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OCAN (Ontario Common Assessment of Need). Supporting Recovery by Capturing Consumers’ Complex Needs 2010 PSR Conference September 20, 2010. Today’s presenters. J ENNIFER Z OSKY Community Mental Health Common Assessment Project OCAN and Recovery W ILL T ODD

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ocan ontario common assessment of need

OCAN(Ontario Common Assessment of Need)

Supporting Recovery by Capturing Consumers’ Complex Needs2010 PSR ConferenceSeptember 20, 2010

today s presenters
Today’s presenters

JENNIFER ZOSKYCommunity Mental Health Common Assessment Project

OCAN and Recovery

WILL TODD

Community Mental Health Common Assessment Project

How OCAN Works

OCAN Reports

LAURIE ALBERTINI

Community Mental Health Common Assessment Project

Using OCAN to Support Recovery– The Consumer Perspective

ALAN MATHANY

Frontenac Community Mental Health Services

Using OCAN to Support Recovery– The Pilot Experience

ocan and recovery

OCAN and Recovery

Jennifer Zosky, Clinical Lead

slide4

Local Health Integration Networks (LHINs)

Community Care Information Management (CCIM)

CCAC

CSS

CMH&A

LTCH

CHC

SCCH

Common Intake

Assessment Tool

InterRAI Community Health Assessment

Ontario Common Assessment

of Need

Resident

Assessment

Instrument

MDS 2.0

Assessment

Projects

Long Stay

Assessment

Software

ScreenerCapability

Integrated Assessment Record

Integrated Data Strategy

Management

Information

Systems

Management

Information

Systems

Management Information Systems

Management

Information

Systems

Management Information Systems

Management Information Systems

Business

Systems

Human

Resources Information Systems

Human

Resources Information Systems

Human

Resources

Information

Systems

Human

Resources Information Systems

Infrastructure & Operations Standards Security, Privacy & Risk Management Transition

Initiation stage

Pilot stage

Currently rolling out

Completed and transitioned

CCAC = Community Care Access Centres CSS = Community Support Services CMH&A = Community Mental Health and Addictions

LTCH = Long-Term Care Homes SCCH = Small & Complex Continuing Care Hospitals CHC = Community Health Centres

what is ocan
What is OCAN?

Ontario Common Assessment of Need (OCAN) is a standardized, consumer-led decision making tool that allows key information to be electronically gathered in a secure and efficient manner.

Assists client-leddecision-making at an individual level

Identifies individual needs and helps match these to existing services and identifies service gaps

Provides aggregate data to informorganizational, regional and provincial level planning and decisionmaking that is consistent with a recovery approach

Further facilitates inter-agency communication through common data standards

5

5

what is recovery
What is recovery?

A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness.

Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.

Anthony WA (1993) Recovery from mental illness:

the guiding vision of the mental health service system in the 1990s,

Psychosocial Rehabilitation Journal, 16, 11-23.

the bigger picture canadian perspective
The bigger picture: Canadian perspective

Goal 1: The hope of recovery is available to all

A person-centred mental health system

Genuine partnership between consumer and service provider

Hope and expectation that people can achieve a meaningful life in the community

Mental Health Commission of Canada (2009) Toward recovery and well-being, Calgary, AB: MHCoC.

8

the bigger picture ontario 10 year mental health strategy
The bigger picture:Ontario 10 Year Mental Health Strategy*

Standard assessment, treating planning, supports crisis management.

* Every Door is the Right Door, July 2009

project overview and development
Phase 1 – Initiation (with stakeholder representation)

Analysis of many assessments tools

Selection of a core tool – Camberwell Assessment of Need

Province-wide consultations to introduce the tool

Formation of working groups (e.g., to develop additional data elements)

Phase 2 - Pilot

Piloting of the automated OCAN in 16 CMH organizations

Early learnings gatherings

NE LHIN Implementation pilot

Phase 3 - Implementation

Provincial roll-out

Integration with a changing CMH landscape

Powerful reporting to drive enhancedperson-centered service and system planning

Project overview and development

2006

2008

2009

2010

2011

2012

10

10

can tool
CAN tool

Consumer identifies unmet needs/serious problems

Service provider identifies unmet needs

Covers a range of life domains

Value of both perspectives

Also identify areas of met need

and no need - strengths

Focus on meeting consumer

expressed unmet needs

11

empirical conclusions
Empirical conclusions*

Meeting consumer-identified unmet need improves outcomes:

Well-being

Relationship - Therapeutic alliance

Satisfaction with services

Equivalent research into staff-rated unmet need does not show the same benefits

Reassessment improves mental health outcomes

* Source: Mike Slade, Made in Ontario conference and The Power of Shared Information conference (2009)

how ocan works in brief
How OCAN works (in brief)

Internationally-researched and locally-customized as the common assessment tool to support mental health recovery in Ontario

the foundation beliefs and values of recovery
The foundation: beliefs and values of recovery*

Values Empowerment

Consumer perspective and input is central to information gathered in OCAN and the determination of priority areas to work on.

Values and Elicit Hope

Although the tool focuses on unmet needs/problem areas, It also promotes a dialogue where consumers share and discuss strengths, hopes and dreams.

Values Self Determination

OCAN provides the opportunity for consumers to make decisions on the life domains they would like to focus on.

Works Toward the Elimination of Prejudice and Discrimination

OCAN approach views a consumer as a whole person and an active participant in the assessment process, not as a diagnosis (“patient”)

Values Meaningful Choice

Consumers engage with their workers to focus on their perspective and choices in preparation for action and service planning.

Source: “Recovery Values and Principles in the Mental Health and Addiction Service System” – Self Help Alliance

ocan benefits
OCAN benefits

Holistic consumer based approach

Relevant information available for service planning (identify needs earlier)

Standard approach to information gathering and sharing

Resource stresses and gaps identified

Improved sharing of information

15

ocan challenges being addressed
OCAN challenges being addressed
  • Need-based rather than strength-based
    • Training encourages discussing areas of no need or met needs which can be interpreted as strengths
    • Added question on hopes and dreams
  • One tool – variety of services
    • Support is provided to all CMH services
    • Flexibility in where OCAN fits in assessment process
  • Tool terminology takes time to learn
    • Have definitions in training and communications
  • Multiple language environment
    • Translation process in place; supports in place to share language versions
  • Demand for sharing between service providers as a result of the OCAN common language leads to challenges in understanding the privacy and security issues associated with sharing information
    • Develop of CPF, toolkit, info for consumer and staff, data sharing agreements
slide17

OCAN with consumers

What we’ve heard!

91% of surveyed consumers reported satisfied or very satisfied with the OCAN experience – OCAN Evaluation in NE LHIN C/SIs, March 2010

Source: OCAN Evaluation in NE LHIN C/SIs, March 2010

Source: Caislyn Evaluation, August 2008

ocan and the sector
OCAN and the sector

OCAN users realize its value in improving assessment practice in Ontario

The field is supportive of OCAN, however there is never 100% consensus

What we’ve heard!

Source: Pilot Coordinator Survey, July 2008

ocan on the international scale
OCAN on the international scale

Academics have stated,

“Ontario is an international leader…”

Engaged those who are going to be using the measure in choosing the measure

Took an approach that is focused on seeing the person rather than the illness

Understands there will be differences between what consumers say and what members of staff think about the person’s needs

Performed a genuine piloting of the assessment tool

What we’ve heard!

Source: Mike Slade, March 2003

what is a lhin
What is a LHIN?

In 2006, MOHLTC established 14 Local Health Integration Networks (LHINs)

Main roles: to plan, fund and integrate health care services locally

ocan and the lhin
OCAN and the LHIN

Consumersreceive a holistic assessment, enabling a more coordinated approach to service

Staffare provided with a common, comprehensive initial assessment to support service planning

All service providers and our LHIN have access to stronger LHIN-wide data to identify gaps, poorly served geographic areas and good practice

Our LHIN will use this pilot to support IT strategies

Our LHIN has the opportunity to gather further learnings about how we provide services with diverse populations (e.g., Francophone and/or Native)

What we’ve heard!

Source: Mike O’Shea, NE LHIN, December 2009

ocan initiatives
OCAN initiatives

MINISTRY OF HEALTH AND LONG-TERM CARE

CMH CAP STEERING COMMITTEE

HSP ORGANIZATIONS

WORKING & REFERENCE GROUPS

Consumers

Data Elements WG

Addictions WG

Management

Technical Decisions RG

Reports WG

Coordinator

Diversity RG

Shared Assessment

Single Framework WG

Staff workers

Consumer WG

Business Requirements WG

Technical leads

Geriatrics WG

OCAN

Cross Sector Advisory

PROJECT TEAM

Project Management

Communications

Sector Expertise

Technology

Business Process

Education

22

where we are today
Where we are today

NE LHIN implementation pilot wrapping up

Over 2150 assessments have been submitted

Lessons learned presented to Steering Committee

Initial discussions underway for implementation of OCAN 2.0

  • LHIN-wide OCAN implementations underway
  • TC LHIN, SE LHIN, MH LHIN
  • Select OCAN-IAR implementation
implementation approach
Implementation approach

Planning

Strategy

Change Management

Strategy

Communications

Strategy

Business Process

Strategy

Technology

Strategy

Education & Training

Strategy

Support

Strategy

implementation support
Implementation support

Getting prepared

Specific help

Information sessions and kick-off

Subject matter experts in business process, technology, clinical issues, communications, consumer lead

Accessing resources

Learning OCAN

Online portals

OCAN user

Educators to train on a series of education modules

Reaching the project

CMH CAP Support Centre

Getting together

On-site support as required and available

Staying updated

Regular touchpoints – teleconference/WebEx

how ocan works

How OCAN Works

Will Todd, Education Lead

types of ocan
Types of OCAN

There are three (3) “types” of OCAN:

  • The COREOCAN includes consumer demographic information, service use summary and Common Data Set (CDS) questions
  • The CORE + Self (-assessment) adds a section for consumers to record their needs as they see them (in 24 life areas, such as Food and Money).
  • The Full OCAN adds a space for a staff person or worker to also record consumers’ needs.
introduction to consumer
Introduction to consumer

Review purpose of OCAN with focus on recovery

Offer support

Discuss confidentiality and consent

Inform how assessment information will be used by health care worker, health service provider and system

Inform client when and where their comments will be used now and in the future

consumer self assessment additional questions
Consumer self-assessment:Additional questions
  • Please write a few sentences to answer the
  • following questions:
  • What are your hopes for the future?
  • What do you think you need in order to get there?
  • How do you view your mental health?
  • Is spirituality an important part of your life?
  • Is culture (heritage) an important part of your life?
assessment conversation
Assessment conversation

Engages the person with lived experience and the person with assessment knowledge in a conversation focused on the consumer’s strengths, challenges and goals for recovery.

consumers lead the way
Let’s Practice!

Individually:

Complete OCAN Self Assessment

In small groups:

Discuss debrief questions

Consumers lead the way
consumer self assessment36
Consumer self-assessment

Debrief questions:

What connections do you see between the use of the Consumer Self-assessment and PSR principles?

What kind of support might a Consumer require when completing the Consumer Self-assessment?

outputs summary of actions
Outputs:Summary of actions
  • Actions will be pulled from where they are entered in the staff automated assessment and populated with the corresponding domain
  • The consumer and staff will determine the priority for each of action
outputs summary of referrals
Outputs:Summary of referrals
  • Provides staff with a place to consistently document referrals and their status
  • Documents service gaps (b/w services available and optimal services) for planning
ocan reports

OCAN Reports

Will Todd, Education Lead

using ocan information
Using OCAN Information
  • The primary purpose of the need information gathered from the self and staff OCAN assessments is to assist in service planning and to support consumers in recovery
  • Standardized information collected via OCAN can offer:
    • a holistic view of the individual consumer, and
    • a big picture of mental health needs in an HSP, LHINs or the province.
using ocan information42
Using OCAN information
  • Individual use
    • Gather pertinent information to inform the service plan, including internal and external referrals
    • Assist consumers in tracking their own progress
    • Help consumers to move appropriately through the system
  • Organization use
    • Information on populations served
    • Identification of service gaps in organization and community
    • Identification of trends for further investigation
  • Sector use
    • Information on populations served
    • Identification of gaps and trends
    • May help to inform resource allocation (e.g., health prevention initiatives)
outputs ocan reports
Outputs:OCAN reports
  • Assessment data is the foundation upon which reports are built
    • Current data leads to current reports
    • Consistent data leads to comparable reports
    • Quality data leads to quality reports
using recovery based research to understand outcomes
Using recovery-based research to understand outcomes*

* Source: Mike Slade and Tom Trauer, Made in Ontario conference, March 3, 2009

44

  • Research has provided insight into valuable outcome findings:
    • Converting unmet needs into met needs improves quality of life
    • Outcomes are better when the degree of agreement on need ratings between staff and consumers is higher
ocan reports types and levels
OCAN reports: types and levels

2 different types and levels:

individual reports
Individual Reports

Focus:

  • How to make OCAN useful in your day-to-day work

Development Status:

  • Reports created by vendors
  • Included in vendor software specifications
  • Vendors/HSP organizations may jointly define other individual level reports

Developed Reports:

  • Individual Need Rating Over Time
  • Need Rating Over Time
  • Summary of Actions and Comments
  • Staff Workload View
individual reports development process
Individual reports:Development process

In January/February 2009, individual level reports were developed using a collaborative approach

Researchers

Original pilots

Reports development by project team

Consult

Consult

Consult

Steering

Committee

47

standardized reports
Standardized reports

Focus:

  • How to help organization/program better plan services around needs

Development Status:

  • Generated from HSP organizations’ monthly data submissions
  • Not included in vendor software specifications
  • Captures only aggregate information on unidentified consumers

Developed Reports:

  • Data Quality report
  • Need Analysis – Consumer view, staff view
  • Consumer/Staff Need Comparison
  • Consumer/Staff Need Agreement
  • Trend reports in progress
  • Need Analysis – Unmet + Met
    • Consumer view, staff view, comparison
  • Need Analysis – Age Range
    • Consumer view, staff view
standardized reports development process
Standardized reports:Development process

Organizational reports:

Reports

Development

Data Collected

Finalized Report

Develop mock reports

Researcher analysis

Consult with HSPs and SC

Visibility

LHIN reports:

Reports

Development

Discuss

Requirements

Finalized Report

Develop mock reports

Researcher analysis

Consult with LHIN

reassessment and reporting
Reassessment and reporting
  • OCAN Reassessment provides an opportunity for consumers and providers to regularly review needs, identify accomplishments and inform next steps in a structured way every 6 months
  • Trending information can be used to better understand needs of service recipients in community mental health. For example:
    • Is the consumer meeting their goals for recovery?
    • How do needs change over time?
    • Are there local trends or areas of strength?
    • Are consumer demographics changing and are new services needed?
researchers review of the data so far
Researchers’ review of the data so far…

Researchers’ review of data shows that:

Distribution of needs shows similar patterns as international results

Some small differences in patterns may highlight local perspectives

Level of consumer participation has increased from the original to LHIN pilots

Consumer participation is significantly higher than what has been seen internationally

56

using ocan to support recovery two views one goal

Using OCAN to Support Recovery:Two Views – One Goal

The Consumer Perspective

Laurie Albertini, Provincial Consumer Lead, CMH CAP

The Pilot Experience

Alan Mathany, Director of Mental Health Services, FCMHS

a consumer s view on ocan

A Consumer’s View on OCAN

Laurie Albertini, Consumer Lead

my involvement with the project
My involvement with the project
  • Began in January 2010 as member of a provincial Consumer Working Group
    • Primarily tasked to develop and recommend guiding principles for OCAN use in C/SIs
  • Became second Provincial Consumer Lead in May 2010
    • Primarily tasked to provide consumer leadership and expertise as OCAN is implemented
why i got involved
Why I got involved
  • A fellow consumer advocate who was involved in choosing and developing the tool as a Steering Committee and Working Group member
  • Feedback from consumers who have conducted an OCAN assessment
    • Evaluation of OCAN in the North East’s Consumer/Survivor Programs
  • Tool questions

– identified with my own recovery process

  • Research by Dr. Mike Slade
but ultimately
But ultimately…

I brought my 26 years of experience in the mental health system to ensure that OCAN implementation will:

  • Help reduce and eliminate stigma
  • Advocate for consumers and consumer initiatives
  • Support consumers in their own ongoing recovery journey to lead meaningful and successful lives
consumer focus
Based upon recovery principles and empowerment

Provides an array of service and support options that are collaborative, person-directed and individualized

Service plans are created based on individuals’ needs and preferences

Based upon recovery principles and empowerment

Provides a great deal of support based upon personal lived experience in recovering from mental illness

No emphasis on treatment – meeting people “where they are”

Consumer focus

PSR

Peer Support

what about ocan
What about OCAN?

As the standardized assessment for Ontario, OCAN will be the tool that marries the two approaches:

Identifying

needs

and goals

using OCAN

PSR Practices

Peer Support

ocan embracing peer support
OCAN - Embracing peer support
  • Consumers have been involved throughout every step of the project
  • Two Provincial Consumer Leads have been hired
  • Each agency starting to implement OCAN is encouraged to have a Consumer Lead on the change team
  • Peer Educators have been hired to assist in the training of agencies on assessment and OCAN
  • Every job description contains the statement:

“lived experience with mental illness is considered an asset”

ocan experience in peer programs
OCAN experience in peer programs*
  • Peer support is rated very highly by the majority of consumers in helping to complete OCAN
  • Consumers preferred the non-judgmental and supportive approach used by peer worker
  • The sharing of experiences between one peer to another during the OCAN assessment process made the person feel they were not alone or so different in having specific needs.

In their words…

“The peer worker was knowledgeable and I think it was a good type of support!”

- A consumer’s feedback

Source: Evaluation of OCAN in the North East’s Consumer/Survivor Programs (March 2010)

what does this mean for individuals
What does this mean for individuals?

Individuals are encouraged to be an active participant in their recovery journey

Individuals are engaged in a conversation about their needs, hopes and dreams

Promotes an ongoinginformed dialogue with providers to monitor progress and identify new needs as they arise

May improve access to available support programs and approaches

Adapting to new terminology within the tool may be challenging

Understanding the privacy and security issues resulting from the demand to share OCAN information may be challenging

66

using ocan to support recovery two views one goal67

Using OCAN to Support Recovery:Two Views – One Goal

The Consumer Perspective

Laurie Albertini, Provincial Consumer Lead, CMH CAP

The Pilot Experience

Alan Mathany, Director of Clinical Services, FCMHS

slide68

Our OCAN Experience

Alan Mathany, Director of Clinical Services

Frontenac Community Mental Health Services

who we are
Who we are
  • Established in 1976, Frontenac Community Mental Health Services is a non-profit private corporation which offers a continuum of services in Frontenac County for people with a serious mental health illness and/or addictions concerns.
  • The clients, staff and members of the Board of Directors work as a community to offer quality services with an emphasis on psychosocial rehabilitation principles and practices.

Our Mission

  • Building on individuals’ strengths, Frontenac Community Mental Health Services supports recovery and community for persons with a mental illness and/or an addiction.
ocan in fcmhs
OCAN in FCMHS

Assertive Community Treatment Teams

Case Management

Court Support

Vocational Services

Residential (low to high support)

Transitional Case Management

Forensic Case Management

Mobile crisis, 24 / 7 crisis line, crisis beds

Family Resource Centre

FCMHS began implementing OCAN in March 2008 as one of the original 16 pilot sites

70

why we got involved
Why we got involved

FCMHS wanted an assessment that was:

PSR oriented

consumer friendly

helpful in informing service plans

FCMHS required a tool that could:

be used across almost all our services

provide a common language for service discussions and planning

lead to service/care planning

FCMHS preferred a tool which had:

direct consumer input

direct staff involvement

71

why i got involved72
Why I got involved

PSR recovery-focused assessment (after 25 years waiting!)

Other tools did not meet requirements

Increased integration of our services

Aligned with provincial and national mental health vision

72

applying psr principles using ocan
Applying PSR Principles using OCAN

Person-centred

Community Integration

Support Networks

Improved Quality of Life

  • Designed to address the distinct needs of individuals
  • Consistent with their values, hopes and aspirations
  • FCMHS has been involved in OCAN development and delivery from the beginning
    • Promotes its client-centred orientation
    • Ensures it is sensitive to individual client need and PSR values
applying psr principles using ocan74
Applying PSR Principles using OCAN

Person-centred

Community Integration

Support Networks

Improved Quality of Life

  • Build on strengths and capacities of individuals receiving services and supports
  • Staff use OCAN information to create service plans and set goals with clients in order to meet their needs
applying psr principles using ocan75
Applying PSR Principles using OCAN

Person-centred

Community Integration

Support Networks

Improved Quality of Life

  • Support full integration into communities, which include:
    • Exercising rights of citizenship
    • Accepting responsibilities
    • Exploring opportunities
  • FCMHS uses OCAN information to provide direction on how its services can best promote clients’ integration back into and in the community
applying psr principles using ocan76
Applying PSR Principles using OCAN

Person-centred

Community Integration

Support Networks

Improved Quality of Life

  • Facilitate development of personal support networks (e.g., family, friends, peer support, etc)
  • Help improve quality of all aspects of life (e.g., social, occupational, educational, etc.)
  • Staff use OCAN to generate discussions around areas that clients want to engage in (e.g., social activities, employment opportunities, connection with friends and family), which results in better goal plans
the early days
The early days

Pre-pilot

Case management program was selected for pilot

Did not have a good assessment process

Program had long waiting list

Questions around our consumer need and service plan development approach

  • Initial Concerns
  • Time required to do the assessment
  • Replacing other tools?
  • Adding more work?
  • Training required to use the tool

77

what we discovered
What we discovered

More direct consumer involvement in recovery plans

Both consumers and staff could use the tool easily

A common assessment language is now used across agency

Staff were asking new questions

“Unmet” needs helped to focus on service delivery

Training time decreased as trainers became more experienced

78

thank you
Thank you!

Project Support Centre

Telephone: (416) 314-7365 or

1-866-909-5600 (8:30-4:30 weekdays) e-mail: cmhcap@ccim.on.ca

website: www.ccim.on.ca