TP05 - System Integration Connecting Care Across the Continuum

Transcription

1 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, Presenters: Leslie Gaffney, RN Client Services Manager MHAN Program Jody Wellings, PMP PMO Lead Continuous Improvement

2 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 2

3 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 3

4 Our District School Board (DSB) Partners: 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 4

5 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, persondirected health services 5

6 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 6

7 Background: 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 7

8 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 8

9 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 9

10 Kotter s Model Change Management 10

11 CREATE THE CLIMATE FOR CHANGE: 11

12 Launch the program ASAP! Step 1 Establish a Sense of Urgency 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 12

13 Program Implementation Teams: 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 Step 2 Build the Guiding Team 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. 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 Key Team Program Reporting and Tracking Work Group Deliverables: Establishing program metrics to measure improvements in the delivery of MH&A care. Other Stakeholder Groups and Subject Matter Experts Provide expertise and insight into program implementation and solutions 13

14 Defining the Program: 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 14

15 Key Differentiators: The MHAN team supplements the existing DSB staff in the following ways: Step 3 Get the Right Vision 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 15

16 ENGAGING AND ENABLING THE WHOLE ORGANIZATION: 16

17 Lean Six Sigma Practices: Step 4 Communicate For Buy In 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 17

18 Development of Desired State: We empowered the nurses to build the desired state process to meet the DSB requirements Step 5 Empower for Action 18

19 Collaborate To Implement Change: 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 Step 6 Create Short Term Wins 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 19

20 IMPLEMENTING AND SUSTAINING CHANGE: 20

21 Plan for Adoption: 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 21

22 THE MHAN PROGRAM TODAY: 22

23 Why does this work? Step 8 Making It Stick 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 23

24 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) 24

25 Contact Information: 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) ext Toll Free: Website: Jody Wellings, PMP PMO Lead, Continuous Improvement Hamilton Niagara Haldimand Brant Community Care Access Centre 310 Limeridge Road West, Hamilton ON L9C 2V2 Phone: Toll free: (Ext. 6021) Website : 25

26 Thank you! 26