Primary Care for At Risk Youth

Overview:

Hamilton is a city with dramatic disparities in income, life expectancy, education, and overall health. The highest need neighborhoods have the:  highest rates of children under 18 living below the poverty line; in some neighbourhoods the poverty rate is 100%; highest rates of psychiatric-related emergencies (88 per 1,000 compared to 2.6 per 1,000); highest rates of trauma incidents to children under the age of 16 (264 per 1,000 vs. 33 per 1,000);  highest rates of drop out (267 per 1,000 compared to 6 per 1,000) 

Neighbourhoods with the 10 highest rates of psychiatric related emergencies are found in Hamilton’s downtown core. Many of these residents have no family physician. The poorest and the least educated are those who, in general, are the biggest consumers of health care services.  In one school, 31 per cent of students do not have a family physician.  Hamilton children and youth generally score lower in mental health indicators than their counterparts across the province and there is greater proportion of students in the Hamilton-Niagara-Haldimand-Brant LHIN report depressive symptoms, suicidal ideation, delinquent behaviour, experience bullying, and rate their mental health as poor, than the overall Ontario average. Poverty and mental health issues appear to be interrelated. Principals in Hamilton schools most challenged by poverty have collectively identified mental health as the most serious issue in their schools.  

OUR MODEL-  Nurse Practitioner in Schools
Given the great disparities within Hamilton, we believe a targeted approach to specific high-needs schools would yield the best overall outcomes for children and youth in our community. We believe there are benefits of taking a broader approach by addressing overall health. This will lead to improved student health outcomes and, in turn, result in system level benefits such as reduced emergency department visits, improved access to primary health care, and a reduction in unattached patients. The complex health needs of children and youth in these high-needs communities call for the advanced practice knowledge and skills of a primary health care nurse practitioner. Providing a Nurse Practitioner to the highest need schools would help to alleviate many of the health issues students without a family doctor experience.  For those students without access to a family physician,  the in-school team would pair the students with a family physician who is part of a family health team.  We believe this would help facilitate the rest of the student’s family joining the family health team and thus  reducing the number of unattached patients and facilitating emergency room diversion.  Nurse Practitioners (NPs) are “registered nurses with additional education preparation and experience who possess and demonstrate the competencies to autonomously diagnose, order and interpret diagnostic tests, prescribe pharmaceuticals and perform specific procedures within their legislated scope of practice. Their focus is on health promotion, preventative care, diagnosis and treatment of acute minor illnesses and injuries, and monitoring and management of stable chronic diseases. The advanced practice role of the NP is a cost effective approach to ensuring access to psychiatric services. Unlike an RN or RPN, the NP can refer students directly to a psychiatrist, thereby saving the cost of a family physician visit. We believe this innovative approach to healthcare for our students and families will contribute to a healthier more prosperous community.  This model will help ensure students receive the right care, at the right time, by the right care provider.