Enhancing Evidence Based Services:

Enhancing Evidence Based Services:
Ontario Perception of Care and Addiction Screening & Assessment

Presentation Outline Looking Back Current State Coming Soon!
Results of Drug Treatment Funding Program (DTFP) research, development and piloting of both the Ontario Perception of Care tool for Mental Health & Addictions and the new Staged Screening and Assessment process for addictions Current State Status of both projects Coming Soon! Next steps for Ontario wide implementation

Presentation Objectives
Enhance knowledge regarding the purpose and impact of the Ontario Perception of Care tool for Mental Health and Addictions Increase knowledge and understanding regarding the staged screening and assessment protocol for addictions and concurrent disorders Enhance knowledge regarding implementation plans and system readiness for implementation Funded by DTFP

What is DTFP? Drug Treatment Funding Program (DTFP) is funded by Health Canada Overarching goal of enhancing quality of addiction treatment systems Resources flowed to provinces and territories as well as selected national projects Ministry of Health and Long Term Care funds projects to enhance the Ontario addiction system Good to include the DTFP focus on system enhancement Not all provinces asked for money eg Quebec and Yukon has benefited as well

Looking Back…..

Drug Treatment Funding Program Staged Screening and Assessment for Addictions
Brief Project History More detail at:

Last Round of DTFP: Informed Process
Evaluation of ADAT (pre-DTFP) Background literature review Environmental scan of Ontario’s addiction agencies Consultation with large Advisory Committee and close engagement of Working Group New process piloted within 5 treatment agencies Recommendation: to move forward with implementation of new suite of tools Advisory: comprised of addiction sector and consumer stakeholders Best practices for screening & assessment are critical to efficient and effective service Earlier evaluations of the current common assessment tools used in the addictions treatment system in Ontario (ADAT=Admission and Discharge Criteria and Assessment Tools) highlighted variations in how the tools are used (e.g., the wide range of completion times and the purpose for the information for treatment planning) and literature shows that newer, more integrated screening and assessment tools that can function in a staged manner. A “refresh” of ADAT was recommended on the basis of this provincial evaluation. The DTFP Screening and Assessment project ( ) drew on the best available evidence as well as the feedback of key stakeholders throughout the province to select/develop and pilot new screening and assessment tools and procedures for all publicly funded substance use services in Ontario. New suite of SSA tools piloted with: Alcohol and Drug Services of Thames Valley (ADSTV), Addictions Centre, Four Counties Addictions Services Team (FourCAST), Manitoulin Community Withdrawal Management Services, Rideauwood Addiction and Family Services New process enhances ability to assess people with co-occurring mental health issues and develop individualized treatment planning Link to performance measurement & system monitoring See page 28 of report for tool selection criteria

Conceptual Framework Developmental Perspective
DIVERSITY LENS Developmental Perspective Child Adolescent Transitional Youth Adult Older Adult Screening Stage of Client Engagement Stage 1 (case finding) Stage 2 (case definition) Assessment Stage 1 (placement matching) Stage 2 (modality matching) Treatment & Support Stage 1 (within-treatment monitoring) Recovery Monitoring Stage 2 (post-treatment monitoring)

Definitions Placement Matching
Initial client assignment to a treatment setting with a certain resource intensity (therefore important cost implications) Modality Matching Creation of a case conceptualization and formulation leading to an individualized and adaptable treatment plan Grounded in person’s overall life situation and problem-focused, including trauma informed

Selected and Piloted GAIN-SS GAIN Q3 MI ONT MMS (Modified Mini Screen)
1st Stage Screener GAIN-SS 2nd Stage Screener MMS (Modified Mini Screen) PDSQ (Psychiatric Diagnostic Screening Questionnaire) POSIT (Problem Oriented Screening Instrument for Teens) 1st Stage Assessment GAIN Q3 MI ONT

Pilot Sites Engaged five treatment agencies to pilot all components of Staged Screening and Assessment Including one youth agency 234 clients recruited Feedback Gathered On…. Feasibility Potential usefulness at clinical and agency levels Sources of Data Clinical staff Study leads Executive Directors Methods of Collection s Informal discussions Clinician logbooks Online survey Key Informant interviews (and on-site debrief) PILOT: Addictions Centre (Belleville), Addiction Services of Thames Valley (London), Fourcast (Peterborough) Manitoulin Community Withdrawal Management Services (Little Current), Rideauwood Addiction and Family Services (Ottawa)

Perceived STRENGTHS of New Process
Screeners (stage 1 and 2): Quick and easy to administer Facilitates a comprehensive look at relevant psychosocial domains Stage 2 screener facilitates referrals for mental health services GAIN-Q3 (stage 1 assessment): The assessment is comprehensive and standardized Concrete recommendations for treatment planning and referral Reasons and readiness to change questions highly valued Strong foundation for outcome determination

Perceived CHALLENGES of New Process
Screeners: Established cut offs for stage 1 screener (GAIN-SS) Some redundancy between the screeners GAIN-Q3: Insufficient coverage of substance use history Challenge for administration in a group intake context Sensitivity around the perceived invasiveness of some questions Timing of administration for youth (impact on rapport) Length of administration More training needed to edit and interpret summary reports

Compared to ADAT….. Reported Value-add: Possible Value-loss:
Staged approach seen as efficient and comprehensive Better quality data Less variability in clinical interpretation Better treatment planning Better support for referrals to mental health services for clients with concurrent disorders Summary reports for clients provide better documentation Possible Value-loss: Flexibility of group intake Concern about potential impact on wait times – quality vs. quantity Collection of detailed information regarding substance use history

Bottom Line from Pilot Work
Support for staged model General support to replace part or all of ADAT with screening and assessment tools Some revisions needed for the GAIN-SS and the GAIN-Q3 (i.e. more on substance use) Need to build on existing infrastructure and provincial processes underway Recommendation: Move forward with Ontario implementation of new suite of tools

Responding to Pilot Feedback
Addressing the concerns/challenges identified in advance of broad implementation including: Only one second stage screener for adults (mitigate redundancy) Pilot agency has been successfully engaging in client self-administration process (allow group intake, mitigate possible wait times) Adapting GAIN Q3 MI ONT to include more detailed substance use and treatment history (respond to need for more depth of information in this area) Advisory: comprised of addiction sector and consumer stakeholders Best practices for screening & assessment are critical to efficient and effective service Earlier evaluations of the current common assessment tools used in the addictions treatment system in Ontario (ADAT=Admission and Discharge Criteria and Assessment Tools) highlighted variations in how the tools are used (e.g., the wide range of completion times and the purpose for the information for treatment planning) and literature shows that newer, more integrated screening and assessment tools that can function in a staged manner. A “refresh” of ADAT was recommended on the basis of this provincial evaluation. The DTFP Screening and Assessment project ( ) drew on the best available evidence as well as the feedback of key stakeholders throughout the province to select/develop and pilot new screening and assessment tools and procedures for all publicly funded substance use services in Ontario. New suite of SSA tools piloted with: Alcohol and Drug Services of Thames Valley (ADSTV), Addictions Centre, Four Counties Addictions Services Team (FourCAST), Manitoulin Community Withdrawal Management Services, Rideauwood Addiction and Family Services New process enhances ability to assess people with co-occurring mental health issues and develop individualized treatment planning Link to performance measurement & system monitoring See page 28 of report for tool selection criteria

Supporting Agency & System Planning
Pilot Sample Data: Supporting Agency & System Planning

Analysis of Initial Assessment Data – combined substance use
Case Defined As Also Experienced Heavy Alcohol Use (53.5% of sample) N = 76 Heavy Marijuana Use (30.3% of sample) N = 43 Heavy Cocaine/ Crack Use (10.3% of sample) N = 14 Heavy Heroin/ Methadone/ Opioid Use (12.5% of sample) N = 17 Heavy Alcohol Use 48.8% 71.4% 70.6% Heavy Marijuana Use 27.6% 28.6% 35.3% Heavy Cocaine/Crack Use 13.5% 9.5% 11.8% Heavy Heroin/ Methadone/ Opioid Use 16.2% 14.3% This data is from pilot phases. Example of what can be extracted from Q3 MI ON that is helpful at agency and system levels. Presently, we can generate report on “presenting substances” but not depth of use or depth of concurrent use. NOTE: Read the data DOWN each column and ignore going across. So for the 76 cases defined as Heavy Alcohol Use, 21 or 27.6% were also Heavy Marijuana Users. Don’t try to read across.

Analysis of Initial Assessment Data – % severe problem areas by gender (n=150)
Male Female Total Problem Domain SU 62.8 84.3 70.3 Int. MH 64.9 88.5 73.3 Ext. MH 38.3 55.8 44.5 Physical 35.8 54.7 42.6 Work 7.4 16.7 10.7 Stress 43.2 47.3 Risk Behav. 17.2 48.1 28.3 Crime-Viol. 2.2 8.3 4.3 90-days Trauma 32.3 57.7 41.4 90-days Victimization 26.9 47.1 34.0 Data can be extracted across problem domains in the Q3 MI ONT. This demonstrates that women had more significant problems across all problem domains. This is helpful for service/program planning.

Analysis of Initial Assessment Data – % using community services in past 90 days
Note data on ER use related to MH and A.

Analysis of Initial Assessment Data – % using community services in past 90 days by gender

Value of GAIN-Q3 MI for Outcome Monitoring
In 2013/14 the project team also completed analysis of pilot outcome data 117 clients followed for 3 and then 6 months Results show the value of the GAIN-Q3 for outcome monitoring 90 day re-administration of Q3 MI ONT showed: Decrease in substance use Positive changes in mental health, stress, physical health and risk behaviours Fidelity use of GAIN Q3 MI linked to better client outcomes The 90 day re-administration is not an “expectation” of the provincial roll out, but REALLY rich opportunity for outcome monitoring

Ontario Perception of Care Tool for Mental Health and Addictions (OPOC-MHA)
Brief Project History More detail at:

Ontario Perception of Care Project
Measures of client experience are widely used by customer-oriented businesses and healthcare services and settings Recognized as an important indicator of the quality of care as it is a direct measure of whether a client received services that met expectations and needs

Satisfaction versus Perceptions of Care
Satisfaction a measure of the reaction to the services received Respondents tend to report high levels of satisfaction even though dissatisfaction might be voiced in open-ended questions or other feedback formats such as focus groups Measures of perception of care ask more directly about the care experience in relation to what is expected as standard practice Range of responses likely to be wider as respondents may be more willing to report infrequent exposure or use of a practice than express dissatisfaction about it

Previous DTFP Iteration
Literature review completed Environmental scan All mental health and addiction agencies in Ontario using ConnexOntario database (30% response rate) Asked about current tools and processes to assess client perceptions of care Most agencies using something Majority of tools developed in-house Extensive stakeholder consultation through Advisory Structure and project Working Group

OPOC- MHA Developed new tool with support of Working Group
All tools evaluated in the literature review were assessed according to validity, usage, length, and relevance 8 tools were selected from this process All items from these 8 tools were collated according to domain for review by the Working Group and served as the foundation for the new tool Can be used in addictions, mental health, and concurrent disorder settings Translated into French

Domains of the OPOC-MHA
Sample Question Access/Entry “The location of services was convenient for me”. Services Provided “I had a good understanding of my treatment and support plan”. Participation/Rights “I felt comfortable asking questions about my treatment and support, including medication”. Therapists/Support Workers/Staff “I found staff knowledgeable and competent”. Environment “I felt safe in the facility at all times”. Discharge/Leaving the Program “I have a plan that will meet my needs after I leave the program”. Overall Experience “The services I have received have helped me deal more effectively with my life’s challenges”.

OPOC-MHA Versions CLIENT Version (38 items)
Registered clients of the program Those receiving services for their own treatment/support Family members/significant others/supporters who are receiving services in their own right) Note: 6 items specific to inpatient/residential treatment services only FAMILY/SUPPORTERS (17 items) Family members/significant others/supporters who are not registered clients but who are also receiving services from the program (such as parent who has a child in the program)

OPOC-MHA Additional Questions
Respondent’s age, gender, sexual orientation, ethnic background, and stage in the treatment process are included Information can be used for subgroup analyses and from an equity perspective Two open-ended questions to allow for comments about what the respondent found most and least helpful in their experience with the program, as well as room for comments throughout the questionnaire

OPOC-MHA Pilot Process
Data collected April 1/12 through June 30/12 1, 753 respondents Administration process varied by site Least disruptive to program Administered at various points in time Pilot Sites 23 pilot sites from both mental health & addiction sectors Sites represented a diversity of clients and services across Ontario (i.e. inpatient/community, gender-specific, youth, Indigenous, ethno-racial and immigrant etc.) Each client was given the tool to complete at a time agreed upon by the agency and project staff, and in a way that was least disruptive to the regular functioning of the program. Some agencies administered the tool at program completion while others conducted a one-day or one-month blitz and administered the tool to all participants for that time period. Across Boundaries ADAPT Addiction Services of Thames Valley (ADSTV) Canadian Mental Health Association - Kenora Branch Canadian Mental Health Association, Halton Region Branch Canadian Mental Health Association, Grey Bruce Branch Dave Smith Youth Treatment Centre Four Counties Addiction Services Team G & B House Grey Bruce Health Services HopeGrey Bruce Mental Health and Addiction Services Jean Tweed Treatment Centre Maison Fraternité Manitoulin Community Withdrawal Management Services Nipissing Detoxification and Substance Abuse Programs Pine River Institute Pinewood Centre Portage Ontario Ray of Hope Youth Addictions Services Red Lake: Community Counselling and Addiction Services Rideauwood Addiction and Family Services Sunnybrook Hospital Youth Addiction Services CAMH

OPOC-MHA Pilot Results
We have a tool and it works! Overall feedback from staff and clients about the OPOC-MHA was positive Significant interest from mental health and addiction agencies in the province (and elsewhere) to implement the tool The OPOC-MHA demonstrated strong psychometrics

OPOC-MHA Pilot Sample Data

OPOC-MHA: Referral to Services

OPOC-MHA: Environment

OPOC-MHA: Feeling Safe

OPOC-MHA: Effectiveness

Sub-group Differences in Responses - Some Findings
Patients and supporters did not differ substantially in their opinion on most of the statements Respondents from MH programs answered strongly agree less often on some statements compared to respondents from A and CD programs Young respondents (age <=18) appeared to answer strongly agree less often on most of the statements Need to give them copy of OPOC-MHA

Differences in Responses - Some Findings
LGBQT respondents were less likely to endorse strongly agree on all the statements Respondents who have been mandated by court, medical authority, etc. appeared to answer strongly agree less frequently on all statements than respondents who voluntary participated in the program/treatment

Provincial Implementation
Staged Screening and Assessment Process being implemented in Ontario MoHLTC funded Addiction agencies OPOC-MHA being implemented in Ontario MoHLTC funded addiction, mental health and concurrent disorder programs Implementation beginning in about half of the LHINs, with other half beginning early 2016 KIM

Research Based Approach to Implementation
Implementation Science (IS) is a proven approach to bringing evidence-based research into practice to improve client outcomes IS means purposeful, planned and active implementation, supporting fidelity and sustainability Planned and supported implementation results in higher implementation with fidelity More info on IS: Reference: Greenhalgh et el Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. The Milbank Quarterly, Vol. 82(4), 581 – 629. KIM

Implementation Science Supports
Implementation supports increase direct practice change from 5% to as much as 95% Implementation supports (i.e. fidelity monitoring and supervision/coaching) help staff see the new evidence based practice is not ‘just another change/project/model’ Increases staff’s ability to provide the new evidence-based practice competently & flexibly KIM

Implementation Planning to Date
Developed Provincial implementation plan using implementation science framework Fine tuning tools and processes to support implementation Developing infrastructure (i.e. catalyst) Capacity building for DTFP implementation team Certification to trainer level of GAIN assessment tool KIM

DTFP Implementation Team
DTFP Implementation Team includes: DTFP Implementation Supervisor Implementation Coordinator (assigned to LHIN) Implementation Coach (assigned to LHIN) Evaluation Coordinator Knowledge Broker Research Analyst (OPOC-MHA) Dr. Brian Rush providing ongoing consultation and guidance to the team KIM

What is Being Implemented
The Details: What is Being Implemented

Best Practices for Screening and Assessment – Key Principles
Structured information gathering with validated tools is vital: unstructured interviews miss co-morbidity – you have to ask! Staged approach saves time and resources for the longer screening and assessment Tools that cover both mental health and addictions enhance communication & relationship building across sectors Assessment has individual, organizational and system level implications.

Staged Screening & Assessment Process
If score is 2 or greater on internalizing scale, proceed to 2nd stage screener. Stage 1 Screener: GAIN SS Stage 2 Screener: MMS (18+) POSIT (12-17) Stage 1 Assessment: GAIN Q3 MI ONT (with detailed SU & tx. history) If score is less than 2 on internalizing scale, proceed to 1st stage assessment. NOTE: The internalizing scale cut off of 2 is under review presently. Some people are familiar with the GAIN family of tools. You can note that the detailed substance use and treatment history section are the SU grids taken from the GAIN I. Some also familiar with use of PDSQ in the pilot. If they ask, you can note that it was dropped from broad scale implementation for a couple of reasons: 1) the MMS does a similar and adequate job getting at MH issues and 2) PDSQ is cost prohibitive at $2 US per use so not sustainable

All Tools Available in English and French
Will be accessible via Catalyst/DATIS Ease of administration Supports development of clinical profile/system level data NOTE: If asked about using with First Nations, Metis and Inuit population, please note that the SS&A tools were not piloted or validated in Ontario with that population. Which is not to say that some organizations serving this group will not choose to use the tools and we are pleased to support this. But, we are not saying that these are validated for that population. May also note the other DTFP project under Renee Linklater’s purview that is developing a trauma informed, addiction assessment tools for First Nations and Inuit populations. INFO Package to include hard copy sample of all tools

Stage 1 Screening: GAIN-SS
Studied and used in a number of different settings including Canada Valid and reliable down to 10 years of age – Canadian validation with adults – recommend for age 12 and up Cost: $100 agency licensing fee for 5 years unlimited use Self- or clinician-administered (via GAIN ABS or paper and pencil) Reported to take minutes to complete Pilot used the CAMH-modified version – 7 additional questions NOTE: CHS has history of providing GAIN SS licenses to large geographic areas at a cost of $100. We will investigate this by LHIN area.

Stage 2 Screening (Adults): Modified Mini Screen (MMS)
Validated in public sector settings in the U.S. No cost 22 items divided into 3 sections to capture the three major categories of mental illness (mood, anxiety and psychotic disorders) Paper and pen: self-/clinician- administered Estimated 15 minutes to complete

Stage 2 Screening (Youth): Problem Oriented Screening Instrument for Teenagers (POSIT)
Valid and reliable Designed to identify problems and potential treatment/service needs in 10 areas including substance abuse, mental and physical health and social relations Estimated minutes to administer, 2-5 minutes to score Administered by self/clinician and with paper/computer For use with clients aged

Stage 1 Assessment: GAIN-Q3 MI (Ontario Version)
Developed by Chestnut Health Systems in Illinois Good psychometric properties One of main instruments in the GAIN family of assessments Ontario version was developed to increase the tool’s relevance to the provincial context Incorporated items around trauma and barriers Cross-walk with ADAT; mapped to strengths and needs criteria

Stage 1 Assessment: GAIN-Q3 MI (Ontario Version)
Multi-purpose tool that identifies a wide range of life problems For use among adolescents and adults in both clinical and general populations For use in diverse settings Established with strong focus on subsequent outcome monitoring Diverse Settings: i.e. mental health and substance abuse treatment, health clinics, juvenile and criminal justice programs, and child welfare programs

Content of GAIN-Q3 MI (Ontario Version) Basic Domains Covered:
School Problems Work Problems Physical Health Sources of Stress Mental Health Risk Behaviours for Infectious Diseases Substance Use Crime and Violence Life Satisfaction

On the GAIN-Q3 MI (Ontario Version) Each domain includes motivational-based questions specific to readiness for change and reasons for changing behaviour Estimated 45 minutes to complete face-to-face administration Computer/ABS (accessed via Catalyst) paper-and-pencil Self administration in a group format being used regularly at one of the pilot sites (quite successfully) Completion time: but pilot study suggests a bit longer (though this decreases with clinician experience)

On the GAIN-Q3 MI (Ontario Version)
Supports system-level client profile mentioned previously A number of reports can be generated to support clinical decision making and referral process Individual Clinical Profile (ICP) Personalized Feedback Report (PFR) Recommendation Referral Summary (RRS) Validity Report Info package to include hard copy sample of reports

Examined Complementarities of GAIN-Q3 MI ONT with other Tools
Crosswalk between GAIN-Q3 and OCAN, RAI and LOCUS was conducted to explore relevant contributions of the GAIN-Q3 Results: Tools can complement each other Only the GAIN Q3 provides the level of information needed for substance use assessment and treatment planning

Substance Use Grids Embedded within the GAIN Q3 MI ONT:
Provide greater depth of information regarding substance use and treatment history Supports referral and/or treatment planning for clients with more complex issues Clinician may administer in same session as Q3 MI ONT or subsequently if more information deemed necessary Note: SU grids allow direct mapping of substance use problems onto the DSM criteria (currently updated to V) for substance use dependence or abuse. In addition to its clinical significance this information can also be used for population/system level metrics

In Summary, New Staged Process……
Includes screeners: That are quick and easy to administer Provide comprehensive look at relevant psychosocial domains Facilitate referrals for mental health services Includes assessment that: Is comprehensive and standardized Provides concrete recommendations for treatment planning and referral Includes reasons & readiness to change questions that are highly valued Provides a strong foundation for outcome determination

Value Add at Multiple Levels
Clinical: Assessment a process that should occur over time Assessment needs to be motivationally oriented and comprehensive across bio-psycho-social and spiritual domains of health Assessment alone can contribute to outcomes GAIN assessment fidelity is linked to clinical outcomes Assessment plus evidence-informed interventions improves outcomes Assessment has individual, organizational and system level implications.

Organizational: Analysis/summary of initial assessment data Organizational clinical profile informs program planning and quality improvement Electronic administration and printable validity reports (that notes administration inconsistencies) can support performance monitoring and coaching Assessment has individual, organizational and system level implications.

System: Structured data: Basic information on demographic characteristics of clients that can be compared to the community profile to identify under-served populations Development of clinical/severity-based profiles of people in treatment (i.e. to confirm that those with the most severe profiles are being served in the most cost-intensive services) Provide a baseline for follow-up outcome assessment, which also has value at the individual level

Clinical & Agency Value-Add Summary
Tools with sound psychometrics and track record Comprehensive assessment and resulting reports facilitate better treatment planning Higher concurrent disorder capacity High level of detail on substance use and overall severity: holistic view of client need Fully integrated process incl. report generation Agency clinical and psychosocial profile = informed planning

LHIN/System Value-Add Summary
Placement matching: Initial client assignment to a treatment setting with appropriate resource intensity (important cost implications and better use of existing resources) Detailed client profiles for community gap analysis, project planning (i.e. reducing ER and hospital use) and performance monitoring High potential for outcome monitoring Comparable data with other LHIN’s for potential benchmarking

OPOC-MHA Implementation

OPOC-MHA Implementation
Objective: Systematically implement OPOC-MHA across all MoHLTC funded substance use, concurrent disorder and mental health services Projected Outcomes: Standardized information regarding client satisfaction/perception of care Enhanced quality improvement and accountability processes at both service and system levels across Ontario

OPOC-MHA Administration Essentials
Details of tool administration can and will vary by agency Each agency and/or program can determine how and when the tool should be administered Four key requirements: Provide entire questionnaire Ensure anonymity Ensure completion is voluntary Provide facilitation as needed Tool is copyrighted.

OPOC-MHA Data Collection
Variety of ways the OPOC-MHA can be administered. No prescribed way, as this depends on the practices of each agency and/or program Distributed to clients in many ways, i.e. group setting, individually, in person at the agency or through /mail Current administration via paper and pencil or electronically through Fluid Survey database Data will be collected and analyzed centrally Future administration through DATIS/Catalyst (for both MH and A)

OPOC-MHA Administration
Timing At any point in the person’s treatment process One question asks which part of the treatment process a participant is currently engaged Scoring Likert scale strongly agree, agree, disagree strongly disagree, N/A

Analyzing OPOC-MHA Data
Analysis & interpretation of OPOC-MHA data may involve individual or grouped items Responses to each item may be reported as % OR averages “Overall Perception of Care” score Plus subscale scores for “Accessing Services” & “Within Services” Scales # of Items Items Scoring Overall Perception of Care 23 1-8, 12-15, 17-18, 20-25, 30-32 Average score of the 23 items Accessing Services 6 1-6 Average score of the 6 items Within Services 17 7-8, 12-15, 17-18, 20-25, Average score of the 17 items

OPOC-MHA and Quality Improvement
OPOC-MHA designed to capture information on quality improvement indicators such as: safety, accessibility, client-centredness, equity, integration, effectiveness, and appropriate use of resources OPOC-MHA identified by Accreditation Canada as an instrument approved for use for assessing client satisfaction/perception of care for accreditation purposes NOTE: Be aware that CAMH developed and is using (along with the other psychiatric hospitals) a survey called CES or Client Experience Survey. This was developed with psychiatric inpatient in mind.

Implementation Next Steps
LHIN Engagement - Scope of the work # of agencies key contacts (A and MH networks?) current process for system access etc. Development of LHIN-specific implementation plans Using Implementation Science Connected to overall Provincial plan Contextualized to the LHIN Development and implementation of LHIN and agency supports KIM

Note on Coordinated/Central Access
Staged process lends itself more to coordinated access models than previous ADAT assessment process who does what component can vary but the package is well-developed and supported LHIN-level implementation plans will be developed for the specific community context Supported and tailored approach Implementation will work within access model to determine how the tools best fit KIM Key point: implementation contextualized to community, including way people access care - Staged process more conducive to application in coordinated access model than ADAT. A matter of determining who does what element.

Key Milestones and Timelines
Anticipated Timeline Engage with early adopter LHINs May/June 2015 Assemble DTFP Advisory Committee and SS&A/OPOC Working Group June 2015 Develop LHIN Specific Implementation Plans July 2015 LHIN Implementation Team Development August 2015 Develop Agency Implementation Plans (incl. coaching support) August/September 2015 KIM

Key Milestones and Timelines
Anticipated Timeline Training and Capacity Building Begins September/October 2015 Initial Implementation begins in Early Adopter LHINs October 2015 Track implementation, monitor progress, engage in developmental evaluation October 2015 – April 2016 Engage with remaining LHINs February/March 2016 Full Implementation in Early Adopter LHINs May – December 2016 KIM

Training: Staged Screening & Assessment
Mixed modalities Web based training on some elements Introduction to the process GAIN – SS MMS POSIT Face to face training GAIN Q3 MI ONT Motivational Interviewing Implementation KIM

SS & A Training Plan Overview
Chestnut Health Systems Trains DTFP Team to Trainer Certification Level on GAIN Q3 MI ONT Trains Team of LHIN Based Trainers to Trainer Certification Level of GAIN Q3 MI ONT DTFP Team Trains early adopter/champion agencies in each LHIN on entire SS&A process, including administration certification on GAIN Q3 MI ONT Trains Team of LHIN Based Trainers on all other elements of the SS&A process LHIN Based Trainers Trains all other implementing agencies on the entire process (with DTFP Team support) and provides ongoing training for sustainability KIM Explain: 2 levels of certification on the GAIN Q3 MI ON – administration and trainer level Only CHS can train to trainer level certification They have engaged with our team so we can become trainers and will engage with LHIN based team to become trainers (sustainability) To get some folks into initial implementation, DTFP Team will train champion/early adopter agencies in the LHIN to administration certification while training team is engaged with CHS to get trainer certification (which can take several months) LHIN based training teams will need to train on entire process ongoing (Intro, GAIN SS, MMS, POSIT, GAIN Q3 MI, MI, Implementation

OPOC-MHA Capacity Building
Web based orientation and training Understand the tool Administration details Data gathering Quality Improvement implications KIM

Linda Sibley Donna Rogers Addiction Services of Thames Valley FourCast
Kim Baker Brian Rush DTFP Implementation Supervisor Project Consultant Linda Sibley Donna Rogers Addiction Services of Thames Valley FourCast Brian to close?

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