1 Champlain LHIN Mental Health and Addictions Value Stream Mapping Summit February 12, 2013 Overview Event Morning Afternoon Current State Mapping Identifying opportunities Developing Action Plans
2 Participation Mental Health & Addictions Continuum 120 participants, including 24 (20%) identified persons with lived experience or family members Over 60 organizations, associations or networks represented led by 2 VSM consultants and 15 facilitators, including 2 representatives from Health Quality Ontario 15 tables, 35 action sheets submitted Positive feedback: The opportunity to participate, the experience, the ideas, the outcomes... thank you. ( ) participants feel engaged, productive and hopeful about the outcome of this mapping exercise.
3 Outcomes Overview Action Plan Themes That Emerged
4 Action List Action Plan Theme Accessing Services Accessing Services Accessing Services Accessing Services Accessing Services Care Planning & Co-ordination Care Planning & Co-ordination Care Planning & Co-ordination Client & Family Client & Family Action Action Proposed Transition Table ID# Worked On 1 Access to Alterative care to Emergency Room 1. Entry at ER 2 Creation of an alternative care system for mental health crisis (mobile crisis, crisis line, distress centre, family docs need resources E-mental health resources, screening tools for docs, MH walk-in clinics, urgent care) 3 of family members (ask permission to share with family on admission/ prior expressed wish) 4 Emergency Room diversion starts at youth (Head Space ; deal with stigma, starts early, create alternative access points) Table # 1. Entry at ER 1 1. Entry at ER 1 4A. Discharge from hospital 5 Centralized access to care, simplify process, entry at any point: information, at time of crisis, at discharge: referral, case manager, keep client until successful referral made, normalized and standard known service 6. Transitions in recovery 5 6 Inclusive care plan that starts at admission in Emergency Room 5B. Discharge from hospital 5 (focus on primary care) 7 Inclusive care planning (written Treatment Plan with patient/family) 5B. Discharge from hospital 5 (focus on primary care) 8 Replicate model like GEM program in Emergency Room for MH&A e.g. 2. ER to inpatient 8 implement a mental and addiction Registered Nurse in Emergency Room 9 Plan to involve family in circle of care (see CRAFT program for parents, 1. Entry at ER specialized services in Emergency Room for families, Emergency Room brochure explaining process) 10 Engaging person in wellness recovery action plan (development of WRAP with every client being referred to specialized services 3. Inpatient to specialized services 2 Client & Family 11 Client engagement via community involvement during hospitalization (include patient, family, peer, agency ) 3. Inpatient to specialized services 3
5 Action Plan Theme Client & Family Action ID# Action Proposed 12 Patient + Family Supports + education to manage chronic illness & navigate the system (build curriculum for med students empathy; build MHA curriculum for parents & families) Transition Table Worked On 4A. Discharge from hospital Table # 2 Client & Family 13 Making Emergency Room MHA Friendly (paid supporters in ED Family + Peer workers 4A. Discharge from hospital 2 Client & Family 14 Respite system safe for crisis, emergency (residential drop in supported 24/7 safe place) 5B. Discharge from hospital (focus on primary care) Client & Family 15 Access to respite beds in community with 24/7 minimal support (a few days) 6. Transitions in recovery 14 Client & Family 16 Link peer resource workers to ED at key times e.g. evenings 2. ER to inpatient 8 Client & Family 17 Peer support from emerge to inpatient 2. ER to inpatient 13 Client & Family 18 WRAP to simplify thinks for patients, minimize stress 2. ER to inpatient 13 Transitions 19 Functional referral process (improve knowledge of referral source in community, collaboration between providers of specialized services/follow up 3. Inpatient to specialized services ensure services received/ initiate process of referral in timely fashion Transitions 20 Information flow to/from school 1. Entry at ER Transitions 21 Discharge phone call 4A. Discharge from hospital 4 5 Transitions 22 Post discharge follow-up: a phone call within 48hrs to family/cif, SDM to discuss any discharge problems and review usefulness of discharge plan Transitions 23 The Hands-off: ensuring that information/car/follow up are done appropriately and officially :do not let go until lead/accountability transferred/smooth transition Transitions 24 Transition recovery: navigator approach with role to seamlessly integrate and co-ordinate so that consumer fully benefit from circle of care 4A. Discharge from hospital 4A. Discharge from hospital 10 6. Transitions in recovery 15
6 Action Plan Theme Action ID# Action Proposed Transitions 25 Increase collaboration amongst agencies, providing care and other caregivers (including family, friends, etc.) opportunity with OCAN Transitions 26 Communication to assist the transition to Inpatient unit (improve communication with family and patients) 27 Electronic Health Record for MHA for Champlain or at a minimum information sharing (develop evidence based min required info) Transition Table Table Worked On # 6. Transitions in recovery 11 2. ER to inpatient 13 4A. Discharge from hospital 2 28 Identifying lacks in Services to have a system to identify + create both missing services & understand services 3. Inpatient to specialized services 29 Establish protocols in ER to standardize the care for psychosis, suicidal thoughts, withdrawal and anxiety and for people who come to Emergency Room with police Streamline care, set standard for first contact, increase awareness to WRAP 2. ER to inpatient 8 System 30 Information sharing to create a document from?clearing? loose documents 4A. Discharge from hospital 4 31 Sincerity, trust from professional 5B. Discharge from hospital (focus on primary care) 5 32 Education of employers (paid or volunteer work) about mental illness to make 6. Transitions in recovery 14 workplace accommodating to needs of person with mental illness 33 Education & support of physicians so that they are able to support people w/ 6. Transitions in recovery 14 MI and Addictions in the community (ex. FHT with psychologist, doctors trained to listen and believe in patient and begin process of recovery; develop capacity of physicians to see beyond MI sometimes don t see physical illness because of that) 34 Put out information to young kids to address stigma, warning sign of MHA 6. Transitions in recovery 14 conditions, bullying especially with people with lived experience giving testimony (already exist in some schools, try to make it at every school at minimum during MH awareness weeks in October and May) 35 Improve access to services and material in French (ensure that if services 6. Transitions in recovery 14 received at hospital in French, services hospital refer to also exist in French),
7 Action Plan Theme Action ID# Action Proposed Material and courses should also be available in French as well as therapeutic material Could be extended to other cultures: making available cultural interpreter for all languages or at least most common ones in region; Put out information to young kids to address stigma, warning sign of MHA conditions, bullying especially with people with lived experience giving testimony (already exist in some schools, try to make it at every school at minimum during MH awareness weeks in October and May) Transition Table Worked On Table #
8 Cross-Checking and Regrouping
9 Mental Health & Addictions Key Actions by Theme Work in progress: What? Identify initiatives, projects that are already started or starting Why? No need to reinvent the wheel: Build on what s already there So, we are seeking your insights on current initiatives that would move the identified actions forward. Question: Do you know of initiatives with quick, mid and longer term actions that would help moving forward the identified action for the next 3 years?
10 Phase in centralized access, assessment, triage and referral/simplify the process at any entry point (#5) Accessing Services Involve family members at entry point:ask permission on admission or prior expressed wish (#3) Develop alternative to ER (#1, #2, #4))
11 Care Planning and Coordination Create inclusive care plan from the start/engage client/family in care plan from the start (#6, #7) Develop navigation system to create seamless system & appropriate care early on through something similar to GEM nurse in ER for MHA (#8)
12 Client and Family Implement Peer and family support worker pilot at ERs at key times (#13, #16, #17) Provide tool, education material, training to family and clients/build on Recovery Connections tools, ensure wide dissemination (#12) Engage person in wellness recovery action plan, care plan/involve family too (#9,#10, #11,#18) Ensure that respite beds available (#14, #15)
13 Improve knowledge of referral source and referral process to ensure appropriate and timely referral (#19) Transitions Follow up after discharge from hospital, from and to school (#20, #21, #22) Ensure that providers collaborate early on in developing care plan and overlap during transfer (#23,#24,#25) Improve communication with family and patients to assist the transition (#26)
14 Implement Electronic Record (#27) Identify where services are needed and develop ways to understand the needs and address them (#28) Establish standard protocols (#29) Create MHA Clearinghouse with multiple points of access (#30) Educate & support physicians and professional to respond to the needs of people with mental health and addiction conditions and to better interact with them/ Adopt curriculums in place in other jurisdictions, pilot and evaluate (#31,#33) Educate employers on accommodating needs of people with mental health or addiction conditions (#32) Inform kids early in school about MHA (#34) Make material available in French and ensure that services available in French after hospital stay (#35)