Healthcare professionals – FAQ

Information in a person’s clinical or medical file cannot be shared with a third party without their consent. Additionally, CMHA-QC coaches are not trained to interpret analysis and assessment forms from the health and social services network to include the information in the coaching plan. The BounceBack® self-care program has its own procedures for collecting information and coaching participants in their choice of actions and workbooks for the program.

CLSC professionals can close a person’s assignment in I-CLSC after they receive confirmation of the start of the program by email and if the person is not awaiting other CLSC services. An initial acknowledgement of receipt for the referral form will be sent to the referring professional, but the professional can close the assignment only after the second email confirming the participant has started the program. The CMHA-QC makes several attempts through different means to contact the person referred. If they cannot be reached, the referring professional will be notified by email and can try to reach the person for an update on the situation and adjust the services offered. In any case, a new referral is not required. The person can always contact the CMHA-QC again within the six-month service period to start the coaching, and the referring professional will be notified of this by email.

The CMHA-QC coach ensures the participant is making an informed decision, and they reconfirm needs and review the benefits of the BounceBack® self-care program. If the person reiterates their desire to withdraw from the program, an end-of-program email is sent to the person, and a report is sent to the referring professional and the sponsor/responder.

Professionals in CLSCs use the procedure code “7724 Autosoins non dirigés” to refer someone to the BounceBack® self-care program.

BounceBack® is based on solid research data that shows that simple skills and techniques are effective for helping people overcome mild to moderate symptoms of depression and anxiety. The BounceBack® program offers exercises that use cognitive-behavioural techniques.
According to a study by Lau and Davis (2019), nearly 69% of participants in the BounceBack® program in British Columbia who had symptoms of depression or anxiety saw the frequency and severity of their symptoms reduced to a level that was no longer clinically significant upon completion of the program. These same participants also showed a significant improvement in their quality of life, mood, and general health.

The BounceBack® self-care program, with its online platform and phone coaching, uses cognitive-behavioural techniques assisted by information and communication technologies. Programs that use cognitive-behavioural techniques assisted by information and communications technologies are recognized as effective for treating mild depressive disorders in adolescents. Based on their clinical judgement, if the adolescent’s interest, motivation, and functioning are adequate, psychosocial workers may recommend participation in such programs as part of a global plan that includes other interventions.

CMHA-QC coaches are not clinicians, and they do not provide psychological advice. Through six phone sessions over a period of three to six months, CMHA-QC coaches help participants acquire the skills to improve their mental health. The role of CMHA-QC coaches is to motivate and support participants as they progress through a series of workbooks with exercises that use cognitive-behavioural techniques selected to meet their needs. CMHA-QC coaches ensure sponsoring/responding psychosocial workers or services are informed of the participants’ progress, and they are notified if a risk is detected during the sessions. Depending on the level of risk detected, the sponsoring/responding psychosocial worker or service may be asked to follow up with the participant. CMHA-QC coaches also inform the sponsoring/responding psychosocial worker or service if a participant is no longer interested in continuing in the program, if a participant is no longer eligible for the program or can’t be reached. In such cases, we ask the sponsoring/responding psychosocial worker or service to follow up with the person to explore other programs or resources that may be more appropriate. Coaches are CMHA-QC employees who have received in-depth training on the BounceBack® program. They also receive clinical support from professionals authorized to practice psychotherapy.

The main objective of BounceBack® phone coaching sessions is to help people get the most out of the program by lending support, structure, and motivation. The individual coaching sessions are shorter (usually 20 to 25 minutes) than the one-hour sessions for psychological consulting. The shorter time does not enable CMHA-QC coaches to learn all the details of the participants’ situation. CMHA-QC coaches instead help participants move through the program material, follow up with participants, answer their questions, and help them solve problems if they have difficulty applying what they have learned. This form of communication is also different from the open conversations typical of therapy sessions.

No, referrals to the program cannot be received from a department without the name of a referring professional. The referring party must be a physician, professional, or psychosocial worker who has spoken to the person referred, ensured they are eligible for the program, and completed the CMHA-QC referral form. The physician, professional, or psychosocial worker indicates their contact information on the referral form and can be contacted by the CMHA-QC if essential information is missing from the referral.

No, because professionals in the private network are not authorized to consult the participant’s medical file or contact the crisis management service if the participant’s condition deteriorates. As such, only physicians, professionals, and psychosocial workers in the healthcare network can make referrals to the BounceBack® program. However, family doctors, even in a private medical clinic, may refer their patients to the BounceBack® program. Professionals in the private network can use BounceBack® videos without a referral to the program. They are available on the website: www.bouncebackvideo.ca. The person registers with their email and uses the access code: bbtodayqc

Yes, professionals in a youth service program can refer a parent if they meet the eligibility criteria for adults, with the understanding that if a CMHA-QC coach observes a deterioration in the parent’s situation or a crisis, they will make a telephone transfer of the adult to Info-Social 811 for immediate crisis management.

People can self-refer to the program if they meet the eligibility criteria and if they indicate the name and contact information of their physician, professional, or psychosocial worker who has agreed to act as sponsor/responder if the situation deteriorates. BounceBack® program coaches verify eligibility and validate with the physician, professional, or psychosocial worker if they have agreed to be the sponsor/responder for the given service period. To reduce the validation steps and the time required before someone can start the BounceBack® self-care program, physicians, professionals, and psychosocial workers from the healthcare network are encouraged to refer the person directly using the online referral form.

No, because school psychosocial workers and staff are not authorized to consult the person’s medical file or contact the crisis management service if the person’s condition deteriorates. Only physicians, professionals, and psychosocial workers in the healthcare network can make referrals to the BounceBack® program. School psychosocial professionals and staff can talk about the BounceBack® program to people aged 14 and older and encourage them to ask their physician, professional, or psychosocial worker from the healthcare network for a referral. The person can also refer themselves, indicating the contact information for their healthcare network professional or family doctor as sponsor/responder. If the person does not have a physician, professional, or psychosocial worker in the healthcare network, they can contact Info-Social 811, which will direct them to a service that can refer them to the BounceBack® program if it meets their needs. School psychosocial workers and staff can use BounceBack® videos without making a referral to the program. They are available on the website: www.bouncebackvideo.ca. The person enters their email and the access code: bbtodayqc

For professionals who use the suicide risk estimate grid Grille d’estimation de la dangerosité d’un passage à l’acte suicidaire, a person who has been referred who is considering suicide with a final risk assessment of green (absence of risk) or yellow (low risk) may be eligible for the program if that person presents ALL the characteristics below. For referring professionals who do not use this tool, someone who is thinking of suicide but who, based on the professional’s clinical judgement, does not present a danger to themselves in the short term (a low risk), may be referred to the BounceBack® self-care program if that person presents ALL the following characteristics:

• Suicidal ideation without a scenario or a plan for the suicide (means, place, time)
• Has not attempted suicide in the past year
• Does not have a substance abuse disorder
• Does not demonstrate impulsivity, aggressivity, or loss of contact with reality
• Has a safety net with reliable support from the people around them
• Agrees to help for their suicidal ideation
• Has hope for the future

According to BounceBack® program eligibility criteria, only the results from the PHQ-9 assessment questionnaire are required on the online referral form. Only the PHQ-9 assessment questionnaire (or RCADS-MDD for young people) appears on the online referral form. At each session, CMHA-QC coaches will measure anxiety symptoms using the GAD-7 assessment questionnaire, and the results will be communicated in the end-of-program report.

Self-care interventions are effective for specific people with mild or moderate symptoms of a mental disorder, whether confirmed or not. Self-care must not be used “while waiting” or as a prior service with people for whom other, generally more intensive, interventions are indicated or planned. As such, it is essential to identify people with the characteristics that will allow them to successfully complete their self-care program and to meet their needs without requiring additional interventions.

Before referring someone to the BounceBack® program, the referring physician, professional, or psychosocial worker must first consult the information in the person’s file to verify that they meet the eligibility criteria. The referring professional then completes the online referral form with the person. The referring party cannot be a service, because the referring professional who intervened with the person must indicate their contact information so the CMHA-QC can reach them if essential information is missing from the referral.

The sponsor/responder professional or service remains available to be contacted in case of a deterioration in the participant’s condition. In the event of a crisis, immediate interventions will be made by Info-Social 811. The sponsor/responding professional or service will then be notified by email that the person had to be transferred to Info-Social 811 and that the coaching must be momentarily interrupted. The sponsor/responding professional or service must ensure that the person was contacted, that a new analysis has been done, and that the required services have been requested. At the end of the program, the sponsor/responding professional or service are responsible for including the end-of-program report in the participant’s clinical or medical file, to ensure continuity of care if the participant has difficulties in the future.

In Quebec, physicians, professionals, and psychosocial workers in the healthcare network can refer people to the BounceBack® program, because of their access to the person’s clinical or medical file. Quebecers are encouraged to make a request with their physician, professional, or psychosocial worker in a family medicine group (FMG) or a CLSC where they are a patient or to contact Info-Social 811. The Table nationale de coordination des services sociaux généraux was notified on November 3, 2022 that requests to access the program can be received through Info-Social.

The BounceBack® program is designed for people with mild to moderate symptoms. According to a study by Lau and Davis (2019), people with moderately severe symptoms of depression (initial score on the PHQ-9 of 15 to 19) who completed the program showed a significant reduction of almost 9 points on their score on the PHQ-9 at the end of their coaching. This is why the BounceBack® program can accept participants with an initial score of up to 21. Based on the psychosocial worker’s clinical judgement, if the person’s interest, level of literacy, autonomy, and functioning are adequate, they can benefit from the program, even if these symptoms seem initially more severe when their condition is assessed.

When physicians, professional, and psychosocial workers register for the BounceBack® self-care program to familiarize themselves with its contents, the CMHA-QC takes time and resources to analyze the application, contact the person, and begin the coaching. We ask that physicians, professionals, and psychosocial workers read the introductory documents for the BounceBack® self-care program, so that the CMHA-QC’s time and resources can be dedicated to responding to the needs of people who need the services.

Documents for the BounceBack® self-care program are protected by a copyright held by Dr. Chris Williams (5AreasTM). However, a number of documents are available to you: 

– Program Overview for Physicians, Professionals, and Psychosocial Workers (available soon in English)

– Excerpt from the workbook Understanding Low Mood and Depression

– Excerpt from the workbook Understanding Worry and Stress

– Excerpt from the youth workbook Why Do I Feel So Bad

– Excerpt from the youth workbook The Things You Do That Mess You Up

You can download electronic brochures or order print brochures by email, indicating the complete address, recipient, and number of brochures requested (French and English). Please coordinate with your colleagues to avoid ordering duplicate brochures.

The BounceBack® coaching program includes up to six phone sessions. Sessions generally last 20 to 25 minutes and are scheduled every two to three weeks. Participants have six months to complete the program. Before the end of their six-month program, participants may have two additional follow-up phone sessions if requested.

In Quebec, the BounceBack® self-care program and phone coaching are available in French and English. The psychological education videos are available in English, French, Arabic, Persian, Cantonese, Mandarin, and Punjabi.

Adolescents 14 and older have access to essentially the same program, based on the same cognitive-behavioural approaches, but the printed booklets for teens are abridged, with an appropriate level of language, examples, and exercises. During the initial meeting with the CMHA-QC coach, adolescents can choose to complete their program using the workbooks for adults.

According to a study by Lau and Davis (2019), of the 10,903 participants who attended their initial phone coaching session, 7,203 completed the BounceBack® self-care program, for a completion rate of 66%.