By Jane Kitchen

The mental health teams at The Hospital for Sick Children (SickKids) and SickKids Centre for Community Mental Health (CCMH) in Toronto have had a rapid advance into virtual care in response to COVID-19.

SickKids TeleLink Mental Health Program, SickKids CCMH and SickKids are part of the SickKids mental health enterprise dedicated to the care and treatment of children and youth with mental health disorders.

“Building on the TeleLink program’s extensive experience of delivering video-based mental health services for the past two decades, virtual care is now part of the strategic plan and includes SickKids and SickKids CCMH,” says Christina Bartha, Executive Director of the Brain and Mental Health Program, SickKids and SickKids CCMH. “The current pandemic has moved up the timeline on our planned innovations and led to some rapid, creative problem-solving.”

SickKids: Combining in-person and virtual care

At SickKids, there are three mental health skeleton crews circulating, each consisting of a psychiatrist, a nurse practitioner and other allied health professionals. The teams support the mental health inpatient unit and provide mental health services to the medical-surgical floors, and the emergency department.

Other services, such as new psychiatric assessments, individual and group therapy, and connecting with families of inpatients moved to PHIPA-compliant videoconferencing within days of the emergency measures associated with COVID-19 being implemented.

“In conjunction with the recent move in the Emergency Department towards more virtual consults, we’re now moving forward on developing the appropriate safety measures to ensure that a thorough psychiatric assessment is conducted when children, youth and families present to the ED in crisis,” says Dr. Suneeta Monga, Associate Chief of Psychiatry, SickKids.

The change in the service delivery model has created a new service as well: A research-focused clinic for children with Autism Spectrum Disorder (ASD) was converted to a preventative virtual clinic to support these families as they face a sudden change in routine, and to help prevent their children from tipping into crisis; planned development of further levels of care is about to be launched.

SickKids CCMH: Transition to staff working from home while still caring for clients

Within five days of COVID-19 being declared a global pandemic by the World Health Organization, the two locations of SickKids CCMH transitioned to a work-from-home model to curb the spread and minimize risk to clients, families and staff. As part of the transition-in-service model, staff communicated to clients that while the treatment centres would be physically closed, they would keep appointments via telephone.

Before the pandemic, only a handful of staff had ever remote-accessed in to their work desktops. The Information and Communication Technology team worked diligently to extend remote access to all staff, with training guidelines sent out to staff setting up at home within hours. The following day, an updated remote desktop server that had been in testing was rolled out ahead of schedule to provide faster access to the network.

Videoconferencing platforms were introduced within days into the work-from-home model for staff meetings, including virtual staff Town Halls. Two weeks into the physical closure, SickKids CCMH had a PHIPA-compliant videoconferencing platform available to clinicians with which to conduct therapy sessions, thanks to technical support from their IT colleagues at SickKids.

Videoconferencing has been adopted by every department at SickKids CCMH, from helping staff and trainees continue with more intensive individual or family therapy sessions to youth group therapy sessions and offering Families First workshops to parents. It has also allowed staff to remain connected through virtual wellness activities such as a pet meet n’ greet and stretch and movement sessions.

Next steps

“Virtual care will not disappear when COVID-19 is done,” says Bartha. “It won’t replace in-person interaction, but provides a supplemental level of care in-between visits, or for those who can’t come into the sites in person.”

Both SickKids and SickKids CCMH are sharing their expertise and learnings through the pandemic. The Department of Psychiatry at SickKids updated the COVID-19 Learning Hub on the AboutKidsHealth website (www.aboutkidshealth.ca/COVID-19) with tips on how to help children stay healthy through a pandemic, how to talk to your child about COVID-19 and how to support children with ASD.

Registered nurses and occupational therapists at SickKids CCMH have developed a document for staff providing care in residential settings during a pandemic, and the SickKids CCMH Learning Institute and SickKids CCMH will be collaborating on a series of webinars on virtual care and best practices for physicians, therapists and intensive services (launching in May; check www.sickkidscmh.ca for details).

Jane Kitchen is Communications Advisor at The Hospital for Sick Children.