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3 years ago

Child & Youth Mental Health Algorithm - GPSC

Child & Youth Mental Health Algorithm - GPSC

PART 5 – REASONS FOR

PART 5 – REASONS FOR REFERRAL – PLEASE COMMENT IN ALL SECTIONSPsychiatric reason for referral:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Brief history of Psychiatric concerns:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Safety concerns including past or present risk of harm to self or others:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Any history of violence or ongoing family violence?_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Substance use concerns including past or present alcohol use and drug use:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________PART 6 – MEDICAL INFORMATIONCurrent medications including dose and date began:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Allergies and known medical conditions:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please attach additional information if available.REFERRAL SIGNATURE: ________________________ DATE: __________________PLEASE FAX ALL RELEVANT CONSULTATION REPORTS AND ANY ADDITIONAL INFORMATION TO604-587-3857

Fraser Health Infant Psychiatry ClinicAre you concerned aboutyour infant or child?about their emotional or socialdevelopment or challengingbehavior.about difficulties they areexperiencing as a result oftrauma or extreme stress.Have you spoken to acommunity professionalwho shares your concernsabout your child?Please know help is availablethrough a variety of servicesincluding Fraser Health’s InfantPsychiatry Clinic.This clinic is for infants, youngchildren and their families who livein the communities of Fraser Health.About our clinicOur specialists, a psychiatristand therapist, provideassessments, consultations andshort-term treatment to supportthe developmental, social andemotional needs of infants andyoung children, from birth tofive years of age.All participation is voluntary.Families who require longertermsupport will be referred toappropriate resources in thecommunity as needed.Referral Process‣ A referral from yourfamily doctor or medicalspecialist is required inorder for you to participatein this clinic.‣ Once the appointment hasbeen scheduled, yourdoctor/medical specialistwill be notified of the dayand time, and he/she willlet you know about theappointment details.‣ It is your responsibility toconfirm the appointmentwith the clinic.If it is determined that this clinic isnot the best service to meet yourchild/family’s needs you will beredirected to other suitable servicesin your community.

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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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    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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    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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    For teens: Although you should enco

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    This STOP Plan is for:_____________

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    FEELING: _____________________FEELI

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    THINKING TRAPSThinking TrapsExample

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    REALISTIC THINKING FORM (E.g.)Situa

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    REALISTIC THINKINGWe can all be bog

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    Step 3: Challenge your “anxious

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  • Page 235: FRASER HEALTH CHILD AND YOUTH PSYCH
  • Page 239 and 240: FRASER HEALTHINFANT PSYCHIATRY CLIN
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