Connecting Care Across the Continuum Mental Health and ... · • Create healthy, resilient, inclusive communities • Identify mental health and addictions problems early and intervene

TP05 - System Integration – Connecting Care Across the

Continuum

Mental Health and Addictions Nurses (MHAN) in the

District School Boards (DSB) Program – A

Collaborative Integrated Approach to Program

Development

Session Date & Time: June 20, 1345 – 1415

Presenters: Leslie Gaffney, RN Client Services Manager MHAN Program

Jody Wellings, PMP PMO Lead Continuous Improvement

Hamilton Niagara Haldimand Brant CCAC

Goals for this Session:

• To provide insight into the HNHB CCAC Mental Health and Addictions

Nurses MHAN program development and highlight our approach for cross

sectorial collaboration.

• We will discuss the following:

• Adoption of Kotter’s Change Model

• Implementation Approach

• Approach to Stakeholder Engagement & Communication Planning

• Collaborative approach to program design & development

• Challenges faced

• Assessment Tool Development

• Next Steps

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Hamilton Niagara Haldimand Brant

Community Care Access Center

(CCAC)

Our System Partners Include:

• HNHB LHIN

• 81 Community Support Service Agencies

• 10 Hospitals across 21 sites

• 17 Family Health Teams/ Organizations

involving more than 250 family

physicians

• 88 Long-Term Care Homes

• CCAC represented on over 90 regional /

local community committees

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• Hamilton Wentworth District School Board

• Hamilton Wentworth Catholic District School Board

• Niagara District School Board

• Niagara Catholic District School Board

• Grand Erie District School Board

• Brant Haldimand Norfolk Catholic District School Board

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Our District School Board (DSB)

Partners:


Overview of MHAN Program:

In 2011, the Ontario Government announced funding

for a new initiative for mental health and addictions

The 4 guiding principles are:

• Improve mental health and well being for all

Ontarians

• Create healthy, resilient, inclusive communities

• Identify mental health and addictions problems

early and intervene

• Provide timely, high quality, integrated, person-

directed health services

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Program Aim/Goal:

• The program aim is to help district school boards build capacity to

recognize and respond to student mental health and addictions

issues

• Linked to the ASSIST program, which provides access to a group

of mental health experts to help school boards build mental health

capacity, the mental health and addictions nurses will

become an integral part of an inter-disciplinary DSB based

team of mental health leaders, community mental health

workers, and existing DSB staff that will work together to

provide early identification and intervention services and supports

to students who have mental health and addictions issues

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Hamilton Niagara Haldimand Brant CCAC 7

• Mental illness can affect anyone at any time but 70% of mental

health problems/illnesses have their onset during

childhood/adolescence.

• Studies suggest that between 15 and 21% of Ontario’s

children/youth have at least 1 mental health disorder.

• Mental illness affects school drop out rates – accounts for 14.2%

of all high school drop outs

• Mental illness affects school attendance – it is estimated that

people with mental illnesses miss 40% more school days

• Psychiatric disorders contribute to poor performance – 30 – 58%

of students with psychiatric disorders (depending upon the

disorder) will experience under achievement

Background:


Implementation Approach:

Complex Scope:

• Broad stakeholder group including Tri-ministerial – MOHLTC, MCYS, MOE

• Evolution of requirements (provincially mandated Mental Health and

Addictions Program)

Principles:

• Adopt best practice for Change Management – Kotter’s Model

• Collaborate, Collaborate, Collaborate

• Program will focus on meeting DSB needs while embracing the OA MHAN

requirements

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Approach to Partnership:

• Recognize and accept the need for partnership

• Develop clarity and realism of purpose

• Ensure commitment and ownership

• Develop and maintain trust

• Create clear and robust partnership arrangements

• Monitor, Measure and Learn

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Kotter’s Model – Change Management

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CREATE THE CLIMATE FOR

CHANGE:

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Step 1

Establish

a

Sense of

Urgency

Launch the program ASAP!

• The focus on the issues of mental illness within the province’s youth

has been identified in several studies and was being actively

communicated to the public

• Provincial funding to support existing MH services in the form of

MH&A nurses was announced

• The HNHB CCAC received the funding and the program and was

required to launched ASAP

• There was an identified risk of a potential shortage of qualified

Mental Health and/or Addiction Nurses. We needed to recruit quickly


CCAC Program Management Team

•Deliverables:

•Management of implementation activities & schedule

•Manage Issues, Risks and Action Items

Change Management

Work Group

Deliverables

•Change management planning and execution including;

•Stakeholder Engagement

•Communication Plan

•Education Plan

Program Reporting and Tracking Work Group

•Deliverables:

•Establishing program metrics to measure improvements in the delivery

of MH&A care.

Executive Sponsors - CCAC, LHIN and District School Board

Provide executive leadership and strategic direction for the Program.

Ensure visibility and support for the Program at all levels of the organization

Advisory Committee - CCAC and District School Board Leaders

Provide a system wide perspective and expertise to support the development of program solutions

Provide subject matter expertise on best practices to meet program objectives

Represents all program stakeholders

Advise on integration strategies for nurses in DSB Inter-disciplinary teams.

Other Stakeholder Groups and Subject Matter Experts

Provide expertise and insight into program implementation and solutions

Step 2

Build

the

Guiding

Team

Program Implementation Teams:

Key

Team


Defining the Program:

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Step 3

Get

the Right

Vision

• We worked closely with our DSB partners to develop clear messaging

regarding the program

• A clearly defined program aim/goal was identified and prevalent in all

reports, initial meetings etc.

• Key Message - “We want to integrate into current practices not

reinvent or duplicate practices”

• Emphasizing the partnership wherever possible was key. We

developed a consolidated logo for program documents. This alone

provided the message that we were collaborative in our approach to

each DSB


Key Differentiators:

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Step 3

Get

the Right

Vision

The MHAN team supplements the existing DSB staff in the following

ways:

• The nurses have child/youth mental health and/or addictions

expertise

• Working within the Ministry of Health and Long Term Care, the nurses

are able to provide additional medical perspective and clinical

information not previously available to the DSB teams

• Each student will have a Best Practice Medication History and

medication reconciliation completed

• They provide medication management services and related education

to students/families and school staff as appropriate and can liaise with

the prescriber or Most Responsible Physician regarding medication

as required


ENGAGING AND ENABLING

THE WHOLE ORGANIZATION:

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Lean Six Sigma Practices:

• Adopting the Lean Six Sigma methodology for implementation of

change, CCAC worked with the DSB’s and other partners to

complete;

• An environmental scan to assess needs of the DSB’s.

• Documentation and understanding of current practices;

• Interviews & meetings

• Current state mapping sessions with each of the DSB’s,

Acute Inpatient Hospitals and Emergency Departments and

several community partners

• Development of “desired state” for MHAN program

• Collaborative development and implementation of future state

processes

Step 4

Communicate

For Buy In

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Step 5

Empower for

Action

• We empowered the nurses to build the desired state

process to meet the DSB requirements

Development of Desired State:

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Step 6

Create Short

Term Wins

• Completion of a future state mapping session which was attended by both the DSB and MHAN nurses resulted in a proposed future state design and scope of services. The tone for the day was to embrace our differences in the program design

• The collaborative approach undertaken lead to strong working relationship across all partner organizations. When faced with developing shared practices, the mutual understanding of each others needs came through and supported quick development of solutions that met each organizations needs These included;

• Eligibility Criteria

• Consent Processes

• Scope of Services

• Where Nurses would work

• Referral Processes

• Collaboration agreements

Collaborate To Implement Change:

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IMPLEMENTING AND

SUSTAINING CHANGE:

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Step 7

Don’t

Let

Up

1. Communication and Stakeholder Engagement Plan for

Program

• Articulate Goals, Success Criteria and Deadlines

• Identify the stakeholders

• Identify the relationship of the impact on each stakeholder

• Map the impact to stakeholder relationship on the stakeholder

impact analysis table

• Complete a W5 analysis for each Impact Statement

• Develop and approve the Communication Strategy

• Develop detailed communication action plan

• Track and evaluate

2. Program Launch

• Training for staff and partners

• Communication to all stakeholders

• Stakeholder Launch Meeting

3. Go Live support and “huddles” for issue resolution

Plan for Adoption:

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THE MHAN PROGRAM

TODAY:

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• There was full participation from both sides as we moved through

the process

• After reviewing the current state process, it was identified that there

are several tools available that the board/community agency staff

use

• CCAC has a history of using a RAI suite of tools as assessments

• The 6 DSB partners agreed that this was a good opportunity to not

duplicate resources/assessments and have the nurses use the RAI

• HNHB CCAC requested to be a pilot site for the RAI-ChYMH

• Through input from the RAI-ChYMH education session it was

identified that there was a need for a shorter version of the

assessment tool and in consultation the RAI-RS was developed

• After a nurse completes either a RAI-ChYMH or RAI-RS

assessment a student care plan will be developed from the

indicators

Why does this work?

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Step 8

Making

It

Stick


Next Steps:

• Continue to meet with each DSB on a monthly basis

• Obtain signed collaborative agreements from all 6 DSBs

• Record and monitor referral volume

• Monitor RAI assessments and provide feedback for the pilot

• Meet with each ED in the LHIN to present our program

• Continue to liaison with community agencies about how we can work together

for the children/youth in our communities

• See students in their homes over the summer

• Set up meetings with Principals/staff for the end of August to discuss students

that we have seen over the summer

• Work with student groups in the summer (summer school programs, Grade 9

orientation day, board specific programs)

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Contact Information:

Jody Wellings, PMP

PMO Lead, Continuous Improvement

Hamilton Niagara Haldimand Brant

Community Care Access Centre

310 Limeridge Road West,

Hamilton ON L9C 2V2

Phone: 905.575.6021

Toll free: 1.800.450.8002 (Ext. 6021)

Website :www.hnhb.ccac-ont.ca

E-mail: [email protected]

Leslie Gaffney RN, B.Sc.N.

Client Services Manager (Mental Health and Addictions)

Hamilton Niagara Haldimand Brant Community Care

Access Centre (CCAC), Hamilton Branch

310 Limeridge Road West

Hamilton, Ontario L9C 2V2

Phone: (905) 523-8600 ext. 2118

Toll Free: 1-800-810-0000

Website: http://www.ccac-ont.ca

E-mail: [email protected]

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http://www.hnhb.ccac-ont.ca/



mailto:[email protected]



http://www.ccac-ont.ca/









Thank you!

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Documents

Connecting Care Across the Continuum Mental Health and ... · • Create healthy, resilient, inclusive communities • Identify mental health and addictions problems early and intervene