How OCAN is used to Support a

Recovery Approach

1

Agenda

• OCAN background• What is Recovery• Applying OCAN using a recovery approach• Consumer and health service provider (HSP)

experiences• Q & A • Wrap Up

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OCAN Background

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Tool Selection

In 2007, a process was launched to select a standardized assessment tool for the community mental health sector, including:

– criteria established by sector for the common assessment tool

– robust analysis of more than 80 assessment tools shortlisted from >300 tools

– rigorous review by consumers, other stakeholders and leading academics

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OCAN

• In 2008, the sector selected what would become known as the Ontario Common Assessment of Need (OCAN)

• Based on the Camberwell Assessment of Need (CAN)

• Elements added to reflect Ontario’s community mental health sector

• 2009 – 2013: OCAN was implemented

• Current focus: quality, utility and sustainability

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Ontario Common Assessment of Need (OCAN) is a standardized, assessment that allows key information to be electronically gathered in a secure and efficient manner.

• Supports a consumer driven approach with the inclusion of a self-assessment

• Supports conversations with consumers about needs, strengths and actions

• Provides aggregate data to inform organizational, regional and provincial level planning and decision making that is consistent with a recovery approach

• Further facilitates inter-agency communication through common data standards

What is OCAN?

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What is Recovery?

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What is Recovery?

The most widely cited definition:

• A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles

• A way of living a satisfying, hopeful and contributing life even with limitations caused by the illness

Anthony WA (1993) Recovery from mental illness: the guiding vision of the mental health service system in the 1990s,

Psychosocial Rehabilitation Journal, 16, 11-23.

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What is Recovery?

As defined by developer of CAN, Dr. Mike Slade:

• Recovering a life worth living…building a life that is satisfying, fulfilling and enjoyable

• This understanding of recovery comes from people who have experienced it, and is based on the idea that each person should be able to feel in control of, and make decisions about, their own lives, rather than simply doing what a health professional tells them

Slade M, Amering M, Farkas M, Hamilton B, O'Hagan M, Panther G, Perkins R, Shepherd G, Tse S, Whitley R (2014)

Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems, World Psychiatry, 13, 12-20.

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The Bigger Picture: Ontario - Canadian Perspectives

Ontario: The system will provide services … within a recovery approach to care, which looks at the whole person and defines individuals positively, focusing on their strengths and goals rather than their illness

Canadian: In a recovery-oriented system … people make their own choices about which services …may be best for them, informed by the advice of professionals

Minister’s Advisory Group (2010): Respect, Recovery, Resilience: Recommendations for Ontario’s Mental Health and Addictions Strategy

Mental Health Commission of Canada (2012) Changing Directions, Changing Lives, Calgary, AB

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Applying OCAN using a recovery approach

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OCAN vision

Consumer Lead

OCAN

Entry

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Consumer Self-Assessment

Rating need

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Consumer Self-Assessment

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Refocusing on the Main Purpose of OCAN

Less of this More of that

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HSP comments

“ One worker has a high number of clients and another worker has a low number of clients completing OCAN self assessments. What’s different about their approach?”

“ Some staff like using OCAN and others see it as purely an administrative burden. What’s different about their approach?”

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Consumer and Health Service Provider (HSP) Experiences

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The OCAN Consumer Experience Gordon’s Perspective

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Engagement

• This presentation is about my experience completing the Self-Assessment OCAN as a consumer

• I hope to share with you some of my ideas

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Completing the OCAN: Helpful Aspects

• Staff explained the OCAN • Staff explained the confidential nature of the

information • Staff later asked about additional consent to

share the OCAN information with other providers• OCAN was completed in a

private environment

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Completing the OCAN: Helpful Aspects

• The length of the tool was fine• Questions which may be seen as sensitive

questions were well worded • Ratings of ‘No Need; Met Need; Unmet Need; I

don’t Want to Answer’ were respectful and flexible

• The 5 open questions allowed for more conversation between myself and my worker

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Completing the OCAN:Challenges Using the Tool

• At first it was unclear whether the information would be shared exclusively in-house or with others

• Thought some of the questions were worded in an unusual way [How do you find using the bus, streetcar or train? Do you know how to use the telephone?]

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Suggestions

• At the beginning clearly explain to the consumer the utilization of the OCAN data

• At the beginning clearly explain about the consent related to the sharing of the OCAN information within the consumer’s circle of care

• At the beginning clearly explain the need for ongoing assessment if that is the process

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Suggestions

• For staff to provide information that is tailored to the consumer

• It would be helpful to emphasize to the consumer the questions were carefully chosen to elicit information about different areas of the consumer’s life

• For staff to keep in mind the goal of the OCAN is to give a voice to the consumer in

order to learn what is necessary to improve her/his life

How can I help?

My goal is to go to school

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OCAN & AN Assertive Community Treatment (ACT) TEAM

Sharon Blom

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Assertive Community Treatment Team (ACT)

• Provides intensive treatment, rehabilitation and support services for individuals with serious mental illness

• The goal is to support individuals in their recovery and their desire to live in the community

• ACT teams are multidisciplinary

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Benefits of using OCAN in ACTT

• Recovery focus – client is in the driver’s seat

• Rapport building - learn more about your client through conversation

• Holistic - covers various aspects of clients’ lives housing, health, family etc…

• Provides a format to discuss “sensitive” topics (e.g. intimate relationships, safe sex, culture)

• Staff training – “Asking the Right Question Workshops”

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Benefits of Sharing Client and Clinician Perspectives

Compare self and staff assessments• A guide for the person with lived experience and the clinician

to share their ideas• Use variances as an opportunity to discuss recovery goals

Client highlights their priority recovery goal• e.g. To live independently

Clinician links this with other goals that the client may not have identified

• e.g. To develop skills in order to successfully live independently: cooking, cleaning, budgeting

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How the ACT team uses the OCAN

• Ask client to complete self assessment: Explain purpose, benefits and offer support if neededAsk for informed consent

• Assessment conversation

• Reassessment - staff reviews the self assessment with client and completes OCAN every 6 months

• Staff expected to complete OCAN on time & this is monitored by management

• Goals are prioritized and worked on over the 6 months

• The clinician is responsible for scheduling work to address recovery goals

• Client goals are discussed daily at team meetings & weekly clinical meetings

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Tips for staying on track with OCAN• Ensure clinical value of OCAN by using the

information – recovery focused

• Clinical decisions based on information – using data

• Reminders - schedules so staff know when OCANs are due

• Monitoring

• Refresher training – mentoring

• Use in quality improvement

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Benefits of IAR for the client & the clinician:

• New intakes – gives direction to care of a client new to the team• Integrated Assessment Record (IAR):

– Easier to exchange information (e.g. RAI MH and OCAN) between health care providers. Improves efficiency

– Sharing common assessments – means smoother transitions to a new health care provider. Use the same “language”( e.g. rating client needs)

– Comparing Assessments: Clinicians working with new client(s) can more quickly begin working on client goals.

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Consent Process & IAR

• Clinician obtains client informed consent for the Integrated Assessment Record (IAR)

• Explain to client the pros/cons of sharing their record• Electronically stored personal health information

• Sharing of client information ONLY with client consent

• Identify service overlaps and gaps to improve the quality and reliability of care

• Promotes a client centered approach

• Enables faster care planning, easier collaboration (between clients and workers as well as between HSPs) and workload reduction for HSPs

• Increases the reliability of information 32

A client’s experience with OCAN:Peter’s Story

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Starting Treatment Early for Psychosis Service (STEPS)

• Youth between the ages of 14 to 35 who are experiencing signs and symptoms of what may be a first/early episode of psychosis.

• Youth may also be homeless and have concurrent substance abuse problems.

• Multi-disciplinary team: Case management and psychiatric support.

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Incorporating use of OCAN In work with clients

• OCAN consumer self- assessment– Helpful in engagement tool upon intake– Information gathering (goals/risks)– Ensures comprehensive assessment

• Example: Joe’s main goals is to make more friends and return to work

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Use of OCAN to present in team meetings

• OCAN self and staff assessments used as framework for treatment plan presentations (initial/existing clients)

• Schedule presentations according to OCAN due dates (tracking sheet)

• 15-20 min presentations per client• Content of presentation include:

– Brief History, 3 unmet needs, 3 met needs, client strengths, safety concerns, importance of spirituality and culture in Client’s life, and clients hopes for the future.

– Consumer self assessments are presented

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Benefits of using OCAN to guide team meetings

• Adds structure• Consistency• Provides information that elicits

treatment/service recommendations from multidisciplinary team

• Example: Joe reports he would like to meet more people. Recommendations from staff members re: community resources available, engagement strategies

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A client’s story and use of OCAN

Stacey (OCAN Reassessment)• 24 years old, Admitted Jan 2013 (2.5 years)• Brief History: Diagnosis Bipolar Affective Disorder, 2

hospital admissions for psychotic symptoms, lives in own apartment, ODSP, supportive mother, working part time at retail store, history of marijuana use.

• Client’s self-assessment is presented• 3 Unmet Needs:

– 1. Daytime activities (return to work) 2. Budgeting 3. Psychological distress (coping with AH)

• 3 Met Needs:– 1. Psychotic symptoms (medication compliance) 2.

Company (family support) 3. Addictions (marijuana)38

• Strengths: open minded, positive• Safety concerns: currently none, previously: inability to

care for self• Importance of spiritualty: very important• Importance of culture: very important• Overall recommendations: Support client with identified

unmet need as discussed and discuss discharge plans before next re-assessment

Stacey’s story and use of OCAN continued

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Removing Barriers to Integrated Mental

Health Recovery

Kim Lewis

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To Provide a Model of Care that:

• Maximizes the OCAN to it’s full potential

• Provides services based on Consumer

identified recovery goals

• Supports Evidence-Based practices• Supports seamless transition between

programs•Addresses concerns about wait times for

service

Mission

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•By using the OCAN results and the IAR reports as tools to gather information about collective consumers needs from our services and individual programs

• By using common consumer identified Unmet Needs to map service delivery options through group based programming

How will we get there?

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•Expansion of group-based programming into the community to provide support in Homes For Special Care, Social Housing and Shelters

•Increased Peer Support to assist and empower individuals to attend group-based programming

Mission Achievement

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What was working well?

A measurement tool was in place. CMHA has worked hard over the past 5 years to

implement the OCAN and monitor quality through quarterly quality improvement

meetings. At these meetings we monitor best practice recommendations and any

updates that staff need to be informed of. We look at ways to promote the OCAN to

all staff and run routine refresher trainings to all staff

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Some Statistics

How many people access services from CMHA York Region & South Simcoe in

2014?

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375

253

195120154186

155

137

627651 5116

Total number of clients per program (2014) (TOTAL 1832 clients)

Community Connections (375)

Psychotherapy (253)

Employment (195)

Housing First (120)

Case Management York Region (154)

Mental Health & Justice (186)

ACTT (155)

EPI (137)

Case Management South Simcoe (62)

Homes Plus Care (76)

Case Management Seniors (51)

Youth Wellness (51)

Choices (16)

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406

122

105

44 23

2018 17109 6 3

Number of clients waiting for services as of Nov 2014 (Total 377 Internal) PA & IA

Case Management York Region (406)

Employment (122)

Psychotherapy (105)

EPI (44)

Youth Wellness (23)

ACTT (20)

Case Management South Simcoe (18)

Housing First (17)

Psychogeriatric (10)

MHJP (9)

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312

155119101

92

64

74

68 5918 11 1

Average Days Waiting for Entry to Program During a One-Year Period

Case Management York Region (312)

Employment (155)

ACTT SW (119)

EPI (92)

ACTT SE (64)

Court Support Case Management (74)

Psychotherapy (68)

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Some Challenges we were facing

When people call for services, they were often looking for an immediate support but the barrier was the waitlist for service.

ExampleOut of the total number of phone assessments done for Psychotherapy in 2013 & 2014, between 44-50% of consumers did not followed up with part two of the assessment which was a face to face assessment.

Avg. phone assessment time is 45-60 minutes

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Challenges

When it is time for consumers to engage in programs:1. Sometimes their needs have changed since initial

assessment and possibly have intensified2. Sometimes they are no longer interested in the

applied for service because they have found it elsewhere

3. Sometimes their information has changed and we have lost contact

4. There has not been a consistent structure in place to support clients who are on a waitlist for CMHA services or transferring between services (i.e. ACTT to Case Management)

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What model of care works for CMHA York Region

& South Simcoe?

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CMHA York Region’s OCAN Model of Care

Comprehensive. holistic and informed by client self-ap-

praisal

OCAN Domain Group Pilot Project

(Nov/Dec 2014)

Process•Rapid Response - Central Intake will call back within 24 hours and provide an over the phone assessment that is completed at earliest convenience of consumer

•Central Intake staff extended an invitation to our Community Connections Orientation for an introduction to our group-based programming and a chance to meet in person while waiting for applied for services

•Introduction to the OCAN Self-Assessment as a tool to plan service needs

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What did we want to achieve?

•No wait for services when consumers are at a critical point in their recovery

•On-going contact with individuals on a waitlist for an internal service

•A way to support consumers who are in need of short term support in different areas of their life

•Smooth & seamless transitions into and out of programming

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What do we want to achieve?

•Unique supports for people at ALL stages of their recovery

•Provide programming based on consumer identified needs •A model of care that shows CMHA (York Region) is a champion in mental health care and optimally supports consumer recovery from serious mental illness

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1. Accommodation2. Food3. Looking After the Home4. Self Care5. Daytime Activities6. Physical Health7. Psychotic Symptoms8. Psychological Distress9. Information on

Condition & Treatment 10.Safety to Self11.Safety to Others12.Alcohol

13. Drugs14. Other Addictions15. Company 16. Intimate Relationships17. Sexual Expression18. Child Care19. Other Dependents20. Basic Education 21. Telephone 22. Transportation 23. Money24. Benefits

OCAN DOMAINS

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Managing Client Flow – The OCAN Model

CLIENT INTAKE

Entry/Exit

Specialized Service

(EMP, PSY, ACTT)

OCAN Domain Groups

No waitlist for serviceby utilizing OCAN do-

mains to provide struc-tured group-based sup-

port

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Scenario

Al comes to CMHA for help with maintaining his Employment. He struggles with symptoms of Anxiety and he is worried that he is going to lose his job because he is having difficulty using public transportation. Al would like support to maintain his employment. He has an intake and goes on the waitlist for Employment.

What happens to Al during the next 6 months?Over the next six months, Al loses his job. He also loses his housing because he couldn’t afford his rent. He isn’t eating properly and his symptoms of Depression escalate to the point of needing to go into the hospital for support. The Employment program is no longer his first concern.

What could have happened?Al could have received immediate support in all the areas that were providing challenges to him at the time when he most needed it. This would have kept his situation from escalating to a point of intensive/crisis support.

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AL – Example of OCAN Model

Al has anIntake (EMP)

and isinvited to

attend Orientation

EmploymentSupport Program

IMR----------------

Stress Management

----------Support for Depression

Life Skills-------------

Career Café---------------

Activity Health & MH

Transit

Training

Activities of Daily Living Domain

Transportation

Domain

Psychological Distress Domain

OCAN DOMAINS

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Piloting the OCAN Domain Group-Based Programming in Community Connections

2014

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Totals

Community Connections 6 3 2 5 4 4 8 6 10 9 26 24 107

During the month of November 2014- Central Intake invited 26 new people out to the New Member Orientation

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Piloting the OCAN Domain Group-Based Programming in Community Connections

2015

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Totals

Community Connections 36 27 41 25 129

Since November 2014, the number of participants has increased monthly and we have had up to 41 new participants in one month

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Benefits of the Pilot Project

•These are people who may have sat on a waitlist with no follow-up until activation in specialty program

•Members are being introduced to the OCAN Self-Assessment earlier on and this provides a tool for them to map out their care needs as well as an opportunity for them to become familiar and equipped with the tool that will be later explored by the OCAN Lead in their chosen program

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Community Connections Groups

Activity, Health & Mental HealthAddictionsArts & CraftsBack in the SaddleBoard Games Birthday CelebrationsCareer Café Chit Chat With FriendsCooking GroupCooking at the York Region Food NetworkDrumming CircleGoals Check inIndependent Living SkillsIMR (Illness Management Recovery)KnittingLife Skills via OTNMood Walks

Member’s MeetingsMindfulnessMusic TherapyNetflix MoviesNew Member OrientationNutritionPeer Led Drop InPing PongQuiltingSock Monkeys SpiritualityStress Management Themes of RecoveryWalking @ Upper Canada MallWalking @ YMCAWhat’s Up?Women’s GroupYoga @ Yoga Source

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Moving Forward with the

OCAN Model

•IAR reports assist with planning groups. These reports can be excellent indicators of consumer driven service needs in specific programs.

•Group-based programming allows the member to pick from a range of on-going supports that are available under one roof where they are able to attend

•Supports the role of staff to complete an OCAN that provides quality information because group-based services can be developed based on reports that show consumer identified needs

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Moving Forward with the

OCAN Model

Example:

In the Case Management Program the top three collective consumer unmet domains could be: 1. Activities of Daily Living2. Psychological Distress3. Transportation

This informs the Community Connections Program of what collective consumer needs are to provide true consumer driven services and in turn can be the optimum referral for all programs

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THANK YOU!!!

Kim Lewis, Clinical Coordinator, Flexible Supports Program

Canadian Mental Health Association, York Region & South Simcoe

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University Health NetworkUse of OCAN

Faith VermeerFaith Vermeer

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Assertive Community Treatment Team

• ACT is an assertive community treatment team for individuals with serious mental illness who require intensive community support

• Service is provided by a multidisciplinary team including psychiatrists, registered nurses, social workers, occupational therapists, and peer support

• The team provides outreach, treatment, rehabilitation and recovery support

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Incorporating use of OCAN in work with clients

• New clients: helpful in the engagement process

• OCAN self assessment - Client’s voice

• Helps in treatment planning, assessing goals and reviewing progress

• When clients express no goals, the self assessment is where you can discuss identified unmet needs and begin goal planning

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Initial Challenges following OCAN standards

• Keeping up with the 6 month reassessment cycle

• Completing the OCAN and information not being used regularly

• Taking on new referrals and OCANs not being in IAR

• Continuing the 6 month reassessment cycle for new intakes

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Addressing the Challenges: Reducing Repetition• Developed a process that builds on existing client

information

• At Intake – we search IAR and/or request a copy of the latest OCAN (for clients that have had an OCAN completed by another organization)

• In the first month OCAN is reviewed during treatment planning and a new one started with team input.

• Allows the team to have more of a history and build on the clients story.

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Presenting OCANs at weekly treatment planning meeting

• Use treatment planning to complete outstanding OCANs and new intakes

• Discuss any urgent issues and use OCAN to create action plan

• View client history and review/complete current OCAN

• Allows us to view progress/strengths/goals

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Example of client’s story and use of OCAN

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Story of Bob

• 49 year old male

• Paranoid Schizophrenia – challenges managing psychotic symptoms

• Unmet needs: Housing, financial, safety to others, safety to self, food, and psychotic symptoms

• Strengths – social, self care

• Goal: housing

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Incorporating OCAN into Recovery Oriented Practice

Shirley Gilpin, BSW, RSWSherri Baird, RSSW

7676

Programs that use OCAN at CMHA

• CoreCourt OutreachRelease from CustodyTransitional Community Support• FullCase Management Residential

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Recovery Oriented Practice - Outcomes

Boston University Approach to Rehabilitation Environments• Rehabilitation Readiness• Readiness• Overall Rehabilitation Goal• Achieving Valued Roles

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Outcomes Tool: Personal Goals Form

Details Details

Client 9991

Chart 01

Practitioner Sherri Michaluk

Gender Female

Diagnosis Anxiety

ORG Link ORG

Environment Living

Personal Goal Eating healthy on a budget

Domain Activities of Daily Living

Start Date 6/16/2014

Review Date 7/14/2014

End Status Undefined

End Date

AttainmentRate

Active Yes

Comments Log Sherri Michaluk (7/15/2014 3:26 PM): Look through grocery store flyers to find the items on sale necessary for the weekly meal menu.

Sherri Michaluk (7/15/2014 3:25 PM): Created weekly menu with 4 healthy meal choices, and a treat day.

Sherri Michaluk (7/15/2014 3:23 PM): Called Health Unit for resources such as Canada Food Guide and BMI information.

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How we incorporated use of OCAN into our Outcomes

Domains from OCAN were used to help develop “Personal Goals” Personal goals:

• are short term• help to identify specific/immediate needs• help Individuals feel motivated and on track• break down the long term goal and keeps track of

their journey of small successes

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How we incorporated use of OCAN into our Outcomes cont’d

Personal Goals Domains Accommodation Activities of Daily Living (ADL) Addiction Crisis Educational Finance Interpersonal Relations Legal Loss Medication Mental Health Physical Health Spirituality Vocational Wellness81

Benefits of OCAN

• Rapport building with individuals• Opens up dialogue – person may feel comfortable to

share when asked the questions, rather than bringing it up on their own

• Reassessment of needs on a regular basis• Identify improvements• Identify challenges• Identify recovery goals• Holistic – looks at all aspects of a persons life and not

focused on mental health symptoms only

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Challenges of OCAN

• Staff buy-in• Viewed as having to do more work, on top of

large case loads• Difficulty with change• Staying on track with reassessment OCANs• Missed appointments to complete OCAN

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Addressing Challenges with OCAN

• Ongoing training for staff• Recurring appointments in Outlook to notify of

upcoming OCANs• Electronic File System notification of upcoming

OCANs• Promoting OCAN in a positive way, indicating that

is useful on all levels (individual, staff, organization and ministry)

• Use in quality improvement – guide programming

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Individual Story # 1

• Male individual, accessing case management services, who completed OCAN for the first time by completing self-assessment at home

• Individual put a lot of time and effort into completing the open-ended OCAN questions

• When worker and individual processed experience, individual shared that completing the questions has inspired him to write a book about his experience living with a mental illness

• Confidence building 85

Individual Story # 2

• Female individual accessing case management services • Worker and individual compared initial OCAN

completed with current OCAN completed, looking at met and unmet needs

• It was discovered that prior unmet needs were now met

• Discussion occurred regarding individual graduating from services as all needs were met

• Individual and worker agreed that individual no longer needed CMHA services

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Wrap Up

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Key messages – lessons learned using OCAN

• It’s about the conversation

• Follow the standards using an approach that fits:– your style of practice

– where the consumer is at

– the context of the service

• “Unknowns” are OK

• Leaving out some information is OK e.g. medication, stages of change, capacity

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OCAN Assessment Data Elements

• Document that contains each OCAN element and whether it’s mandatory or optional

..\..\..\Assessments\OCAN_2 0_DataElements.xls

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Community Care Information Management (CCIM) Website

Make Use of OCAN education materials

e.g. elearning & Videos

OCAN Education and Training

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Questions or Feedback

• If you have any questions or comments, please contact:

Service Desk

Telephone: 1-866-909-5600

Website: www.ccim.on.ca

E-mail: cmhcap@ccim.on.ca

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