CELHIN Assertive Community Treatment Teams ACTT Quality Improvement

CELHIN Assertive Community Treatment Teams (ACTT) Quality Improvement Initiative: October 10 th, 2013 ACT TOGETHER Prepared by

Project Overview – Mission and Success Project Mission Project Success Increase capacity by 200 total spaces and flow within ACT Teams to potentially save 10, 000 hospital days 1. Find efficiencies and define standard practices within the topics of: 1. ACTT Intake & Referral 2. ACTT Treatment and Planning 3. Hospital and ACTT Relationships 4. Discharge From ACTT 2. Create MOUs to support the implementation of these efficiencies and standard practices for all ACT providers and primary stakeholders 3. Generate interest and support across the LHIN of these changes © 2013 All rights reserved

Project Overview – The Work Regional Kaizen* Learning Day Topic specific Kaizens* Working Groups Reveal Day/ Final Report March 2012 June 2013 *Kaizen is Japanese for "improvement", or "change for the better" and refers to the LEAN philosophy or practices that focuses upon continuous improvement of processes. © 2013 All rights reserved 3

Project Overview – Oversight Committee Each of the members of this group also participated in at least 1 working group to enable cross-pollination of ideas and to ensure working group suggestions were represented at the final decision-making table. § The mandate § Address larger system issues § Provide feedback and direction to the working groups as they developed their processes § Review and make final decisions on all materials included in this document. § Output § Creation of two visionary documents for this project; the Memorandum of Understanding and the Guiding Principles for Hospital and ACTT relations. © 2013 All rights reserved

Project Overview - Current State Findings The majority of the basic processes within ACTT are consistent. There are however, variation in how these steps are ordered, dispersed throughout team members, and conducted. Standardizations § Items that created overall efficiencies and a more unified “brand” to external stakeholder groups were standardized. The following items are examples of this: § Letters § Forms § Timeframes § Waitlist protocols § Primary assessment tools (OCAN, ATR) Recommended Best Practices § Items where efficiencies were best determined at the individual team level were supported by recommended best practices. The following items are examples of this: § Meetings § Team functioning and task allocations (including the psychiatrist) © 2013 All rights reserved

Working Group Outcomes – The Introduction Individual working groups submitted their recommendations for Oversight Committee review and approval for each of the following four areas: § ACTT Intake & Referral § Standardizing the approach and policies for referral to and intake by ACTT § ACTT Treatment and Planning § Ensuring consistent and best practice approach to treatment planning § Hospital and ACTT Relationship § Strengthening hospital and ACTT relationships and coordination § Discharge From ACTT § Standardizing the approach and policies for discharge from ACTT © 2013 All rights reserved 6

Working Group Outcomes – Referral & Intake Working group purpose § Identify ACTT appropriate clients sooner § Reduce notification timelines of acceptance to/declined ACTT service § Increase communication with referral sources and circle of care Standardized items § Referral source ACTT screening tool § Referral source ACTT referral form § Letters § Intake prioritization processes § Wait times of notification of acceptance/declined ACTT service to 30 days © 2013 All rights reserved Recommended best practices § ACT Team intake personnel § Client Welcome Package Checklist Measures of success § Reduced inappropriate referrals § Reduced referrals without complete information § 30 day wait for notification

Working Group Outcomes- Referral & Intake Screening Tool © 2013 All rights reserved 8

Working Group Outcomes- Referral & Intake Common Referral Form © 2013 All rights reserved 9

Working Group Outcomes- Referral & Intake Example of the many standardized letters © 2013 All rights reserved 10

Working Group Outcomes – Treatment Working group purpose § Ensure consistent and best practice approach to treatment by: § Streamlining processes and documentation § Enhancing communications with clients, families and community services § Reducing paperwork while increasing level of relevant information collected Standardized items § Expectations Agreement § OCAN used as the Treatment Plan § ATR used as a tool to identify potential for stepped care or discharge (with clinical judgement) © 2013 All rights reserved Recommended best practices § Waiver for Group Programs § Collaborative Crisis Plan (within ACT Teams) Measures of success Fidelity to new process Comparative OCAN data Participate in ATR data collection Reduced staff time spent on redundant paperwork § Current ACTT clientele identified as ready for reduced service levels or discharge § §

Working Group Outcomes – Treatment © 2013 All rights reserved

Working Group Outcomes – Hospital Relationship Working group purpose § Define guiding principles for ACTT and Hospital relations Standardized items § Psychiatrist communications § Documentation between ACTT and Hospitals § Inclusion of ACTT in rounds, case conferences and discharge meetings § Timings © 2013 All rights reserved Recommended best practices § ACTT provides local schedule 1 hospitals with updated client lists provided given client consent on a monthly basis Measures of success § Psychiatrist communication increases § Continuity of care for client is enhanced

Working Group Outcomes – Hospital Relationship © 2013 All rights reserved

Working Group Outcomes – Discharge Working group purpose § Standardize the approach and policies for discharge from ACTT Standardized items § ACTT readiness for stepped care overview § Service overlap between ACTT and new provider for up to 30 days © 2013 All rights reserved Recommended best practices § Defined stepped care model of service § Team staffing allocations through the discharge process § Client Disengagement Practices Measures of success § Implementation of a stepped care model of service § Increased number of identified clients requiring and referred to reduced services

Working Group Outcomes – Stepped Care Model Proposed Model § Addition of 1 FTE RN to each ACT team within the CELHIN § Additional Funding for psychiatry to care for the additional ACT clients § Funding for Project Management to lead the implementation of the QII Functions § RN will be able to continue specific medication protocols that were established on the ACT team § ACTT Stepped Care Services or traditional ACT services will be interchangeable based on client need. § Stepped Care Model will be able to have a caseload of 25 clients (max) Outcomes § Increases the ACT capacity within the CELHIN by over 200 clients (the equivalent of two full ACT teams) § Subsequently decreasing inpatient days for clients that previously were waiting for ACT intervention © 2013 All rights reserved

Next Steps What we will do… Next Step Timing ACTT Oversight Committee Formation • Additional membership • MOU signing • LHIN proposal • Evaluative framework Immediately Training • ACT Teams • Community Services • Hospitals Over the next year Measurement of progress • • • ATR/OCAN Peer reviews Collaborative data collection © 2013 All rights reserved Over the next year

Questions and Answers Access to ACTT /hospital WIFM approach to Main recommendation - Step down (newer philosophy – not abandonment – ACTT light) Reference Oversight at end of purpose © 2013 All rights reserved