psychoeducation • Process • Individual, family, peer support groups • Clinician role to navigate and validate various perspectives • Client centred approach to youth w/o support – on-going risk assessment

Trans Youth With Supportive Parents

Trans Youth With Unsupportive Parents

2012 Trans Pulse Project in Canada study surveyed 433 youth

Peer Support • On-line • Face to face • Mentoring • Trans* friendly services

PHO Clinical Updates

Michelle Meyer, Clinical Advisor, WBoP PHO

DHB / Covid Update

Dr Luke Bradford, CMO, BOPDHB

Reporting Deaths of Covid-19 infected patients - New Bpac eReferral form- Covid 19-Related Deaths Long Active Reversible Contraception – LARC • Reminder –This funding initiative is to increase equity of access for contraception for high risk wahine and NOT for hormone control • Halcyon form changes • Guidelines/application forms with links to Goodfellow Unit e-Learning modules on PHO Portal

E-laboratory ordering system • Full e-laboratory orders referral system from 1 June • Emailing paper forms to requestforms@pathlab.co.nz will be turned off on this date also

Falls prevention service - Body in Motion Physio/rehab programme • Referral for high risk patient BEFORE a fall • 75+ or Māori/Pacifica 65+ at risk of falling due to deficits in strength and balance • In home • eReferral ‘falls management’- BIM

Increased VTE risk with COVID-19 in Pregnancy- Anticoagulation (clexane) may be required • BPAC eReferral to the obstetric service at BOP DHB (Include wt, ht, & BMI) • Triage + arrange script and make contact with patient • If you prescribe anticoagulation yourself- send an eReferral to notify the obs service register can be maintained of pregnant patients with COVID-19

New BPAC e-Referral now available for 3D (CHIRP) Child Health Integrated Response Pathway BOPDHB is working to improve its referral process and pathway for children presenting with ‘neuro-developmental, behavioural, and associated mental health concerns’. These are referrals that would have normally been made to 3D. This project is known as CHIRP – Child Health Integrated Response Pathway. Over the course of the next 6 months BOPDHB will be refining their internal pathways for conditions such as ADHD/ASD, which will hopefully lead to a timelier and more integrated response. For the time being continue to refer as you have always done, through ‘3D’ – also now referred to as CHIRP.

Tunstall referral for weekend handover- New BPAC eReferral form

Quick Chat Points from the DHB Seeing patients in the world of Covid – we have to increase this Preferred method of contact in referrals New immunisation centre Focus on childhood immunisations How do we increase availability for patients to enroll?

Paediatric clinical governance role and similar positions Models of Winter infections

Supporting People Living with Dementia to Live Their Best Lives

‘A demonstration model of the importance of psychosocial care for those with dementia in the community’

“Dementia is one of the biggest health and social care issues of the 21st century. Many face the condition alone or struggle with inadequate care and support.” WHO One in three children born today will develop it in their lifetime, and nearly all of us will be affected by dementia in some way”

Dementia Economic Impact Report 2020

Focus Groups FINDINGS • Confronting • Voices – Wanting to be heard, understood and accepted • Confusing, scary for PwD • Complex difficult to navigate system • Stress on primary carers • Stigma and gradually reducing world • Fragmented, underfunded system • Community Support task orientated • Models for GP’s / Crises for specialists

NEEDS • • • • • • • • • •

Living purposeful, fulfilling and connected lives Reduced anxiety and stress A voice Person Centred – own goals and aspirations Education & Advocacy Acknowledging, but not being defined by dementia Respect / inclusion Human Rights and independence where possible Support for primary carer and family Consistent care from people who understood dementia

Many of these fitted with the Global Dementia Charter

A Change in Care Models

Tom Kitwood, Psychologist: Person Centric Model of Care

What - Pillars • Improve outcomes and equity for people living with dementia

• A demonstration model of care • A change in the culture of dementia care – Person Centred & strengths based

• Better training standards for people working in the community • Training specific to dementia and its complexities • Careers in this space

• Better collaboration and integration in the dementia ecosystem • Health – social • NGO’s / Organisations / Families

Vision • To change the culture of dementia care in New Zealand to better support people living with dementia to live their best lives • Purposeful, fulfilling and connected lives • Reduced anxiety and stress • Acknowledging dementia but not being defined by it

Goals • To support people living with dementia to live independently in the comfort of their own homes • UK study 89% prefer this

• To support improved quality of life • • • • •

Respect in interactions with others Feeling brighter, Enjoying the moment Feeling Useful Having a purpose Sense of belonging

Strategically • Individualised Support • Empowering through their goals, aspirations and needs • Meaningful activities • 1:1 home based support

• Specialist Dementia Care • Specialist Care Manager – Registered Health professional with experience / training in dementia • Living Well Support Person – LCP4, EnlivenPlus training, commitment to ongoing regular interactive training and mentoring

• With You Every Step

• Consistent support • Trusted • Smoothing the pathway through the journey

• Purpose Driven

• Big picture goals • Charity

• All One Team • • • •

Wrap around support PLwD, Primary Carer, family, wider support network Health - Social Community

Who • EnlivenPlus is part of Enliven an organisation under the PSN umbrella, an NGO with 130 year + history.

Ruth Thomas

Adrian Toft

Lead Specialist Care Manager

Programme Manager

A registered psychiatric nurse with 30 years in the field of dementia. Known as the ‘dementia lady’, Ruth was previously a dementia expert for the ministry of health.

She holds a masters in dementia and is the Lead Specialist Care Manager for Enliven Plus.

Holds a post grad in musculoskeletal med and previously set up a pilot interdisciplinary chronic pain centre. He has spent the last few years with his own business, with start ups and turnarounds as CEO. In 2021 he returned to health driven by a desire to work to a purpose. Adrian’s role has been to research and set up the Enliven Plus programme.

When • Starting here in Tauranga – build robust model, expand as we recruit and train appropriate support workers.

• Demonstration Model - If successful, we want to roll it out nationally • Evaluated internally and externally • Private subscription • Unconstrained by contracts • Circuitous route to end goal (pillar 1)

For More Info • • • • • •

EnlivenPlus brochures / leaflets / illustrative stories To arrange a visit Dementia Mate Wareware Action Plan NZ Dementia Economic Impact Report NZ Global Dementia Action Plan Global Dementia Charter

CONTACT Clinical Ruth Thomas 07 547 4349 E: enlivenplus@psn.org.nz

Programme Adrian Toft 0274 335072 adrian.toft@psn.org.nz

www.enlivenplus.org.nz

Illustrative Stories • To the Moon

12m post diagnosis

• World Cruise

Newly diagnosed

• The Christmas Cake

Moderate

Latest Innovation Rapid Response for Community Allied Health Presenter Emma Green, Allied Health Community Strategic Lead, BOPDHB

Kia tau Karakia whakamutunga (closing) Kia tau kia tātou katoa Te āio, te aroha me te marutau Tīhei Mauri Ora

May peace, love and safety Be upon us all Let there be life

Thank you for joining us!