Using standardized tools to improve mental health and addictions services
In November 2020, Evidence Exchange Network (EENet) and Community Care information Management co-hosted a World Café-style event with more than 70 participants, focusing on the use of standardized tools.
Participants were located in every region of the province (as well as the province of Alberta) and represented sectors such as: community mental health and addictions; harm reduction; social services; developmental services; housing; children/youth and family mental health; hospital; government; public health; education; settlement services.
Each participant took part in three facilitated, small-group, virtual breakout sessions focusing on their topic selections out of a total of nine topics. The breakout sessions allowed participants to learn from each other's experiences and hear more about how to use different tools to support client-centred care and quality improvement.
The nine breakout topics and their facilitators are listed below:
- The OPOC tool for Mental Health and Addictions: Collecting and using client feedback to improve services (Renee Behrooz & Jonathan Berges)
- Using SS&A tools to support client care (Marina Menezes & Deanna Huggett)
- Using interRAI ChYMH in the child and youth sector (Jaime Brown)
- Using interRAI MH in in-patient mental health (Naomi Vodden)
- How to use data that come from the tools (Frank Sirotich)
- Using the tools for QI projects (Laura Daly-Trottier)
- Using the Recovery Model to support staff and client engagement with assessments (Nicole Allin)
- Using OCAN and other standardized tools to frame recovery plans and progress notes (Deb Pultz & Kathy King)
- Using the integrated assessment record (IAR) to support client care and facilitate inter-agency communication (Ashim Rizki)
Stakeholders participating in the event agreed that the use of standardized tools is essential for raising the quality of mental health and addictions services. Client information collected in evidenced-based tools can lead to better care at the individual client level and the data can be used for planning and performance measurement at various levels.
Below is an overview of the themes that emerged from the breakout sessions, looking specifically at the challenges associated with using the tools, strategies to address these challenges, and how to leverage the use of standardized tools for quality improvement.
Next steps: We plan to host other World Café-style events that will focus on select topics of interest. If you would like to hear from us when we schedule these events, please ensure that you subscribe to the EENet newsletter.
Summary of sessions
Challenges/barriers to the use of tools
- Lack of staff understanding of the benefits of using the tools.
- Insufficient staff training on how to use the tools for service planning and quality improvement.
- Lack of client understanding of how the tools work and the benefits of using them.
- Perception that the tools take too long to complete.
- Gaps in comfort level and access to technology among some service providers and clients.
- Lack of structured documentation processes in some organizations.
- Lack of tool integration and poor information sharing among organizations, sectors and regions.
- Limited tool relevance to the needs of certain populations (e.g., Black, Indigenous and people of color [BIPOC]; individuals with non-binary gender identity).
- Loss of client engagement and rapport building during the COVID-19 pandemic.
Strategies organizations can use to address challenges/barriers
- Focus on continuous training for staff to enhance optimal use of standardized tools and increase buy-in.
- Equip staff with the technology and training they need to increase their comfort level with using standardized tools.
- Educate clients on the benefits of the tools for goal setting and treatment planning to engage them in the assessment process.
- Highlight the benefits of virtual tool administration for clients (e.g., reduces childcare and travel costs; lower risk of COVID-19 transmission) and for service providers (e.g., ability to gather data to compare client and program outcomes over time).
- Engage clients in service planning and provision as well as in quality improvement, especially BIPOC groups and vulnerable populations.
- Divide assessments into multiple short sessions, using the tool to guide the conversation with the client about their needs and desires for their care plan.
- Be flexible and adapt how tools are applied.
- Meet the client where they are to do the assessment, even if that is on a street corner.
- Build a culture of recovery to ensure staff approach service provision from a Recovery Model framework (i.e., embed Recovery Model training in agency/program processes and procedures, e.g., Recovery Model staff training curriculum at CMHA Peel Dufferin).
- Approach assessments from the client’s perspective (e.g., watch for traps such as use of clinical language, jargon, and acronyms, making decisions for the client).
- Ensure the client and/or family are in control of decision-making.
- Watch for stigmatizing language or use of stereotypes when discussing clients.
- Identify alternate methods for completing the tools to comply with physical distancing requirements during the COVID-19 pandemic (e.g., phone calls; fillable PDFs; Survey Monkey questionnaires; Ontario Telemedicine Network; email response cards).
Recommendations for the system to help overcome existing challenges to using the tools
- Make tools shorter, more user-friendly and easier to understand for staff and clients.
- Streamline and integrate the different tools and assessments – reduce the administrative burden on staff by mapping tools and eliminating duplication.
- Improve technology:
- Centralize software procurement
- Provide organizations with reports and the ability to query their data
- Provide organizations with dedicated resources for decision support/quality improvement (QI) work as currently many organizations are doing this “off the side of their desks.”
- Adapt assessments to be inclusive of and compatible with the cultures and traditions of clients and other equity-seeking groups. In particular, consider language and other elements of the tool that may be oppressive to certain groups (e.g., BIPOC; non-binary individuals; people of various ethnicities, etc.).
- Make training modules available to a more broad range of stakeholders, especially those in regional programs.
- Establish/strengthen information-sharing mechanisms among organizations and sectors.
- Implement a Recovery Plan blueprint. Ensure that service providers understand how they can link the tools to the Recovery Plan as a blueprint for service delivery.
- Develop resources to help educate clients about the uses and benefits of the tools.
- Ensure that reporting requirements align with standardized tools.
- Focus on treaty representation. Develop a tool that is easy to use and accessible 24/7 to Indigenous clients.
- Connect and collaborate with jurisdictions that work with BIPOC.
How to use the data that comes from standardized tools
- Ontario Health Teams can compare the readmissions against hospital data to inform planning.
- Collaborate with the local hospital to look at 30-day emergency department readmission data and determine if there are any patterns in client characteristics.
- Use the physical health domain in the OCAN tool for a QI project (e.g., use it to improve access to primary care services provided to supportive housing clients involved in the justice system).
- Consolidate client information in a single data repository to allow for sharing across the continuum of health services so that everyone in the circle of care has all the information they need to provide effective care (e.g., integrate the PS Suites EMR primary care database with IAR).
- Integrate the organization’s QI team with the accreditation team to identify connections.
- Undertake a research project using the tool data.
- Look at elements of various tools to determine if there are common elements that can be mapped into quality standards or strategic priorities.
- Use the InterRAI suite (child & youth, MH, geriatric) to integrate data with other sectors and tools.
- Use the Global Appraisal of Individual Needs (GAIN) addiction suite of tools to determine clients’ substance use health status at the time of clinical care. Measure client outcomes using the GAIN Short Screener to identify changes over time.
- Ways to use the Ontario Perception of Care for Mental Health and Addictions (OPOC) tool:
- Use the filters to look at specific areas or populations.
- Use OPOC data through a health equity lens.
- Identify data quality issues and work to improve data collection and response rates.
- Use data to inform better client outcomes, strategy, highlight successes/clinical cases.
How to increase the use of standardized tools for QI projects
- Use the following strategies to enhance staff uptake of tool use for QI purposes:
- refresher training
- review of processes and procedures
- dedicated resources
- embed use of data from tools into daily work
- support from managers/senior leadership.
- Collect data over time to monitor improvements and inform future work.
- Learn about what other organizations are doing and use networking to discuss possible solutions.
- Use established QI tools (e.g., process maps, standard operating procedures) to guide QI practices.
- Increase staff buy-in for QI methods by connecting the results to direct care.
Nicole Allin, Manager, Recovery West & Impact, Canadian Mental Health Association, Peel Dufferin, AllinN@cmhapeel.ca
Renée Behrooz, Implementation Specialist, Provincial System Support Program, CAMH, Renee.Behrooz@camh.ca
Jonathan Berges, Implementation Specialist, Provincial System Support Program, CAMH, Jonathan.Berges@camh.ca
Jaime Brown, Research Coach, Ontario Centre of Excellence for Child and Youth Mental Health, JBrown@cheo.on.ca
Laura Daly-Trottier, Quality Improvement Coach, Excellence through Quality Improvement Project (EQIP), firstname.lastname@example.org
Deanna Huggett, Manager, Implementation, Provincial System Support Program, CAMH, Deanna.Huggett@camh.ca
Kathy King, Quality Improvement Team Member, Excellence through Quality Improvement Project (EQIP), email@example.com
Marina Menezes, Implementation Specialist, Provincial System Support Program, CAMH, Marina.Menezes@camh.ca
Debra Pultz, Manager of Mental Health Programs, CMHA Cochrane Timiskaming, firstname.lastname@example.org
Ashim Rizki, Business Lead, IAR and Assessment, Community Care Information Management email@example.com
Frank Sirotich, Director of Research and Evaluation, CMHA Toronto firstname.lastname@example.org
Naomi Vodden, Director, Mental Health and Addiction Services, Grey Bruce Health Services, email@example.com