DisclosureThe Implementation of a The Implementation of a

Specialized Geriatric Mental Specialized Geriatric Mental Health Outreach Program Health Outreach Program (GMHOP): Responding to (GMHOP): Responding to the Needs of Long Term the Needs of Long Term

Care HomesCare Homes

Joanne Walsh, RN, MHSAnne Stephens, BScN, MEd, GNC(C)

2nd National Canadian Coalition for Seniors’ Mental Health Conference, 2007

Disclosure

We would like to acknowledge the exemplary work of the Toronto Region Long Term Care/Mental Health (LTC/MH) Steering

Committee in producing the

Psychogeriatric Framework Report December 2006

For further information: ayau@toronto.ca Sandra Pitters: Chair, LTC-MH Implementation Committee

Angelina Yau: Project Manager, LTC-MH Implementation

Presentation OverviewPresentation Overview

BackgroundToronto Region Psychogeriatric FrameworkGMHOP development & implementation:

key elements for successChallenges and benefitsQ & A

BackgroundBackground

MOH LTC Toronto Region Steering Committee established in November 2005Response to the recommendations arising from the Casa Verde inquest report in June 2005Part of the Toronto Region’s LTCH Bed Strategy to address the needs of individuals requiring specialized programming related to significant behavioral response issues

Model of System FailureModel of System Failure

Reason, J. “Education and debate. Human error: models and management.” British Medical Journal. 2000 Mar 18; 320 (7237): 769.Mishap

Latent FailuresLatent Failures

Latent Failures

Active Failures

Failed or

Absent Defenses

Toronto Region Toronto Region Psychogeriatric FrameworkPsychogeriatric Framework

A consistent, coordinated and integrated approach to providing care for seniors with serious mental health illness and serious behavioral response issues

Based on current best practices

TertiaryCare

EMS

Hospital In-patient GMHOP

EmergencyDept.

CCAC

LTC Team

PRCPRC

LTCH

Resident&

SDM

System Integration & Coordination

Adapted from Toronto Region LTC MH Psychogeriatric Framework Report 2006

Geriatric Mental Health Geriatric Mental Health Outreach Program (GMHOP)Outreach Program (GMHOP)

Implemented in April 2006Funded by the Ontario Ministry of Health and Long Term Care (Federal Accord Funding)Designated seven LTCH

Team CompositionTeam Composition

The team consists of: - 1 full time mental health - 1 part time geriatric psychiatrist

Target PopulationTarget Population

Seniors (55 and over) with serious mental illness and severe behavioral problems living in long term care homes

ServicesServicesConsultation model

- Assessment- Treatment recommendations- Follow up - Referral to other services- Family/SDM support and

education- Education of LTCH staff related

to clinical consultation

Key Elements for SuccessKey Elements for SuccessEnsure organization’s commitment Incorporate evidence based practiceEstablish trusting relationshipsDevelop mutually agreed upon modes of communicationWork in partnership with the various service providersClarify rolesEvaluate the program

Ensure Organization’s CommitmentEnsure Organization’s Commitment

Ensure the program is in alignment with the organization’s vision, mission and valuesIdentify championsGet stakeholder buy-in

Incorporate Evidence Based Incorporate Evidence Based PracticePractice

Ensure practice standards, policies, protocols, and documentation tools reflect mental health/geriatric clinical practice guidelines (e.g. CCSMH, RNAO)Link with PRC for education to LTCH staff on clinical practice guidelines

Establish Trusting RelationshipsEstablish Trusting Relationships

Initiate meeting with LTCHs at the outset to introduce self, discuss expectations, roles and responsibilitiesMeet regularly with LTCHs to review program implementation and progress and to resolve issuesEstablish collaborative relationships with service providers (i.e. DOCs, attending physicians, solo practitioners, front line staff, PRCs)Participate in case conferences and Professional Advisory Committees

Develop Mutually Agreed Upon Develop Mutually Agreed Upon Methods of CommunicationMethods of Communication

Develop tools in collaboration with LTCHs (e.g. referral form) Identify LTCHs needs regarding their specific processes (e.g. consultation notes) Establish communication protocols (e.g. urgent referrals)

Work in Partnership with the Work in Partnership with the Various Service ProvidersVarious Service Providers

Recognize that old and new “pieces” are coming together to form a new paradigm of careUnderstand that all “pieces” need to “fit” together to make it work and that some of the “fits” aren’t easy to “fit”

Putting the Pieces Putting the Pieces TogetherTogether

Clarify Roles and ResponsibilitiesClarify Roles and Responsibilities

Define roles and responsibilities of GMHOP and LTCH (e.g. information sharing, follow up on recommendations)

Establish conflict resolution process

Evaluate the ProgramEvaluate the Program

Satisfaction surveysCommon Data Set (CDS)MOHLTC Research Grant to evaluate Toronto GMHOPs

ChallengesChallenges

Recruiting appropriate staffGaining trust“Customizing” the program to meet the different characteristics and needs of LTCHsInterfacing with long term care system

BenefitsBenefits

Infusion of specialized geriatric mental health expertiseSupport/resource to LTCHsTimely interprofessional assessments, recommendations and follow upAvoid unnecessary hospital admissions

Working towards an integrated system of care Opportunity for inter-professional education and research

Q & A