By Dr. Jennifer Russel and Jonah Starr

In September 2018, the Child and Youth Mental Health Program at BC Children’s Hospital launched COMPASS, a new service to support physicians, as well as mental health and substance use clinicians across the province in being better equipped to support the complex needs of children and youth up to age 25 struggling with mental health and substance use challenges.

Throughout the country, access to mental health services is limited. Epidemiological data in British Columbia suggests that 180 000 youth (0-25) require mental health services each year in our province.  Of those, 130 000 seek support from their family physician and 25 000 received specialized services through the community child and youth mental health teams.  However, approximately 50 000 youth do not receive any mental health services at all.

In response to these alarming statistics the COMPASS Program was born.  Learning from successful programs in the United States such as the Massachusetts Child Psychiatry Access Program (MCPAP) and the Seattle Partnership Access Line (PALS), Compass Program was designed to support clinicians to provide evidenced based mental health and substance use treatment for children and youth close to home.

It is widely recognized that family physicians and community mental health and substance use clinicians are over stretched in their capacity to meet the needs of this vulnerable and ever growing population.  The COMPASS Program  provides a unique service that reduces the barriers to accessing psychiatry and mental health/substance use support by providing telephone consultation directly to the provider when they need it the most.

The COMPASS team is comprised of local and remote Child and Adolescent Psychiatrists as well as a diverse team of mental health and substance use clinicians who all specialize in delivering evidenced based psychological treatments and pharmacologic recommendations required for optimal mental health & substance use care.  In addition to telephone consultation and support, the COMPASS team is able to provide direct psychiatric assessments via video conferencing, tailored education and training, and coordinate referrals to local mental health resources in the child’s home community to further bolster care. From there, following the initial call to COMPASS, the provider is offered ongoing follow up with the COMPASS team to ensure he/she/they is feeling supported moving forward to care for their patient.  The provider is then given a confidential letter that outlines all of the COMPASS interventions to date and recommendations moving forward to keep on the client’s file.

Although it remains early days, the COMPASS Program has been able to reduce visits to hospital emergency departments, shorten existing hospital stays, and strengthen the capacity and confidence of primary healthcare providers to manage this complex population.  In less than one year ( Sept/18-June/19), COMPASS has enrolled 750 providers and managed over 800 unique cases and represents a new approach in supporting the provision of comprehensive mental health and substance use care in communities throughout BC.

Testimonials

1. I have had three calls with Compass now and they have all been helpful. On a recent call I specified that I was looking for clinical practice help with a tough case and a practitioner called me back within a week. The conversation was very helpful. This is an especially good support that goes beyond the medical model of diagnosis but offers some fine tuning of the treatment options. particularly good for a rural practitioner.
2. Very easy access and strong support, follow up and timely access to specialist and expert guidance and consultation. This is a great resource especially for low resource communities. Please inform all providers of this valuable service.
3. I am very grateful for the Compass line at BC Children’s. As a family physician striving to meet the ever-increasing mental health needs of the children and youth in my practice, the Compass line has improved the quality of life of my patients and greatly increased my professional satisfaction. My interactions with the various psychologists, psychiatrists, and other allied health professionals have been nothing short of enriching and informative. For example, I feel so much more comfortable now initiating and monitoring medical treatment. In addition to being better equipped with clinical knowledge and skills, I feel both empowered AND encouraged to care for my own patients. In fact, because of Compass, I have a new-found interest in children and adolescent psychiatry.
4. Overall, my interaction with Compass has been one of the most positive interactions I have had with child psychiatry in my 10 years of practice. I felt heard, and that the clinicians I was speaking with “got it”, recognizing that patients can easily fall through the cracks, especially for those who live outside of Vancouver but who come into Vancouver for care. I comment the Compass team for putting this resource together and will definitely be spreading the word about it.

Dr. Jennifer Russel M.D. F.R.C.P.C  is the Clinical Director of Compass Line BC Childrens Hospital at and Jonah Starr M.S.W. R.S.W. RCC  is a Clinical Social Work/Therapist  in Vancouver BC.