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Disclosure. The Implementation of a Specialized Geriatric Mental Health Outreach Program (GMHOP): Responding to the Needs of Long Term Care Homes. Joanne Walsh, RN, MHS Anne Stephens, BScN, MEd, GNC(C) . 2nd National Canadian Coalition for Seniors’ Mental Health Conference, 2007.

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Disclosure

The Implementation of a Specialized Geriatric Mental Health Outreach Program (GMHOP): Responding to the Needs of Long Term Care Homes

Joanne Walsh, RN, MHS

Anne Stephens, BScN, MEd, GNC(C)

2nd National Canadian Coalition for Seniors’ Mental Health Conference, 2007


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We would like to acknowledge the exemplary work of the Toronto Region Long Term Care/Mental Health (LTC/MH) Steering Committee

in producing the

Psychogeriatric Framework Report

December 2006

For further information: ayau@toronto.ca

Sandra Pitters: Chair, LTC-MH Implementation Committee

Angelina Yau: Project Manager, LTC-MH Implementation

Disclosure


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Presentation Overview Toronto Region Long Term Care/Mental Health (LTC/MH) Steering Committee

  • Background

  • Toronto Region Psychogeriatric Framework

  • GMHOP development & implementation:

    key elements for success

  • Challenges and benefits

  • Q & A


Background l.jpg

MOH LTC Toronto Region Steering Committee established in November 2005

Response to the recommendations arising from the Casa Verde inquest report in June 2005

Part of the Toronto Region’s LTCH Bed Strategy to address the needs of individuals requiring specialized programming related to significant behavioral response issues

Background


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Latent Failures November 2005

Latent Failures

Latent Failures

Active Failures

Failed or

Absent Defenses

Reason, J. “Education and debate. Human error: models and management.” British Medical Journal. 2000 Mar 18; 320 (7237): 769.

Mishap

Model of System Failure


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A consistent, coordinated and integrated approach to providing care for seniors with serious mental health illness and serious behavioral response issues

Based on current best practices

Toronto Region Psychogeriatric Framework


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System Integration & Coordination providing care for seniors with serious mental health illness and serious behavioral response issues

EMS

Tertiary

Care

Emergency

Dept.

LTCH

LTC

Team

Resident

&

SDM

Hospital

In-patient

GMHOP

PRC

CCAC

Adapted from Toronto Region LTC MH Psychogeriatric Framework Report 2006


Geriatric mental health outreach program gmhop l.jpg

Implemented in April 2006 providing care for seniors with serious mental health illness and serious behavioral response issues

Funded by the Ontario Ministry of Health and Long Term Care (Federal Accord Funding)

Designated seven LTCH

Geriatric Mental Health Outreach Program (GMHOP)


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The team consists of: providing care for seniors with serious mental health illness and serious behavioral response issues

- 1 full time mental health

- 1 part time geriatric psychiatrist

Team Composition


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Target Population providing care for seniors with serious mental health illness and serious behavioral response issues

  • Seniors (55 and over) with serious mental illness and severe behavioral problems living in long term care homes


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Consultation model providing care for seniors with serious mental health illness and serious behavioral response issues

- Assessment

- Treatment recommendations

- Follow up

- Referral to other services

- Family/SDM support and education

- Education of LTCH staff related to

clinical consultation

Services


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Key Elements for Success providing care for seniors with serious mental health illness and serious behavioral response issues

  • Ensure organization’s commitment

  • Incorporate evidence based practice

  • Establish trusting relationships

  • Develop mutually agreed upon modes of communication

  • Work in partnership with the various service providers

  • Clarify roles

  • Evaluate the program


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Ensure the program is in alignment with the organization’s vision, mission and values

Identify champions

Get stakeholder buy-in

Ensure Organization’s Commitment


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Ensure practice standards, policies, protocols, and documentation tools reflect mental health/geriatric clinical practice guidelines (e.g. CCSMH, RNAO)

Link with PRC for education to LTCH staff on clinical practice guidelines

Incorporate Evidence Based Practice


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Initiate meeting with LTCHs at the outset to introduce self, discuss expectations, roles and responsibilities

Meet regularly with LTCHs to review program implementation and progress and to resolve issues

Establish collaborative relationships with service providers (i.e. DOCs, attending physicians, solo practitioners, front line staff, PRCs)

Participate in case conferences and Professional Advisory Committees

Establish Trusting Relationships


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Develop tools in collaboration with LTCHs (e.g. referral form)

Identify LTCHs needs regarding their specific processes (e.g. consultation notes)

Establish communication protocols (e.g. urgent referrals)

Develop Mutually Agreed Upon Methods of Communication


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Recognize that old and new “pieces” are coming together to form a new paradigm of care

Understand that all “pieces” need to “fit” together to make it work and that some of the “fits” aren’t easy to “fit”

Work in Partnership with the Various Service Providers


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Putting the Pieces Together to form a new paradigm of care


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Define roles and responsibilities of GMHOP and LTCH (e.g. information sharing, follow up on recommendations)

Establish conflict resolution process

Clarify Roles and Responsibilities


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Satisfaction surveys information sharing, follow up on recommendations)

Common Data Set (CDS)

MOHLTC Research Grant to evaluate Toronto GMHOPs

Evaluate the Program


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Recruiting appropriate staff information sharing, follow up on recommendations)

Gaining trust

“Customizing” the program to meet the different characteristics and needs of LTCHs

Interfacing with long term care system

Challenges


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Benefits information sharing, follow up on recommendations)

  • Infusion of specialized geriatric mental health expertise

  • Support/resource to LTCHs

  • Timely interprofessional assessments, recommendations and follow up

  • Avoid unnecessary hospital admissions

  • Working towards an integrated system of care

  • Opportunity for inter-professional education and research


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Q & A information sharing, follow up on recommendations)