1. Disclosure The Implementation of a Specialized Geriatric Mental Health Outreach Program (GMHOP): Responding to the Needs of Long Term Care Homes Joanne Walsh, RN, MHS Anne Stephens, BScN, MEd, GNC(C) 2nd National Canadian Coalition for Seniors’ Mental Health Conference, 2007

2. Disclosure We would like to acknowledge the exemplary work of the Toronto Region Long Term Care/Mental Health (LTC/MH) Steering Committee in producing the Psychogeriatric Framework Report December 2006 For further information: ayau@toronto.ca Sandra Pitters: Chair, LTC-MH Implementation Committee Angelina Yau: Project Manager, LTC-MH Implementation

3. Presentation Overview Background Toronto Region Psychogeriatric Framework GMHOP development & implementation: key elements for success Challenges and benefits Q & A

4. Background MOH LTC Toronto Region Steering Committee established in November 2005 Response to the recommendations arising from the Casa Verde inquest report in June 2005 Part of the Toronto Region’s LTCH Bed Strategy to address the needs of individuals requiring specialized programming related to significant behavioral response issues

5. Model of System Failure Reason, J. “Education and debate. Human error: models and management.” British Medical Journal. 2000 Mar 18; 320 (7237): 769. Mishap Latent Failures Active Failures Failed or Absent Defenses

6. Toronto Region Psychogeriatric Framework A consistent, coordinated and integrated approach to providing care for seniors with serious mental health illness and serious behavioral response issues Based on current best practices

7. Tertiary Care EMS Hospital In-patient GMHOP Emergency Dept. CCAC LTC Team PRC LTCH Resident & SDM System Integration & Coordination Adapted from Toronto Region LTC MH Psychogeriatric Framework Report 2006

8. Geriatric Mental Health Outreach Program (GMHOP) Implemented in April 2006 Funded by the Ontario Ministry of Health and Long Term Care (Federal Accord Funding) Designated seven LTCH

9. Team Composition The team consists of: - 1 full time mental health - 1 part time geriatric psychiatrist

10. Target Population Seniors (55 and over) with serious mental illness and severe behavioral problems living in long term care homes

11. Services Consultation model - Assessment - Treatment recommendations - Follow up - Referral to other services - Family/SDM support and education - Education of LTCH staff related to clinical consultation

12. Key Elements for Success Ensure organization’s commitment Incorporate evidence based practice Establish trusting relationships Develop mutually agreed upon modes of communication Work in partnership with the various service providers Clarify roles Evaluate the program

13. Ensure Organization’s Commitment Ensure the program is in alignment with the organization’s vision, mission and values Identify champions Get stakeholder buy-in

14. Incorporate Evidence Based Practice Ensure practice standards, policies, protocols, and documentation tools reflect mental health/geriatric clinical practice guidelines (e.g. CCSMH, RNAO) Link with PRC for education to LTCH staff on clinical practice guidelines

15. Establish Trusting Relationships Initiate meeting with LTCHs at the outset to introduce self, discuss expectations, roles and responsibilities Meet regularly with LTCHs to review program implementation and progress and to resolve issues Establish collaborative relationships with service providers (i.e. DOCs, attending physicians, solo practitioners, front line staff, PRCs) Participate in case conferences and Professional Advisory Committees

16. Develop Mutually Agreed Upon Methods of Communication Develop tools in collaboration with LTCHs (e.g. referral form) Identify LTCHs needs regarding their specific processes (e.g. consultation notes) Establish communication protocols (e.g. urgent referrals)

17. Work in Partnership with the Various Service Providers Recognize that old and new “pieces” are coming together to form a new paradigm of care Understand that all “pieces” need to “fit” together to make it work and that some of the “fits” aren’t easy to “fit”

18. Putting the Pieces Together

19. Clarify Roles and Responsibilities Define roles and responsibilities of GMHOP and LTCH (e.g. information sharing, follow up on recommendations) Establish conflict resolution process

20. Evaluate the Program Satisfaction surveys Common Data Set (CDS) MOHLTC Research Grant to evaluate Toronto GMHOPs

21. Challenges Recruiting appropriate staff Gaining trust “Customizing” the program to meet the different characteristics and needs of LTCHs Interfacing with long term care system

22. Benefits Infusion of specialized geriatric mental health expertise Support/resource to LTCHs Timely interprofessional assessments, recommendations and follow up Avoid unnecessary hospital admissions Working towards an integrated system of care Opportunity for inter-professional education and research

23. Q & A