OCAN Refresher
Webinar
March 2014
Agenda
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Background
Research
OCAN use in the sector
Successes and challenges
Health service provider (HSP) examples
Refresher training tips
OCAN standards
– Core
– Consumer Self Assessment
– Staff Assessment
• Integrated Assessment Record (IAR)
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Background
• OCAN was selected by the sector
• Based on The Camberwell Assessment of Need
• Additional elements were added
• OCAN supports a consumer driven approach
• 2010 – 2013: OCAN was implemented
• Current focus: quality, utility and sustainability
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Purpose
• To help consumers by supporting conversations
about needs, strengths and actions
• To provide a common source of information for
service planning at various levels
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Research
What this means
Findings
for services
Meeting consumer
identified unmet needs
improves outcomes
Service plans should focus on
consumer identified unmet
needs
Increasing agreement
between consumers
and staff improves
outcomes
Engage in conversations that
_ share staff and consumer
__perspectives about needs
Regular review with
consumers
Improves outcomes
Use reassessments as a time
to review progress and plan
next steps
*references at the end of this slide deck
OCAN Related Work
• Provincial Steering Committee
• CCIM OCAN Quality Webinars
• CCIM Support Centre
• Shared Assessment Approaches
• OCAN Reports at Different Levels: HSP and LHIN
• LHIN Initiatives
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HSP Reports
Reports
Description
Aggregated
Assessments Response
Reports
-Provides response count and percentage for each of the
raw elements in the OCAN
Needs Analysis Reports:
• Consumers Self
Assessment
-Provides areas of need from highest to lowest
- 40 out of 100 clients do not have a family doctor = 40%
-Broken down by functional centre & age ranges
• Staff Assessment
- top 3 unmet & met needs are “company”, “food” and
“money”
Level of Agreement
Report
- Measures how closely consumer and staff need ratings are
aligned
- alignment for “accommodation” is high and for
“company” is low
Change in Unmet Needs
Over Time Reports :
-Provides a measure of the impact of services on
addressing client needs
• Consumers Self
Assessment
-Broken down by functional centre
• Staff Assessment
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-30 clients rated “drugs” as an unmet need. 6 months
later, 18 rated “drugs” as a met need = 60% Progress
OCAN use in the sector
• Evidence Exchange Network (EENet): building an
OCAN Community of Practice
• Health Equity: Community of Interest for
Racialized Populations
• Report: Identifying the Needs of Complex Health
Populations using OCAN data
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OCAN successes
• Over 200 HSPs implemented
• OCANs with consent to share granted: About 50%
• Raises issues important to the client
• Supports a more action oriented approach
• Improves documentation
• Starting to use OCAN data in quality improvement
planning
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OCAN Challenges
• Time consuming
• Keeping up with reassessment cycle
• Consumer participation in the self assessment
• Relevance in certain programs
• Technical challenges
• Evaluating the quality of assessments
• Using the aggregate reports
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Experiences From The Sector
• Successes
• Challenges
• Strategies
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Refresher Training - Planning
Why is it important?
• So that accurate OCAN information is being
used to support service delivery and planning
• “On the job” training/coaching is critical to success
• One time “train and hope” approach is ineffective
How do I plan refresher training?
1. Review CCIM resources available
– Refresher Training materials
– User Reference Guide & Domains Information
– OCAN Quality Toolkit
2. Focus on most challenging parts of OCAN
3. Determine a practical approach
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Options for Delivering Refresher
Training
• Hold sessions for staff every six months
– CCIM Case Studies or clients using your service
• Incorporate into existing team meetings
– Validate client’s OCAN during client review
– Break OCAN into manageable pieces
• One to one training
– Staff review completed OCANs with manager,
– OCAN coordinator or peer
• Accessible refresher training materials
– Develop a refresher training folder
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Key messages – lessons learned
using OCAN
• It’s about the conversation
• Follow the standards using an approach that fits:
– your style of practice
– where the consumer is at
– the context of the service
• “Unknowns” are OK
• Leaving out some information is OK
e.g. medication, stages of change, capacity
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Standards
OCAN at a glance
Consumer SelfAssessment
Staff Assessment
Consumer Information Summary
Mental Health Functional Centre Use
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What?
(are your needs)
Who?
(are you)
Where?
(do you receive
services)
OCAN Assessment
There are three “types” of OCAN:
• The CORE OCAN consists of the
Consumer Information Summary
and the Mental Health Functional
Centre Use
• The CORE + Self OCAN consists of
the Consumer Information Summary
elements, the Consumer SelfAssessment and the Mental Health
Functional Centre Use
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• The Full OCAN consists of the
Consumer Information Summary, the
Consumer Self-Assessment, the
Mental Health Functional Centre Use
and the Staff Assessment
Consumer SelfConsumer
SelfConsumer
Assessment
Assessment
Assessment
Staff
Assessment
Staff
Staff Assessment
Assessment
Consumer Information
Information Summary
Summary
Consumer
Consumer
Information
Summary
Mental Health
Health Functional
Functional Centre
Centre Use
Use
Mental
Mental
Health
Functional
Centre
Use
Functional Centre use of OCAN
Full OCAN
• Assertive
Community
Treatment
• Day/Night Care
• Counseling and
Treatment
• Case Management
Core OCAN
• Peer/Self-help
Initiatives
• Crisis Intervention
• Clubhouse
• Diversion and Court
Support
• Community Mental
Health Clinic
• Early Intervention
• Dual Diagnosis
• Eating Disorders
• Social Rehabilitation/
Recreation
• Psychogeriatric
• Support within
Housing
• Vocational
Employment
• Short-term
Residential Crisis
Support Beds
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• Forensic
• Concurrent
Disorders
The Provincial Consumer Working Group recommends the use of Core + Self OCAN for
Peer/Self-Help initiatives as a peer-to-peer recommendation
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CORE OCAN
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True or False?
What are the reasons you would do an OCAN?
• Because my manager told me I had to
True
• To identify needs when a client enters services
True
• Every time circumstances change for a client E.g.
hospitalization or housing
False
• To periodically do an overall review with a client True
• To make sure no more services are required True
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Reason for OCAN
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Steve was discharged from your program
five months ago.
To your knowledge, no other HSP has been
doing OCAN during this time.
Steve has returned and you are about to
complete an OCAN. Which reason for OCAN
would you choose?
A. Reassessment
B. Initial
C. (Prior to) Discharge
Answer: B. Initial
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Initial OCAN
• An Initial OCAN is completed when:
– the consumer is new to the Community
Mental Health system
– the consumer has re-entered the
Community Mental Health system more
than 3 months after a discharge
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Mary is entering your HSP for the first time to
receive support within housing services.
She has been receiving counseling and
treatment services from another HSP for the
past 8 months.
The organizations are not using a shared assessment
approach. Which reason for OCAN would you choose?
A. Reassessment
B. Initial
C. (Prior to) Discharge
Answer: A. Reassessment
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Reassessment
• A “Reassessment” OCAN is completed every 6 months.
This is referred to as the Reassessment Cycle
• It is also completed:
– On the six-month reassessment cycle if consumer has
re-entered the Community Mental Health system less
than 3 months after a discharge
– When a consumer is receiving CMH services
elsewhere for at least 3 months and you are starting
OCAN for that consumer.
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You have been Mohamed’s case manager
for the past 4 months and you completed an
OCAN with him 2 months ago.
Despite your attempts to contact him, he stopped meeting
with you for case management services and you are now
discharging him.
Do you need to do a
(Prior to) Discharge OCAN?
A. Yes
B. No
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Answer: A. Yes
(Prior to) Discharge (from HSP)
• HSPs are encouraged to have a conversation with
the consumer just prior to discharge to ensure their
most up to date needs are documented
• A (Prior to) Discharge OCAN is conducted by the
OCAN Lead when the consumer is discharged from
ALL the functional centres within an HSP
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Which Functional Centres are exceptions
to the “reason for OCAN” rules?
A. Short Term Residential Crisis Support Beds &
Crisis Intervention
B. Forensics & Early Intervention
C. Crisis Intervention & Diversion and Court Support
Answer: A. Short Term Residential Crisis Support
Beds & Crisis Intervention
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Standards for Crisis Services
• If the consumer is involved with only one
functional centre, do the following:
– Conduct an Initial OCAN including the exit date and
exit disposition
– A new Initial OCAN is completed each time a client is
admitted.
• If the consumer is involved with more than one
functional centre, do the following:
– Complete the Mental Health Functional Centre Use
Section information and provide it to the OCAN Lead
to be included in the next OCAN
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Reassessment Cycle
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Initiating
Initiating the Reassessment Cycle
Start Date
End Date
Start Date
End Date
Assessment 1
Assessment 1
Assessment 2
Assessment 2
May 1/11
May 30/11
Nov 1/11
Nov 30/11
30 Days Max
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30 Days Max
M O N T H S
Until next assessment
Once the start date is chosen, the end date is 30 days from the start
date. The next assessment happens 6 months from the start date of the
previous assessment.
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Yes or No?
Should I do an OCAN when … ?
A. I’m in the process of completing an OCAN
that I started 3 weeks ago with a new client?
The client then left the service.
Yes. Separate discharge OCAN is not required
B. consumer dies? Yes
C. consumer only attends our drop in group and
we have a policy not to collect any client
level information? No
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Core OCAN Overview
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Consumer Demographic Information
Mental Health Functional Centre Use
Contacts
Consumer Capacity
Culture and Citizenship
Current Legal Status
Accommodation
Employment Status
Education level
Psychiatric History
Income
Presenting Issues
COMP-BR-1, 2
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Find out:
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My burdens
ER visits
legal
symptoms
unemployed
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My supports & strengths
partner
employment
program
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peers
doctor
My issues
Sexual abuse
financial
Substance
use
symptoms
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HELP!
CORE
OCAN
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Core OCAN Elements
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Core OCAN Elements
My Cheat Sheet
My Organization LHIN :
My Organization Name:
My Organization Number:
My Program Name:
My Program Number:
My Functional Centre Name:
My Functional Centre Number:
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My LHIN
Sunny Community
Centre
1234
Sunny Days
6789
Social Recreation
725 10 76 81
Where do you live?
Susan has been in your HSP for several years. You
are now completing Core OCAN in your HSP. Susan
lives in ValleyView Adult Care facility which is funded
by the Municipality and privately owned and operated.
Refer to the User Reference Guide to identify the
housing type in the scenario above
Answer:
Domiciliary Hostel
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User Reference Guide:
IF In Doubt – Look it Up
Where Do You Live?
• Domiciliary Hostel: Municipally-funded, privately owned and operated
accommodation providing room and board.
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No fixed address: Includes living in the streets, rooming with a friend, etc.
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Hostel/Shelter: Temporary housing for the homeless.
•
Private Non-Profit Housing: Units in shared or self-contained apartments owned
and managed by community based non-profit corporations. Excludes rooming/boarding
homes
•
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Supportive Housing –Congregate Living: Residence of mental health service
consumers with varying levels of supervision and support services
Self Assessment
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Benefits of the Self Assessment
• Provides an opportunity for consumers to
participate in determining their own needs
• Can potentially link consumers to the most
appropriate services based on their needs
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Introducing the Self Assessment
• Self assessment is optional
• Complete the parts you feel comfortable with
• Helps me understand areas of your life where you
need support and where things are going well
• Gives you a voice
• Would you like support to complete it?
Reassessment
• Review progress and next steps
• Use last self assessment and make changes
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Steps to help guide the consumer
– For each of the 24 domains, think about whether
you have a problem in that area of your life
– The question is a “jumping off point” for you to
think about that area of your life in general
– The question is not meant to be answered literally
– Check off one of the four boxes
– Provide comments to explain your choice if you
want
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Consumer Self-Assessment
Rating need
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Intent of these domains is to
determine:
Telephone:
If you have access to and the ability to use a
telephone or other means of communication.
Company
If you organize and have social contact with family
and/or friends
Intimate
If you have close relationships with a partner, family
Relationships member and/or friend
Sexual
Expression
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If you are satisfied with your sexual expression
Consumer Self-Assessment
Additional Questions
Please write a few sentences to answer the
following questions:
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What are your hopes for the future?
•
What do you think you need in order to get there?
•
How do you view your mental health?
•
Is spirituality an important part of your life?
•
Is culture (heritage) an important part of your life?
Staff Assessment
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Assessment Conversation
• Engages the person with lived experience and
the person with assessment knowledge in a
conversation focused on a person’s needs and
strengths
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OCAN Staff Assessment
Score Need
Score Help
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OCAN Staff Assessment Need rating reference
The intent of the needs
assessment is to highlight
the major issues that
stand in the way of a
person’s recovery.
UNMET NEED
SERIOUS PROBLEM
2
A major
issue that
stands in
the way of
person’s
recovery,
regardless
of its cause
or whether
help is
provided
1
Which of these
ratings applies
to the need in
this domain?
UNKNOWN
9
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MET NEED
No serious problem because of help
given. Would be serious problem if help
was stopped
No or not enough
information
available
NO NEED
NO SERIOUS PROBLEM
Person is
independent in
this domain or
is relatively
independent
with minimal
help that
would not lead
to a serious
problem if
stopped.
0
OCAN Staff Assessment
Scoring Help
Scoring informal and formal help
• based on frequency and effectiveness of help
0 = No help
1 = Low help
2 = Moderate help
3 = High help
9 = Not known
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OCAN Staff Assessment
Scoring Help, Question 2, 3a/b
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OCAN Staff Assessment
Comments:
• Will help others understand your scoring
• Include “need to know” information
• Follow your own HSP’s guidelines for
documentation
• May be viewed by other service
providers involved in supporting
consumers
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OCAN Staff Assessment
Actions:
• Are recorded in the Staff Assessment
• Can be identified by the consumer or staff on either
assessment or during the conversation
Information includes:
• mutually agreed actions in each domain
• who is responsible for completing the action
• timelines for completing and reviewing agreed actions
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OCAN Staff Assessment
Hopes and Dreams Section:
• The staff summarizes or elaborates
on the hopes and dreams that the
consumer expresses in their self
assessment or during the
conversation
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Outputs
Making OCAN information useful
Information in the OCAN can assist in:
– Identifying areas of need
– prioritizing actions
– determining referrals
– Acknowledging strengths
– viewing changes in needs over time
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Summary of Actions
• At the end of the assessment, all actions documented
will be automatically listed in a chart
• Priorities need to be entered manually
Priority Domain
1
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Accommodation
Action
Submit application for
supported housing
Summary of Referrals
• At the end of the assessment, referrals and the
current status of the referral can be documented
in this chart
• An outcome of the Summary of Referrals is the
identification of gaps in service
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Optimal
Referral
Specify
Actual
Referral
Specify
Reason for
Difference
Status of
Referral
Drop down
list
Name of
optimal
referral
Drop down
list
Name of
actual
referral
Drop down
list
Drop down
list
Individual Assessment Reports
1. Individual Need Rating Over Time
2. Needs Over Time
3. Summary of Actions and Comments
4. Staff Workload
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Integrated Assessment Record
•
LHINs have access to aggregate clinical and will have access to operational
information through standardized reports based on the assessments your HSP
uploads to the IAR.
•
As part of the assessment standard, all completed assessments should be uploaded
to the IAR. Uploading all assessments ensures availability of assessments for
sharing, within the circle of care, and more accurate aggregate clinical reports
•
The consent you gather determines if an uploaded assessment can be viewed
through the IAR. If consent is not granted, the assessment cannot be viewed.
•
Remember to work with you user coordinator to ensure that if staff has left your
organization, their IAR accounts are removed from the system. Please see link
below:
– https://www.ccim.on.ca/IAR/Private/Document/Forms%20and%20Guides/Gener
al/IPAddressAddRemoveChange_20130523_v1.0_AEM.doc
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•
Consider ways to include use of IAR in your workflow to support service planning and
care coordination
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If your are having issues with uploading or viewing assessment within the IAR, please
contact the IAR Support Centre at:
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Telephone: 1-866-909-5600
•
Email: iar@ccim.on.ca
Orientation to website
CCIM.on.ca
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Questions or Feedback
• If you have any questions or comments,
please contact:
Support Centre
Telephone: 1-866-909-5600
Website:
www.ccim.on.ca
E-mail:
cmhcap@ccim.on.ca
Bibliography – sources for slide #5
.
• Fleury, M., Grenier, G., & Lesage, A. (2006). Agreement between
staff and service users concerning the clientele's mental health
needs: A Quebec study. Canadian Journal of Psychiatry , 51 (5),
281-286. )
• Leese, M., Johnson, S., Slade, M., Parkham, S., Kelly, F., Phelan,
M., et al. (1998). User perspective on needs and satisfaction with
mental health services. British Journal of Psychiatry , 409-415.
• Junghan U et al (2007) Staff and patient perspectives on unmet
need and therapeutic alliance, Brit J Psychiatry, 191, 543-547
• Slade, M., Leese, M., Cahill, S., Thornicroft, G., & Kuipers, E.
(2005). Patient-rated mental health needs and quality of life
improvement. British Journal of Psychiatry , 187, 256-261.
…. 2
Biobliography
• Lasalvia, A., Bonetto, C., Malchiodi, F., Salvi, G., Parabiaghi, A.,
Tansella, M., et al. (2005). Listening to patients' needs to improve
their subjective quality of life. Psychological Medicine , 35, 1-11.
• Slade, M., Leese, M., Taylor, R., & Thornicroft, G. (1999). The
association between needs and quality of life in an epidemiologially
representative sample. Acta Psychiatrica Scandinavica , 100, 149157.Transcript:
• Lasalvia et al (2008) Does staff-patient agreement on needs for care
predict a better mental health outcome?, Psychological Medicine,
38, 123-133
• Carina K et al (2009) Effect of feedback of treatment outcome in
specialist mental healthcare: meta-analysis, British Journal of
Psychiatry, 195, 15–22.