CSS and MH & A Quarterly Sector Meeting. June 29 th, 2011

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1 CSS and MH & A Quarterly Sector Meeting June 29 th,

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3 Mental Health and Addictions Services Integration Opportunity CSS and MH&A Quarterly Sector Meeting June 29,

4 Program / Service Description MH LHIN funds 12 Community Mental Health & Addictions Programs = $31 M in funding 1. Canadian Mental Health Association (CMHA) Halton Region Branch 2. Halton Alcohol, Drug & Gambling Assessment Prevention Treatment (ADAPT) - Addictions 3. Halton Recovery House & Hope Place Women s Treatment Centre - Addictions 4. Peel Addiction Assessment and Referral Centre (PAARC) - Addictions 5. North Halton Mental Health Clinic (Region of Halton) 6. Summit Housing and Outreach Program 7. Grace House Group Home 8. Support & Housing Halton 9. Supported Training & Rehab in Diverse Environments (STRIDE) 10. Credit Valley Hospital -Community Mental Health 11. Halton Healthcare Services- Community Mental Health 12. Trillium Health Centre - Community Mental Health 4

5 Current State System Integration Group Mental Health and Addictions (SIGMHA) Is a well established MH LHIN MH&A working group of funded and non-funded HSPs, consumers, community support service providers and a physician. MH LHIN investments in MH&A over last few years: Psycho Geriatrics - $1,077,577 Community Concurrent Disorders Program (CCDP) - $1,730,000 Psychiatric Sessionals - $365,160 Performance of the HSPs: Most performance targets are being met Some HSPs have done outstanding work on integration Some good examples of integration: Halton Homes Program (4 HSPs), Early Intervention in Psychosis (5 HSPs), CCDP (5 HSPs) 5

6 Current Initiatives Regional initiative for Community Concurrent Disorders has 3 services: Community Crisis Support, Community Chemical Withdrawal Management in Halton, and Enhanced Concurrent Case Management. SIGMHA work includes: Partnership Evaluations LHIN-wide Education Workshops Standardized Client Satisfaction Survey MH&A Resource Guide Standardized Screening tool and Assessment tools Protocol Implementation of : No Wrong Door Protocol and Transitional Aged Youth Protocol Expanded Community Service Hours Participation in ConnexOntario for central reporting for wait times and available services Standardized Data Reporting Creation of Urgent Clinics at EDs to bridge clients to community 6

7 Key Drivers for Integration Provincial priorities - Excellent Care for All Act - MOHLTC 10-year strategy for Mental Health and Addictions MH&A Strategy is informed by Every Door is the Right Door discussion paper; Minister s Advisory Group Report; Select Committee Report; Inter-ministerial Work; Excellent Care for All Act MH LHIN Integrated Health Service Plan (IHSP): strategic priority is to integrate mental health and addictions services to better serve clients needs Aligns with Local Health System Integration Act (LHSIA), 2006 Section 25. 7

8 MH LHIN Current Opportunities for Integration Trillium Health Centre and Credit Valley Hospital proposed merger Transportation moved from Acclaim Health to Red Cross Respite Program The Province is seeking significant integration of mental health and addictions services Integration approach for MH&A Governance to Governance session 8

9 Other LHIN Integrations Provincially, most MH&A integrations have occurred because agencies are at risk (cannot meet requirements, performance issues), or by attrition in executive staff, or leases are coming due. NE LHIN In January 2009, a report was completed for integration in the Algoma Region (18 agencies). Consultation and community engagements were held. The NE LHIN Board approved the Anchor Agency option and the integration of all MH&A treatment services in Algoma. In October 2010, a Project Team was formed to move toward integrated services. Project Charter and Business Case completed. A clinical advisory committee established to guide planning for program and services. Completion of integration

10 CE LHIN Recent Integrations Thoracic services- Peterborough Regional Health Centre, Scarborough Hospital, and Rouge Valley Health System. Alzheimer Society- Amalgamation of Alzheimer Society of Kawartha Lakes with Alzheimer Society of Peterborough area. Northhumberland Hospice Services- Amalgamation of Hospice Northumberland Lakeshore and Palliative care Campbellford. Kawartha Lake Hospice Services- Amalgamation with Community Care City of Kawartha Lakes. Beacon House- Ontario Shores to Durham Mental Health Services Survivors Psychiatric Advocacy Network (SPAN) to Canadian Mental Health Association of Peterborough. 10

11 Vision for MH&A Services in the MH LHIN LHIN Board passed a motion on June 2, 2011 to pursue a Facilitated Integration of MH&A service providers across the MH LHIN (under Section 25 in LHSIA, 2006) What is the Vision for MH&A? To create one agency that is accountable for managing, coordinating and delivering all services within the mental health and addictions system across the MH LHIN One agency to be responsible for data collection, contract performance, clinical outcomes, etc One agency to be responsible for making connections with other ministries, agencies, other LHINs, etc to ensure seamless and effective delivery of care to all clients 11

12 MH LHIN Commitment One-time funds to help with the planning and potential implementation of this Facilitated Integration Dedicated Staff and resources Events To-Date LHIN Board Chair met with other HSP Board Chairs during some pre-engagement meetings to discuss the vision MH LHIN hosted a Governance to Governance session on June 8, 2011 with all 12 MH&A agencies to introduce the vision for integration Summary report from the G2G session was distributed to all participants and agencies 12

13 Next Steps LHIN will be assembling the following information over the next couple of months: Performance data, stats, satisfaction survey results, Provincial report results + recommendations, local CE results, etc Answers/responses to the questions posed during the G2G session Informational slide deck on the process for a Facilitated Integration Focus group with psychiatrists and family physicians will be held over the summer to gather input into and support for the vision Special SIGMHA meeting on Aug 4, more G2G sessions Sept and Oct

14 Questions? 14

15 Building Health Care Capacity to Serve Individuals with a Developmental Disability

16 Central West Network of Specialized Care Service Area: Is made up of five counties in total: Waterloo, Wellington, Dufferin, Halton and Peel.

17 Networks Mandate Is to better coordinate the specialized service system, increase the range and availability of specialized supports and build expertise and community capacity through joint education and training initiatives 17

18 Health Care Issues Individuals with developmental disabilities have on average 5.4 medical conditions (more than twice the usual) Many of these conditions (ie. Epilepsy, mental disorders, sensory impairments, swallowing disorders, chronic constipation, reflux and dental disease) are more common in patients with a developmental disability than the general population Many also have communication impairments which makes it difficult to communicate health-related issues Patients with DD are often recipients of too many, or sometimes inappropriate, medications and often experience serious side-effects which go unrecognized

19 Health Care Issues cont Patients with DD often do not receive health promotion or disease prevention maneuvers (ie. Immunizations)* Patient with DD are often dealing with medical conditions AND lifestyle challenges such as poor diet, obesity and inadequate physical activity (Source: The Consensus Guidelines for Primary Care of Adults with Dual Diagnosis)

20 Background Historically, provincial facilities provided both primary health care expertise and training in the field of developmental disabilities Individuals with developmental disabilities are now living in the community and professionals without specialized knowledge are being asked to care for them* The Consensus Guidelines for the Primary Care of Adults with Developmental Disabilities were released in November, created to assist primary care providers when working with DD clients

21 Why is Primary Care Difficult to Access? Primary care providers receive little (if any) formal training in developmental disabilities, Lack of specialized experience makes providers uncomfortable in providing care, Individuals with developmental disability often have complex medical issues requiring more attention from a physician, and General shortage of physicians in the community

22 The Purpose of the HCF Role is To build capacity in the local health care community, To compliment efforts by MOHLTC to improve overall health care experience of Ontarians, and To expand access to health care for individuals with a dual diagnosis It is not intended to duplicate the role of health care providers

23 Discussion

24 What we've accomplished thus far in CW... Through outreach we have begun identification and cataloguing of healthcare access issues for individual with developmental disabilities across 3 sectors Bridged a connection to a GP & NP for two (2) Christian Horizon clients in the Georgetown area [created new access] Engaged in capacity building for a GP in Elora [client consultation] Provided education/training on Medication Reviews & the Use of Psychotropics for GPs in Waterdown

25 Work Plan: The next 6 months Continue to develop a work plan based on community needs assessed through outreach Collaborate with Bill Sullivan RE: Consensus Guidelines & TK, DDPCI training course and Clinical Support Networks Community presentations at local planning tables across sectors Develop linkages with community FHT / CHC Develop communication materials - (flyer, website, etc) Education and training to service providers across 3 sectors (Health, MH, DS) re: building capacity to serve individuals with a DD Develop a training calendar for health care professionals

26 Referral Process: Please or call the CW Region Coordinator: Trevor Lumb (905) ext. 321

27 Questions?? Trevor Lumb Regional Coordinator Sabrina Vertolli Health Care Facilitator

28 MH ED FLOW INITIATIVE (Tri Hospital ED Project) June 2011 Mississauga Halton

29 MH ED FLOW Initiative: Brief Overview and Rationale CCACs have historically provided a modest level of support to high volume EDs through our traditional hospital case management model. As ED pressures have escalated, CCAC referrals have increased in number, but there has been no fundamental change to the way in which we work with ED teams. Mississauga Halton

30 MH ED FLOW Initiative: Brief Overview and Rationale As a key point of access, the ED is also a key point of opportunity to work more effectively as an integrated CCAC/Hospital team to enable more efficient flow and better client outcomes. We believe that targeted ED CM resources can have a significant impact on length of stay in the ED, admission avoidance and reduced recidivism. There is solid research to support the role of case management directly in the ED and its positive impact. Mississauga Halton

31 Case Management Role in the ED Work in partnership with hospital staff as an integral member of the ED team to identify and support seniors with complex needs, with high risk of admission and ALC designation. Mississauga Halton

32 Program Goals 1. To enable the early and effective discharge of seniors who attend the ED and who require community supports and services. 2. To reduce avoidable patient admissions through targeted and proactive identification of clients who can be supported in the community. 3. To support frail seniors to reduce frequent and repeated admissions to the ED. 4. To reduce number of clients designated ALC within 2 days of admission Mississauga Halton

33 Expected Outcomes Create ED capacity by enabling more timely discharge to appropriate community resources. Reduce fragmentation/increase integration of care delivery to the elderly. Increase number and scope of community referrals to fully leverage community resources and investments. Enable the right care in the right place, at the right time, by the right person. Create additional acute care capacity through further reduction in ALC days. Mississauga Halton

34 Focus of this project Supporting complex and frail seniors who have a high probability of admission and ALC designation. Enabling achievement of the articulated directions of the Integrated Health Services Plan. Improving integration across the hospital and community sector Mississauga Halton

35 Critical Success Factors 1. Collaborative planning Hospital, CCAC, and LHIN. 2. Dedicated space and equipment for Case Managers. 3. Enablement of enhanced role of CM through integration into the ED team. 4. Ongoing joint/collaborative work to complete design, implementation and monitoring of model. 5. Mutual access to relevant databases CCAC access to Hospital; Hospital access to CCAC. Mississauga Halton

36 Interdependencies 1. Restore Express Initiative 2. Hospital Express Bed 3. Integrated Discharge Planning Project 4. CCAC Enhanced Role in Placement Mississauga Halton

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38 Next Steps 1. Evaluate screening tool that will be used for the ED CM FLOW Initiative 2. Determine use of metrics to be used to evaluate success 3. Determine use of space and equipment in ED department 4. Initiative to start July 4th, 9 am to 5 pm at larger hospital sites 5. Continue to recruit staff to eventually provide coverage 7 days per week 9 am to 9 pm at larger sites and 10-6 pm at smaller sites 6. ED Managers to facilitate ED department meeting with CCAC Manager and staff to review enhanced role Mississauga Halton

39 BREAK

40 Restore and Restore Express CSS and MH & A Quarterly Sector Meeting Wednesday June 29 th, 2011

41 Restore: Right Care Right Place Right Time Right Cost

42 Restore Program Background and Achievements

43 Restore Program 26 bed unit in a LTCH that provides rehabilitation and restorative care for people no longer requiring acute care but cannot safely return home due to de-conditioning and loss of ability to complete ADLs Without this program individuals would have been seen as candidates for LTC placement. Primary program goal is for person to return to their home and remain living in the community as long as possible. Allows for assessment of functional levels and determination of appropriate discharge destination and level of care. Supports flow from hospital and prevents premature admission to longterm care 43

44 Restore Program Performance Indicators Indicators 2008/ / /11 Admissions Total Admissions Average Length of stay 44 days 56 days 51.5 days Discharges Discharge Home Discharge to LTC Other 78% 11% 10% 72% 15% 13% 55% 33% 11% Admission MAPLe Scores 3,4,5 97% 100% 99% Client Satisfaction Good to Excellent Satisfactory Somewhat Satisfied 74% 10% 16% 81% 14% 5% 87% 13% Over three years a total of 442 people have received service This represents a total system savings of 23 acute care beds 44

45 Restore Express

46 Restore Express Specialized program developed in collaboration with the MH LHIN, MH CCAC, THC, NP STAT and Cooksville Care Centre 4 beds have been designated within the existing Restore program and dedicated solely to the Restore Express program for a 3 month pilot Supports adults 18+ who present in the Emergency Department and do not require hospitalization A period of assessment and short term care at Cooksville Care Centre in a Restore Express bed is designed to support a safe discharge home Goal to avoid hospital admission to an acute care bed where that level of care is not required, and to reduce 2 day ALC rate

47 Restore Express - Who? Individuals who would have had a recent decline in functional ability/change in condition and are assessed as having potential for improvement The acute reason for coming to the Emergency Department has improved Treatment is underway, individual is medically stable and the course of treatment can be managed and monitored in a Restore Express bed at Cooksville Example: a patient who lives with elderly spouse, with an acute illness (not actively infectious), fever, needs a few days of IV therapy with follow-up treatment and support at home)

48 Indicators for Restore Express Recent decline in functional ability Recent Falls Absence of home support (social admission) Recent decline in cognition Frail, malnourished Poor hygiene Poly pharmacy Pain control

49 Restore Express - Outcomes

50 Restore Express Outcomes The goal during this short length of stay (up to 7 days) will be to provide support and care to return the individual to a level of functioning that can be managed with or without support in the community Team members from hospital, Restore Express, CCAC, NP Stat and community agencies will work with individuals and families to develop a discharge plan from Restore Express This could include for example, home with or without CCAC support, Supports for Daily Living, Retirement home, Day Program, or Long Term Care Discharge summary will be provided for all patients leaving Restore Express

51 Restore Express Next Steps Confirm physician on-call coverage Provide hospital, CCAC and Cooksville staff with information/education about the program Develop information for patient/family Roll out drum roll please..july 2011

52 Questions?? (Restore Express Graduate!!)

53 Acclaim and Red Cross Integration Example Angela Brewer, Acclaim Valerie Cook, Red Cross

54 MHLHIN Financial Update June 29, 2011 Finance Team - MH LHIN, Paulette Zulianello and Mirella Semple

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56 Finance Update MH LHIN Funding and Allocation TEAM Paulette Zulianello - Manager, Finance and Risk Mirella Semple - Senior Lead Funding and Allocation TBD - Senior Lead Funding and Allocation (more Hospital Related) Chak Lee - Finance Clerk

57 Finance Update Reporting Recap: Q4 CAT Tool (RO): due June 30/11 23 providers have submitted (as at June 28), 21 outstanding Performance will review and follow up with providers if there are any significant variances Q4 Supplementary AAH Report All submitted

58 Finance Update Q4 ARR Due June 30, 2011: 15 providers have submitted (as at June 28). Please send a signed copy of the ARR and the Audited Financial Statements to FMB and one copy to the MH LHIN Address of FMB: Ministry of Health and Long-Term Care Financial Management Branch 5700 Yonge Street, 12th Floor Toronto ONT M2M 4K5 Contact CSS kelvin.wong2@ontario.ca denise.mendes@ontario.ca CMH&A ronald.smith@ontario.ca

59 Finance Update SRI SELF REPORTING INITIATIVE UPDATE WERS will be shut down July 15, 2011 (at 23:59 pm) Important to have Q4 and ARR submission in by then. Planning target is to have Q2 quarterly reports on SRI. Health Data Branch will be responsible for training. No training dates have been communicated to LHINs. Stay tuned for further communication. Any questions or comments can be directed to:

60 Questions

61 Closing Please complete your survey 61