Ontario Common Assessment of Need (OCAN) Refresher Training

1. Ontario Common Assessment of Need (OCAN) Refresher Training

2. Objectives • The background and current picture of OCAN in Ontario • The components and type(s) of OCAN • Core OCAN Review • Core plus Self OCAN Review • Full OCAN – Review of Need Ratings Increase understanding about:

3. Training Materials • OCAN Forms • Complete Tool Training • Refresher Training • OCAN User Reference Guide - OCAN Dictionary Core + Self Full Core

4. Background and current picture of OCAN in Ontario

5. Main Purpose of OCAN: To Support Recovery Oriented Conversations Engages the person with lived experience and the service provider in a conversation focused on a person’s needs and strengths

6. Flexibility of OCAN • Have conversations and enter the information using the “template” of the OCAN • Follow the standards using an approach that fits: • your style of practice • where the consumer is at • the context of the service • “Unknowns” are OK • Embed OCAN into your workflow so it becomes a routine process that supports your work

7. Current Picture of OCAN in Ontario • OCAN Community of Interest (CoI) • OCAN Quality Improvement Network: partnership with Excellence through Quality Improvement (E-QIP) • Annual OCAN Think Tank Event • Research and Evaluation: use of OCAN data provincially including looking at OCAN data quality - OCAN elements noted for data improvement are marked in the presentation with the following:

8. Components and Types of OCAN

9. Sections of OCAN What? (are yourneeds) Who? (are you) Where? (do you receive services)

10. OCAN Assessment There are three “types” of OCAN: • The CORE OCAN consists of the Consumer Information Summary and the Mental Health Functional Centre Use • The CORE + SelfOCAN consists of the Consumer Information Summary elements, the Consumer Self-Assessment and the Mental Health Functional Centre Use (MHFCU) • The Full OCANconsists of the Consumer Information Summary, the Consumer Self-Assessment, the Mental Health Functional Centre Use and the Staff Assessment

11. Full OCAN Core OCAN • Peer/Self-help Initiatives • Crisis Intervention • Community Mental Health Clinic • Eating Disorders • Assertive Community Treatment • Case Management • Clubhouse • Early Intervention • Social Rehabilitation/ Recreation • Support within Housing • Short-term Residential Crisis Support Beds • Day/Night Care • Counseling and Treatment • Diversion and Court Support • Dual Diagnosis* • Psychogeriatric • Forensic • Vocational Employment • Concurrent Disorders* The Provincial Consumer Working Group recommends the use of Core + Self OCAN for Peer/Self-help Initiatives as a peer-to-peer recommendation Functional Centre Use of OCAN * Removed

12. Core OCAN Review

13. Core OCAN Elements *mandatory fields • Mandatory fields: • Have a * at the end • Means that the system doesn’t allow you to complete the assessment until you have entered a response • Does not always mean you need to get an answer as many field include options such as “Prefer not to answer” or “Do not know” • Have been recommended by stakeholders working with OCAN information • Non-mandatory fields: • Can be left blank (e.g. medication list – if you don’t collect this information) • Where options exist such as “Prefer not to answer” or “Do not know”, select the appropriate option rather than leaving it blank

14. Reason for OCAN • Reason for OCAN identifies at what point the OCAN is being completed through the course of their involvement with services • Initial, Reassessment and (Prior to) Discharge are regularly used as part of the standards (definitions to follow) • Significant change is an additional optional assessment OCANs completed outside the reassessment cycle. An organization should decide whether or not to use this and under which circumstances

15. Initial and Reassessment OCAN Definition Change An Initial OCAN is completed when: • the consumer is new to your HSP organization • the consumer has re-entered your HSP organization more than 3 months after a discharge. A Reassessment OCAN is completed: • every 6 months • If a consumer has re-entered your HSP organization less than 3 months after a discharge *Exception: • The reference point for Initial and Reassessment can be from across the partner organizations if you use a shared assessment model: • A formal partnership of 2 or more organizations contributing to a single OCAN • This is only for organizations that have formally agreed to use this model and established detailed processes

16. (Prior To) Discharge (From HSP) • HSPs are encouraged to have a conversation with the consumer just prior to discharge to ensure their most up to date needs are documented • A (Prior to) Discharge OCAN is conducted by the OCAN Lead when the consumer is discharged from ALL the functional centres within an HSP • When completing a (Prior to) Discharge OCAN, the exit disposition and exit date should be captured in the Mental Health Functional Centre Service Use

17. Significant Change • This is optional. The choice about doing a Significant Change assessment resides with the HSP organization • If an organization decides to use Significant change, guidelines should be set specifying the circumstances for completing a significant change (e.g. client hospitalized) • If significant change is selected, there is a free text field where the reason for completing the OCAN is documented • A Significant Change OCAN does not change the reassessment cycle

18. You have been Mohamed’s case manager for the past 4 months and you completed an OCAN with him 3 months ago. Despite your attempts to contact him, he stopped meeting with you for case management services and you are now discharging him. Do you need to do a (Prior to) Discharge OCAN? • Yes • No Answer: Yes

19. Steve was discharged from your program five months ago. Steve has returned and you are about to complete an OCAN. Which reason for OCAN would you choose? • Reassessment • Initial • (Prior to) Discharge Answer: B. Initial

20. Reassessment Cycle

21. End Date Assessment 1 May 30/18 Start Date Assessment 1 May 1/18 End Date Assessment 2 Nov 30/18 Start Date Assessment 2 Nov 1/18 30 Days Max 30 Days Max 6 M O N T H S The Reassessment Cycle • Once the start date is chosen, the end date is 30 days from the start date. The next assessment happens 6 months from the start date of the previous assessment. • Regardless of any “Significant Change” OCANs completed between scheduled reassessments, the reassessment cycle remains the same. Reassessment Initial Significant Change Aug 15/18

22. Crisis Service Functional Centres: Exceptions to the Rules The following crisis services are exceptions to the “reason for OCAN” and “reassessment cycle” rules : • Short Term Residential Crisis Support Beds • Crisis Intervention Rules for Crisis services: • If the consumer is involved with one functional centre, do the following: • Complete an Initial OCAN and include the exit date and exit disposition • A new Initial OCAN is completed each time a client is admitted. • If the consumer is involved with more than one functional centre, do the following: • Complete the Mental Health Functional Centre Use Section information and provide it to the OCAN Lead to be included in the next OCAN

23. When you first meet me…. BLANK SLATE

24. Using information fromCORE OCAN Start creating a picture

25. Find out: SUSAN female married 50s

26. ER visits legal symptoms My burdens unemployed

27. My supports & strengths partner peers doctor employmentprogram

28. My issues HELP! Sexual abuse financial Substance use symptoms

29. HelpTHE SYSTEMbegin to get a picture of : Who I am What are my issues where I’ve been

30. Core OCAN Elements Expanded gender options aligned with the socio-demographic questions developed by the Health Equity Data Collection Research Project Here are links for more information • Gender identity is your sense of self, specifically your sense of being male, female, both, or neither. It may be different from your biological sex (i.e.. anatomy, physical body) and includes: • Intersex describes people whose bodies, reproductive systems, chromosomes and/or hormones are not easily grouped as male or female. • Trans Female to Male is a person who identifies as male but was born as a biological female. • Trans Male to Female is a person who identifies as female but was but was born as a biological male • http://torontohealthequity.ca/training/ and Tri-Hospital and TPH Health Equity Data Collection Research Project.

31. Mental Health Functional Centre Use Section • Captures the type(s) of service that the client is accessing within your HSP organization unless you have a shared assessment model* • Captures dates* when: • Service was requested • Client was accepted or not • Service was initiated • Client was discharged • *Dates reflect the current status at the time of the Initial OCAN and service use since the last assessment for Reassessment • Important Tips: • Only one section should have OCAN Lead = Yes • If other functional centres are involved, other sections should have OCAN Lead = No • Only include functional centres in your organization, unless using a formal shared assessment model • * If you are using a formal shared assessment model, the OCAN Lead must include all the information of the contributing providers i.e. the partner organization(s) – name, numbers and relevant dates

32. Core OCAN Elements OCAN Dictionary/User Reference Guide:IF In Doubt – Look it Up! Search the OCAN Dictionary Using Control “F”

33. 7.What is Joe’s Employment Status? Joe is new to your HSP and he tells you that he is currently working at a workplace that is operated by consumers. His job is to deliver parcels throughout the city. Refer to the User Reference Guide to identify the employment type in the scenario above Answer: Alternative Businesses

34. Hospitalization Time Frame rules If it’s an initial OCAN, capture if the client has been hospitalized in the past 2 years. If it’s a reassessment, capture if the client has been hospitalized since the last OCAN assessment. Use similar rules for hospital days.

35. OCAN Self Assessment

36. Using an Evidence-Based Tool:CANSAS-P Research Findings What this means for services Meeting consumer identified unmet needs improves outcomes in: • Well-being • Therapeutic alliance • Satisfaction with services Regular review with consumers Improves outcomes Service plans and activities should focus on addressing consumer identified unmet needs Use reassessments as a time to get consumers perspective on their progress and new needs

37. Consumer Self-Assessment Cover page of the self-assessment. Review it together with the client

38. Informing clients of their privacy right and your consent practices • Your organization may decide that this is an appropriate time to provide this information • Inform client of their privacy rights: • What information is collected • How information is protected • Why and when information is shared • *This will be part of the Privacy, Security and Consent Management Training session • *For the purposes of this training, we will leave this part out

39. Covers 24 Domains: Identifying Areas of Need • Food • Accommodation • Benefits • Looking After • the Home • Education • Transportation • Sexual • Expression • Daytime • Activities • Self-Care • Other Dependents • Communication • Child Care • Psychotic • Symptoms • Physical • Health • Money • Intimate • Relationships • Safety • to Self • Company • Psychological • Distress • Other Addictions • Drugs • Information on • condition and treatment • Alcohol • Safety to • Others

40. Consumer Self-Assessment – OCAN 3.0 Review Instructions to review with client Rating need

41. Consumer Self-Assessment Guide Resource Material: One Page Guide Completing the self assessment can give you a voice in identifying areas that have been a problem (or area of need) in your life over the past month. This information is used to guide conversations with your worker and focus services on your needs Below are the definitions of the “Need Scale”

42. Walk through the Intent of these Domains with your Client

43. Consumer Self-Assessment: Open Ended Recovery Questions

44. Susan’s Story Susan Marshall: Community Mental Health Sector and Use of OCAN

45. Full OCAN

46. OCAN Process * Above is the “ideal” process. But there are many circumstances where this is not how it will work. Remember the flexibility of OCAN. Focus on the conversation and what’s most important to the client.

47. OCAN Staff Assessment Score Need Score Help

48. Rating Need

49. Research Findings What this means for services

50. MET NEED No serious problem because of help given. Would be serious problem if help was stopped The intent of the needs assessment is to highlight the major issues that stand in the way of a person’s recovery. UNMET NEED SERIOUS PROBLEM NO NEED NO SERIOUS PROBLEM A major issue that stands in the way of person’s recovery, regardless of its cause or whether help is provided Person is independent in this domain or is relatively independent with minimal help that would not lead to a serious problem if stopped. 0 1 2 UNKNOWN 9 No or not enough information available OCAN Staff AssessmentNeed rating reference Which of these ratings applies to the need in this domain?