Concurrent Sessions

F2 CFHT- Hospital for Sick Children Collaborative Integrated Care Initiative For Youth with Medically Unexplained Symptoms and Co-occurring Medical and Mental Health Disorders

Theme 2. Planning programs for equitable access to care

Presentation Details

  • Date: Thursday, October 26, 2017
  • Concurrent Session F
  • Time: 11:45am-12:30pm
  • Room:
  • Style: Presentation (information provided to audience, with opportunity for audience to ask question)
  • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
  • Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Representatives of stakeholder/partner organizations

Learning Objectives

Participants will learn about the program and collaborative between the Hospital for Sick Children and CFHT.  Participants will hear about challenges and successes and the evidence supporting the continued implementation of this program.


In the Fall of 2016, the Couchiching Family Health Team (CFHT) began work on an exciting new partnership with Hospital for Sick Children (HSC) through the Collaborative Integrated Care Initiative. The CFHT was selected to be the pilot site for development of an innovative program for youth between ages 8-17 who are experiencing unexplained medical symptoms and co-occurring mental health issues. Working with an HSC psychiatrist, the child’s family doctor and/or community paediatrician, the clinic provides a 16 week protocol to treat children and youth with comorbid medically unexplained symptoms and mental health issues.  Psychiatric consultations occur through the Ontario Telehealth Network and involve the child, family, a CFHT Social Worker, as well as the child’s medical/psychiatric team. The goal of the project is to provide comprehensive, seamless, coordinated service to complex children and families, while simultaneously building the capacity of paediatricians and family doctors to effectively manage these cases in the future  MUS in youth is a clinical classification describing a pattern of behaviour in which young people and their parents repeatedly seek medical help for disabling physical symptoms.  Despite extensive medical evaluation, there is no identifiable organic pathology to explain the severity of symptoms or functional impairment. The families generally attribute the condition entirely to physical disease. In addition to the term MUS, there are several other descriptive terms applied to this population. These include psychosomatic symptoms, somatoform disorders, functional disorders and now Somatic Symptom Disorders (DSM V). Common MUS presentations include abdominal pain, headaches, chest pain, gait disturbances, pseudo seizures or other somatic symptoms associated with decreased ability to function. This CFHT- HSC project is a quality improvement initiative supported by the Medical Psychiatry Alliance (MPA), an innovative partnership between the Centre for Addiction & Mental Health, the Hospital for Sick Children (HSC), Trillium Health Partners and the University of Toronto; the goal of which is to create new innovative models of care.  The integrated collaborative initiative is a team-based care service where outcome is tracked and treatment modified accordingly. The team consists of a care manager Ms. Norangie Carballo-Garcia MA, MSW, the primary care physician who remains the most responsible physician (MRP) and a HSC psychiatrist Dr. Rose Geist. The team will use OTN for team and patient based consultation and care planning. Dr Geist will be available to discuss patient care issues with the Mapmaking the collaboration from MRPs key in successful intervention for these patients and families. Our goal is to support primary care in the management of these patients using this collaborative service delivery model (described below) for 16 weeks, after which time the patient will be referred back to their MRP with ongoing support to the primary care physician by the care manager and the psychiatrist.


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