Module 3: OCAN Training

1. Module 3:OCAN Training Full OCAN Assessment

2. Objectives • The resource materials for the Full OCAN (staff needs assessment component) • The purpose and research related to the Full OCAN • Scoring “Need” and “Help” in the staff assessment • Assessment conversation - client and worker sharing their perspectives on areas of need • How the OCAN informs client driven service plans: The Summary of Actions and Referrals Increase understanding about:

3. Review of Homework on the Self Assessment

4. Homework Consumer Self-Assessment Practice! Complete an OCAN Self- Assessment on yourself Debrief Discussion: • What was the experience like? • What did you like about it? • What did you find challenging?

5. Homework Using the materials provided, create a script for introducing the OCAN Assessment that fits with your organization’s culture Debrief Discussion: • What aspects did you focus on? • What parts will be well received by your clients? • What parts will be challenging? • What are your next steps? *Lessons Learned: Completing self assessment is always the client’s choice, but staff explanation does have an impact

6. The Consumer Experience with the Self Assessment:Tips for Staff Gordon’s Perspective

7. My Suggestions • For staff to provide information that is tailored to the consumer • It would be helpful to emphasize to the consumer the questions were carefully chosen to elicit information about different areas of the consumer’s life • For staff to keep in mind the goal of the OCAN is to give a voice to the consumer in order to learn what is necessary to improve her/his life • At the beginning clearly explain the purpose of ongoing assessment How can I help? My goal is to go to school

8. OCAN Self Assessment Experience Shirley Gilpin, BSW, RSW Sherri Baird, RSSW 8

9. Individual Story • Male individual, accessing case management services, who completed OCAN for the first time by completing self-assessment at home • Individual put a lot of time and effort into completing the open-ended OCAN questions • When worker and individual processed experience, individual shared that completing the questions has inspired him to write a book about his experience living with a mental illness • Confidence building 9

10. Full OCAN

11. Full OCAN The Full OCAN consists of the Consumer Information Summary, the Consumer Self-Assessment, the Mental Health Functional Centre Use and the Staff Assessment

12. Training Materials Training Resources: • Full User Manual • Full User Activities • Reference Guide • Domain Intent + Need & Help Rating Examples *Developed by CMHA Haliburton, Kawartha, Pine Ridge Branch

13. 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.

14. Assessment completion period • The assessment start and completion date should be within 30 days of each other • Start date of assessment in the system is whichever is started first: Consumer Self-Assessment or Staff Assessment * Start date for a new client should be as early as possible in your organization’s process. Do not wait until you have responses for every OCAN element. “Unknowns” are valid responses.

15. OCAN Staff Assessment Score Need Score Help

16. Rating Need

17. Research Findings What this means for services

18. 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?

19. OCAN Staff AssessmentRating Need, Question 1 2 = Unmet need (Serious problem) - With or without help 1 = Met need (No or moderate problem due to help given) - If the help was removed, the problem would be serious 0 = No need (No serious problem) - No help or minimal help – self sufficient or “does not apply” 9 = Not known Source: Manual for Camberwell Assessment Tool

20. 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

21. Domain Intent + Need Rating Examples • Walk through of this important reference material • This will be your “go to” document • Contains 2 pages per domain: • Page 1 • Intent/definition of the domain • Guiding questions you could ask client • Potential consumer issues related to the domain • Page 2 • Examples for each need rating • Examples for each help rating

22. Rating NEED Exercise

23. Rating Need 2 0 2 1 0 2 1 1

24. Rating Need 2 1 0 2 0 1 0 2 2

25. Rating Need 0 1 2 0 9 0 2

26. Rating Help

27. OCAN Staff Assessment Score Need Score Help

28. OCAN Staff AssessmentRating Help, Question 2, 3a/b Scoring informal and formal help • Based on frequency and effectiveness of help • To be used as a guide to support actions/service plans • Different from need rating – not a research metric 0 = No help 1 = Low help 2 = Moderate help 3 = High help 9 = Not known

29. OCAN Staff AssessmentRating Help, Question 2, 3a/b

30. Domain Intent + Need & Help Rating Examples • Walk through of this important reference material • This will be your “go to” document • Contains 2 pages per domain: • Page 1 • Intent/definition of the domain • Guiding questions you could ask client • Potential consumer issues related to the domain • Page 2 • Examples for each need rating • Examples for each help rating

31. “Comments” and “Actions”

32. OCAN Staff Assessment Score Need Score Help

33. OCAN Staff Assessment Comments: • Comments will help others understand your scoring • Include all pertinent, “need to know” information. • Ensure that the information is valid, thorough, objective, concrete and descriptive • Comments should follow your own HSP’s guidelines for documentation • Comments may be viewed by other service providers involved in supporting consumers • Comments may capture historical information and collateral information

34. OCAN Staff Assessment Actions: • Actions are only recorded in the Staff Assessment • Actions can be identified by the consumer or staff • Focus on actions that are most important to the client Information included: • mutually agreed actions in each domain • who is responsible for completing the action • timelines for completing and reviewing agreed actions

35. OCAN Staff AssessmentKey Points • In each of the 24 domains, the staff is determining and recording the ratings for need • For every Met or Unmet Need, the Help rating should be completed • For No Need, the Help rating is not completed • Extra questions in the domain are always completed • Action and Comments fields can be recorded for any domain regardless of what the ratings are (emphasis is on domains with unmet need rating) • Information gathered informs the ongoing work with the consumer

36. OCAN Staff Assessment “Hopes” … open ended questions: The staff elaborates on the responses the consumer expressed in the self assessment based on additional information shared during the conversation 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?

37. Excerpts from HSP Organization Presentations

38. Understanding the client through the use of OCAN Erin Chan 38

39. A client’s story and use of OCAN Stacey (OCAN Reassessment) • 24 years old, Admitted Jan 2013 (2.5 years) • Brief History: Diagnosis Bipolar Affective Disorder, 2 hospital admissions for psychotic symptoms, lives in own apartment, ODSP, supportive mother, working part time at retail store, history of marijuana use. • Client’s self-assessment is presented • 3 Unmet Needs: • 1. Daytime activities (return to work) 2. Budgeting 3. Psychological distress (symptoms of anxiety) • 3 Met Needs: • 1. Psychotic symptoms (medication compliance) 2. Company (family support) 3. Addictions (marijuana) 39

40. Stacey’s story and use of OCAN continued • Strengths: open minded, positive • Safety concerns: currently none, previously: inability to care for self • Importance of spiritualty: very important • Importance of culture: very important • Overall recommendations: Support client with identified unmet need as discussed and discuss discharge plans before next re-assessment 40

41. Outputs

42. Outputs: Now What? Making OCAN information useful • Information in the OCAN can assist in: • prioritizing actions • determining referrals • Supporting your ongoing work with clients by referring to information captured in OCAN

43. Summary of Actions • At the end of the assessment, all actions documented will be automatically listed in a chart • Review Summary of Actions with your client • Have your client determine the priority • Priorities need to be entered manually • Use the Summary of Actions in your work: • Informs your client’s service/goal plan • Refer to the domain and action you’re focusing on each client meeting Client Driven Care 1

44. Summary of Referrals • At the end of the assessment, referrals and the current status of the referral can be documented in this chart • An outcome of the Summary of Referrals is the identification of gaps in service

45. Post Card given to Clients at CMHA-CT

46. Homework: Practice Completing The Staff Assessment Mock Client: Mike OCAN Lead: Lorraine Materials-Full OCAN User Activities • Assessment conversation scriptpgs. 24-28 • Mike’s partially completed OCAN • Completed self assessment pgs. 31-34 • Partially completed staff assessment pgs. 36-51 * The mock scenario is for training purposes and doesn’t give you the kind of detail you would likely get in a real situation. With the information there, select the ratings that fits best *Practice is key! Please complete the rest of the assessment before Module 4 – At least up to/including Domain #13

47. Questions?

48. Bibliography – sources for slide #5 . • Fleury, M., Grenier, G., & Lesage, A. (2006). Agreement between staff and service users concerning the clientele's mental health needs: A Quebec study. Canadian Journal of Psychiatry , 51 (5), 281-286. ) • Leese, M., Johnson, S., Slade, M., Parkham, S., Kelly, F., Phelan, M., et al. (1998). User perspective on needs and satisfaction with mental health services. British Journal of Psychiatry , 409-415. • Junghan U et al (2007) Staff and patient perspectives on unmet need and therapeutic alliance, Brit J Psychiatry, 191, 543-547 • Slade, M., Leese, M., Cahill, S., Thornicroft, G., & Kuipers, E. (2005). Patient-rated mental health needs and quality of life improvement. British Journal of Psychiatry , 187, 256-261.

49. Bibliography • Lasalvia, A., Bonetto, C., Malchiodi, F., Salvi, G., Parabiaghi, A., Tansella, M., et al. (2005). Listening to patients' needs to improve their subjective quality of life. Psychological Medicine , 35, 1-11. • Slade, M., Leese, M., Taylor, R., & Thornicroft, G. (1999). The association between needs and quality of life in an epidemiologially representative sample. ActaPsychiatricaScandinavica , 100, 149-157.Transcript: • Lasalvia et al (2008) Does staff-patient agreement on needs for care predict a better mental health outcome?, Psychological Medicine, 38, 123-133