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Child & Youth Mental Health Algorithm - GPSC

Child & Youth Mental Health Algorithm - GPSC

Strongest Families BC

Strongest Families BC Referral FormReferral Checklist: Disruptive Behaviours ages 3 - 12Strongest Families BC is a parent training program for disruptive behaviour in children aged 3 to 12.Please print:Child’s Name:Parent/ Guardian Name:Mailing address:DOB: / / Gender:mm dd yyyyPhone number:Postal Code:PHN#:Referring physician:Phone:Fax:Inclusion Criteria Ineligible Eligible1. Is the child 3–12 years of age? No Yes 2. Does this child exhibit symptoms of disruptive, defiant or oppositional behaviour/No Yes conduct or attention/concentration problems at home or school/daycare?3. Are these symptoms a regular feature of the child’s behavior (not isolated instances)? No Yes 4. Is the child’s behaviour problem considered mild or moderate? No Yes Exclusion Criteria1. Does this child have any of the following: Autistic spectrum disorder, early psychosis? Yes No 2. Does this child have significant intellectual impairment that would interfere with a skill Yes No focused intervention program?3. Is the child’s behaviour problem considered severe (i.e. child is at imminent risk ofYes No harming self; extreme conduct issues; or multiple severe co-morbid conditions)?DO NOT refer if any answer appears in shaded columndo notrefer ok toreferDate:Comments:Fax completed/signed referral to: 1-877-688-3270Strongest Families BC is offered in partnership with the Strongest Families Institute in Nova ScotiaFunding for Strongest Families BC provided by the Province of British ColumbiaCMHA BC DivisionStrongest Families BCToll-Free Fax: 1-877-688-3270Toll-Free Phone: 1-855-297-4777Strongestfamilies@cmha.bc.caStrongestfamiliesbc.ca

FH Referral Flags in the Electronic AlgorithmThis page will help you to access information on FH services. Use the links on this page to access thebrochures and referral forms in the algorithm.Referral FlagsEmergency:• Suicidal intent with plan, or moderate to serious suicide attempt including overdose, hanging,choking or excessive bleeding as a result of deep cutting etc.– go to ER• Acute psychosis – go to ER; if possibly manageable in community/by parents, consult with orrefer to Early Psychosis Intervention (EPI) Program.Urgent:a. For patient information about EPIb. For physician referral to EPI• If first time presentation of psychotic symptoms or suspected psychosis, refer to Early PsychosisIntervention (EPI) Programa. For patient information about EPIb. For physician referral to EPI• For other acute mental health crises, severe symptoms & deterioration in function, suicidalideation, other major psychiatric conditions, refer to Child & Youth Crisis ProgramUsual:For additional therapy and support, refer to MCFD Child and Youth Mental Health(then search site for your local CYMH office. For Surrey region, call the Integrated Intake & ScreeningTeam)• For specialized psychiatric consultations refer to:o The Infant Psychiatric Clinic: For patient information about Infant Psychiatric Clinic For physician referral to Infant Psychiatric Clinico The Child & Youth Neuropsychiatric Clinic: For patient information about Child & Youth Neuropsychiatric Clinic For physician referral to Child & Youth Neuropsychiatric Clinico The General Teaching Clinic: For patient information about the General Teaching Clinic For physician referral to the General Teaching ClinicNote: For further FH programs and resources please refer to the FH Physicians’ website by clicking onthe FH logo.

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    MOA TasksTools/ResoucesMH Screening

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    Child/Parent or Youth:Child and You

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    PSP Child and Youth Mental Health M

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    Child and Youth Mental HealthPSP Mo

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    Child Functional Assessment (CFA)Th

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    Child and Youth Mental HealthPSP Mo

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    Never or Sometimes Often or Very of

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    Never or Sometimes Often or Very of

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    WEISS FUNCTIONAL IMPAIRMENT RATING

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    Tool for Assessment of Suicide Risk

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    Let’s be clearer with words - Dru

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    Child and Youth Mental HealthPSP Mo

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    Psychotherapeutic Support for Teens

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    Worry Reducing PrescriptionThere ar

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    Safety Card- Emergency Contact Numb

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    DSM-IV Multi-axial SystemPsychiatri

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    CBIS Lifestyle SkillsHealthy Habits

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    Healthy Habits for SleepingDepressi

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    IT’S TRUE: YOU ARE WHAT YOU EAT!

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    CBIS MANUAL | ADOLESCENT VERSION |

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    Tips for Teachers of Anxious Studen

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    LETTER REQUESTING PSYCHOEDUCATIONAL

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    • • • • • • • • •

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    LETTER REGARDING SCHOOL SUPPORTS AN

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    Patient Name:Date of Birth:Physicia

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    Motor Skills (gross/fine): Does thi

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    Child and Youth Mental HealthPSP Mo

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    Have Trouble Getting Up in the Morn

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    2Child: Um. Lots of things I guess.

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    4For children who have worries abou

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    Use with Permission. Guidelines for

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    DSM-IV TR criteriaDSM-IV-TR. Primar

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    DSM-IV-TR. Primary Inattentive type

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    ADHD Assessment ToolsSNAP IV18 Item

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    12 Often runs about or climbs exces

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    SNAP-IV 26 RATING SCALE: SCORING IN

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    Patient Name:Date of Birth:Physicia

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    Reason for ReferralReferred by: Pho

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    Patient Name:Date of Birth:Physicia

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    Functioning and Lifestyle Evaluatio

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    Functioning at School (if not at sc

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    MENTAL STATUS EXAMINATION (clinical

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    Treatment PlanPatient Name: _______

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    PSP Child and Youth Mental Health -

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    Collaborative Prescribing Agreement

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    Referral FlagsReferral of the child

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    PSP Child & Youth Mental Health Mod

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    6 - item KADS scoring:In every item

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    Permission to use the KADSThe KADS

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    Depression in Children and YouthA G

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    Use with Permission. Guidelines for

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    CHALLENGE NEGATIVE THINKINGQuestion

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    2HOW TO DO IT!Step 1: Teach younger

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    It is ver y useful to help a child

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    CBIS Cognition SkillsAnti-Depressio

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    Small GoalsThe concentration, fatig

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    Problem SolvingDepression can make

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    Common Thinking ErrorsThe situation

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    Thought StoppingDepression often ma

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    Use with Permission. Guidelines for

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    Referral FlagsReferral of the teen

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    DSM-IV TR. Oppositional Defiant Dis

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    Specific PhobiaA. Marked and persis

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    Social Anxiety DisorderA fear of on

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    SCARED - Child VersionPg. 1 of 3 (T

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    SCARED Scoring - This page is for o

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    Screen for Child Anxiety Related Di

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    Section B: Fear/Avoidance - Seminal

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    Not at all Somewhat Pretty much Ver

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    Not at all Somewhat Pretty much Ver

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    Weiss Symptom Record (WSR) Instruct

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    CY-BOCS Symptom ChecklistChildren

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    CY-BOCS Symptom ChecklistChildren

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    RESOURCES.RESULTS.RELIEF.© Anxiety

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    © AnxietyBC3

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    CBIS ToolsIntroduction toRelaxation

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    Abdominal/Belly BreathingPurpose•

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    PurposeGroundingGrounding is a calm

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    Passive RelaxationPurpose• Passiv

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    CBIS MANUAL | ADOLESCENT VERSION |

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    MindfulnessMindfulness originally c

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    ThoughtsMindfulness Meditation• A

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