Building Capacity for Better Care Behavioural Support Systems Across Canada Dr. J Kenneth LeClair Sarah Clark

The Challenge 1.Dementia 2.Chronic Illness 3.Behaviour 4.Aging

18th Century Health Care in the 21st Century

The Supports System failure Capacity failure Prevention / early detection M. Kirkevold

Key to Change: Multi-level Approach Health Care System Organizational Community / Team Point of Care D. Offord

Behavioural Support Systems Framework

National BSS: Guiding Principles and Components What, who, why?

Guiding Principles for a BSS 1.Care is Relationship-Centred and Person-Directed 2.Behaviour is Communication 3.Respect is Given for All 4.Care System Must be Accountable and Provide Leadership 5.Care is Provided in the Least Restrictive Environment 6.Health Promotion and Chronic Disease Prevention are the Cornerstone of the Health System

Recommended Components

1. An Integrated Care System System Level The system supports cross-sector partnerships, collaboration and information sharing to enable smooth transitions and quality care Organization Level A collaborative, shared-care model is used across services and includes contractual relationships to enable inclusive admission criteria, cross- sector information sharing and cross-sector consultation and education Team Level Staff demonstrate an understanding of other roles within their team, organization and system Point-of-Care Level Technology enables accessible health information between sectors

2. Comprehensive Clinical Services System Level Health organizations are held accountable and recognized for their ability to provide collaborative, person-directed care for persons with responsive behaviours Organization Level A balance of organizational services exist across the continuum of care including preventative services, responsive community services and specialized services which is determined by the local context and culture Team Level Teams engage in cross-team care planning, collaborative outreach and consultation Point-of-Care Level Staff are trained and able to use appropriate best practice with an emphasis on non-pharmacological approaches when responding to behavior

3. Collaborative Care System Level Cross-ministry collaborative approaches and structures are implemented Organization Level Consultation and information sharing between organizations is supported through appropriate technology, policies and leadership Team Level All members of the person and caregiver team are included in care planning Point-of-Care Level Persons and care givers have been actively included in care decisions and care planning

4. Culturally Appropriate Services System Level The system is actively informed by a variety of cultural perspectives and needs, relevant to the context of that system Organization Level Policies and processes are flexible to reflect cultural differences Team Level Services are provided in both official languages Point-of-Care Level Culture is respected and recognized as critical component of the person’s identity

5. Continuous Quality Improvement System Level System standards and funding require, reward and celebrate person-directed approaches to care Organization Level QI approaches and evaluation (qualitative and quantitative) are built into existing organizational processes and policies Team Level QI training is provided to staff and staff are supported through leadership and policy in the application of QI techniques Point-of-Care Level Care plans are informed by results of relevant QI approaches

6. Supportive Access to Resources System Level Service and resource accessibility, regardless of location, literacy, culture, language etc., is supported by system level policy and funding priorities Organization Level Services provided by health organizations, including acute and long-term care, creatively support individuals living at home or transitioning back to home to live there as long as possible Team Level System navigator functions are readily available to individuals accessing the system and these involve individuals, teams, organizations staying connected Point-of-Care Level Tele-health is leveraged to enable comprehensive assessment in rural-remote settings

7. Supportive Environments System Level Policies are in place to ensure the standards for environmental design are met and the care continuum is supported to do so Organization Level Organizational environments are person-centre, in that they are designed to respond to a range of abilities and changes in vision, cognition, hearing, mobility Team Level Technology is available for teams to assist assessment, care planning, walking etc. in lease restrictive environment Point-of-Care Level Environments evoke feelings of comfort and security in the person and promote engagement in social activities appropriate to age and level of cognition

8. Caregiver Support System Level Federal, provincial and workplace policies are in place to support care at home Organization Level Organizations are enabled to provide home and respite support (including night programs) Team Level The caregiver is encouraged to be an active part in the team care planning to manage responsive behaviours in addition to the person’s long-term care plan Point-of-Care Level Conversations with caregivers regularly include questions about their own health status (physical, emotional, etc.) as a means to ‘screen’ regularly for stress and burnout

9. Education and Training System Level Standard training requirements are endorsed that include education in non-pharmacological interventions to responsive behavior Organization Level Professional organizations are involved in infrastructures to support continuous learning and development Team Level Mentoring and coaching of non- pharmacological approaches occurs by the team in the moment Point-of-Care Level Education is available for the person and his or her caregivers which targets understanding the behavior, improving quality of life and preventing further decline

10. Health Technology System Level Reliable online platforms are funded to enable knowledge exchange, collaboration, consultation, and the sharing of assessment tools and other related resources Organization Level Organizations are supported in terms of capacity development (skills, knowledge, funding, human resources) to best leverage technology platforms and integrate them into current practice Team Level Health technology is used to: enable information transfer, support patient safety, engage caregivers in supportive conversations (etc.) Point-of-Care Level E-learning opportunities are provided for caregivers and staff

Questions? Reactions? Interested in delving deeper? Leave us your card and we’ll send you: The draft “National Behavioural Support Systems Project: Guiding Principles and Recommended Components” document An online review template and an invitation to provide your feedback and reactions to what is presented in the draft document Visit or contact Sarah Clark Thank you!