Incorporating Mental Health and Addictions Services into a Primary Health …
Connecting Care Across the Continuum Mental Health and ... · • Create healthy, resilient,...
Transcript of Connecting Care Across the Continuum Mental Health and ... · • Create healthy, resilient,...
TP05 - System Integration – Connecting Care Across the
Continuum
Mental Health and Addictions Nurses (MHAN) in the
District School Boards (DSB) Program – A
Collaborative Integrated Approach to Program
Development
Session Date & Time: June 20, 1345 – 1415
Presenters: Leslie Gaffney, RN Client Services Manager MHAN Program
Jody Wellings, PMP PMO Lead Continuous Improvement
Hamilton Niagara Haldimand Brant CCAC
Goals for this Session:
• To provide insight into the HNHB CCAC Mental Health and Addictions
Nurses MHAN program development and highlight our approach for cross
sectorial collaboration.
• We will discuss the following:
• Adoption of Kotter’s Change Model
• Implementation Approach
• Approach to Stakeholder Engagement & Communication Planning
• Collaborative approach to program design & development
• Challenges faced
• Assessment Tool Development
• Next Steps
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Hamilton Niagara Haldimand Brant CCAC
Hamilton Niagara Haldimand Brant
Community Care Access Center
(CCAC)
Our System Partners Include:
• HNHB LHIN
• 81 Community Support Service Agencies
• 10 Hospitals across 21 sites
• 17 Family Health Teams/ Organizations
involving more than 250 family
physicians
• 88 Long-Term Care Homes
• CCAC represented on over 90 regional /
local community committees
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Hamilton Niagara Haldimand Brant CCAC
• Hamilton Wentworth District School Board
• Hamilton Wentworth Catholic District School Board
• Niagara District School Board
• Niagara Catholic District School Board
• Grand Erie District School Board
• Brant Haldimand Norfolk Catholic District School Board
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Our District School Board (DSB)
Partners:
Hamilton Niagara Haldimand Brant CCAC
Overview of MHAN Program:
In 2011, the Ontario Government announced funding
for a new initiative for mental health and addictions
The 4 guiding principles are:
• Improve mental health and well being for all
Ontarians
• Create healthy, resilient, inclusive communities
• Identify mental health and addictions problems
early and intervene
• Provide timely, high quality, integrated, person-
directed health services
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Hamilton Niagara Haldimand Brant CCAC
Program Aim/Goal:
• The program aim is to help district school boards build capacity to
recognize and respond to student mental health and addictions
issues
• Linked to the ASSIST program, which provides access to a group
of mental health experts to help school boards build mental health
capacity, the mental health and addictions nurses will
become an integral part of an inter-disciplinary DSB based
team of mental health leaders, community mental health
workers, and existing DSB staff that will work together to
provide early identification and intervention services and supports
to students who have mental health and addictions issues
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• Mental illness can affect anyone at any time but 70% of mental
health problems/illnesses have their onset during
childhood/adolescence.
• Studies suggest that between 15 and 21% of Ontario’s
children/youth have at least 1 mental health disorder.
• Mental illness affects school drop out rates – accounts for 14.2%
of all high school drop outs
• Mental illness affects school attendance – it is estimated that
people with mental illnesses miss 40% more school days
• Psychiatric disorders contribute to poor performance – 30 – 58%
of students with psychiatric disorders (depending upon the
disorder) will experience under achievement
Background:
Hamilton Niagara Haldimand Brant CCAC
Implementation Approach:
Complex Scope:
• Broad stakeholder group including Tri-ministerial – MOHLTC, MCYS, MOE
• Evolution of requirements (provincially mandated Mental Health and
Addictions Program)
Principles:
• Adopt best practice for Change Management – Kotter’s Model
• Collaborate, Collaborate, Collaborate
• Program will focus on meeting DSB needs while embracing the OA MHAN
requirements
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Hamilton Niagara Haldimand Brant CCAC
Approach to Partnership:
• Recognize and accept the need for partnership
• Develop clarity and realism of purpose
• Ensure commitment and ownership
• Develop and maintain trust
• Create clear and robust partnership arrangements
• Monitor, Measure and Learn
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Hamilton Niagara Haldimand Brant CCAC
Kotter’s Model – Change Management
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Hamilton Niagara Haldimand Brant CCAC
CREATE THE CLIMATE FOR
CHANGE:
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Hamilton Niagara Haldimand Brant CCAC 12
Step 1
Establish
a
Sense of
Urgency
Launch the program ASAP!
• The focus on the issues of mental illness within the province’s youth
has been identified in several studies and was being actively
communicated to the public
• Provincial funding to support existing MH services in the form of
MH&A nurses was announced
• The HNHB CCAC received the funding and the program and was
required to launched ASAP
• There was an identified risk of a potential shortage of qualified
Mental Health and/or Addiction Nurses. We needed to recruit quickly
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CCAC Program Management Team
•Deliverables:
•Management of implementation activities & schedule
•Manage Issues, Risks and Action Items
Change Management
Work Group
Deliverables
•Change management planning and execution including;
•Stakeholder Engagement
•Communication Plan
•Education Plan
Program Reporting and Tracking Work Group
•Deliverables:
•Establishing program metrics to measure improvements in the delivery
of MH&A care.
Executive Sponsors - CCAC, LHIN and District School Board
Provide executive leadership and strategic direction for the Program.
Ensure visibility and support for the Program at all levels of the organization
Advisory Committee - CCAC and District School Board Leaders
Provide a system wide perspective and expertise to support the development of program solutions
Provide subject matter expertise on best practices to meet program objectives
Represents all program stakeholders
Advise on integration strategies for nurses in DSB Inter-disciplinary teams.
Other Stakeholder Groups and Subject Matter Experts
Provide expertise and insight into program implementation and solutions
Step 2
Build
the
Guiding
Team
Program Implementation Teams:
Key
Team
Hamilton Niagara Haldimand Brant CCAC
Defining the Program:
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Step 3
Get
the Right
Vision
• We worked closely with our DSB partners to develop clear messaging
regarding the program
• A clearly defined program aim/goal was identified and prevalent in all
reports, initial meetings etc.
• Key Message - “We want to integrate into current practices not
reinvent or duplicate practices”
• Emphasizing the partnership wherever possible was key. We
developed a consolidated logo for program documents. This alone
provided the message that we were collaborative in our approach to
each DSB
Hamilton Niagara Haldimand Brant CCAC
Key Differentiators:
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Step 3
Get
the Right
Vision
The MHAN team supplements the existing DSB staff in the following
ways:
• The nurses have child/youth mental health and/or addictions
expertise
• Working within the Ministry of Health and Long Term Care, the nurses
are able to provide additional medical perspective and clinical
information not previously available to the DSB teams
• Each student will have a Best Practice Medication History and
medication reconciliation completed
• They provide medication management services and related education
to students/families and school staff as appropriate and can liaise with
the prescriber or Most Responsible Physician regarding medication
as required
Hamilton Niagara Haldimand Brant CCAC
ENGAGING AND ENABLING
THE WHOLE ORGANIZATION:
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Hamilton Niagara Haldimand Brant CCAC
Lean Six Sigma Practices:
• Adopting the Lean Six Sigma methodology for implementation of
change, CCAC worked with the DSB’s and other partners to
complete;
• An environmental scan to assess needs of the DSB’s.
• Documentation and understanding of current practices;
• Interviews & meetings
• Current state mapping sessions with each of the DSB’s,
Acute Inpatient Hospitals and Emergency Departments and
several community partners
• Development of “desired state” for MHAN program
• Collaborative development and implementation of future state
processes
Step 4
Communicate
For Buy In
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Hamilton Niagara Haldimand Brant CCAC
Step 5
Empower for
Action
• We empowered the nurses to build the desired state
process to meet the DSB requirements
Development of Desired State:
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Hamilton Niagara Haldimand Brant CCAC
Step 6
Create Short
Term Wins
• Completion of a future state mapping session which was attended by both the DSB and MHAN nurses resulted in a proposed future state design and scope of services. The tone for the day was to embrace our differences in the program design
• The collaborative approach undertaken lead to strong working relationship across all partner organizations. When faced with developing shared practices, the mutual understanding of each others needs came through and supported quick development of solutions that met each organizations needs These included;
• Eligibility Criteria
• Consent Processes
• Scope of Services
• Where Nurses would work
• Referral Processes
• Collaboration agreements
Collaborate To Implement Change:
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Hamilton Niagara Haldimand Brant CCAC
IMPLEMENTING AND
SUSTAINING CHANGE:
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Hamilton Niagara Haldimand Brant CCAC
Step 7
Don’t
Let
Up
1. Communication and Stakeholder Engagement Plan for
Program
• Articulate Goals, Success Criteria and Deadlines
• Identify the stakeholders
• Identify the relationship of the impact on each stakeholder
• Map the impact to stakeholder relationship on the stakeholder
impact analysis table
• Complete a W5 analysis for each Impact Statement
• Develop and approve the Communication Strategy
• Develop detailed communication action plan
• Track and evaluate
2. Program Launch
• Training for staff and partners
• Communication to all stakeholders
• Stakeholder Launch Meeting
3. Go Live support and “huddles” for issue resolution
Plan for Adoption:
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Hamilton Niagara Haldimand Brant CCAC
THE MHAN PROGRAM
TODAY:
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Hamilton Niagara Haldimand Brant CCAC
• There was full participation from both sides as we moved through
the process
• After reviewing the current state process, it was identified that there
are several tools available that the board/community agency staff
use
• CCAC has a history of using a RAI suite of tools as assessments
• The 6 DSB partners agreed that this was a good opportunity to not
duplicate resources/assessments and have the nurses use the RAI
• HNHB CCAC requested to be a pilot site for the RAI-ChYMH
• Through input from the RAI-ChYMH education session it was
identified that there was a need for a shorter version of the
assessment tool and in consultation the RAI-RS was developed
• After a nurse completes either a RAI-ChYMH or RAI-RS
assessment a student care plan will be developed from the
indicators
Why does this work?
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Step 8
Making
It
Stick
Hamilton Niagara Haldimand Brant CCAC
Next Steps:
• Continue to meet with each DSB on a monthly basis
• Obtain signed collaborative agreements from all 6 DSBs
• Record and monitor referral volume
• Monitor RAI assessments and provide feedback for the pilot
• Meet with each ED in the LHIN to present our program
• Continue to liaison with community agencies about how we can work together
for the children/youth in our communities
• See students in their homes over the summer
• Set up meetings with Principals/staff for the end of August to discuss students
that we have seen over the summer
• Work with student groups in the summer (summer school programs, Grade 9
orientation day, board specific programs)
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Hamilton Niagara Haldimand Brant CCAC
Contact Information:
Jody Wellings, PMP
PMO Lead, Continuous Improvement
Hamilton Niagara Haldimand Brant
Community Care Access Centre
310 Limeridge Road West,
Hamilton ON L9C 2V2
Phone: 905.575.6021
Toll free: 1.800.450.8002 (Ext. 6021)
Website :www.hnhb.ccac-ont.ca
E-mail: [email protected]
Leslie Gaffney RN, B.Sc.N.
Client Services Manager (Mental Health and Addictions)
Hamilton Niagara Haldimand Brant Community Care
Access Centre (CCAC), Hamilton Branch
310 Limeridge Road West
Hamilton, Ontario L9C 2V2
Phone: (905) 523-8600 ext. 2118
Toll Free: 1-800-810-0000
Website: http://www.ccac-ont.ca
E-mail: [email protected]
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Hamilton Niagara Haldimand Brant CCAC
Thank you!
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