Community Support Services Common Assessment Project (CMH CAP) OAILP May 5, 2010

2 Agenda Who we are and what we’re doing –An Ontario-wide common assessment The value of a good assessment –Leading to accessible and standard ways to care What is a good assessment? –Generating good information for better planning From thought to action –Implementing the common assessment tool Working together –Applying knowledge to promote good health

3 Infrastructure & Operations Standards Security, Privacy & Risk Management Transition Community Care Information Management (CCIM) Program CCACCSSCMH&ALTCHCHCSCCH Local Health Integration Networks (LHINs) Integrated Data Strategy Assessment Projects Business Systems Common Intake Assessment Tool Long Stay Assessment Software Management Information Systems Human Resources Information Systems Management Information Systems Human Resources Information Systems Management Information Systems Human Resources Information Systems Management Information Systems Human Resources Information Systems interRAI CHA Ontario Common Assessment of Need Resident Assessment Instrument MDS 2.0 Management Information Systems Completed and transitionedInitiation stagePilot stageCurrently rolling out CCAC = Community Care Access Centres CSS = Community Support Services CMH&A = Community Mental Health and Addictions LTCH = Long-Term Care Homes SCCH = Small & Complex Continuing Care Hospitals CHC = Community Health Centres Management Information Systems Integrated Assessment Record

4 CSS CAP implementation model

5 What we’re doing: The CSS CAP objective Every client who receives Community Support Services (CSS) will have an initial standard assessment and appropriate reassessments completed according to established guidelines. This approach will: Enable appropriate care planning and service navigation Ensure the right service at the right time –Indicating when a client requires a higher level of care Facilitate data sharing and reduce repeated “story telling” Provide high quality data for reporting at client, organizational, LHIN, and provincial level Ensure a client receives an assessment regardless of services provided –Is appropriate to the level of care currently provided Consider all populations within the sector Identify potential areas for process redesign and streamlining

6 Current CSS sector profile Over 900 CSS health service providers across Ontario which use an assessment instrument and many that do not –Includes 200+ EPC and 100+ Aboriginal, First Nation agencies High demand for a common assessment in Ontario –No stranger to Ontario: 12-20% are currently implementing InterRAI CHA Diverse array of service delivery models –Comprehensive models with a wide range of services including assessment and case management –Small volunteer organizations that deliver meals and provide transportation

7 Current Ontario CSS challenges No common language or consistency of assessment approaches -- Ontario organizations have a choice of several assessment tools or develop their own with little or no guidelines No formal collection of data across the Ontario CSS sector to identify and address gaps in services and resources Lack of standardized quality data gathering for aggregate reporting, benchmarking and comparisons at the organizational, regional and Ontario Local Health Integration Network (LHIN) levels

8 The value of a good assessment Using a good assessment… …properly identifies clients needs… …and provides good information… …to inform and promote better health!

9 What is a good assessment? –Has buy-in from staff and sector –Effectively identifies needs –Service can be properly identified: Home, Supportive Housing, Retirement Home, Long-term Care –Allows for seamless delivery of services regardless of provider –Enables sector (CSS) and cross-sector (CCAC / CMH) communication –Provides good information for better planning

10 CSS Common Assessment vision Current Situation Focuses on Services Productivity and Efficiencies Multi-Disciplinary Service Plan Focuses on Client’s Needs ORG 1ORG 2ORG 3 Report Functional Centre Productivity / Efficiency Track quantity of clients receiving services Track quality of services accessed by clients Report Outcomes / Effectiveness ORG 1ORG 2ORG 3 Vision Equipping Community Support Service providers with tools that can facilitate the collection and use of client information. Creating a sustainable approach to manage and measure improvement in client outcomes over time.

11 Referral Screener Self administered or org administered Service Planning Right Service for Right Client Data Sharing Data Submission More intensive services Supportive Housing Adult Day Program Need for a comprehensive assessment Less intensive services Meals Delivery Transportation Drop-in Centre Outcomes Out of SCOPE In SCOPE Reports Data Management CSS CAP project scope

12 From thought to action: Sector driven and developed A collaborative effort through full sector representation –Endorsed by the CSS CAP Steering Committee and a working group which included front line staff, senior management, LHIN representatives, Ministry –Enthusiastic volunteer response to participate –Very positively received by the sector Promote best practices to ensure quality assessment and reporting Ensure the instrument will be used to generate information valuable to HSPs, the sector and LHINs

13 Selecting the common assessment: Approach Engaged a Fairness Advisor to: –Oversee the conduct of the process for consistency with process design and adherence to fairness –Review documentation and materials that establish, manage and facilitate all stages of the process –Submit a final report to Project team and presented the results of the process to Steering Committee

14 Process used to determine instrument selection Activities Working Group Steering Define benefits and criteria Define list of instruments to be evaluated Approve benefits, criteria and instruments to be evaluated Advocates presentation on instruments (March 3rd) Evaluation assessment instruments Teleconference to discuss individual evaluations Finalize recommendation to Steering Committee Review recommendation from Working Group Recommend assessment instrument for CSS Common Assessment to MOHLTC

15 Working Group Recommendation made to CSS CAP Steering Committee The InterRAI Community Health Assessment (CHA) was chosen as the common assessment instrument for the Community Support Services sector

16 What is the InterRAI CHA? InterRAI Community Health Assessment (CHA) can assess the well elderly individual and identify persons meriting further assessment to prevent or stabilize early functional or health decline. Assists clients in accessing most appropriate available services Reduces duplication of assessments Informs service plans Further develops the practice of assessment and care planning Standardized, aggregate data can inform decision-making and planning Further facilitates inter-agency communication through a common language based on recognized data standards

17 Test for best practice Are all clients appropriate for a comprehensive assessment? What is the value to the client? What requirements are needed for resourcing and capacity? What subset of HSPs is required to administer the comprehensive assessment? Opportunities for screener What is the purpose of the screener? What is the minimum set of data required? What does the screener need to inform?

18 Test for best practices Referral Processes How does the client access the right service in the right place at the right time? How is client information shared between sectors? CCAC? CMH? How is assessment information shared to reduce duplication and assessment burden?

19 Assessment Skills Workshop pilot Assessment Skills Workshop Best practices focus of a generic assessment interview to understand: –How to conduct an effective assessment –How to effectively engage clients in an interview process –Methods to introduce clients to an assessment –Ways to involve clients in conversations that yield required information Expected outcomes: Validate core assessment skills workshop is appropriate for sector Identify participants and programs appropriate for this workshop and any changes/enhancements needed Expected outcomes of the workshop from participants Learn new skills in facilitating conversations Learn from peers regarding tools in use and associated best practices Networking opportunities

20 Comments from the workshop “I want to bring this material back to staff at my organization. I think this would help our assessment skills and customer services.” “I enjoyed learning from other's experiences” “A great opportunity to recognize things I'm doing well and areas that I could improve on” “I learned valuable tips / strategies for conducting an effective assessment.” Comments were based on the evaluation results from two workshops run in Toronto on March 26th and Hamilton on April 8th

21 Working in partnership Information Management Alliance CSS CAP Steering Committee Working and Reference Groups LHIN Implementation Steering Comm LHIN 2 etc. LHIN 1 Consent ManagementAboriginal Data MgmtMobility Shared AxReports Best Practices -DQ Education ScreenerCross Sector Common Assessment PROJECT TEAM Project Management Business ProcessEducationImplementation Communications

22 Working together to align with sector, LHIN and provincial initiatives ALC Use outcomes of assessment to help inform right service in right place Support quality of life and sustains clients in their home Screener modules Assist, MH LHIN; CNAP, TC LHIN; Easy Access to Care, WW LHIN; etc. Ensure the common assessment aligns to interRAI CHA Aboriginal Priorities Work closely with the Aboriginal community to align common assessment with their processes Link health service providers to assessment best practice Aging at Home Strategies Improve access to care through standard assessment, care planning, referral and outcomes

23 Sep Environmental Scan Assessment Tool Approved by Steering Committee Full Implementation Assessment Tool Evaluation and Selection First Steering Committee Meeting 2010 JanFebMarSepMayOct 2009 Sustainability Strategy Transition Plan Pilot to confirm full implementation approach 2012 April 2013 Transition Timeline

24 Contact information CSS CAP Support Centre Phone: Thank you!