1. Canadian Coalition for Seniors’ Mental Health The Southwestern Ontario Geriatric Assessment Network Catherine Glover Dr. Lisa VanBussel September 24-25, 2007

2. Declaration We are unaware of any apparent conflict(s) of interest that may have a direct bearing on the subject matter of this presentation.

3. SWOGAN Network of specialized teams of clinicians located in the ten counties of Southwestern Ontario that provide specialized services to the frail seniors and their caregivers.

4. SWOGAN Figure 1: Map of Southwestern Ontario Table 1: Population 65 years of Age and Older in Southwestern Ontario Note: 2001 information from 2001 Census data, Statistics Canada; 2006, 2010 and 2016 population projections from the Ministry of Finance

5. Vision To lead and sustain a network of care in the Southwestern Ontario region that builds local capacity to care for older adults with multiple, complex needs.

6. Programs and Service Delivery Consultation Education Research Evaluation

7. Implementation Integration of programs and services: local and specialized; Geriatric Mental Health and Geriatric Medicine Leadership Infrastructure creation Partnership Implementation of education initiatives Network-wide evaluation framework.

8. Service Delivery Model Vision of the Network Why a “Service Delivery Model” Current function Future opportunities Breakthrough success Reference: Making It Happen MOHLTC 1999

9. Partnership Local Family Doctor with Expertise in Eldercare Alzheimer Society Local Geriatric Nurse Home Care Community Family Doctor Long Term Care Local Hospital Specialized Geriatric Psychiatry Geriatric Medicine Collaborative Care

10. Service Delivery Model

11. Development and implementation of network-wide service delivery model. This model is expected to support timely and consistent access to expertise in Geriatric and Psychogeriatric care throughout the Southwest. Service Delivery Model

12. SWOGAN Evaluation Framework Development of a Network Balanced Scorecard Consensus approach  Framework  Quadrant themes  Indicator selection  Data collection procedures Feedback  Local team meetings  Leadership forum discussions

13. Education Build Capacity Links with Academic Community and Resources Links with LHIN’s Links with provincial and national bodies

14. Innovation and Learning Indicators Number of educational opportunities delivered and received. SWOGAN Spring Team Exchange. Research and Evaluation Inventory. Challenges Categories. Process Submitted annually.

15. Utilization and Quality Indicators # referrals, # consultations, # initial assessments, # follow-ups, wait times Challenges Definitions Setting targets Process Collected throughout year Data quality checks Submitted quarterly Summaries available within 1 month

16. Client Satisfaction Indicators Tool development. Challenges Some pre-existing tools / expectations. Additional work. Satisfaction of other stakeholders also important. Process Clients seen in 1 st & 3 rd quarter sent questionnaire in 2 nd or 4 th quarter.

17. Infrastructure Network Strategic Plan Communication Mechanisms Structures and processes for clinical collaboration. Provincial linkages

18. Staff: Indicators

19. Data Collection Challenges  Staff burden. Complexity of data entry. Process Four 1-week snapshots. Face-to-face meetings with local teams about data collection processes. Ongoing support.

21. Strategic Planning SWOGAN continues to grow and the commitment of Network partners to develop an evidence-based model of care is further reflection of its commitment to evidence-based practice, evaluation, and the full engagement of Network partners in planning.

22. Getting back to Vision Increase in quality of care provided to frail seniors in a large geographic area Locally available with access to specialized services when necessary Influence on Public policy Influence on Education of Health providers Collaborative care within communities combined influencing methods of care delivery across the Region

23. Getting There Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed it’s the only thing that ever has” Margaret Mead

24. Breakthrough Success Work of the task team Discussion and Consensus process today Delivering on the strategic goals Abstracts and publications Service to clients: Blueprint Local access –Regional access

25. Contacts Bonnie Kotnik, Director, Geriatric Psychiatry Program Maureen Vickers, Director, Specialized Geriatric Services Dr. Lisa Van Bussel, MD Physician Leader, Regional Psychogeriatric Program