1. Approach to Implementing the SMHPL in a Large Health Organization Site Liaison – Dr. Maggie Gibson Site Facilitator – Julia Horan jhoran@uwo.ca St. Joseph’s Health Care, London

2. Background  Located in London, ON  One of Ontario’s leading teaching hospitals  Advancing health care, education and research  Partner in London’s academic health sciences community  Publicly funded Catholic health care organization

3. Background  Owned by the St. Joseph’s Health Care Society of the Roman Catholic Diocese of London  Volunteer board of directors  120 year legacy, advancing a ministry of compassionate, excellent service  Further information see http://www.sjhc.london.on.ca/ http://www.sjhc.london.on.ca/

4. Strategy  Create one page handout to be presented to key contacts at SJHC Included information re timeline of project, introduction to SMHPL, and 6 discussion questions Included information re timeline of project, introduction to SMHPL, and 6 discussion questions  Email sent out to 5 contacts within SJHC selected by site liaison with attached handout  Set up meetings with contacts and give them a hard copy of the lens or link to online version prior to meeting

6. Discussion Questions 1. Have you ever heard of the SMHPL? 2. Are there any processes in place in terms of policy and programs where seniors’ perspectives and values are addressed? 3. Are there any processes in place that would benefit from the seniors’ mental health perspective? 4. Are you aware of any examples at SJHC where consideration of seniors' mental health issues specifically helped to shape the development of a policy? 5. What value might be added by a specific consideration of senior's mental health issues in policy development? 6. What thoughts/recommendations do you have on how a tool such as the SMHPL could be of use to St. Joseph's?

7. Approach to Implementing SMHPL  Interview-style meetings, approximately 45 minutes Introduction of SMHPL, examples of use Introduction of SMHPL, examples of use Brief background of contacts’ roles Brief background of contacts’ roles Discussion questions Discussion questions Conclusion Conclusion  Received feedback and obtained consent to be used in project  Create table of responses for comparison  Get references to other contacts

8. Contacts at SJHC  Deb Wiltshire – Veterans Care leader at Parkwood Hospital  Lisa Van Bussel – Psychiatrist at Regional Mental Health Care, London and St. Joseph’s Hospital, & member of Outreach team  Deb Miller – Director of Organizational Development and Learning Services at SJHC (phone interview)  Beth McCarthy – Director of Specialized Geriatric Services (SGS) at Parkwood Hospital  Lynda Martin – Mount Hope, LTC program (response pending)

9. Contacts at SJHC  Phyllis Brady – Patient Relations and Risk Management at LHSC and SJHC  Kendra Kasubeck – Risk Management and Patient Safety, Policy development at LHSC and SJHC, citywide policy, corporate development

10. Responses 1. Have you ever heard of the Seniors Mental Health Policy Lens? Deb Wiltshire - Yes, through Dr. Gibson - Have not used it Lisa Van Bussel -No, not until I received the email to meet Kendra Kasubeck -No, not until I received the email to meet Phyllis Brady -No, not until I received the email to meet Deb Miller -No, not until I received the email to meet Beth McCarthy -No, not until I received the email to meet

11. Responses 2. Are there any processes in place in terms of policy and programs where seniors’ perspectives and values are addressed? Deb Wiltshire -Informal – integrated into planning and care (more ingrained) -Get feedback from patients one-on-one -Satisfaction survey to patient and family every 2 years to get feedback -Have no control over the content of these surveys as they are standardized Lisa Van Bussel -Meetings with seniors and their family depending on cognition of senior -Use of a template, but not explicit -Family given education with social worker in some instances -Evaluations/surveys to patient/caregivers every 2 years -Mail out patient satisfaction surveys -Informal – hear experience from other areas of work and bring back to SJHC

12. Responses Kendra Kasubeck -Corporate policy manual -Reviewed every 2 years unless it’s regarding staff safety then it is every year -6 months before review is due, an email is sent out as a reminder -Template online to follow for formatting and checklists -Policy development companion -Policy coaching tool -This can be used for all people, not just seniors Phyllis Brady -Corporate policy manual -Reviewed every 2 years unless it’s regarding staff safety then it is every year -Template online to follow for formatting and stakeholders -Used for all people, not just seniors -New, developing multidisciplinary group ex. Discharge Policy – has representatives from different areas Deb Miller -Clinical program for specific seniors population -Organizational tool for anyone -Follow template for quality workplace considering physical, social and mental well-being not specific to mental health -Informal process

13. Responses Beth McCarthy -Patient satisfaction survey for out-patients and in-patients -Once patients are discharged send a survey in the mail based on their experience -Out-patient survey for new patients is distributed monthly and may receive phone calls about feedback -Evaluation tool for patient and their family at workshops -Review with staff re how patients get referred -Patients given a brochure in acute care with expectations in response to feedback -Upfront management is general change to health care system

14. Responses 3. Are there any processes in place that would benefit from the seniors’ mental health perspective? Deb Wiltshire -Don’t have an explicit checklist like this in place and may benefit from using it -Do consider seniors’ needs, but make assumptions -Don’t generally ask the seniors themselves, so this may be helpful Lisa Van Bussel -Incorporating what is learned to use in care -No focus group or survey formally asking seniors what they want -Staff and caregivers make the assumptions for them -Would benefit from an explicit seniors’ perspective with a family council Kendra Kasubeck -Always looking for areas of improvement and this would help -Could be useful in stakeholder review looking specifically at policies regarding seniors and mental health

15. Responses Phyllis Brady -Not really because Mount Hope and Parkwood which are geared toward seniors already have increased awareness about their perspective and needs Deb Miller -Yes in terms of the mental health perspective, but not just seniors, more generic Beth McCarthy -All programs have target group of frail seniors (over 75 years of age with more than one complex medical issue) -Needs are critical to be met in terms of access, barriers, accessibility, and communication -Seniors perspective is already addressed

16. Responses 4. Are you aware of any examples at St. Joseph’s where consideration of seniors’ mental health issues specifically helped to shape the development of a policy? Deb Wiltshire -No as most are corporate policies, done by the employees -Policy is dealt with mostly by administrative people Lisa Van Bussel -Patient and Family Handbook gives information on program, roles, expectations and diseases -Initiative Mental Health Program for recovery needs held a Christmas bazaar -City of London and UWO put on Think Tank – a meeting that addressed mental health needs and issues and the services available

17. Responses Kendra Kasubeck -End of Life Care policies and Palliative Care policies would involve thinking about seniors’ needs specifically -Policy decision makers in End of Life Care -Standards for Relationships Policy development as is requires respect for all people -Policy on Accessibility for Persons with Disability Phyllis Brady -Regional Mental Health Care London -Sites with specific seniors/geriatric population (Parkwood, Mount Hope) -Some involvement at St. Joseph Hospital because of the recent move the demographic in the ambulatory care program changed (more seniors now) Deb Miller -No, work more with entire population -There would be at program level at Regional Mental Health Care London and Specialized Geriatric Services for example Beth McCarthy -Standards of Relationships Policy is framework for staff to deal with cognitively impaired and unpredictable behaviour patterns of patients and families that become agitated -Accessing Services of People with Disabilities Policy includes getting information to people who are depressed or cognitively impaired and have physical disabilities -Not specific to mental health, but these policies involve mental health issues

18. Responses 5. What value might be added by a specific consideration of seniors’ mental issues in policy development? Deb Wiltshire -Policy impacts care and service, not just administrative -Policy for standards of relationship (i.e. staff  staff, staff  family, family  patient, staff  patient) -Address differences in mental health behaviour of capable vs. incapable Lisa Van Bussel -Would be valuable for everyone of all ages -High risk nowadays for mental health issues, and having information guides would prepare them -People with variable capacities and the policy should reflect this (flexibility) -Important for health promotion and prevention -Seniors with mental health issues may have complex needs with functional decline and lack capacity

19. Responses Kendra Kasubeck -Strengthen policy development -Allow you to consider all age groups -Helpful to all stakeholders to use as a guide and follow a checklist when they are reviewing a policy -Filling in the gaps of policies Phyllis Brady -Would be valuable as mental health now affects 1 in 4 people (more prevalent) -Useful to Regional Mental Health Care London and the Family and Patient Council Deb Miller -Allow groups to meet at a deeper level fulfilling SJHC Catholic mission -Group learning together combining intelligence -Broaden knowledge Beth McCarthy -Provide a framework to meet the needs of seniors at Parkwood -In a larger perspective, other hospitals that aren’t targeted to seniors may find this useful in case they miss something -SJHC preadmission clinic may not consider things so this would act as a reminder

20. Responses 6. What thoughts/recommendations do you have on how tool such as the Seniors’ Mental Health Policy Lens could be of use to St. Joseph’s? Deb Wiltshire -Meet with leaders/directors of groups who are directly influenced by policy -The process heightens awareness -E-learning tool would increase awareness and can be used for program development – keep it short, simple and easy to operate -Create 4 or 5 cue cards or a poster to be placed on back of ID or a brochure that identifies a checklist of keywords as a reminder on a daily basis -Example – deck of cards of fire safety reminders is an easy way to reach more people and less formal -Key is keeping it in the forefront and integrated into daily use

21. Responses Lisa Van Bussel -Talking through is beneficial in itself -Perhaps make it bilingual if that hasn’t been done already -Create a one page template, similar to what is already in place and keep it simple -Target at the managers level -Provincial LHIN (Local Health Integration Networks) just developed an Aging at Home policy – have they considered needs of seniors with mental health issues? (follow-up opportunity) -CCAC is another large organization that may be contacted -Knowledge web based practice SHRTN AKE mechanisms, may discuss/use the SMHPL (follow-up opportunity) Kendra Kasubeck -Be of use to stakeholders who work directly with mental health -Leaders  delegate to committees Phyllis Brady -Short, snappy -Implemented in stakeholder review Deb Miller -Make available in broader quality workplace initiative -Organizational tool for all staff

22. Responses Beth McCarthy -SMHPL Resource would be helpful to senior-friendly hospitals -Trying to make hospitals a good experience for people, specifically seniors, and this tool would help consider their needs -Approach Ontario Hospital Association (http://www.oha.ca) which is involved in setting policies to be used at all hospitals in Ontario http://www.oha.ca -Each hospital must follow the standard template policy as outlined by OHA -Approach Communications department at SJHC and get approval by senior leadership to have SMHPL Resource placed in SJHC website References section

23. What We Learned  Majority of responses included use of standardized policy template at SJHC, but not explicit  Process of going through SHMPL would be valuable to gain clarity, gain seniors’ perspectives, and consider things that were missed in policy/program development  Keep it short, simple, and in plain language  Be directed to individuals of different capacities  Valuable resource for people of all ages

24. Next Step  Create a one-page version of the SMHPL that is similar to the processes in place at SJHC, providing a shortened version for efficient use  Take questions directly from Part II: Assessing Policy/Program Content because Part I: Process Factors are already accounted for at SJHC  Follow-up email to contacts with the Seniors’ Mental Health Policy Lens Resource attached

26. Feedback  Online survey of questions to gain feedback based on the following questions: 1. Is the purpose of this resource clear? If not, can you explain what is needed? 2. Is the wording of each item clear? If not, which items need to be re-worked? 3. Is the follow up action listed at the bottom of the page clear? If not, can you comment on what is needed? 4. Where would you see this resource being housed in the organization? 5. Who would you see using this resource? 6. Do you have any suggestions as to how to increase visibility and use of this resource?

27. Survey Feedback  Clarity of purpose Yes – I found the introductory overview very helpful. Clearly presented using the handout/booklet Yes – I found the introductory overview very helpful. Clearly presented using the handout/booklet  Wording of each item Yes – The framework is clear Yes – The framework is clear Have the questions be positive or negative but not both (consistency) Have the questions be positive or negative but not both (consistency) Change wording of #3 – “Handicaps” to “Barriers Change wording of #3 – “Handicaps” to “Barriers

28. Survey Feedback  Clarity of follow-up action Yes – It provides a great way to evaluate how "senior friendly" the policy is and an opportunity to understand how to improve (and validate) the draft Yes – It provides a great way to evaluate how "senior friendly" the policy is and an opportunity to understand how to improve (and validate) the draft  Location for potential use of resource Policy formulation as it is drafted by the writer and then a "checklist" for use by a committee/workgroup as a last lens/feedback Policy formulation as it is drafted by the writer and then a "checklist" for use by a committee/workgroup as a last lens/feedback  Use of the resource Anyone drafting a policy or participating a review of a policy Anyone drafting a policy or participating a review of a policy

29. Survey Feedback  Suggestions to increase visibility Get to senior leadership of organizations to incorporate into the development/approval process for policies Get to senior leadership of organizations to incorporate into the development/approval process for policies New Ontario Act and Regulations is clear that accessibility must be considered when policies are developed/revised and this reference could be added New Ontario Act and Regulations is clear that accessibility must be considered when policies are developed/revised and this reference could be added

30. Challenges  Because SJHC is a large organization directed to seniors’ needs, they have procedures in place and are committed to making facilities senior- friendly already  Standardized policy templates are city-wide – not a lot of flexibility  Not explicit use of templates – used as a general reminder  Availability of contacts for scheduling meetings

31. Follow-up Opportunities  Collecting and analyzing feedback from survey  Approach SHRTN AKE (Seniors Health Research Transfer Network, Alzheimers Knowledge Exchange) which is a web-based practice in Ontario as recommended  Approach provincial LHIN (Local Health Integration Networks) to review Aging at Home Policy  Develop plain language version of lens as a companion to the Patient and Family Handbook used at SJHC

32. Follow-up Opportunities  Approach Ontario Hospital Association (OHA) to get their feedback and approval of lens as province wide recommendation  Approach Communications department at SJHC to increase visibility of SMHPL Resource on website

33. Conclusion  In order to implement a policy template into a large organization, the best approach is to be used as a companion resource to what is already in place  Not a lot of flexibility in terms of what is used  Meeting with leaders in different areas helps represent the broad perspective at SJHC  Interview style was time efficient, to the point, and helped eliminate problems in scheduling meetings  Positive response to the content of the lens; perhaps different format such as the SMHPL Resource