1. Toronto Client Access to Integrated Services and Information (CAISI) Roundtable

2. 1.0 Chronic Homelessness Case Example 1 40 y.o. female, severe schizophrenia, no income, becomes combative in shelter 1, staff call police, taken to hospital A, treated, discharged with follow up, returns to shelter 2, combative, sent to hospital B, discharged with follow up, further decompensates, picked up by police, taken to hospital, admitted for 2 months, discharged with follow up, goes to shelter 1, becomes combative police called, taken to hospital A…

3. 1.0 Chronic Homelessness Case Example 2 49 y.o. male, brain injured, receives welfare cheque, buys 6 bottles of wine with friends, blacks out, robbed, picked up by EMS taken to hospital A – detoxed, discharged, next day has multiple seizures taken to hospital B treated, discharged to Family MD – panhandles buys rubbing alcohol – goes to shelter – altercation – gets barred, picked up by police, in station overnight, drinks mouthwash, blacks out, taken to hospital B, combative, put in restraints, detoxed, discharged, barred at next shelter, gets pneumonia goes to hospital B admitted, non-compliant, goes out drinking then leaves against medical advice…

4. 1.0 Chronic Homelessness in Toronto Chronic Homelessness in Toronto 31,985 used shelter in 2002 3,070 used shelter > 1 year (9.6%) Shelter beds: 5,300 shelter beds 58% used > 1 year 26% used > 3 years

6. A call for better Integration n n Golden Task Force on Homelessness n n Toronto Public Health n n Toronto District Health Council 1.0 Chronic Homelessness

7. City of Toronto - Supportive Communities Parternship Initiative Toronto Client Access to Integrated Services and Information (CAISI) 1) System for multi-agency integration of client care 2) multi-agency population care 3) Developed by front line agencies / workers 1.0 Chronic Homelessness

8. 2.0 CAISI Background CAISI Mandate: n n Toronto Public Health, Golden Report, Toronto District Health Council recommendations for better multi-agency integration n n Proposal developed with front line staff in consultation with SSHAD n n Project funded by SSHAD SCPI Program n n Project approved by Toronto City Council

9. 2.0 CAISI – Client Access to Integrated Services and Information Vision: End chronic homelessness among those with severe mental illness, addictions and disability through: 1) More integrated individual care 2) Population care and advocacy (NB Homelessness not a medical problem)

11. CAISI Components – 1) More integrated individual care: a) a) Early intake and appropriate referral b) b) Multi-agency case management c) c) Support movement from streets and shelters to housing 2.0 CAISI – Client Access to Integrated Services and Information

12. CAISI Components – 2) Population care and advocacy: a) a) Real time needs assessment for homeless with mental illness, addictions & disability b) b) Real time advocacy for supportive housing / resources c) c) TB control, Influenza pandemic planning / outbreak control 2.0 CAISI – Client Access to Integrated Services and Information

13. CAISI Open Development – 1) Open source IT development (free to all) 2) Front line agencies custom develop with project team 3) Rapid and frequent release of changes 4) Build on currently available systems 5) Privacy 2.0 CAISI – Client Access to Integrated Services and Information

14. CAISI Open Development – Systems Currently being integrated through CAISI 1) 1) OSCAR (electronic medical record) 2) 2) UHN PRO Integration (hospital system) 3) 3) EMS: e-PCR 4) 4) SMIS (shelter system) 2.0 CAISI – Client Access to Integrated Services and Information

15. CAISI Target Groups / Partner Agencies 1) 1) Shelters 2) 2) Drop-in centres 3) 3) Mobile Outreach teams 4) 4) Hospitals 5) 5) Primary care providers 6) 6) EMS / Public Health 7) 7) Advocacy groups / other 2.0 CAISI – Client Access to Integrated Services and Information

16. CAISI Strategy / Operation – Open Development Strategy n n Make work easier for front line agencies n n Provide better individual / population care 2.0 CAISI – Client Access to Integrated Services and Information

17. CAISI Strategy / Operation – Open Development Operation 1) 1) Identify partner agency 2) 2) Make custom changes to CAISI 3) 3) Implement next version of CAISI a) a)Inventory of services – intake criteria b) b)Custom agency intake c) c)Integrate current systems 2.0 CAISI – Client Access to Integrated Services and Information

18. CAISI Strategy / Operation – Open Development Input from n n partner front line agencies n n Clients n n Advocacy groups 2.0 CAISI – Client Access to Integrated Services and Information

19. 2.0 CAISI Background CAISI Partner Agencies/Users: n n Toronto Public Health n n Toronto EMS n n St. Michael’s Hospital, University Health Network, other hospitals n n Partner shelters, drop-ins, mobile teams n n Community Mental Health Court

20. 2.0 CAISI Background CAISI Strategic Support: n n Toronto Shelter, Support & Housing Administration Division n n Ministry of Health and Long Term Care – –Chief e-Strategist, CIO Office – –Primary Care Model Delivery Unit n n Smart Systems for Health

21. 2.0 CAISI Background CAISI Components: 1. 1. Stakeholder inter-relations 2. 2. Health triage tool; 3. 3. Integration and discharge planning; 4. 4. Action-based education; 5. 5. Electronic health information forms; 6. 6. Homeless health knowledge for population programming; and, 7. 7. Ground work for sustainability.

22. 2.0 CAISI Background CAISI IT Functionality: 1. 1. Health intake 2. 2. Referral 3. 3. Queuing 4. 4. Program admission and discharge 5. 5. Multi-agency case management 6. 6. Individual level reports 7. 7. Population level reports

23. 2.0 CAISI Background CAISI IT Infrastructure: 1. Expansion and modules built onto OSCAR system (electronic medical record) 2. Open Source development (GPL License) 3. Linkages with other information networks: a.UHN PRO System b.EMS: e-PCR c.SMIS

24. Privacy ’ ‘the right of an individual to control his or her personal information.’ City Of Toronto Privacy Impact Assessment Toolkit 2005 3.0 CAISI – Issues

25. 2.0 CAISI Background CAISI Privacy: 1. 1. Build on experience of similar systems 2. Will encompass HIC and non-HIC agencies 3. Parallel Privacy Processes: a.City legal privacy support b.Toronto CAP PIA

26. Privacy – Vulnerable Clients n Improve on existing mechanisms of client privacy and consent –Role based access to information –Mechanisms to check competence –Multiple modes of messaging –Clear decision making when consent cannot be obtained 3.0 CAISI – Issues

27. Privacy n n PHIPA (Provincial Health Information) – –Build on UHN PRO experience – –Extend circle of care n n MFIPPA (Provincial Municipal Information) – –City Legal support – –City of Toronto Privacy Impact Assessment 3.0 CAISI – Issues

28. CAISI - Sustainability 1) 1) governance 2) 2) Ongoing development 3) 3) Resourcing 4) 4) Hosting 2.0 CAISI – Client Access to Integrated Services and Information

29. CAISI Outcomes 1) 1) Short term a) a)Early identification and referral b) b)Assessment of all clients in partner agencies c) c)Number of homeless with disability / mental illness 2) 2) Medium term a) a)Agencies providing integrated care b) b)Increased client satisfaction 3) 3) Long term a) a)More effective use of social services b) b)End of homelessness among those with mental illness / addictions / disability 2.0 CAISI – Client Access to Integrated Services and Information