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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

The Upper Island Geriatric Outreach Team

Sandie Somers, RPN, MEd

Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp.38-39

The Upper Island Geriatric Outreach Program provides a multidisciplinary, comprehensive, individualized psychiatric consultation service for the residents and health care providers of North Vancouver Island. This service addresses the special and often complex mental health needs of seniors through assessment and diagnosis; treatment recommendations; outreach consultation to Indian Bands and remote Northern communities; liaison with all health care service providers; individual and family education; in-services and workshops for caregivers, professionals and the public; consultation to hospital and care facilities; program development; research; and the prevention of illness and the promotion of health.

As the number of older adults with complex heath care issues increases, the demand for coordinated health care is growing. There are different types of health care delivery systems and a vast array of community-based services, both public and private. Matching this complex system to the multiple needs of older adults requires a coordinated, collaborative effort by a team of professionals and caregivers across the entire continuum of care.

The philosophy of today’s heath care delivery system focuses on health promotion and illness prevention. With this shift in philosophy towards optimal health rather than treatment of illness, mental health is being seen as an essential component of a healthy lifestyle for seniors. Recognizing their responsibility as active participants in their health, the residents and health care professionals of the North Vancouver Island communities lobbied for enhanced resources and for equal access to programs that support effective health promotion and optimal level of functioning. They were successful in acquiring funding to develop this traveling team.

The goal of the Upper Island Geriatric Outreach Program is to collaborate with all of these communities to enhance their health potential through specialized assessment, treatment and education for seniors, and consultation and education for service providers. The program functions within a community collaborative care model that has evolved in cooperation with health care professionals, administrators, educators, volunteers, and the residents of each community. This cooperation led to the creation of formal and informal health care service provision links throughout the North Island.

Collaborative care is a process of needs identification and service coordination that is designed to maximize the function and independence of the individual, while also recognizing the individual’s right to self-determination. It involves coordinating the different types of health care provided in all settings, including the home, medical clinic, hospital or long-term care facility. It involves collaboration among all of the health care providers: physicians, nurses, social workers, psychologists, occupational therapists, physiotherapists, home support workers, volunteers and most importantly, families.

Effective collaborative care is a dynamic process that allows for change in accordance with each individual’s needs. Individuals and their families are informed of options for care, both in their immediate environment as well as throughout British Columbia, in line with their needs. Care is provided from a conceptual perspective that recognizes and appreciates the medical, functional, psychological, social, environmental and spiritual needs of each individual. Individuals actively participate in the formulation of the plan for care and the evaluation of the plan’s effectiveness.

Given precious financial, time and professional resources, the Upper Island Geriatric Outreach Program delivers services via consultation. Assessment reports are generated and liaison established with the referring source(s) who then make independent decisions regarding any recommendations.

Team Statistics

The team consists of 1.6 FTE nursing, 1.75 FTE occupational therapists, 1.0 FTE administrative support and 2.0 FTE geriatric psychiatrists. In the fiscal year 2001/02, team members provided 686 assessments to referring sources, 359 of which were for new clients. Direct client contact occurred 4,392 times during this period.

About the author
Sandie is based in Comox and is the Coordinator of the Upper Island Geriatric Outreach Team. She is a geriatric nurse clinician/ educator with 26 years experience in the field of geriatric psychiatry and is a founding member of the BC Psychogeriatric Association where she currently is on the Board of Directors

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