Mind Space (formerly CBT Skills Groups) Referral Form

ONE REFERRAL FORM

You do not need to specify the particular program for which you are referring; there is only one referral form, and then patients self-select their program.

Screening: Please review our  inclusion and exclusion criteria. A PHQ9 screen must be done to rule out severe depression; refer only if the score is 18 or less and if there is no acute suicidality. Also assess for group readiness and suitability. Depending on the complexity of the presentation, we may request additional clinical information and confirm that follow up can be provided.

Referral Form: Our administrative team is lean and we require referral forms to be filled out completely. If ANY information is missing it will be sent back to you, which will delay the patient’s enrollment. 

The more skilled you become at selecting patients and completing the referral form, the better able we will be to quickly and effectively support patients within your ever-increasing panel.

ONE REFERRAL FORM is required to access any Level 1 program:

• CBT Skills Foundations

• Skills for Success: ADHD Strategies for Adults

• Raising Resilient Kids Parenting Group

• CBT Skills for Insomnia

• CBT Skills Indigenous

Access: All programs are available virtually, and some CBT Skills Foundations courses are in-person. Programs are offered consistently throughout the year, at varying times of day, including evenings and weekends. Most Level 1 groups have little to no wait list.

We are unable to accept referrals without a Most Responsible Provider (MRP) for the time during which a patient enrols in Mind Space programs.

We require the capacity to liaise with clinicians knowledgeable about the patient and/or about local resources, in the event of individual or crisis-related needs arising for patients while they are in our programs. These clinicians need to be MDs or Nurse Practitioners (NPs), or work on a team with an MD or NP. We consider the MD/NP involved in the referral to be the Most Responsible Provider (MRP).

Other clinicians, as designates, may assess, screen and make referrals, but must also indicate the MRP attached to the patient (name, MSP number, agency/clinic). It is the responsibility of the designate to ensure the MRP agrees with the referral.

If specialist physicians refer, they must either agree to be MRP, or ensure the patient’s primary care clinician agrees with the referral and can serve as MRP.

Designates with the following credentials can refer to Mind Space programs, if they have the agreement of the MRP:

(Professional registration must be active with the appropriate provincial governing body)

• MD Resident
• Nurse Practitioner Student
  • Registered Nurse Certified; RNC Student
  • Registered Nurse General; RN Student
• Mental Health Substance Use Health Consultant
  • Registered Psychiatric Nurse; RPN Student
  • Master of Social Work
  • Registered Clinical Counsellor
  • Clinical Psychologist (PhD)
  • Registered Midwife
  • Occupational Therapist
• Physician Assistant

Are you a Designate from a Primary Care Network or Urgent Primary Care Centre?

If you are an accepted designate from a Primary Care Network, Urgent Primary Care Centre, or Virtual Care Clinic (such as Telus Health), please ensure that an MD/NP from your agency/clinic agrees with the referral and agrees that you can refer on their behalf. List this MD/NP as the MRP (Most Responsible Provider). We will use their MSP number for billing purposes, and will liaise with them if necessary, should the patient require individualized care while they are involved in our programs. We will also send them copies of summary notes or other medical records.

If you are an accepted designate and referring, please specify your clinic or agency on the referral form

What is the rationale for MRP policy?

To run our service, we require:

1. Referrals from MDs, NPs or others eligible to refer to psychiatry under MSP regulations.
2. A clinician who holds a patient’s medical record, so we can share progress and summary notes.
3. Clinicians who are knowledgeable about the patient and/or about local services, in the event of a patient needing individualized care that is beyond the scope of the group service.
• Localized knowledge of higher acuity mental health services. Our physician facilitators may not work in the community from which your patient was referred and/or accesses medical care. Mental health resources are geographically complex and can be quite specific to regional communities.
• This patient population may be at higher risk of destabilization. Patients participating in Mind Space programming may occasionally destabilize and need more urgent assessment and management within their communities. We treat patients with anxiety and depression (inclusion/exclusion criteria). The severity of these conditions fluctuate, and participants in groups may at times require a higher level of care. We are not able to provide urgent or individualized care, due to limited physician capacity. We are not resourced to have clinical staff. 
• In the event of symptom exacerbation the Mind Space facilitator will complete a safety assessment and liaise with the MRP. The referring clinician/MRP can further assess, support, and refer if necessary to higher acuity services in the patient’s local community.