Developing & Implementing Evidence-Informed Policy Framework for Person-Centered Care in Substance Use Services Ashley Ward, Valerie Sadler, Heidi Klett, Corrie McIlveen Mission Services of Hamilton May 30, 2016

Organizational Context Mission Services of Hamilton (1956-present), a faith-based social service agency. Three campuses: Men’s campus, women’s campus, community services. Initiating person-centered framework across substance use programs (outpatient, supportive housing, Drug Treatment Court).

Workshop Objectives Understand the components of person-centered policy and its implementation. Understand how the policy was enacted within service delivery in two substance use services. Identify particular implementation issues experienced by social service agencies. Begin to consider a similar process for person-centered policy for their organization.

Part I: About Policy and A person-Centered Approach

“Policies and procedures link vision to operations” - Tom Bartridge

Why Policies are Important Communicates values and expectations for how things are done at your organization. Ensures accountability in the organizational context of expediency. Facilitates the documentation and implementations of best practices appropriate to service delivery. Facilitates decisions that align with quality improvement: consistent, predictable, and uniform.

Our Foundation: Quality Care (Health Quality Ontario, 2016) Excellent Care for All Act (ECFAA) (2010) “A high quality health care system is accessible, appropriate, effective, efficient, equitable, integrated, patient centered, population health focused, and safe.” Institute of Medicine (IOM) “Safe, effective, patient-centered, timely, efficient, and equitable.”

Person-Centered Pathways (Canadian Centre for Substance Abuse, 2008)

What is a person-centred approach? An overarching philosophy and approach that all client services are derived based on client needs and preferences.

Elements of Person-Centered Care (McCormAck et al., 2015) Holistic care Working within the person’s lived context, perceptions, values, etc. Shared decision-making Continuous engagement A sympathetic response

Policy and Procedures Development Organize a committee and delegate one person to take the lead. Create a work plan with realistic timelines. Develop and draft policy content with a review schedule. Write out procedures with quality indicators of person-centered care. Implement the policy. Check out www.hrcouncil.ca/ for further guidance

Who Benefits from Your Policy? (Springtide Resources Inc., 2008)

Practice Examples: CCSA Behaviour Indicators(2014) Client-Centered Change “Enhance, facilitate, support, empower, and otherwise increase client motivation for positive change.” Client Service Orientation “Provide service excellence to clients (which can include individuals, groups, communities and organizations). Includes making a commitment to serve clients and focusing one’s efforts on discovering and meeting client needs.”

Making Policy Accessible (Springtide Resources Inc., 2008) Is the policy available in different formats? Is the policy written in language that is easy for all to understand? Could it be translated to other languages? Does the policy state who it affects? Does the policy state who is responsible for implementing it?

Example: Person-CentereD Policy

Example: Attending to Language We will teach and educate our clients. We will holistically care for our clients. Treat others in the manner we wish to be treated. We will provide the support and resources to meet the wishes and goals of the person. We will work in partnership to meet the goals of the person in their lived context. We will honour the person’s cultural beliefs and values in all aspects of care.

Part II: Putting Policy into Practice

Fostering a Person-centered Culture (McCormAck et al., 2015) Competence Interpersonal skills Commitment to working towards a person-centered standard Clarity of beliefs and values Knowing self

RNAO Clinical Best Practice Guidelines in PCC (2015) Practice, education, and policy recommendations. Practice recommendations include: Assessment Planning Implementation Evaluation

Outcomes of Measurement (McCormack et al., 2015) Satisfaction with care Involvement with care (i.e., engagement) Feelings of well-being A healing environment

Measuring Care Experience Client experience How clients perceive and experience their care, requiring providers to understand and use this information to shape policies, practices, rules and responsibilities, etc. Client engagement The way in which providers collect information about client needs and preferences to ensure they are delivering client- centred care.

The Engagement Continuum

Quality Targets: Making PCC Happen Assess current PCC practices to identify gaps in service delivery. Align goals with best practice and/or competency standards. Design SMART person-centered goals aligned with policy indicators. Build a plan for training and education. Build in points of supervisory and/or team oversight.

Example: Policy Indicator Monitoring Sheet

Practice Examples: Person-Centered Care in Two substance use services

Suntrac Wellness & Addiction Treatment Centre Outpatient substance use support services Assessment Holistic intake practices that facilitates client-identified needs and priorities for care Establish collaborative partnership approach to care Planning Goal-focused case management support, Mental Health Collaboration Plans, safety plans, etc. Work together to address any barriers to service delivery

Suntrac Wellness & Addiction Treatment Centre Implementation Continuous collaborative goal setting and achievement Negotiable service changes and return to service Evaluation Client engagement through satisfaction surveys, annual focus groups Development of a client advisory group

Lessons Learned Assigning “champions” of the practice can facilitate change. Having regular communication about what expectations are and what is flexible empowers staff. Capacity building takes time; education and training on an ongoing basis is necessary to evolve practice. Plan-Do-Check-Act.

Addiction Recovery Housing Program Long-term housing and abstinence recovery support Assessment Flexibility in program eligibility criteria where possible Advisory Committee review and advocacy Planning Collaborative and tiered goal planning for long-term support Build internal and external partnerships

Addiction Recovery Housing Program Implementation Ongoing tailored in-house client support Extended care and maintenance support available Evaluation Client engagement through satisfaction surveys, annual focus groups Collaborative program development with clients where possible

Lessons Learned Positively frame rights and responsibilities of all roles. Make engagement accessible. Plan out all activities and anticipate barriers for sustainable, long-term change. Emphasize community partnerships to address service gaps.

Questions?