Module 1: Ontario Common Assessment of Need (OCAN) Training

1. Module 1: Ontario Common Assessment of Need (OCAN) Training

2. Objectives • The background of common assessments and OCAN • The type(s) of OCAN and which type(s) to use in your Health Service Provider (HSP) organization • Orientation to the training materials • How to accurately complete the Core OCAN elements • Differences in Core OCAN elements between versions 2.0 and 3.0 Increase understanding about:

3. Background

4. Common Assessment • Internationally recognized sector specific standardized assessment tools that facilitate the collection and use of client information • The assessment information identifies clients’ needs, strengths and preferences to support client centred service delivery and planning • Facilitates a common language between HSP organizations and provides the foundation for policy development, sector planning as well as a platform for research and evaluation

5. Standardizing Assessment within Community Care Sectors Before: Multiple assessments within Community Care sectors Ax: C Ax: B S T A N D A R D I Z E Ax: A After: One standard assessment used within the sector Single Standardized Assessment

6. What is an Assessment? • A dynamic and ongoing collaborative process • Actively involves the client to gather information in an individualized manner • Uses a standardized format to identify client needs and priorities • Information gathered drives service planning

7. Assessment: Communication Tool “I'm a great believer that any tool that enhances communication has profound effects in terms of how people can learn from each other, and how they can achieve the kind of freedoms that they’re interested in.” Bill Gates

8. Assessment Conversation Engages the person with lived experience and the person with assessment knowledge in a conversation focused on a person’s needs and strengths

9. Documenting Assessment Information Using Technology • Include pertinent, “need to know” information • Ensure that the information is objective, concrete and descriptive • Capture comments for viewing by other service providers involved in supporting clients • Follow your HSP’s policy and procedures on documentation

10. Introduction to OCAN

11. OCAN • In 2008, the sector selected what would become known as the Ontario Common Assessment of Need (OCAN) • Based on the Camberwell Assessment of Need (CAN) • Elements added to reflect Ontario’s community mental health sector • 2009 – 2013: OCAN was implemented • 201 Health service providers (HSPs) implemented OCAN in a wide range of service types • Current focus: • quality, utility and sustainability for HSPs that implemented • Implement interested HSPs

12. OCAN Vision Every Door is the Right Door – Towards a 10-Year Mental Health and Addiction Strategy, July 2009

13. Flexibility of OCAN • Main purpose of OCAN is to enhance conversations • 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 “You know you’re doing OCAN well when it doesn’t look like you’re doing OCAN”

14. What is OCAN? Ontario Common Assessment of Need (OCAN) is a standardized assessment that • Supports a consumer driven approach with the inclusion of a self-assessment • Supports conversations with consumers about needs, strengths and actions • Further facilitates inter-agency communication with the use of a common tool and standards • Provides aggregate data to informplanning and decisionmaking that is consistent with a recovery approach

15. Components and Types of OCAN

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

17. Interview With The Developer of the CAN Tools: Dr. Mike Slade Dr. Mike Slade video

18. 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

19. 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 *These programs still complete OCANs, but the Ministry has retired the functional centre categories. These programs now fall under the functional centre that best describes the service activity provided to that population. E.G. Case Management

20. Orientation to materials

21. Training Materials Training Materials: • OCAN 3.0 Forms • Core OCAN User Manual • User Reference Guide * data dictionary for OCAN 2.0. Being updated for OCAN 3.0 • OCAN 3.0 Data Elements spreadsheet with all 3.0 elements and value options

22. Core Elements

23. Core OCAN Elements • Within an OCAN there can only be one OCAN Lead • The OCAN Lead is the person responsible for completing and documenting the assessment • If a consumer is involved with more than one functional centre within the HSP, only the OCAN Lead would complete the OCAN • The other functional centre(s) provide input to the OCAN Lead • These other functional centre(s) are called Contributing Providers DATE-BR-1,2 OL-BR-1, 4, 5, 6 What does this mean? Business rules in the URG

24. 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

25. When do I do an OCAN: True or False? What are the reasons you would do an OCAN? • To identify needs when a client enters services • Every time circumstances change for a client E.g. hospitalization or housing • To periodically do an overall review with a client • To make sure no more services are required True False True True

26. 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

27. Initial and Reassessment OCAN Definitions 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 expanded from within an organization to across partner organizations if you use a shared assessment model: • An agreement between 2 or more organizations contributing to a single OCAN • This is for organizations that have agreed to use this model and established a process for collecting the relevant information to be entered into the OCAN

28. (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

29. 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

30. 2. 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

31. 3. 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

32. Reassessment Cycle

33. End Date Assessment 1 May 30/11 Start Date Assessment 1 May 1/11 End Date Assessment 2 Nov 30/11 Start Date Assessment 2 Nov 1/11 30 Days Max 30 Days Max 6 M O N T H S Initiating 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. Initiating the Reassessment Cycle

34. Sustaining Regardless of any “Significant Change” OCANs completed between scheduled reassessments, the reassessment cycle remains the same. Sustaining the Reassessment Cycle Start Date Reassessment 1 at 6 months Nov 1/09 Start Date Assessment 1 May 1/09 Start Date Reassessment 3 at 18 months Nov 1/10 Start Date Reassessment 2 at 12 months May 01/10 “Significant Change” “Significant Change”

35. Change in Type of OCAN: When the Reassessment Cycle is Reset The reassessment cycle follows the completion of the fullest OCAN. The reassessment cycle is reset when a new service begins with a second functional centre that must complete a Full OCAN. Resetting the Reassessment Cycle Start Date Assessment 1Core Ax or Core + Self Ax May 1/09 Start Date Reassessment 1 at 6 months Nov 1/09 Start Date Other Assessment 1 Nov 15/09 Referral to a 2nd functional centre that is required to complete a Full OCAN Ax Cycle is Reset Start Date Reassessment 1May 15/10 6 month Ax Cycle continues as initiated by 2nd FC through to service completion* Start Date Reassessment 2 Nov 15/10 6 month Ax Cycle continues as initiated by 2nd FC through to service completion* 15 DAY GAP 6 M O N T H S 6 M O N T H S 6 M O N T H S

36. Change in Type of OCAN: When the Reassessment Cycle is Maintained The reassessment cycle is maintained even if a consumer does not continue a service with Full OCAN or Core + Self. If a consumer no longer accesses service from the Full or Core + Self functional centres and only maintains service from the functional centre that completes a Core OCAN the reassessment cycle stays the same.. Full to Core OCAN Reassessment Cycle Start Date Reassessment 1 at 6 months Nov 1/09 FULL OCAN Start Date Assessment 1 May 1/09 FULL OCAN Start Date Reassessment 3 at 18 months Nov 1/10 CORE OCAN Start Date Reassessment 2 at 12 months May 01/10 FULL OCAN Consumer ends service from Full OCAN FC. The Core OCAN FC continues to provide service and completes a Core OCAN from this point forward. Reassessment cycle remains the same. Consumer also receives service from Core OCAN FC. This FC is a contributing provider to the Full OCAN

37. 4a. You start an OCAN for Mary on January 15th 2017. When is the start date for her 6 month reassessment? 4b. You complete the Reassessment OCAN for Cynthia. Cynthia drops out of your HSP on August 1st. She decides to return to your HSP at the end of November. What reason for OCAN do you complete?: • Initial • Reassessment Answer: July 15, 2017 Answer: A. Initial

38. 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

39. Standards for Crisis Services • If the consumer is involved with only one functional centre, do the following: • Conduct an Initial OCAN including 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

40. 5. Should I do an OCAN when … I’m in the process of completing an OCAN that I started 3 weeks ago and the client then left the service? Yes or No? Answer: Yes. *If client exits while worker is in the process of completing an assessment there is no need to complete a discharge OCAN - URG EXIT-BR-3

41. Core OCAN Overview COMP-BR-1, 2 • Consumer Demographic Information • Mental Health Functional Centre Use • Contacts • Consumer Capacity • Culture and Citizenship • Current Legal Status • Accommodation • Employment Status • Education level • Psychiatric History • Income • Presenting Issues

42. What can you learn about a person by collecting Core OCAN information?

43. When you first meet me…. BLANK SLATE

44. Using information fromCORE OCAN Start creating a picture

45. Find out: SUSAN female married 50s

46. ER visits legal symptoms My burdens unemployed

47. My supports & strengths partner peers doctor employmentprogram

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

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

50. 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.