Behavioural Supports Ontario (BSO)

Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN)

2012-13 First Quarter Report

Presentation to the HNHB LHIN Board of Directors

August 29, 2012

Agenda

• Overview HNHB LHIN BSO First Quarter Report • Summary of improvement plans progress • Update on knowledge transfer and capacity building • Lessons Learned • Activity tracking

• Use of quality improvement tools to visually display data to demonstrate performance – i.e. trends, variances

• Next Steps

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Source: BSO Kick off Presentation August 2011

BSO Framework

Focus: How all resources new and existing can be realigned to better service our clients

HNHB Improvement Plans

BSO CONNECT

• BSO Connect

ICL • Integrated Community Lead

COT • BSO Community Outreach Team (Crisis)

PRIMARY CARE

• Primary Care Toolkit

LTCH • Long-Term Care Home BSO Mobile Team

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BSO Connect Model

• Single point of information and referral

Community Care Access Centre (CCAC)

• “Warm” connection

• No wrong door

• Client/caregiver actively referred

• Services ‘pulled’ toward client

• Centralized intake to community services

• Five geographic service area clusters

First Quarter Progress:

• Operational in Niagara Cluster in May – connecting clients to BSO Integrated Community Lead (ICL) agencies

• Implementation scheduled across the LHIN • Brantford Cluster August 13, 2012 • Burlington and Haldimand-Norfolk August 30, 2012 • Hamilton October 1, 2012

• Until ICLs are operational, BSO Connect staff make

efforts to ensure clients/caregivers and health care providers are given warm hand-off

Key Milestones: • 36 clients served by BSO Connect • 36 clients referred to ICL agency • Referrals from family, primary care, other healthcare

providers, police

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Model

• Enhance existing crisis teams

• New resources - Regulated Health Professionals and IGSWs

• Clients supported with strategies until transitioned from crisis to longer term supports

• Linked with longer-term supports to sustain client in community

• Reduce escalation of crisis

Community Outreach Team (BSOCOT) First Quarter Progress: • All five teams implemented

• Access through existing crisis team’s intake

• Developing common templates, resources, processes and

assessment tools

• Collaboration within crisis team to ensure the scope of clients served is within the BSO population

Key Milestones: • 126 cases serviced by the BSOCOT • 91 clients supported by Intensive Geriatric Support Worker

(IGSW) until linked with longer term supports • Standardized assessment tools have been approved and

utilized by BSO coaches in four hubs Issue: • Model in Burlington may change

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Integrated Community Lead (ICL)

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Model: • Single point of contact for BSO clients

• Plan and coordinate supports and

services

• Memorandums of Understanding (MOU)

• Lead role to coordinate services

• Collaborations reduce client frustrations

• Client has one lead agency – person to call

First Quarter Progress: • Focus on service re-design

• Most challenging model given it impacts functions to

existing roles

• Niagara ICL cluster began in June

• Implementation delayed to allow: • Community subcommittee develop service model

pathways • ICL agencies to orientate front line staff

• Tools and processes developed by Niagara ICL Cluster to

share with other clusters • Key ICL Cluster agencies met to plan implementation over

summer (Brantford, Haldimand-Norfolk and Burlington)

Integrated Community Lead (ICL)

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Key Milestones:

• 41 agencies identified as ICLs in the initial roll out.

• 3/41 agencies signed MOU to work together within an ICL Cluster Model to serve BSO population for June (36/40 to August 14/12)

• 1/5 clusters begun implementation

• 3/5 clusters held inaugural meetings to plan implementation

• Brant ICL Cluster operational August 13, 2012

• Burlington and Haldimand Norfolk Clusters scheduled to start at the end of August 2012.

ICL Model - Coordinated Care Surrounds the Client

HNHB BSO LTCH Mobile Team Three Main Functions:

LTCH BSO Mobile Team

Escalating Behaviours

Scheduled and Episodic Care

Transitions

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First Quarter Progress: • Five teams located across the LHIN within

geographic areas

• Promotion and education to LTCHs

• Relationships and collaborations with the other outreach

• Common centralized intake by region, built on existing resources

• Developing shared referral processes

• Responding to referrals and serving residents through centralized intake within each area

• Collaborating with existing outreach teams

HNHB BSO LTCH Mobile Team Key Milestones: • 82/86 LTCHs signed MOU • 80/86 HNHB LTCHs had BSO presentations

(over 1200 staff, residents and families)

• 214 referrals received by central intake

• 192 referrals that met eligibility criteria for BSO LTCH mobile team

• 61/82 LTCHs served in Q1

• 357 visits for all closed cases • 127 modeling activities • 29 educational activities

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First Quarter Progress • Incorporating changes to toolkit

based on test of change feedback

• Identified plan to finalize tool kit and address challenges associated with ‘copyrights’ on select assessment tools

Planning for Phase Two • Provincial Collaborative to start in

September • Finalizing survey for distribution to

primary care providers

Primary Care Toolkit

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Knowledge Exchange and Capacity Building Community Sector

• 574 individuals received training (various levels) on BSO

• BSOCOT staff (10)

• Engagement with community agency staff regarding all HNHB BSO models (263)

• ICL education and preparing for implementation (162)

• Education on dementia and responsive behaviours (58)

• One-to-one coaching (58);

• BSOCOT model education to crisis teams (48)

Long Term Care Sector

• BSO LTCH staff provided education to approximately 174 LTCH staff

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Elements:

• Team building of the BSO staff before integration with crisis team

• Building credibility through sharing expertise

• Putting the model into practice through implementation

• Demonstrating the impact of BSO staff on client outcomes through shared expertise

and collaboration

• Feedback on complex clients between BSO and COAST invaluable learning

Refer to appendix A

BSOCOT - Foundations Integrate BSO and COAST (Hamilton) Teams

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Lessons Learned – for Broader Roll Out Learning • When new models of care are being introduced it is essential to align timelines. • This will ensure that resources are optimized while taking into consideration program

development and adjustments based on early outcomes and evaluations. Benefit to Future • Ensures resources are fully optimized.

• May facilitate successful implementation of the program/strategy while recognizing geographical challenges.

Background • 41 FTE for LTCH mobile staff hired and trained over a three month period, during the

development phase and early testing of the mobile model.

• April 1, 2012 all of the teams were ready to serve residents, while it took two to three months to ramp up the implementation of the models.

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Activity Tracking

• An activity tracking document as been added as a separate item to accompany the quarterly report.

• Purpose - to enable the BSO project to provide high level information on BSO activity at the provincial level on a quarterly basis

• Metrics included are those that are applicable to a majority of LHINs

• Metric definitions are broad to allow LHINs to report on initiatives that have similar function but are not the same

• The activities that are reported by HNHB LHIN do not reflect the HNHB LHIN’s BSO activities.

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BSO Strategy - Quality Improvement Tools

• The BSO Strategy involves implementation and measurement of numerous improvement plans across LHINs

• Standardized software was identified to assist LHINs display data visually across various chart formats

• Allows easy identification of statistical variances and trends over time to inform the performance of an improvement plan

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LTCH Main Reason for Referral to LTCH Mobile Team

17 Pareto Chart–used to identify 80% of reasons for referral to LTCH Mobile Team in Hamilton Hub May 16 – Aug 3/12. Top reasons are Non-Transitional (NT); Physical Aggression, Resistance to Care, Other (non-descript) and Verbal Aggression. Plan to see if different approaches to care and modeling by the team with LTCH staff decrease these over time.

Use: Teams use modeling to build capacity, over time may see a decrease in the number of calls for physical aggression.

Length of Time LTCH Mobile team is involved with a Resident for a Particular Behaviour

18 Shewhart Chart –The average number of days the BSO LTCH Mobile team is involved with residents, from time of first involvement (assessment) to discharge, is 22 days. This information is based on 42 residents who have been discharged. There is a downward trend (5 data points in red) highlighting a change or improvement.

Use: Successive decreasing points suggest trend – change may be result of increased capacity of LTCH staff or team becoming more familiar with the LTCHs or with their role.

Hamilton LTCH Mobile Team Number of Visits per Resident

19 Shewhart Chart –The average number of visits by BSO LTCH Mobile team per resident is 8.5. This information is based on 52 residents who have been discharged from services. Where there are gaps in data points, the file for the resident remains open. The red data point (“outlier”) highlights a situation that required more intense support than the average.

Use: Data shows one resident that has higher number of visits. The team can review that client to review plan and whether other strategies could have been implemented to reduce the teams involvement and increase LTCH staff ability to manage resident

Use: Decreasing trend – review further to see if result of increased LTCH staff capacity or the teams expertize

Main Reason for Call to Community Mobile Team

20 Pareto Chart – Reason for call to Community Mobile Team in Niagara Hub from May 16 – June 30/12. Top reasons are Confusion, Refusing Care, Aggression, LTC, Caregiver Burden and Wandering. Opportunity to connect with community services to impact top reasons and connect with primary care to rule out medical reasons.

Use: Compare main reasons for calls across hubs. Allow comparison of hubs for resources and opportunity to connect with CSS or primary care i.e. availability caregiver respite,

Brant Community BOS COT – Number of Days Referral to Discharge from Team

21 Shewhart Chart –The average number of days the BSOCOT is involved with clients, from referral to discharge, is 26.4 days. The model’s anticipated length of service is 14 to 21 days. The Upper Control Limit (UCL) will be temporarily set once there is a minimum of 12 data points (weeks). This information is based on 9 weeks of reporting.

Use: The average length of stay is longer than expected 26.4 vs. 14 – 21 days – - Opportunity to review the program for cause

Next Steps

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Stakeholder Engagement: • Presentations, newsletters, tools • Target audiences • Planning Ontario Telemedicine Network (OTN)

/Webinar sessions to present models more broadly • Overall BSO project • Model-specific presentations • Audience-specific presentations • Real case scenarios exemplify process • Archived or videotaped for access

Continued Implementation: • Phase One and Quarterly Reports • Presentations (leaders and front-line) • ICL Clusters meeting by region • Staggered ICL roll-out • Ongoing Feedback • Quality lens to improve models/processes • Capacity building (BETSI)

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Questions?