OCAN (Ontario Common Assessment of Need)

1. OCAN(Ontario Common Assessment of Need) Supporting Recovery by Capturing Consumers’ Complex Needs2010 PSR ConferenceSeptember 20, 2010

2. 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

3. OCAN and Recovery Jennifer Zosky, Clinical Lead

4. 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

5. 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

6. 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.

7. CMH CAP vision 7

8. 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

9. The bigger picture:Ontario 10 Year Mental Health Strategy* Standard assessment, treating planning, supports crisis management. * Every Door is the Right Door, July 2009

10. 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

11. 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

12. 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)

13. How OCAN works (in brief) Internationally-researched and locally-customized as the common assessment tool to support mental health recovery in Ontario

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Implementation approach Planning Strategy Change Management Strategy Communications Strategy Business Process Strategy Technology Strategy Education & Training Strategy Support Strategy

25. 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

26. How OCAN Works Will Todd, Education Lead

27. 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.

28. OCAN assessment process

29. 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

30. Consumer self-assessment Rating need

31. 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?

32. 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.

33. Staff assessment

34. Need and help

35. Let’s Practice! Individually: Complete OCAN Self Assessment In small groups: Discuss debrief questions Consumers lead the way

36. 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?

37. BREAK

38. 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

39. 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

40. OCAN Reports Will Todd, Education Lead

41. 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.

42. 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)

43. 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

44. 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

45. OCAN reports: types and levels 2 different types and levels:

46. 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

47. 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

48. Individual Reports Sample: Individual Need Rating Over Time

49. Individual reports sample: Staff Workload

50. 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