Appendix A - Program & Service Details (complete a new sheet for each program/service)
Program/Service Name:
Psychiatric
New/Existing: ☐ New
X Existing
Type: X Chronic Disease Management
Clinical Practice Guidelines finalized for Program/Service?
☐ Health Promotion
☐ Prevention
Priority Addressed (choose the one most appropriate):
☐ Acute/Episodic Care
Planned Staff Involvement (FTE):
☐ Seniors Care
X Mental Health
Provider
Social Work
☐ Yes ☐ No
FTE
0.05
☐ Diabetes
☐ Lung Health
☐ Obesity/Nutrition
☐ Heart Health
☐ Smoking/Addictions
☐ Other -
Collaboration with other organizations for program/service:
St. Joseph's care group in Thunder Bay, Marathon's WMGH, OTN telehealth
High Level Description
& Goals
(2014/15)
Increase access to
psychiatric services
through facilitation of
scheduling of telehealth
appointments with
psychiatrist and indirect
consultations for health
care professionals
working with patients
with psychiatric illness
1) Target
Number of
Patients,
and
2) Target
Population
(2014/15)
1) 24
2) patients and
families dealing
with psychiatric
illness and
requiring
psychiatric
consultations
1) # of
Patients
Served
2) Patient
Encounters
**
(2013/14)
1) 13
2) 20
Activities

Performance Measures
o Corresponding Targets
 Actual Measure
(2013/14)

Performance Measures
o Corresponding Targets
(2014/15)
Planned Quality
Improvements
(2014/15)

Number of patients on wait list
o <5
 9

Number of patients on wait list
o <5



Number of patients served
o 20
 13
Number of patients served
o 20
(2014/15)





triage patients for
psychiatric appointments
complete intake interviews
with patients requiring
psychiatric assessment
complete all pre and post
service reports and
provision of relevant
information to the
psychiatrist
provide support to patient
by attending telehealth
psychiatry sessions with
patient
assist in arranging
opportunities for health care
professionals to consult
with psychiatrist remotely
Work with partners to
increase availability of
telepsych appointments so
as to increase access and
decrease wait list
High Level Description
& Goals
(2014/15)
1) Target
Number of
Patients,
and
2) Target
Population
(2014/15)
1) # of
Patients
Served
2) Patient
Encounters
**
(2013/14)

Activities
(2014/15)
Performance Measures
o Corresponding Targets
 Actual Measure
(2013/14)

Performance Measures
o Corresponding Targets
(2014/15)
Planned Quality
Improvements
(2014/15)
or in person through at least
one site visit
Stories and Highlights (2013/14)
 There was a brief interruption in the telepsych services as one social worker departed and another started.
 An on-site opportunity for physicians to meet and consult with the psychiatrist was arranged and well attended
*For new programs/services, do not complete the shaded cells
**Patient encounters may include but are not limited to in-person appointments, telephone contacts, OTN and home visits. Group sessions should count each participant in each session as a patient encounter.
Programs share the following characteristics: a) specific patient group, b) meaningful, measurable objectives/indicators, and c) outcome measures/indicators that allow the FHT to determine whether the objectives have been achieved