Review of Coordinated/Centralized Access Mechanisms: Evidence, Current State, and Implications Dr. Brian Rush Scientist Emeritus, Centre For Addiction and Mental Health and Birpreet Saini Research Policy Analyst, Addiction and Mental Health Ontario

Background Rationale for the project: o Obvious high interest in improving access to MH & A services in Ontario o Proliferation of several coordinated access models in the province o Lack of provincial description o Lack of published synthesis of relevant research literature Collaboration between Addictions and Mental Health Ontario (AMHO) and the Centre for Addiction and Mental Health (CAMH) Provincial System Support Program (PSSP) Descriptive environmental scan - Not an evaluation to prompt reflections on lessons learned facilitate future planning, performance measurement and evaluation 5/30/20162

What has been driving Coordinated Access? Coordinated access is a tool for simplifying access through the consistent use of standardized processes and tools for intake/screening/assessment and referral. Designed to improve the following: o For clients – Navigation of the system (e.g., one number to call), inconsistency of services, unment needs, wait times, continuity of care o For service providers - information about existing services (e.g., one number to call, one access point), duplication of services, multi- provider coordination, matching and referral appropriateness o For LHINs - Measuring performance, tracking needs and available resources, quality improvement, coordination between MH & A sector, standardized practices between programs 5/30/20163

Project Methods Literature review and examination of similar models in other sectors Interviews with MH & A Leads (all 14 LHINS), ConnexOntario & CritiCall Ontario Follow-up interviews for clarification and validation Review of program documents, where available 5/30/20164

Current State in Ontario Complex modelsLess Complex Features Centralized access point(s) – single or multiple Decentralized – no door is the wrong door Hybrid Warm hand off to other services Integration of services Co-location of services Common screening and assessment process, common referral forms LHINs Waterloo Wellington Mississauga Halton Champlain South West Central Toronto Central Hamilton Niagara Haldimand Brant Central West South East North East North West Erie St. Clair LHINS with no Coordinated Access model – North Simcoe Muskoka, Central East Note: LHINs categorized under ‘less complex models’ are developing their existing approach towards a more ‘complex’ model. 5/30/20165

Key findings A majority of LHINs in Ontario have implemented or are in the process of implementing some type of coordinated access system for MH & A services. Different models, same core principles. Choice of models depends on: desired role of coordinated access model, existing level of collaboration among partners (provider buy- in, type and level of system integration and partnerships), and available resources. No single model seems to fit all regional contexts. Coordinated access offers an efficient approach to service matching if implemented with standardized processes and tools but does not necessarily address the issue of capacity in the system. 5/30/20166

Reported facilitators Buy-in from providers Support from LHIN Regular communication Implementation science Dedicated project management resources Formal change management and QI initiatives Realistic process map Constant performance monitoring Engagement with other LHINs 5/30/20167

Reported barriers Disconnect among providers Under-estimation of needs and resources required Lack of understanding of evidence Resistance to change Challenges with multi-year system transformation (new players) Uncertainties of service providers about ownership of clients Inconsistencies across LHIN Business practices of individual organizations Conflict between hospitals and community based providers 5/30/20168

Implications Strategic direction – need a program logic model or guiding framework at the provincial level to better guide the development and expected outcomes of these regional models Performance measurement indicators – need consistent evidence- based performance indicators to monitor improvement to access and outcomes at the system, program and client level 5/30/20169

Evaluation is needed: what are the key questions? How can these models help with the fundamental systemic challenges in the sector (e.g., diminishing capacity, wide variation in practice)? What is the impact across the province (or region) in terms of system capacity and quality and multi sectoral collaboration? How do the disparate regional/local access models connect at the provincial level (for e.g., ConnexOntario and Provincial Inpatient Mental Health Bed Registry)? 5/30/201610

Other Key Questions What are the critical success factors for this overall provincial move towards more coordinated access? Are there risks that need to be mitigated? How does it fit with other major provincial initiatives (e.g., new staged screening and assessment tools, provincial performance indicators, OPOC-MHA tool)? Can the existing capacity and efficiency of the mental health and addictions system handle a major increase in treatment demand? 5/30/201611

Next Steps Webinar/knowledge exchange process, including feedback from: specialized programs affected by Coordinated Access non-specialist sectors closely affected persons with lived experience Convene a small group to consider the core evaluation issues Potential for a planning guide or resource toolkit to support future development of regional/local access models 5/30/201612

Thank You 5/30/201613