Use of OCAN in Crisis Intervention

Webinar

October, 2014

Purpose

To bring organizations with crisis intervention services together to identify common issues, share successes and discuss strategies to address challenges related to the use of OCAN

2

Primary Goals

• To collect relevant client level information in a standardized way for the purposes of informing service delivery and planning for users of crisis services

• To work towards an approach to collecting information using processes and technical solutions that support the day to day operations of crisis services.

3

Objectives

• Provide OCAN standards for crisis intervention services

• Understand the steps taken to gather feedback from crisis intervention services

• Identify common issues

• Share strategies to address challenges

• Document key issues to take back to the sector steering committee and MOHLTC

4

Crisis Standards

5

Assessment Standard for Crisis Intervention

“Reason for OCAN” rules for Initial OCAN, (Prior to) Discharge and Reassessments do not apply for the Crisis Intervention functional centre

2 Business Rules:

1. If the consumer is involved with only one functional centre, do the following: – When the Consumer comes into the functional centre, conduct

an Initial Core OCAN. When the consumer leaves the functional centre, complete the Mental Health Functional Centre Use Section (exit date and exit disposition) on the Initial Core OCAN that was done at entry. A new Initial CORE OCAN is completed each time a client is admitted.

Assessment Standard for Crisis Intervention Cont’d

Business rules continued:

2. If the consumer is involved with more than one functional centre, do the following:– Complete the Mental Health Functional Centre Use Section each

time the consumer comes into and leaves the functional centre. This should be provided to the OCAN Lead to be included in the next Assessment.

Sector Perspective

Recommendations made by sector steering committee

• Use the same tool across different types of services and allow for the response “unknown” in OCAN

– To allow for standardization

• Include crisis services

– To benefit the client beyond the single crisis contact through sharing of information that can inform next steps

– To use reports to inform service planning decisions that better address the needs of people using crisis services

8

BACKGROUND

Process of gathering feedback from crisis services

9

Steps - progression of feedback collected

• Support Centre Tickets: flagged a common pattern of challenges raised by organizations with crisis services (25% of crisis services)

• Issue presented to the MOHLTC and sector Steering Committee (SC) with approval to investigate further

• Interviews with 12 organizations conducted, analyzed and presented back to SC

• Case study requested and conducted • Guidelines from case study developed• Findings presented to MOHLTC and SC with approval to

conduct Webinars on use of OCAN in crisis intervention• Feedback from participants of this webinar

10

11

HSPs Included in interviews

• Interviews with 12 HSPs were conducted, including:– 8 Community– 4 Hospital– 10 LHINs

• Types of services:– 8 crisis calls– 6 mobile crisis– 4 on-site– 4 follow up

12

Case Study Approach

• Based on information gathered and Steering Committee discussions, the next step was to conduct a case study

• The case study involved working with an HSP to understand what’s working well and identifying challenges regarding the use of OCAN

13

Steps for a Case Study

• Document what’s working

• Identify challenges

• Explain issue

• Identify organizational practices

• Document process

• Review case study with HSP

• Develop guidelines based on case study

14

HSP for the Crisis Intervention Case Study

• York Support Services Network was one of the 12 HSPs interviewed– Staff trained and using OCAN in a range of services

including mobile crisis– Clear business process developed and implemented– See benefit in using Core OCAN for service and

systems planning– Current challenge – not using OCAN for telephone

service because of the high volume of calls

Common Issues Identified

15

York Support Services Network - Challenges

• High Call Volume

• Duplication of information within our database

• Not feasible with current technology to complete the Core OCAN in the telephone response service

• Competing local pressures regarding potential use of other assessment tools

• A number of OCAN elements not collected leading staff to manually entering “unknown” several times

16

Gerstein Crisis Centre - Challenges

• Rational for not collecting Core OCAN’s within crisis calls

– Focusing on the caller’s crisis and building on a rapport

– Creating the idea that the caller’s crisis is the primary reason they are calling and not interrupting the flow with an assessment

– Callers are usually emotionally elevated during a call and this is not an actual snapshot of their baseline and needs

• Lack of software pre-populating basic information into an OCAN document

• How best to utilize IAR standardized reports from uploaded OCAN’s within our service delivery framework

17

Feedback from Webinar Participants

• “Staff are entering the same information twice which is a duplication and time consuming”

• “Unable to obtain all of the information for OCAN ”

• “When a client is in a state of mental health crisis, it is not appropriate to ask some of the OCAN questions.”

• “The goal is to assist the client with the crisis at hand”

• “Clinically contraindicated to have a discussion with the client about consent/releasing their information”

18

19

Summary of Challenges gathered • Challenges following OCAN standards for crisis services

• Business rules from slide #6• Particularly for repeat users of crisis services

• Utility of OCAN information• Many document relevant client information outside of OCAN• Many OCAN elements are not collected • OCAN content is not used - seen as an administrative task

• Type of Crisis Intervention Service• Crisis call services and hospital emergency

• Technology does not support crisis work flow– Entering information requires too many steps– Duplication - information entered in 2 or more places (eg.CDS)

• Challenges related to obtaining consent directive

Discussion

• What do you see as the main challenges?

20

Strategies to address challenges

21

York Support Services Network

Where it’s working and strategies to address challenges:

• Current use of the Core and Full OCAN

• Use of aggregate standardized clinical reports

• Case study process with CCIM to identify the client information that crisis workers are collecting

• Potential for technical solutions to enable the collection of the relevant OCAN elements in telephone response service

• Preliminary discussions with the LHIN

22

Gerstein Crisis Centre

Where it’s working and strategies to address challenges:

• Re-evaluate documentation practices; vendor to be able to pre–populate information entered into a client’s database, to help eliminate double entries

• We have the technology to meet our needs – Client basic information is being collected within a database,

such as name, address, age, diagnosis, etc.

– Enhancement of technology could provide the venue to capture this information within the OCAN

– This could increase our numbers of completed OCAN’s as double inputting would be eliminated

– All information is secure within our database

23

Gerstein Crisis Centre Cont’d

Where it’s working and strategies to address challenges:

• How we are planning to utilize the IAR standardized reports; addressing the needs seen within the OCAN

• A gateway to provide better service delivery based on findings

• A snapshot of what information is being collected / what is lacking

• Assigning a “go to” staff member to help manage questions / concerns

• Assigning a lead staff member at each site to help manage OCAN completion

24

Strategy Ideas from Webinar Participants• “It should be made clear that collecting OCAN is

secondary to responding to the client's crisis”

• “Technological solutions to reduce time on computers”

• “We have built it so that some of the information in OCAN is auto-filled from other documentation”

• “Reduce the number of fields required in crisis situations”

• “The first OCAN is a starting point. With repeat contacts, have software pre-populate so only new info. is added”

• “Make it more meaningful by actually using IAR”

• “Everyone needs to be doing it consistently”

• Address the issue of “double reporting”

25

26

Strategies to address issues

Categories

1. Business Process

2. Technology Enabling Business Process

3. Change Management Strategies

27

Business Process

Review business process:• Complete “As Is” business process map

• Identify information routinely collected in crisis services

• Complete “To Be” business process map• Avoid duplication • Incorporate OCAN so it supports the work• Coordinate across services to complete a single

OCAN

28

Technology Enabling Business Process

Develop technology that supports the workflow:

• View most clinically relevant fields first

• Provide defaults to most common responses

• Pre-populate to avoid duplication

• When collaborating on a single OCAN, automate process of providing the OCAN lead with information

29

Change Management

Develop and implement strategies:

• Communicating the benefits

• Acknowledging the challenges

• Addressing feedback

• Delivering training

• Using the reports for service planning

• Celebrating milestones

Discussion:

• What strategies do you want to raise or elaborate on to address the challenges

30

Wrap Up

• Strategies for organizations to consider exploring internally

• Strategies for sector networks/tables and LHINs to consider exploring

• Issues to take back to the sector steering committee and MOHLTC

31