Mental Health Crisis Response Centre

1. Mental Health Crisis Response Centre Electronic Health Record Presentation for Manitoba Nursing Informatics Association September 16, 2013 Heather Forrest, BSWNancy Parker, MM

2. CRISIS RESPONSE CENTRE

3. 2003/04 - Initial conceptualization of a community based CRC developed by a broad based stakeholder group 2005 - CRC concept included in ER Task Force Report as part of solutions to key issues in ERs related to mental health 2005 – Consumer focus groups re: crisis system redevelopment 2006 – Functional CRC Plan developed by a multi-program planning group and submitted in Regional Health Plan 2007 – NDP Election promise 2008 – Final functional program developed 2009 – Government announcement of the CRC 2011 – CRC groundbreaking ceremony Background

4. WRHA Crisis Services System CRC Components Crisis Stabilization Unit Mobile Outreach Services Scheduled Services Walk In Services

5. Scope of Services The linked service components include: Screening for psychiatric and medical concerns Integrated mental health assessment Crisis response interventions and brief treatment Mobile outreach Onsite psychiatric consultation/referral Referral to the crisis stabilization unit Linkage to short term transitional service Linkage to longer term service and supports

8. CRC IT Project Givens • Build toward electronic linkage between community health services • Facilitate collaborative communication across the social service delivery systems • Improve services for clients, providers & administrators through • More efficient access to information • Improved information sharing & collaboration • More clinical time & less time managing paper • Improved quality of care • Improved reporting for trend analysis & research

9. CRC IT Solution Benefits Momentum Convergence offered a web based solution with a proven track record showing enhanced collaborative practices and outcomes management within the pilot project at PACT – Leila.

10. Risks inherent in CRC IT solution Customization • Too little customization for optimal use in Crisis Services • Too much customization for optimal use by others across the system Integration • Too much information flowing into the integrated solution • Too little information available to health services

11. Canada:How Privacy Considerations Drive Patient Decisions and Impact Patient Care Outcomes 43.2 percent of Canadian patients stated they would withhold information from their care provider based on privacy concerns 31.3 percent stated they have or would postpone seeking care for a sensitive medical condition due to privacy concerns More than 2 out of 5 Canadian patients indicated they would seek care outside of their community due to privacy concerns

12. Mental Health & Substance Abuse:STIGMA 1 in 5 Canadians experience a mental disorder or substance use problem in their lifetime Most people living with a mental disorder say the stigma they feel is worse than the symptoms they feel

13. Health Insurance Portability & Accountability Act(HIPAA) If the information to be used/disclosed contains any of the types of records or information listed below, additional laws relating to the use and disclosure of the information may apply. I understand and agree that this information will be used or disclosed if I place my initials in the applicable space next to the type of information: __________ Drug/Alcohol diagnosis, treatment or referral information __________ Mental Health information – including provider notes __________ HIV/AIDS information __________ Genetic testing information Kaiser Permanete Healthcare e.g.

14. What were the Risk Mitigation Strategies Customization was planned for the following areas: • Client Status Tracking • Staff Dispatch Tracking • Management of linked episodes of care over time • Client Plans at the system level, service level and visit level • History sections for Suicidal Behaviours & Addictions • Visit Summaries and Clinical Reporting, • Documentation of delegated duties related to physician assistants Compromise was reached regarding stepping away from new development that could be better managed by other larger projects • Enterprise number • Waitlist functions • Integration to Accuro

15. CRC EHR ‘must haves’ Functionality Screening Status Board Client Overview Suicidal Behaviour Addictions Diagnosis Medications Admissions Service Plans Alerts Episode Summary Reports

16. Opportunities: Concurrent or Collaborative Documentation Benefits for individuals coming to the CRC: • Involves client/family in the therapeutic process • Empowers the client/family • Increases engagement in process

17. Opportunities:Concurrent or Collaborative Documentation Benefits for Program and Staff: • Ensures greater content accuracy because of reduced time between the actual service and writing the clinical note • Sets a standard for clinical formulation among all staff to assure documentation completeness, consistency, and compliance • Increased staff morale and enhance quality of life would reduce staff burn-out and turnover rates

28. WRHA Research • Re-AIM: • Reach • Effectiveness • Adoption • Implementation • Maintenance

29. RE-AIM REACH • Number and characteristics of clients using the Crisis Response Centre • Age, city location, previous attempts to access other services (ED), socio-economic demographics…

30. RE-AIM EFFECTIVENESS • Outcome measures • Session Rating Scale (SRS-Miller) • Clinical Global Impression • Change of triage status • Request for permission to follow up with research staff

31. RE-AIM ADOPTION • Referral Sources • CRC referrals to programs and resources

32. RE-AIM IMPLEMENTATION • The data gathered from the health record does not specifically speak to this aspect of the research plan. • Materials used include PMO plans such as communication, risks, lessons learnt, etc.

33. RE-AIM MAINTENANCE • Information sources is more program documents and surveys

34. Wait times by priority types Interventions used Clinical outcomes as measured by clients & staff Collaborative partnerships Supports and services accessed Info transferred to collaborative partners Decision Support Many research questions were formulated and several routine reports will be generated. Some of the key areas to be tracked include:

35. Other Research Projects • Round Room Evaluation: Purpose and use of this space • Screening: Both medically and non-medically trained clinicians are performing the initial screening – are both groups able to perform this task with equal effectiveness

37. eHealth / Momentum Mental Health CoreActivities Core Activities MCS Go Live; then CRC Go live Acceptance & Golive Support e v i l o G Addition of new Functionality MCS then CRC User Acceptance Status Board, Assessments, Reports & Data Transfer Change Preparations Coding & Testing Core Functions Analysis & CRC Requirements Design Solution Approval Requirements Gathering Project Startup & Planning Implementation Roles Products CRC Services Web App Documents

38. Mental Health Program:Carolyn Strutt, Susan Chipperfield, Nancy Parker, Heather Forrest, Elliott Drewniak, Laura Calhoun eHealth:Jennifer Glen, Norm Smith, Kelly Francey, Kevin Soroka, Kieran Savage, Larry Cherlet Community Services Information Systems (CSIS): Holly Madden, Sandra Mann, Lisa Rempel, Barb Cieszynski, Janis Wisher WRHA Health Information:Bonnie Schellenberg, Leona Lane WRHA Research & Evaluation:Catherine Charette, Olga Norrie Momentum:Michael Gifford, Kelly Hinds, Giles Thompson, Bruce Penner CRC IT Team:The People that are making it Happen