How are agencies around Ontario using the Ontario Common Assessment of Need (OCAN)?

What is OCAN?

The Ontario Common Assessment of Need (OCAN) is a standardized assessment tool that gathers information on 24 domains and:

OCAN was selected by the community mental health sector in 2007. The tool is based on the Camberwell Assessment of Need. Additional elements were included to reflect Ontario’s community mental health sector. OCAN was implemented in 200 health service provider (HSP) organizations between 2010 and 2013.

In this issue of EENet’s Promising Practices, three community agencies answer our questions to explain:

The agencies sharing their experiences with OCAN are:

Read this issue of Promising Practices below or download the PDF.

Tell us about your agency and when you started implementing OCAN?

CMHA Champlain East: CMHA Champlain East covers the five united counties of Stormont, Dundas, Glengarry, Prescott Russell, and Akwesasne. We were early adopters of OCAN, so we’ve been working with them [Community Care Information Management (CCIM), the project that supports the OCAN] for several years now.

CMHA-Haliburton, Kawartha, Pine Ridge Branch: Our CMHA branch services a pretty large geographic region, about the size of Prince Edward Island.

OCAN started a number of years ago as a Ministry of Health driven tool, so we decided that we were going to jump on board and have all our staff and managers trained. It also became the tool that we decided to use for all intakes going forward, so any individuals coming into our agency would start with an OCAN assessment.

Crisis Response Services Kenora Rainy River District & Dryden Regional Mental Health & Addictions Services: We started using OCAN in 2012. We offer outpatient services, including case management, community mental health treatment, addictions treatment and problem gambling treatment.

What strategies have you used to implement the OCAN?

CMHA Champlain East: We formed a working group of front-line staff along with a manager to support the implementation. They are trained, work closely with supervisors, and act as peer leads/trainers to the rest of the staff. This creates buy-in at the start from front-line staff as they are part of the working group. Having buy-in from the management team at the start is also essential – you cannot implement any assessment tool without having the whole agency on board.

Our OCAN working group meets together every six weeks to discuss issues that are raised by their peers, training that is needed, and accomplishments. The OCAN reports are
reviewed to see if there are any incomplete OCANs or OCANs that were not uploaded to the Integrated Assessment Records (IAR). The working group determines what can be done to
correct the issue and minimize errors. Sometimes the leads in the working group don’t agree on everything, but we discuss all issues and work to iron out everything before the meeting is done. This way all members can communicate the information back to their peers with full understanding and agreement.

We have peer-to-peer shadowing for new staff when they do their first few OCANs. It’s valuable for new staff to observe colleagues completing OCAN with clients, and for experienced staff to support them when they are completing OCAN with their clients for the first couple of times.

At our yearly staff meeting, we include re-training of OCAN to keep everyone fresh on the information.

CMHA-Haliburton, Kawartha, Pine Ridge Branch: We highlighted at the start that OCAN is a valuable evidence-based assessment tool, and we need to use it as such. Staff buy-in has been pretty good here because everyone has been able to participate in determining how we are going to use OCAN. We have so many different programs, e.g. peer support, case management, crisis. So we got everyone together around the table to outline different approaches to using OCAN depending on the service type, and created a manual on how to implement within each program. This helped respond to staffs’ concerns as to how this tool fits within their specific type of work. OCAN is a good framework; you can adapt it to fit each program.

Entering OCAN in the same software has been a help as it makes sharing the OCAN assessment much easier across the agency. If someone is connected to a different program, it’s easier to have all the information in one place.

Crisis Response Services Kenora Rainy River District & Dryden Regional Mental Health & Addictions Services: We received the training offered by our Local Health Integration Network and we have ongoing conversations in our team meetings around how staff are finding the tool, the challenges, whether it’s been useful, etc.

We conduct OCAN electronically and also via pen and paper when we are out in the community. Quite a few of our clients also have strong paranoia, so they will not use the electronic
version, which adds more work for the staff to have to go back and enter the data. If there was a scanning option with the pen and paper version, that would be great!

What are some challenges of using OCAN?

CMHA Champlain East: Some of our staff first saw OCAN as extra clerical and paper work. They also wondered if the tool was going to take away from face-to-face meetings with clients. But after the staff have done the OCAN a couple of times and learned a way of communicating the tool with the client there is more flow to it. They appreciate the OCAN because it’s opened up doors to some of the questions that they might not have asked before. They are also using it to develop service plans with clients.

Some of the challenges they are still facing are around the clients they have not been able to engage for long enough to have a complete OCAN done, or clients that have initially completed OCAN, but then staff are unable to find them to follow up.

Redoing OCAN every six months can be challenging. Some clients feel like it’s too soon and they are questioning if it can be done more sporadically or longer than every six months. I’d
like to see more flexibility for the agencies to determine the frequency of when it should be done.

CMHA-Haliburton, Kawartha, Pine Ridge Branch: One challenge that we run into is that not all agencies complete OCANs in the same way. OCANs completed by some agencies are not as comprehensive as in our agency, so we’re having clients tell their whole story again.

For individuals that have chronic mental health symptoms (e.g., psychosis), completing OCAN can be problematic, depending on their level of wellness.

The six month frequency seems to be ok for us. It’s good practice to do a review of progress and next steps with clients. Initially there was concern about doing it every six months, but having the right software helps. It’s a click of a button and everything repopulates, allowing staff to review the assessment and only revise what’s changed for the client. This really shortens the length of time for reassessment. Our software also allows us to pull up the different OCAN reports so we can see the levels of need change over time. We are looking at how to utilize some of those statistics to engage individuals better and track their progress.

Crisis Response Services Kenora Rainy River District & Dryden Regional Mental Health & Addictions Services: Clients find OCAN long and they don’t understand it. Clients’ feedback is that they don’t find it excessively helpful in their day-today needs that they have. For example, for our case management clients, they are more focused around finding housing, help with talking to ODSP [Ontario Disability Support Program], budgeting, cleaning their place, getting groceries, the basic needs that clients need help with. Clients don’t appreciate using our time together to do the assessment instead of dealing with those issues. 

It doesn’t seem to be a tool that fits with our community, for example some communities might provide education to clients on transportation, but in our community, we don’t have a transportation system! 

At lot of time and resources were invested in OCAN. But it has to be looked at from a different perspective. Everything is generally based around a big city, and then gets filtered down to us, and it ends up not making sense in a small community, like ours. There is a benefit of consistency, but some things just don’t apply for us, and you can’t compare apples to oranges.

What is unique about this practice compared to other practices aimed at achieving similar objectives?

CMHA Champlain East: OCAN encompasses the client’s perspective, so you’re asking them for their input first. There is a lot of value in the client completing the tool with the staff. It’s not the staff completing the document on their own. You are looking at what clients feel their needs are and what you are seeing as staff, and it offers the opportunity to discuss any differences. It opens up a lot of doorways between the client and the staff, and it helps to build the connection and the rapport.

CMHA-Haliburton, Kawartha, Pine Ridge Branch: We use OCAN to guide how we provide services in our agency. It’s really become a bio-psychosocial assessment for individuals accessing services. Clients like OCAN because we are having a lot of conversations with them guided by their responses in the self-assessment. All of the action plans generated from OCAN are used to make a plan on how to drive it forward. It’s a big part of what we do here – we focus on making it client centered, so we help the client walk through it and see that they are making progress in certain areas.

Crisis Response Services Kenora Rainy River District & Dryden Regional Mental Health & Addictions Services: OCAN is unique in that there has been research conducted on it. Also, if you want to pull data about specific information, for example legal issues, that’s available and being able to track data is valuable too. 

Are there factors or aspects of implementing the OCAN that make it ‘work’?

CMHA Champlain East: You have to believe in the tool. If you don’t believe in the tool, then it won’t be successful. We’re often asked how do we have such a high percentage of clients willing to complete the self-assessment and consenting to have their OCAN shared with other service providers in the Integrated Assessment Record (IAR). It’s because of the way staff introduce the tool to clients. They believe that it’s a worthy document and let the client know this, and the clients feel that and appreciate it. 

CMHA-Haliburton, Kawartha, Pine Ridge Branch: The biggest factor is that all agency staff are on board with doing OCAN. We also have training sessions, a working group that discusses what’s working/what’s not, and regular audits on how OCAN is being completed.

Crisis Response Services Kenora Rainy River District & Dryden Regional Mental Health & Addictions Services: OCAN is supposed to provide consistency across the province, determine what clients’ needs are, how to best meet those needs, flow as a natural part of your session, and be userfriendly. The intent is excellent, but the tool doesn’t seem to meet the hope.

How has your agency’s use of OCAN changed since the start?

CMHA Champlain East: Initially, the requirement for a client’s first OCAN was to complete it within 30 days of the client entering the agency. Sometimes when you’re dealing with severe and persistent mental illness, getting them through the door is a success in itself and you don’t want to scare people off with a 24 life domain assessment. In those instances, the first OCAN is completed within 60 days.
There was also a recommendation at the beginning that OCAN be part of the initial assessment process. We found that for our agency, we cannot do it on intake as it would be too long. Then, at the end, if you tell the client they don’t meet the criteria or it’s not the appropriate agency, you’ve just asked a lot of personal questions for nothing. As a result, we decided to use OCAN once the client has been accepted into the program and assigned a worker. 

We are now entering OCAN information electronically during the assessment conversation with clients. A lot of staff were hesitant at first, as they felt that it might break the therapeutic relationship, but once they adopted the practice and we made laptops and tablets available, they see that it works and saves them from extra clerical work.

CMHA-Haliburton, Kawartha, Pine Ridge Branch: Our use of OCAN has changed somewhat. Right off the bat we used it as a comprehensive assessment
tool. Now, the first OCAN is done at intake and it’s helping us to more rapidly direct individuals into appropriate services within our agency and in our community.
One of the initiatives we’ve done here is develop a transitional-aged youth program using OCAN. 

We recognize that there are a lot of challenges for youth accessing adult services. So we went out in our area and trained staff from youth programs to utilize OCAN for transitioning youth from their services to adult programs. The youth now being referred to our programs already familiar with the tool and they are able to start recognizing their needs more effectively using the tool. 

We also recently overhauled our intensive case management, based on OCAN, by focusing service activities on the needs identified by the clients. So we’ve been able to connect individuals quicker and more efficiently with the right services within our community and our agency.

Crisis Response Services Kenora Rainy River District & Dryden Regional Mental Health & Addictions Services: Our main change was that we enter CDS [Common Data Set] in OCAN. Initially, we used the self-assessment as part of their intake and now we do not, as we got feedback from the staff and clients that it’s not helpful.

Where do you see OCAN going in the future and do you have suggestions?

CMHA Champlain East: I’m hoping OCAN gets mandated so more agencies will do OCAN and upload to the IAR. It will then help to achieve the goal of seamless, accessible services for the clients. We can only do that if every agency is doing the same thing. 

CMHA-Haliburton, Kawartha, Pine Ridge Branch: Within our region, there are other agencies that do OCAN, but it hasn’t been rolled out everywhere. It would be valuable if OCAN was used throughout the entire community mental health sector having everyone ‘speak the same language’ across the province.
Crisis Response Services Kenora Rainy River District & Dryden Regional Mental Health & Addictions Services: Our first suggestion is to take away all the rules around when it has to be done. It is important to have some consistency throughout the province in the way client information is captured, so there is benefit in that. 

Published February 2016

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