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Experience Exchange: Using OCAN in day-to-day work with clients at CMHA Niagara

The Ontario Common Assessment of Need (OCAN) is the standardized assessment instrument used in the community mental health sector since 2009. This tool supports conversations between service providers and their clients. It helps to better understand the client’s current situation, needs and strengths, and to develop a service plan. OCAN assesses needs in 24 areas called “domains." OCAN supports a recovery approach with the inclusion of a client self-assessment component.

OCAN Graphic. Areas of Need: Accommodation, Alcohol, Basic Education, Benefits, Child care, Communication, Company, Daytime activities, Drugs, Food, Information on condition and treatment, Intimate relationships, Looking after home, Money, Other addictions, Other dependents, Physical health, Psychological distress, Psychotic symptoms, , Safety to others, Safety to self, Self-care, Sexual expression, Transportation.

At a recent virtual train-the-trainer session hosted by EENet and Ontario Health, Terri Jackson, Clinical Manager at CMHA Niagara, discussed her organization’s approach to using the OCAN in day-to-day work. This edition of Experience Exchange features highlights from her presentation in her own words, edited for clarity and length.

Using the OCAN to guide day-to-day practice with clients

When we use the OCAN tool in our day-to-day practice, it feels less like another checklist we have to use to get the gold star from our supervisor and more like an actual working document that’s guiding our practice.

At CMHA Niagara, we use the OCAN pretty much in every program within our agency, and the beauty of the OCAN is that it really can be tailored to meet the needs of each program. In some of our longer-term services, it guides the day-to-day sessions with clients, while in some of our shorter-term services, it helps determine what impact and support we can make with the limited time we have.

Our use of the OCAN starts at intake when somebody comes in seeking services. The tool helps us identify the client’s needs and what support we can provide to meet those needs. We then use the OCAN in care planning, to help us define the client’s goals and identify what actions will help us achieve those goals.

We also use the OCAN in our meetings with clients and at discharge planning. Having conversations regularly about the client’s shifting needs using the Needs Over Time Report and showing the progress that the client is making helps to prevent discharges from being too abrupt.

Keeping the OCAN relevant and useful in day-to-day practice

Intentional practice

At CMHA Niagara, we use the OCAN intentionally to guide our practice from developing the care plan to our day-to-day services. When I was doing frontline case management, I would bring OCANs to each appointment—physical paper copies. I would review it with the client to identify those needs that were still unmet and what the client wanted to focus on during the session.  

The OCAN can help keep our sessions with clients tightly focused (see Example). Since many of our clients experience crises, service providers sometimes take a crisis approach to their work at times when it may not be needed. But using the OCAN at client meetings can help bring us back to answering the questions:

So the OCAN is a good starting point to develop that plan and guide the day-to-day practice.

Example: OCAN domain - Psychological distress

GoalActions
To feel less anxious

Use a mindfulness application daily

Go for a walk every morning

Refer to cognitive behavioural therapy (CBT)

Case Study: Psychological distress

The case study below shows a client who was experiencing psychological distress and how we might approach such a situation with them. Psychological distress is one of the domains in OCAN and is defined by symptoms of anxiety and/or depression.

In session, the service provider would refer to the OCAN content and discuss what has been happening over the past month. In this example, the client shares that they’ve been worrying about having a relapse and needing to return to the hospital. The client had been told that they had experienced a substance-induced psychosis that led them to be hospitalized. They were discharged with no medication review and no follow-up. The client then shared that they’re currently fearful of the symptoms reoccurring but don’t have a family doctor or psychiatrist who can provide follow-up.

In session, the service provider would engage the client in a conversation about what has brought them to this point and what actions might help relieve their worry about a relapse, such as exploring resources within the region-211 or Niagara Health Family Doctor Directory, which would help them secure a doctor. We could get a Centralized Access to Psychiatric Services (CAPS) referral for faster access to psychiatric assessment and a medication review. We could also refer them to an early psychosis intervention program if the client feels this is appropriate. All of this would always include asking the question: what is the client ready for?

These actions could be completed independently by the client or with the provider’s support. It’s important to always use a trauma-informed lens to validate traumatic experiences the client has had, their fear of relapse and of the unknown, and to congratulate them for seeking support now. It’s important to keep the goals client-centred, focusing on what’s manageable and prioritizing what they’re ready to do independently and providing support when the client needs it.

Client example: Psychological distress domain in the OCAN form

Client self-assessment: 

Client example: Psychological distress. Client selected: Unmet need: A serious problem despite the help I'm given. The client left the following comments: I'm really worried about ending up in the hospital again.

Staff assessment: 
Psychological distress
Have symptoms of depression or anxiety been a problem (an area of need)? These could include feelings of sadness or worry that interferes with your daily life. Are you getting the help you need? Staff rating

1. Does the person suffer from current psychological distress?*
(if rated 0 or 9, go to the next domain)

**Refer to OCAN content during regular appointments. 

2
*unmet need
2. How much help does the person receive from friends or relatives for this distress? 0
3a. How much help does the person receive from local services for this distress? 0
3b. How much help does the person need from local services for this distress? 3
*high level of help
Comments:
The client reports that at some point they were told they had substance-induced psychosis that led to them being hospitalized. Once released, there was no follow-up/medication review. They share that currently, they are fearful of symptoms reoccurring, but they do not have a family doctor or psychiatrist to follow up with.
Goal: Reduce the fear of being hospitalized again.
 
Action(s):
  • Use resources (211, Niagara Health family doctor directory) to get a family doctor. 
  • Access psychiatric assessment through CAPs referral. 
  • Use mindfulness techniques to address anxiety. 

Leveraging OCAN in trauma-informed practice

The majority of the clients who are coming through our doors have experienced trauma at some point in their lives, so during sessions we always aim to meet the five pillars of trauma-informed practice:

One of the domains that I find clients are often hesitant to have open discussions about is intimate relationships. So, when addressing this domain, it’s important to clarify what this means. The OCAN domain dictionary is a useful tool for this discussion, as it helps explain that this is not just a question about romantic or sexual relationships, it’s about the close people in their lives who they can trust, count on and make them feel safe. There is a separate domain called sexual expression, for questions related to sexual relationships.

Of course, with the OCAN, it’s always important to give the client the autonomy to say, “Not right now. I’m not ready to talk about that yet.” But it does open up the conversation so that the client knows it’s a safe place if they want to talk about it in the future.

Always learning

One of the things we’re trying to do at CMHA Niagara is work with our documentation system to link OCAN domains to case notes. This means that, when we’re writing case notes during a client session, we’re able to click on the domains that we’re working on that day and compare them against what we outlined during the initial assessment.

We’re also always learning about some of the things that other agencies are doing. Why recreate the wheel if we don’t have to? It’s important to remember that none of us is perfect but, despite this, we continue to learn and develop processes that guide our day-to-day work in using the OCAN as intended. This will help guide our practice based on what clients are looking for and what’s within our scope.

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