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mhcep_tipp_
Transition into Primary-care
Psychiatry (TIPP)
Overview
TIPP, our “stepping down” service, provides
transitional treatment and support for clients who are recovering from episodic
or other types of mental health services and who are transitioning their care
from ambulatory care to care by the primary care physician. The TIPP client base
consists of Ambulatory Care clients and Prevention and Early Intervention
Program for Psychoses PEPP clients who have maintained a sustained period of
wellness and recovery as demonstrated by no significant medication adjustment or
need for hospital based care over the last year.
TIPP Description of Service
The TIPP program is based on a modified version
of Australia’s Consultation and Liaison in Primary-care Psychiatry (CLIPP)
model.
External Link:
CLIPP (Consultation and
Liaison in Primary Care Psychiatry) Manual - Mental Health Services - Victorian
Government Health Information, Australia
Clients with stable but chronic mental
illnesses will be transitioned back to the family physician with assistance from
a team consisting of a psychiatrist and a nurse with mental health experience.
Other services in the community may be utilized from time to time, according to
client need. The model allows for on-site communication between primary care,
psychiatry and the client in a least restrictive means with low stigma
experience.
The program is unique in that it changes the
culture of primary care practice and the balance of power among the team
members. Essentially, the model serves as a concept for collaboration between
professionals from all fields of health. The TIPP partners include community
family physicians, London Health Sciences Centre, Canadian Mental Health
Association (CMHA) - London, Western Ontario Therapeutic Communities Hostels (WOTCH),
Choice and Opportunities in Rehabilitation and Education (CORE),
Middlesex-London Health Unit, London Mental Health Crisis Service, London East
Community Mental Health Centre, Telehealth Ontario and other specialty services.
a) Direct consultation
The initial meeting is a face-to-face meeting
on site in the family physician’s office with the client/caregiver, if
appropriate. At this visit, the transfer summary, relapse signature and
medications are reviewed and care is transferred officially to the family
physician in primary care practice.
The relapse signature strategy is developed to
prevent relapses and recurrences of the client’s illness. This is facilitated as
an early intervention strategy in clients at high risk for relapse of their
illness. The emphasis is on the wellbeing of the client, prevention of
hospitalization, reducing the cognitive effects of the illness on the brain, and
maintaining community integration in the various domains. Where possible,
members of the client’s family are involved in the preparation of the relapse
signature, especially in cases where the client’s symptoms are first noted by
his/her family.
b) Indirect services
The nurse visits the family physician at an
interval of one to three months while the psychiatrist’s site visits are at
intervals of three to six months. These contacts are increased or decreased in
frequency depending on the client’s symptomatology, overall functioning,
relationships and presence or absence of crises in their lives. During these
visits, the client’s progress is reviewed and documented by the team and future
management planning is done in a collaborative manner. In between these visits,
the family physician maintains the client’s overall status and consults the
service as needed. The nurse facilitates timely access to other required
services.
Follow-up concerns by consultations, telephone contacts, etc. are documented as
indicated. Ongoing assessment during the follow-up is recorded as indicated by
the family physician and the psychiatric team. During a follow-up period, the
client’s quality of life, symptomatology, functioning in various domains,
illness severity and perceived need of care are evaluated, in addition to the
team’s level of satisfaction with the model of service delivery.
TIPP Education and Research Activity
Continuing medical education will be provided
to the family doctor in an informal peer-to-peer case-based format during the
psychiatrist’s and nurse’s regular office visits to the community. The clients’
needs are considered essential in the process so medical education provided to
the doctor is relevant in this regard. The educational interventions will be
designed as a progression, rather than as isolated programs. Residents and
medical students will be encouraged to participate in this teaching and learning
model.
TIPP’s research component involves a cluster
randomization of a certain group of clients into two treatment arms, “care as
usual” and the “TIPP model service care delivery.” The test questionnaire
results and subject satisfaction data will be used to evaluate the effectiveness
of the overall program. Data that are routinely collected will also contribute
to the evaluation of the cost effectiveness of this model of care. The research
component will help to solidify the model into clinical practice with supportive
evidence.
TIPP Research
Transition into Primary-care Psychiatry (TIPP):
A Mental Health Demonstration Project. Funded by The Ministry of Health and
Long-Term Care, Primary Health Care Transition Fund. $236,196.60. October 1,
2004 – July 31, 2006; Principal proponents: Drs. D. Haslam and J. Haggarty;
Co-proponents: Drs. S. Harris, B. Lent, J. Takhar, C. Dewa, A. Donner, J. Hoch,
B. Chaudhuri, J. Goertzen, J. Johnsen.
Transition into Primary-care Psychiatry (TIPP):
Assessment of the continuing medical education needs of family physicians
providing care to the seriously mentally ill population group within the TIPP
model of service delivery. Funded by a Mental Health Grant, St. Joseph’s
Foundation. $4,553.00. March 2005 - March 2006. Dr. Jatinder Takhar Principal
Investigator, Dr. David Haslam Co-Investigator.
TIPP Publications
Book Chapters
Takhar, J; Haslam, D; McAuley, L; Langford, J.
Shared/Collaborative Care for People with Serious Mental Illness. In: A Rudnick
and D Roe (Eds), Serious Mental Illness: Person-centered Approaches. (Chapter
5.3). UK: Radcliffe Publishing Ltd. Submitted for publication.
Peer-Reviewed Journals
Takhar, J; Haslam, D; Hobbs, A; McAuley, L.
(2010).
Enriching relationships through assessment of the Continuing
Medical Education (CME) needs of family physicians working within a
collaborative care model. Current Psychiatry Reviews, 2010, 6(3):210-218(9). doi:
10.2174/157340010791792635
Haggarty, J; Haslam, D; Houlding, C; Armstrong,
D. (2008).
Clinical findings of a cluster randomised control pilot trial of
a Canadian Shared Care service for those with chronic mental illness. Primary Care
and Community Psychiatry, 13(1):19-25(7). doi: 10.1080/17468840801890060
Haggarty, J; O'Connor, B; Dubois, S; Blackadar,
AM; McKinnon, T; Boudreau, D; Haslam D. (2008).
A pilot study of a Canadian shared mental health care programme:
Changes in patient symptoms and disability.
Primary Care and Community Psychiatry, 13(1):27-35(9). doi:
10.1080/17468840801892645
Haslam, D; Haggarty, J; McAuley, L; Lehto, J.
Takhar, J. (2006).
Maintaining and enhancing shared care relationships through the
TIPP clinical model. Families, Systems & Health, 24(4):481-486. doi:
10.1037/1091-7527.24.4.48
Abstracts/Presentations
Baird, K; Takhar, J; Haslam, D; McAuley, L;
Finigan, A; Langford, J. (June 19, 2008). Development of a process for quality
control through chart review within the context of a Transition into Primary
Care Psychiatry (TIPP) program. Poster at Annual Research Day, Department of
Psychiatry, University of Western Ontario, London, Ontario.
Bush, H; Langford, J; Jackson, L; Takhar, J; et
al. (May 29, 2009). Shared care services to indigent populations in London,
Ontario, 2004-2008. Poster at National Conference on Collaborative Mental Health
Care, Hamilton, Ontario.
Haggarty, J; Haslam, D; Takhar, J. (May 20-25,
2006). A tale of two cities: Lessons learned from research protocol variance.
Poster at American Psychiatric Association Annual Meeting, Scientific Program,
Toronto, Ontario.
Haggarty, J; Haslam, D; Takhar, J. (May 11-13,
2006). A tale of two cities: Lessons learned from research protocol variance.
Poster at 7th National Conference on Shared Mental Health Care, Calgary,
Alberta.
Haslam, D; Haggarty, J; Kolisnyk, G; Caruso, R;
McAuley, L; Lehto, J; Dunbar, S; Takhar, J. (Sept 20, 2006.) Transition into
Primary-care Psychiatry (TIPP): Perceived need for care and participant
satisfaction outcomes. Primary Healthcare Network Symposium, Vancouver, British
Columbia.
Haslam, D; Haggarty, J; Kolisnyk, G; Caruso, R;
McAuley, L; Lehto, J; Dunbar, S; Takhar, J. (May 11-13, 2006.) Transition into
Primary-care Psychiatry (TIPP): Perceived need for care and participant
satisfaction outcomes. 7th National Conference on Shared Mental Health Care,
Calgary, Alberta.
Haslam, D; Haggarty, J; Takhar, J. (May 23,
2006). Transition into Primary-care Psychiatry (TIPP): The feasibility of
conducting a full-scale cluster randomization study. Poster at the American
Psychiatric Association 159th Annual Meeting, Scientific Program, New Research,
Toronto, Ontario.
Haslam, D; Haggarty, J; Takhar, J. (May 11-13,
2006). Transition into Primary-care Psychiatry (TIPP): The feasibility of
conducting a full-scale cluster randomization study. Poster at 7th National
Conference on Shared Mental Health Care, Calgary, Alberta.
Haslam, D; Haggarty, J; Takhar, J; Caruso, R;
Kolisnyk, G. (May 11-13, 2006.) It's about the patient: going beyond the
satisfaction questionnaire: research on clients' experiences in a shared mental
health care model. 7th National Conference on Shared Mental Health Care,
Calgary, Alberta.
Haslam, D; Haggarty, J; Takhar, J. (Nov 3-6,
2005). Transition into Primary-care Psychiatry (TIPP). 55th Annual Conference of
the Canadian Psychiatric Association, Scientific Program, Vancouver, British
Columbia.
Haslam, D; Takhar, J; Dixon, D. (May 29, 2009.)
Depression education and enhancement in primary (DEEP) Care. Poster at National
Conference on Collaborative Mental Health Care, Hamilton, Ontario.
Lehto, J; McAuley, L; Melville, S; Haggarty, J;
Takhar, J; Haslam, D. (May 15, 2007). TIPP clinical findings from the third year
in expanding collaborative relationships. Poster at Regional Mental Health Care
London and St. Thomas 8th Annual Research Half Day, St. Thomas, Ontario.
(abstract in Research Insights).
Lehto, J; McAuley, L; Takhar, J. (June 10-11,
2005). TIPP clinical findings from the first year in maintaining and enhancing
shared care relationships. Poster at 6th National Conference on Shared Mental
Health Care, Ottawa, Ontario.
McAuley, L; Lehto, J; Haslam, D; Haggarty, J;
Takhar, J. (April 2006). Transition into Primary-care Psychiatry (TIPP):
Clinical findings from the first year in maintaining and enhancing shared care
relationships. Poster at 19th Annual Research Conference University of Western
Ontario School of Nursing, London, Ontario.
McAuley, L; Lehto, J; Takhar, J. (May 11-13,
2006). TIPP clinical findings from the second year in sustaining collaborative
relationships. Poster at National Conference on Shared Mental Health Care,
Calgary, Alberta.
Takhar, J; Hobbs, A; Haslam, D; McAuley, L.
(June 7-9, 2007). Transition into Primary-care Psychiatry (TIPP): Assessment of
the continuing medical education needs of family physicians providing care to
the seriously mentally ill population group within the model of service
delivery. Poster at 8th National Conference on Collaborative Mental Health Care,
Quebec City, Quebec.
Takhar, J; Hobbs, A; Haslam, D; McAuley, L.
(May 15, 2007). Transition into Primary-care Psychiatry (TIPP): Assessment of
the continuing medical education needs of family physicians providing care to
the seriously mentally ill population group within the model of service
delivery. Poster at Regional Mental Health Care London and St. Thomas 8th Annual
Research Half Day, St. Thomas, Ontario.
Takhar, J; Hobbs, A; Haslam, D; McAuley, L.
(Oct 5, 2006). Transition into Primary-care Psychiatry (TIPP): Assessment of the
continuing medical education needs of family physicians providing care to the
seriously mentally ill population group within the model of service delivery.
Poster at GAMES Education Symposium, London, Ontario. (abstract in Research
Insights)
Takhar, J; McAuley, L; Finigan, A; Langford, J;
Haslam, D; Baird, K. (May 17, 2008). Development of a process for quality
control through chart review within the context of a Transition in Primary Care
Psychiatry (TIPP) program. Poster at 2008 National Conference on Collaborative
Mental Health Care, Victoria, British Columbia.
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