It’s important to have a flexible approach to care. Meeting kids where they are at is key to improving outcomes.
Flexibility is Key
Psychiatrist Dr. Sabina Abidi’s office at the IWK is tastefully decorated in shades of taupe and brown. Her desk holds family photos and house plants. It’s a warm, comfortable sanctuary amid the institutional green hallways of the hospital, and on this particular Tuesday, she’s walking into it for the first time at 4 p.m.
Dr. Abidi started her day treating patients at the IWK Dartmouth Community Mental Health Clinic, then crossed the harbour to attend a meeting at an IWK treatment program for youth with addiction problems in Halifax. Finally, she headed to the children’s hospital. It’s late afternoon and it seems her work day is far from over.
“Every day is slightly different,” says Dr. Abidi. “I wear many different hats. It’s a bit chaotic, but it’s also exciting.”
Dr. Abidi is the head of the IWK Youth Psychosis Program, the division head of Outpatient Services for the IWK Mental Health and Addictions Program, and the interim associate chief of the Division of Child and Adolescent Psychiatry at Dalhousie University. She is also an assistant professor of psychiatry at Dalhousie Medical School.
In addition to her administrative roles, Dr. Abidi is also a practising clinician and researcher.
“I spend one day a week seeing patients with general psychiatric problems in the Dartmouth community clinic,” she says. “It helps me maintain my early intervention skills. Some of the people I see at that clinic are as young as three years old, and I may end up working with them for years.”
Dr. Abidi also works with the IWK Youth Psychosis Program, treating young people – typically around 16 or 17 years old, but some as young as six or seven – showing signs of psychosis. She describes her work with these youth as “the part of my job that I have the most passion for.”
“Sometimes children won’t be symptomatic, but they will be showing subtle signs of psychosis, such as hearing voices,” she says.
These children may have a familial risk of schizophrenia, or they may have other disorders, such as anxiety or mood disorders. Identifying and treating their problems early leads to better outcomes.
“The early intervention program is relatively new, and very exciting,” says Dr. Abidi. “Helping children at such a young age is very rewarding.”
Once or twice a month, she provides care via Telehealth, a provincial video conferencing network. Telehealth allows Dr. Abidi to care for patients who live outside of Halifax – whether those are youth under the care of their family physician, paediatrician or young adults who have been transferred to other treatment programs, such as the Beacon House, a residence-based program in Kentville – without spending the better part of her day in the car.
The secure video link, enables Dr. Abidi to meet with her patients, their parents and their care providers – who may include physicians, nurses and teachers – for a check-in. “It’s collaborative care over the screen,” she says, explaining that having everyone together enables communication and ensures that everyone is on the same page about treatment.
Dr. Abidi also has an interest in the field of collaborative mental health care, with an emphasis on fostering the relationship between primary care providers and child/adolescent psychiatrists. She is particularly interested in working with primary care providers in smaller communities across Nova Scotia to help them build their capacity for recognizing and treating potential psychiatric problems in their young patients.
“If we increase the resources and the level of communication and collaboration with our community partners, we could provide youth with mild to moderate problems with the level of care they need in their community,” she says. “That would free up the tertiary care spots for patients who need more significant resources.”
She says that having a full team – that might include the child’s parents or guardians, paediatrician, teacher and guidance counsellor – devoted to a child’s care in the community is also important. “They see the child in different situations; they can interact with the patient in ways that I can’t necessarily in the clinic context.”
Sometimes Dr. Abidi sees her patients outside the clinic, too. “Sometimes it’s better to see them elsewhere – at home, at school, or even in a coffee shop.”
“There’s something about the office that isn’t ‘real,’” she says. “Things seem possible in the office that might not seem as feasible when the child gets back into the classroom or the schoolyard.”
“It’s important to kids and adolescents to decrease the emphasis on traditional face-to-face care,” says Dr. Abidi. “The traditional doctor-patient relationship that we’re used to doesn’t necessarily meet kids where they are at – and meeting kids where they are at is key to improving outcomes.”
Dr. Abidi says that at a time when more and more children and youth are seeking help for mental health problems such as severe anxiety and depression, working closely with other care providers and being flexible about how and where they provide care is essential.
“Improving communication between care providers helps us collaborate on providing mental health care in the community. By promoting awareness of how mental health problems may present in children and youth, and by building their capacity to deal with those problems at the community level, we’re helping to ensure that more children receive the care they need, when they need it.”