CELHIN Assertive Community Treatment Teams (ACTT) Quality Improvement Initiative:

CELHIN

Assertive Community Treatment Teams (ACTT)

Quality Improvement Initiative:

October 10th, 2013

ACT TOGETHERPrepared by

© 2013 All rights reserved

Project Overview – Mission and Success

Increase capacity by 200 total spaces and flow within ACT Teams to potentially save 10,000 hospital days

Project Mission

Project Success

1. Find efficiencies and define standard practices within the topics of:

1. ACTT Intake & Referral2. ACTT Treatment and Planning3. Hospital and ACTT Relationships4. Discharge From ACTT

2. Create MOUs to support the implementation of these efficiencies and standard practices for all ACT providers and primary stakeholders

3. Generate interest and support across the LHIN of these changes


Project Overview – The Work

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Learning DayLearning Day

March 2012 June 2013

March 2012 June 2013

*Kaizen is Japanese for "improvement", or "change for the better" and refers to the LEAN philosophy or practices that focuses upon continuous improvement of processes.

Topic specific Kaizens*

Topic specific Kaizens*

Working Groups

Working Groups

Reveal Day/ Final ReportReveal Day/ Final Report

Regional Kaizen*Regional Kaizen*


The mandate Address larger system issues Provide feedback and direction to the working groups as they developed their

processes Review and make final decisions on all materials included in this document.

Output Creation of two visionary documents for this project; the Memorandum of

Understanding and the Guiding Principles for Hospital and ACTT relations.

Project Overview – Oversight Committee

Each of the members of this group also participated in at least 1 working group to enable cross-pollination of ideas and to ensure working group suggestions were represented at the final decision-making table.


Standardizations

Items that created overall efficiencies and a more unified “brand” to external stakeholder groups were standardized. The following items are examples of this:

Letters Forms Timeframes Waitlist protocols Primary assessment tools (OCAN, ATR)

Recommended Best Practices

Items where efficiencies were best determined at the individual team level were supported by recommended best practices. The following items are examples of this:

Meetings Team functioning and task allocations (including the psychiatrist)

Project Overview - Current State Findings

The majority of the basic processes within ACTT are consistent. There are however, variation in how these steps are ordered, dispersed throughout team members, and conducted.


ACTT Intake & Referral Standardizing the approach and policies for referral to and intake by ACTT

ACTT Treatment and Planning Ensuring consistent and best practice approach to treatment planning

Hospital and ACTT Relationship Strengthening hospital and ACTT relationships and coordination

Discharge From ACTT Standardizing the approach and policies for discharge from ACTT

Working Group Outcomes – The IntroductionIndividual working groups submitted their recommendations for Oversight Committee review and approval for each of the following four areas:

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Working group purposeIdentify ACTT appropriate clients soonerReduce notification timelines of acceptance to/declined ACTT serviceIncrease communication with referral sources and circle of care

Standardized itemsReferral source ACTT screening toolReferral source ACTT referral formLettersIntake prioritization processesWait times of notification of acceptance/declined ACTT service to 30 days

Working Group Outcomes – Referral & Intake

Recommended best practicesACT Team intake personnelClient Welcome Package Checklist

Measures of successReduced inappropriate referrals Reduced referrals without complete information 30 day wait for notification


Working Group Outcomes- Referral & Intake

Screening Tool

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Common Referral Form

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Example of the many standardized letters

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Working group purposeEnsure consistent and best practice approach to treatment by:

Streamlining processes and documentation

Enhancing communications with clients, families and community services

Reducing paperwork while increasing level of relevant information collected

Standardized itemsExpectations AgreementOCAN used as the Treatment Plan ATR used as a tool to identify potential for stepped care or discharge (with clinical judgement)

Working Group Outcomes – Treatment

Recommended best practicesWaiver for Group ProgramsCollaborative Crisis Plan (within ACT Teams)

Measures of successFidelity to new processComparative OCAN dataParticipate in ATR data collection Reduced staff time spent on redundant paperworkCurrent ACTT clientele identified as ready for reduced service levels or discharge


Working Group Outcomes – Treatment


Working group purposeDefine guiding principles for ACTT and Hospital relations

Standardized itemsPsychiatrist communicationsDocumentation between ACTT and HospitalsInclusion of ACTT in rounds, case conferences and discharge meetingsTimings

Working Group Outcomes – Hospital Relationship

Recommended best practicesACTT provides local schedule 1hospitals with updated client lists provided given client consent on a monthly basis

Measures of successPsychiatrist communication increases Continuity of care for client is enhanced


Working Group Outcomes – Hospital Relationship


Working group purposeStandardize the approach and policies for discharge from ACTT

Standardized itemsACTT readiness for stepped care overviewService overlap between ACTT and new provider for up to 30 days

Working Group Outcomes – Discharge

Recommended best practicesDefined stepped caremodel of serviceTeam staffing allocations through the discharge process Client Disengagement Practices

Measures of successImplementation of a stepped care model of serviceIncreased number of identified clients requiring and referred to reduced services


Proposed ModelAddition of 1 FTE RN to each ACT team within the CELHINAdditional Funding for psychiatry to care for the additional ACT clientsFunding for Project Management to lead the implementation of the QII

FunctionsRN will be able to continue specific medication protocols that were established on the ACT teamACTT Stepped Care Services or traditional ACT services will be interchangeable based on client need.Stepped Care Model will be able to have a caseload of 25 clients (max)

OutcomesIncreases the ACT capacity within the CELHIN by over 200 clients (the equivalent of two full ACT teams)Subsequently decreasing inpatient days for clients that previously were waiting for ACT intervention

Working Group Outcomes – Stepped Care Model


Next Steps

What we will do…

Next Step Timing

ACTT Oversight Committee Formation• Additional membership• MOU signing• LHIN proposal• Evaluative framework

Immediately

Training• ACT Teams• Community Services• Hospitals

Over the next year

Measurement of progress• ATR/OCAN• Peer reviews• Collaborative data collection

Over the next year


Questions and Answers

Access toACTT /hospitalWIFM approach to Main recommendation - Step down (newer philosophy – not abandonment – ACTT light)Reference Oversight at end of purpose

Documents

CELHIN Assertive Community Treatment Teams (ACTT) Quality Improvement Initiative: