Ontario Shores Centre for Mental Health Sciences. CENTRAL EAST LHIN Board Presentation April 26, 2017

Transcription

1 Ontario Shores Centre for Mental Health Sciences Master Planning Project CENTRAL EAST LHIN Board Presentation April 26,

2 Today s Agenda 1. Background & Context 2. Master Planning Project Overview 3. Stage 1-Part A Master Program Approach Planning Assumptions/Guidelines Current Clinical Service Delivery Future Clinical Service Delivery Technology Existing Facilities/Therapeutic Environments 4. Data / Workload Analysis Human Resources, Preliminary Cost Forecasts 5. Questions/Discussion 2

3 01 Background & Context 3

4 How We Got Here? Discussions with the Province on Land Allocation [2010-4] & Lease Agreement [2016] The Lease Agreement requires future master planning: Joint Master Plan with Infrastructure Ontario to resolve shared issues Ontario Shores Master Program & Master Plan for Stage 1 Submission to MoHLTC 4

5 The Master Planning Project Meet lease requirements (Joint Master Plan, transformer relocation, secondary access road location) Create a vision for the future of Ontario Shores site Align with the Strategic Plan and Ontario Shores mission, vision and values Determine and align programming (clinical, research and academic) with space needs and physical planning Guide future decision-making Set the groundwork for future capital planning and development 5

6 The Master Planning Project Joint Master Plan (with Infrastructure Ontario) High-level plan to guide planning and development of the entire Whitby Provincial Lands (all 76 acres) and resolve shared issues with IO (servicing, transportation, hydro transformer relocation) Master Program (Stage 1-1A Submission to CE LHIN & MoHLTC) Long-term plan for clinical, research and academic services examining models of care, organizational structure and future space needs Master Plan (Stage 1-1B Submission to CE-LHIN & MoHLTC) Physical site plan to accommodate the long-term clinical, research and academic plan and guide future facility renewal and development 6

7 02 Project Overview 7

8 Project Governance 8

9 Project Plan 9

10 03 Stage 1, Part A 10

11 Project Component Service Delivery Model Report (Stage 1 Part A Proposal Submission to Central East LHIN & MOHLTC) 11

12 What s Been Accomplished? Over 200 participants representing Ontario Shores, Community Services, Families, Clients September March Data Analysis/Workload Forecasts Functional Evaluation of Existing Facilities 4 sets of Clinical Services User Group meetings 2 sets of Administrative and Support Services UG meetings Client and Family Focus Groups MPWG Parameters and Typical Inpatient Unit discussions Community Services engagement 12

13 Listening to Clients and Families Increase family involvement This presentation makes me feel safe inside; makes me feel that when I leave this place, I can have a job, a family, a house Client comment made at the Client Focus Group, Nov 2016 Enhance range and choice in programming; normalizing activities on site to mimic community options Improve transition services Provide opportunities to engage; to reduce barriers; to plan space where patients and staff can engage Consider staff and patient safety on the units; create safety without creating barriers A better experience would entail - more space; a variety of spaces; privacy and choice 13

14 Listening to Community Partners Build partnerships across society - police, education, healthcare, municipalities Build capacity in communities Have services move around patients instead patients moving among services Ensure people are aware of available services Need affordable, accessible, suitable housing; resources for continued success in the community 14

15 Master Program Outcomes Future Role and Scope of Services, including clinical service planning, data, gaps and patient flow analysis Future Model(s) of Service Delivery, recovery oriented Projected Workload Volumes, including future visit volumes and bed capacities and mixes based on 2015/16 data; projected to 2020/21,20 25/26, 2035/36 Operational Efficiencies, including LEAN approach Consideration of Technological Advancements in mental healthcare provision Future Space Requirements high-level (gross sf/sm) to align with the proposed service delivery models and workload volumes 15

16 Central East LHIN and Ministry Priorities The document content aligns with MOHLTC_LHIN Toolkit for Capital Planning Projects for Stage 1 Submission 16

17 Central East LHIN IHSP 4 The Plan s Mental Health Strategy continues to focus on individuals with mental health and addiction issues who are the most vulnerable, including persons with: Concurrent disorders and/or physical disabilities Dual Diagnosis LGBTQ (lesbian, gay, bisexual, transgendered, questioning) Francophone and other diverse populations Marginalized and socially isolated Seniors with complex medical and social needs Indigenous Peoples Addictions, including expectant mothers Adolescents, school-aged and transitional aged youth migrating from the youth to adult system. 17

18 Project Objectives Align with Ontario Shores Strategic Plan Be Bold Be Inspiring Be Caring Be Extraordinary * Ontario Shores Strategic Plan is in the final stage of development. Partner to create a coordinated mental health and addiction system Fully integrate research into clinical care; share learnings, experiences and outcomes with others Partner with patients and families in their recovery journey; support a meaningful life Create and sustain a healthy and safe workplace Create a learning environment Use new tools and data to improve health outcomes for patients Weave recovery into the fabric of the organization 18

19 Ontario Shores Programming Assumptions Ontario Shores will be a centre of excellence that houses the continuum of care for individuals with mental health issues and concurrent disorders: Advocate for an effective, accessible and resourced mental health system of care Tackle key challenges such as growing burden of youth, indigenous mental health, geriatrics and dementia Operate on and off site in a hub and satellite model Bring the community into our site Operate downstream solutions such as housing and upstream solutions such as prevention with partners on the site 19

20 Ontario Shores Programming Assumptions Cont d: Play a regional role in the provision of Psychiatric Emergency Services, Cognitive Behaviour Therapy (CBT) and Neuro-therapeutics. Be a leading academic health sciences organization generating, adopting and promoting evidence-based, quality care and patient/client outcomes Co-design models of care with people with lived experience and with partners Continue to work to erase the stigma associated with mental illness Be a best employer 20

21 Current Clinical Service Delivery Integrated Community Access Program (ICAP): Intake, Crisis Services, on- and off-site Outpatient Clinics, Outreach Services Adolescent Inpatient Unit (ADOL): Inpatient/Outpatient intensive and specialized recovery focused services for young people from 12 to 24 years of age; Transitional Aged Youth Services; Virtual ER, Day Treatment Assessment and Reintegration Program (ARP): Inpatient, ReAct (transition) Partial Hospitalization (day program) offering Assessment and short-term treatment for adult individuals, aged 18 to 64 years of age, who have a serious and persistent complex mental illness 21

22 Current Clinical Service Delivery Dual Diagnosis Service (DDS): Inpatient and outreach services for individuals, 16 to 65 years of age, with a Dual Diagnosis Eating Disorders Residential Program (EDU): Provincial program; inpatient interprofessional model of care focused on recovery /rehabilitation for the most severely affected adolescents who have not been helped by traditional specialized centres Forensic Program: Inpatient, Outpatient (FOS) offering assessment, treatment, rehabilitation and community reintegration services to individuals 18 years of age and older who have a serious mental illness and come in contact with the law as a result of committing a crime 22

23 Current Clinical Service Delivery Geriatric Program: Inpatient and Outpatient psycho-geriatric services to individuals with a serious age-related mental illness (65+) or dementia (40+) and associated challenging behaviours Neuropsychiatry Service (NPS): Inpatient and Outpatient care to individuals, 18 to 65 years of age, with acquired brain injuries and serious mental illness and associated challenging behaviours 23

24 Current Challenges Ontario Shores encounters challenges daily with patient flow and care that requires access to: Long-term Care and Supportive Housing Community Services that support reintegration and community living Concurrent Disorders programming Better care for patients with a mental illness who require emergency services and access Acute Hospital Emergency Rooms 24

25 Evolving System of Mental Health Care in the Central East LHIN Ontario Shores aims not only to assist individuals with the most severe challenges, but also work together with their health system partners to create a coordinated mental health and addiction system, and to create solutions so those living with mental illness have access to the life-saving treatment and supports they need to lead meaningful lives. 25

26 Future - Partnering to Enhance Access to Mental Health Care in the Central East LHIN Regional Dedicated Psychiatric Emergency Service (PES) Unit: 24-hour 7 day-a-week regional psychiatric crisis service Accessed directly by first responders (EMS, Police) or direct transfer from an acute care ED Registered patients, in crisis, may self-present Services: Provide more timely access to psychiatric emergency care Stabilize acute symptoms Reduce current system delays and time spent waiting for admission Avoid the need for psychiatric hospitalization altogether Improve outcomes increase safety 26

27 Assumptions on Enhanced Clinical Service Delivery Clinical Services will be enhanced in many ways: Improved in-reach, outreach and transitional care services to streamline patient flow; reduce admissions Concurrent Disorders services integrated with patient care Increased focus on therapeutic programming, skills development, job placements to support community reintegration and employment Enhanced Peer Support Services Integrated Research and Clinical Services increased numbers of students 27

28 Assumptions on Enhanced Clinical Service Delivery Cont d: Improvements through the use of new technologies increased capacity in the Partial Hospitalization Program Improved lines of communications with community partners, the Courts, Detention Centres, Ontario Review Board More appropriate care environments (right place) for some patient populations (forensic geriatric/dual diagnosis) Improved on unit psychiatric intensive care environments 28

29 Assumptions on Enhanced Clinical Service Delivery Ontario Shores will operate on and off site Ontario Shores will bring the community into our site Ontario Shores will partner with other health, community, social and retail services in a Community Hub(s). 29

30 Future Clinical Service Delivery Integrated Community Access Program (ICAP) Partner in Access Hub/Navigator Services, embed Crisis Services in the PES, increase Technology to improve access to clinics/staff, leverage Student Training opportunities in outpatient care Adolescent Inpatient Unit (ADOL): reduce wait lists; enhance Inter-Professional Team; outpatient services provided from community-based Youth Hub to improve access/patient experience Assessment and Reintegration Program (ARP): reduce LOS; increase patient flow (improve access to ECT, Concurrent Disorders), formalize Take Back Agreements; Partial Hospitalization Program (PHP): increase capacity; to meet demand for services; provide programming tailored to geriatric and neuropsychiatry populations; provide on- and off-site for easy access 30

31 Future Clinical Service Delivery Dual Diagnosis Service (DDS): focus intake assessment to confirm need; IP short term diagnostic clarification; focus care in community; enhance Outreach Service, avoid admission/re-admission; assume enhanced support of families Eating Disorders Research and Treatment Program: EDU: Add beds for severely chronically ill adolescents; increase Transitional Services; Address gaps in care by providing outpatient, short-term inpatient, transitional care for children, 5-12yrs, young adults and adults Forensic Program: Avoid admitting Geriatric and DD Forensic patients; work w/ ORB enhance patient flow; design units to accommodate highest level of security (greatest flexibility); technology for 'fitness to stand trial' assessments/reduce IP admissions; enhance Transitional Services; enhance skill training 31

32 Future Clinical Services Delivery Geriatric and Neuropsychiatry Program: add a Geriatric/Neuropsychiatry Intensive Treatment Team; enhance Transition Services; provide outpatient services on- and off-site for ease of access and enhanced team support; add specific PHP programs Regional Neuro-therapeutic Program: Support inpatients and outpatients requiring Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) services Simulation Learning Centre: Support staff and patient education and skill development 32

33 Recovery Ontario Shores Inter-professional Collaborative Recovery Model is based on the principles of empowerment, hope, recovery, collaboration, identity, responsibility and meaning in life. Enhanced opportunities for patient choice and participation in programming, skills development/employment, education, social/leisure activities, wellness, and basic living skills Supports family involvement Enhances peer delivered services 33

34 Housing Partnering to Enhance Community Reintegration Effective Supported Transitional Housing: Addressing Alternative Level of Care Challenges, and Enhancing the Patient Experience by Improving Transitions of Care for Individuals with Severe and Persistent Mental Illness The model would house applicable patients in new transitional supportive housing units, created in partnership among Ontario Shores (and other community-based mental health and social services), a private housing developer, and the municipality. 34

35 Integrated Research Incubator for the discovery and implementation of new approaches that will transform what we know about mental illness Collaboration of Research, Professional Practice, Clinical Informatics, Decision Support, Community Partners Focus on Recovery, Eating Disorders, Technology (devices development) and Data Analysis, others 35

36 Technology Innovations Leverage the innovative use of technologies and innovative ways of working Occupancy detection, biometric and object tracking Geriatric and Dementia devices Web-based care plan as part of the recovery Enable patient / staff communication (texting) Attend clinics and group sessions from home; improve access and attendance Simulation lab/ self-directed skills development 36

37 Existing Facilities Evaluation Inpatient Units: Difficulties in wayfinding; feeling lost; fear; institutional Very few single rooms; (best practice - privacy, confidentiality, IPAC) No ensuite washrooms; (best practice) Not enough washrooms Limited space on the PICA; wait lists; not conducive to care of the acutely ill; no access to the outside Limited access to courtyards; limited ability for patients to access on their own (choice) 37

38 Existing Facilities Evaluation Inpatient Units, cont d Perception of limited access to staffing in the care desk;( creates a barrier) Limited space for families Limited space for programming and skills training Non functioning on-unit kitchens; patient meal prep generally limited to central kitchens Layout doesn t support relational security 38

39 04 Part A - Data 39

40 What Affects Future Resource Requirements? Item Factor Planning Assumption 1 Catchment population growth and aging Incorporated into baseline bed and clinic projections 2 Efficiency Bed projections include expectation for LOS improvements 3 Market Share No changes planned 4 Access 5 The broader system of care Added beds to reduce wait times; clinic visits forecast to increase faster than baseline demographic projections Reduced beds for planned increased substitution of community for inpatient care 40

41 The System of Care Framework System of Care Domain 1. Population Segmentation 2. Care Coordination 3. Providers and Networks 4. Outcomes and Performance Measurement 5. Resources Sample Questions What population segments have the most need? Can hospitalizations be reduced? If yes, what is required and by how much? Can length of stay be reduced by improving patients flow through Ontario Shores' inpatient services? Can ALC days be reduced by improving access to other providers' services? What services would help the most? Are Ontario Shores' patients getting the community services they need? What additional services would help Ontario Shores the most? Can other hospitals substitute for Ontario Shores' services? What measures need to be added to the Ontario Shore's performance measurement framework? Can clinical outcomes be improved? Are resources currently adequate to meet the Ontario Shores' catchment population's demand? Are resources currently adequate to achieve the Ontario Shores' standard of care? Are there services in your program that should be prioritized for growth? 41

42 Terry s map 42

43 The Catchment Population Growth and Aging: How fast will demand grow under current practice? Population growth and aging are expected to increase provincial demand for acute hospital services by roughly 75 percent over the next 20 years Assuming no change in practice or disease prevalence rates, demand for Ontario Shores inpatient services is expected to increase by 25 percent 43

44 Access: There is no international consensus on the right supply of mental health beds Sources: OECD, OMHRS 2015/16, Statistics Canada 2011 Census, MOF Population Projections Beds estimated at 90% occupancy OECD rates are not age standardized 44

45 Access: The OECD likes the Australian model 1. Australia has substantially reduced its mental health beds by substituting community for inpatient services 2. Australia still has roughly 50 percent more inpatient beds per capita than the Ontario Shores catchment. 45

46 Access: How big are the supply differences between Central East LHIN and other jurisdictions? Additional Central LHIN beds at Per Capita Rate of: OECD Average 663 United Kingdom 437 Australia 195 Canada 131 Ontario 66 Sources: OECD, OMHRS 2015/16, Statistics Canada 2011 Census, MOF Population Projections In 2015/16, CE LHIN residents used 433 mental health beds, estimated at 90% occupancy. At the OECD beds per capita rate, CE LHIN residents would have used 663 more mental health beds. 46

47 Catchment and Market Share of Inpatient Mental Health Days: Geriatrics LHIN sub-region OSCMH Catchment and Market Share of Inpatient Mental Health Geriatric Days Regional Volume to OSCMH Catchment: Regional Share of Total to OSCMH Regional Volume to Any Hospital Market Share: OSCMH Share of Total in Region Durham Cluster 5,437 37% 9,313 58% North East Cluster 2,843 20% 4,679 61% Scarborough Cluster 1,399 10% 6,760 21% Central York Region 1,361 9% 3,167 43% North York Central 814 6% 5,832 14% South West York Region 805 6% 2,578 31% East Niagara 366 3% 1,738 21% South West 254 2% 5,575 5% North York East 252 2% 1,510 17% Markham 196 1% 1,517 13% South East 189 1% 2,993 6% South Simcoe and Northern York Region 150 1% 1,904 8% Subtotal 14,066 97% 47,566 30% Other 505 3% 196, % Total 14, % 244,493 6% Source: OMHRS 2015/16 47

48 Catchment and Market Share of Inpatient Mental Health Days: Neuropsychiatry LHIN sub-region OSCMH Catchment and Market Share of Inpatient Mental Health Neuropsychiatry Days Regional Volume to OSCMH Catchment: Regional Share of Total to OSCMH Regional Volume to Any Hospital Market Share: OSCMH Share of Total in Region Durham Cluster 2,613 41% 3,004 87% South East % 2,003 38% North East Cluster % % Scarborough Cluster 539 8% 1,458 37% South Simcoe and Northern York Region 378 6% % Parry Sound 366 6% % South Etobicoke 179 3% % Central York Region 163 3% % West 130 2% % Manitoulin-Sudbury 107 2% 1,721 6% North York West 104 2% % Subtotal 6,024 95% 11,482 52% Other 330 5% 41, % Total 6, % 53,441 12% Source: OMHRS 2015/16 48

49 Catchment and Market Share of Inpatient Mental Health Days: Assessment and Reintegrated Program OSCMH Catchment and Market Share of Inpatient Mental Health ARP Days Catchment: Market Share: LHIN sub-region Regional Volume to OSCMH Regional Share of Total to OSCMH Regional Volume to Any Hospital OSCMH Share of Total in Region Durham Cluster 11,593 34% 34,727 33% North East Cluster 3,823 11% 17,077 22% South Simcoe and Northern York Region 3,070 9% 7,538 41% Scarborough Cluster 2,735 8% 28,318 10% Markham 1,545 5% 9,321 17% North York Central 1,422 4% 12,785 11% Central York Region 1,133 3% 9,161 12% North York West 830 2% 15,858 5% North York East 826 2% 6,887 12% North West 745 2% 16,549 5% North Toronto 725 2% 15,918 5% North East 662 2% 7,991 8% South West York Region 635 2% 6,237 10% South East 605 2% 17,614 3% Bramalea and Area 559 2% 10,192 5% Subtotal 30,908 91% 216,173 14% Other 2,908 9% 597, % Total 33, % 813,833 4% Source: OMHRS 2015/16 49

50 Catchment and Market Share of Inpatient Mental Health Days: Dual Diagnosis LHIN sub-region OSCMH Catchment and Market Share of Inpatient Mental Health Dual Diagnosis Days Regional Volume to OSCMH Catchment: Regional Share of Total to OSCMH Regional Volume to Any Hospital Market Share: OSCMH Share of Total in Region Durham Cluster 2,013 60% 2,197 92% North East Cluster 272 8% % Central York Region 202 6% % Scarborough Cluster 165 5% % Oakville 162 5% % South Simcoe and Northern York Region 131 4% % North Toronto 120 4% % North Etobicoke, Malton, West Woodbridge 105 3% % Brampton and Area 104 3% % Quinte 64 2% % Subtotal 3, % 5,233 64% Other 0 0% 21,256 0% Total 3, % 26,489 13% Source: OMHRS 2015/16 50

51 Catchment and Market Share of Inpatient Mental Health Days: Adolescent: Eating Disorders OSCMH Catchment of Inpatient Mental Health Adolescent: Eating Disorders Days LHIN sub-region Regional Volume to OSCMH Regional Share of Total to OSCMH Halton Hills % Ottawa Centre % Manitoulin-Sudbury 329 8% Lambton 314 8% Ottawa East 301 8% Durham Cluster 296 8% Brant and Brantford 270 7% Hamilton Outer Core 224 6% Middlesex 219 6% Barrie and Area 195 5% Essex 187 5% Kingston 139 4% Urban Waterloo & Rural Waterloo South 128 3% South East 118 3% Subtotal 3,733 95% Other 191 5% Total 3, % Source: OMHRS 2015/16 51

52 Catchment and Market Share of Inpatient Mental Health Days: Forensic LHIN sub-region OSCMH Catchment and Market Share of Inpatient Mental Health Forensic Days Regional Volume to OSCMH Catchment: Regional Share of Total to OSCMH Regional Volume to Any Hospital Market Share: OSCMH Share of Total in Region Durham Cluster 11,536 23% 17,133 67% Scarborough Cluster 7,420 15% 12,997 57% Midland and Penetanguishene Area 5,934 12% 26,344 23% North East Cluster 3,886 8% 4,304 90% Unkown Geography 3,553 7% 24,691 North York Central 1,615 3% 3,391 48% North West 1,464 3% 11,908 12% Central York Region 1,462 3% 2,502 58% West 1,064 2% 5,367 20% South Simcoe and Northern York Region 1,062 2% 1,810 59% Subtotal 38,996 77% 110,447 35% Other 11,678 23% 194,494 6% Total 50, % 304,941 17% Source: OMHRS 2015/16 52

53 Future Bed Projections Potentially Conservable Beds 2015/16 New beds for population growth and aging Future Beds Program 2015/16 Budgeted Beds Planning Occupancy Rate Beds Required to Improve Occupancy Beds needed to Redress Wait Times Improved Length of Stay Beds used for ALC Days for Reference Substitution of Community and Ambulatory Services for Inpatient Care 2020 / / / / / / /36 LOS Percent Improvement Base = Adolescent 12 90% % Eating Disorder Unit 12 95% % New: Severely Ill Adolescents 3 90% New: Children < % New: Adult Respite 2 90% Dual Diagnosis % % Assessment and Reintegration 89 90% % Forensic % % Funded by Forensic Branch 92 95% Other Forensic Beds 46 95% Geriatric 48 90% % Neuropsychiatry 17 90% % Ontario Shores Total % Length of stay improvements are implemented at 25, 50, and 75 percent of the 2015/16 total potential reduction at the 2020/21, 2025/26, and 2035/36 years 53

54 Ambulatory Activity Clinic 2013/ / / / / /36 ACTT 14,968 13,794 16,322 17,935 19,548 20,518 Adolescent 6,614 4,457 3,268 5,013 6,759 7,859 Dual Diagnosis Services Dental Clinic ECT ,249 2,497 2,713 Forensic Outreach Services 3,237 3,554 3,924 4,350 4,775 5,300 Geriatrics 1,390 1,213 1,395 2,517 3,639 4,974 HSC 3,213 3,043 2,705 2,972 3,239 3,400 ICAP 14,586 14,458 17,008 26,631 36,254 38,054 Medical Clinic 1,817 1,693 1,297 1,425 1,553 1,631 Metabolic Clinic ,023 1,074 Pain 520 1,041 1,130 PHP 0 2,474 4,744 5,212 5,681 5,963 Prompt Care Clinic 1, ,336 2,092 2,847 2,989 Transitional Aged Youth 0 0 3,761 5,770 7,778 9,079 Vocational Services 5,145 8,049 7,882 8,880 9,878 11,307 Total 53,582 55,286 65,186 86, , ,865 54

55 Human Resources + Preliminary Operating Cost Estimates 55

56 05 Questions/ Discussion 56