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DisclosureThe Implementation of a The Implementation of a
Specialized Geriatric Mental Specialized Geriatric Mental Health Outreach Program Health Outreach Program (GMHOP): Responding to (GMHOP): Responding to the Needs of Long Term the Needs of Long Term
Care HomesCare Homes
Joanne Walsh, RN, MHSAnne Stephens, BScN, MEd, GNC(C)
2nd National Canadian Coalition for Seniors’ Mental Health Conference, 2007
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: [email protected] Sandra Pitters: Chair, LTC-MH Implementation Committee
Angelina Yau: Project Manager, LTC-MH Implementation
Presentation OverviewPresentation Overview
BackgroundToronto Region Psychogeriatric FrameworkGMHOP development & implementation:
key elements for successChallenges and benefitsQ & A
BackgroundBackground
MOH LTC Toronto Region Steering Committee established in November 2005Response to the recommendations arising from the Casa Verde inquest report in June 2005Part of the Toronto Region’s LTCH Bed Strategy to address the needs of individuals requiring specialized programming related to significant behavioral response issues
Model of System FailureModel of System Failure
Reason, J. “Education and debate. Human error: models and management.” British Medical Journal. 2000 Mar 18; 320 (7237): 769.Mishap
Latent FailuresLatent Failures
Latent Failures
Active Failures
Failed or
Absent Defenses
Toronto Region Toronto Region Psychogeriatric FrameworkPsychogeriatric 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
TertiaryCare
EMS
Hospital In-patient GMHOP
EmergencyDept.
CCAC
LTC Team
PRCPRC
LTCH
Resident&
SDM
System Integration & Coordination
Adapted from Toronto Region LTC MH Psychogeriatric Framework Report 2006
Geriatric Mental Health Geriatric Mental Health Outreach Program (GMHOP)Outreach Program (GMHOP)
Implemented in April 2006Funded by the Ontario Ministry of Health and Long Term Care (Federal Accord Funding)Designated seven LTCH
Team CompositionTeam Composition
The team consists of: - 1 full time mental health - 1 part time geriatric psychiatrist
Target PopulationTarget Population
Seniors (55 and over) with serious mental illness and severe behavioral problems living in long term care homes
ServicesServicesConsultation model
- Assessment- Treatment recommendations- Follow up - Referral to other services- Family/SDM support and
education- Education of LTCH staff related
to clinical consultation
Key Elements for SuccessKey Elements for SuccessEnsure organization’s commitment Incorporate evidence based practiceEstablish trusting relationshipsDevelop mutually agreed upon modes of communicationWork in partnership with the various service providersClarify rolesEvaluate the program
Ensure Organization’s CommitmentEnsure Organization’s Commitment
Ensure the program is in alignment with the organization’s vision, mission and valuesIdentify championsGet stakeholder buy-in
Incorporate Evidence Based Incorporate Evidence Based PracticePractice
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
Establish Trusting RelationshipsEstablish Trusting Relationships
Initiate meeting with LTCHs at the outset to introduce self, discuss expectations, roles and responsibilitiesMeet regularly with LTCHs to review program implementation and progress and to resolve issuesEstablish collaborative relationships with service providers (i.e. DOCs, attending physicians, solo practitioners, front line staff, PRCs)Participate in case conferences and Professional Advisory Committees
Develop Mutually Agreed Upon Develop Mutually Agreed Upon Methods of CommunicationMethods 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)
Work in Partnership with the Work in Partnership with the Various Service ProvidersVarious Service Providers
Recognize that old and new “pieces” are coming together to form a new paradigm of careUnderstand that all “pieces” need to “fit” together to make it work and that some of the “fits” aren’t easy to “fit”
Putting the Pieces Putting the Pieces TogetherTogether
Clarify Roles and ResponsibilitiesClarify Roles and Responsibilities
Define roles and responsibilities of GMHOP and LTCH (e.g. information sharing, follow up on recommendations)
Establish conflict resolution process
Evaluate the ProgramEvaluate the Program
Satisfaction surveysCommon Data Set (CDS)MOHLTC Research Grant to evaluate Toronto GMHOPs
ChallengesChallenges
Recruiting appropriate staffGaining trust“Customizing” the program to meet the different characteristics and needs of LTCHsInterfacing with long term care system
BenefitsBenefits
Infusion of specialized geriatric mental health expertiseSupport/resource to LTCHsTimely interprofessional assessments, recommendations and follow upAvoid unnecessary hospital admissions
Working towards an integrated system of care Opportunity for inter-professional education and research
Q & A