Interprofessional care – learning from yet another try at using ICT to move care beyond our silos

While platforms to build care collaboration continue to pop up about our town…constantly, likely some useful learning at this rounds by The Regional Geriatric Program of Eastern Ontario http://www.rgpeo.com/en.aspx  —where ever we are in the system of care from this effort.

Monday Oct 28, 2019 8:00 – 9:00 am
The Ottawa Hospital
Civic Campus, Amphitheatre (live)
1053 Carling Avenue, Ottawa
OTN….Webcast: http://webcast.otn.ca/mywebcast?id=93148230
OTN Videoconference:
Event ID # 93148230 locally at the following rooms at The Ottawa Hospital
Admin Room L at the General Campus & Amphitheatre at the Riverside Campus.

Poster with details for event: Oct 28 Regional Geriatric Rounds -Careteam (1)

Please note recording of presentations can be found here (give them a week to post):  http://www.rgpeo.com/en/health-care-practitioners/professional-development/regional-geriatric-rounds-past-presentations.aspx

Here is a link to the platform vendor’s site, I was able to find: https://careteamhub.com/


 

 

Joining together to address housing that builds ” social, economic and environmental benefits” in Lebreton Flats

A coalition of organizations have joined together to address the development of Lebreton Flats in Ottawa.  The coalition  is unique in its efforts to build a whole community social and health approach.

Background:

The National Capital Commission (NCC) is updating its Master Concept Plan for the LeBreton development. Key milestones include a draft to be released in November 2019 and a final plan to be presented for approval by the NCC Board in January 2020. The NCC launched public consultations in June, continuing through the fall, and will consider development best practices from cities in Canada and internationally.

For more about the NCC plans:
http://ncc-ccn.gc.ca/projects/building-lebreton

Roger Peters explains

… The use of community benefits agreements to build community wealth from major developments is growing rapidly in North America and overseas as communities now realize that the old playbooks used by institutions and developers often leave them little of long-term value. The agreements can ensure that development actually produces social, economic and environmental benefits. They enable the community to play a meaningful role in development planning and execution and they are a defence against weak governance and enforcement. …

Please see the article here: https://www.glebereport.ca/a-community-benefits-agreement-for-lebreton-flats/


Learn and engage with the Coalition here: https://cbaforlebretonflats.ca/

 

How Bereaved Families of Ontario – Ottawa Region, serves the community

Summary- minutes by Carmelina Cimaglia from the SWAG presentation on activities of Bereaved Families of Ontario – Ottawa Region Social Work Advisory for Gerontology (SWAG); September 26, 2019

Topic: Bereaved Families of Ontario – Ottawa Region: How We Serve The Ottawa Community

Guest SpeakersMargaret (Lorrie) Beaton, MA (Counselling Psychology), M.C.Hyp., RP(Q) Program Director, BFO
Rita Myres, MSW, RSW, Therapy for Life-TransitionsVolunteer, BFO  
         

        • Primary objective is to help families and individuals cope with grieving a death
        • Volunteer-based service (approximately 60 volunteers many of whom have been participants and have been trained to become facilitators) 
        • Professional consultants oversee the programs
        • Charitable organization – no ongoing funding – rely on program grants and donations
        • Various support groups for all types of losses
          • Ongoing programs 
            • Grief Support and Share Day
            • Grief Support and Share Companioning Walk
            • Monthly Grief Support and Share Night
          • Seasonal (Closed) programs 
            • Adult Groups (spring/fall)
            • Family Art Grief Group (spring)
        • No waiting lists, no formal intake or referral (except for Seasonal groups)
        • http://www.bfo-ottawa.org/    (613) 567-4278   Email: office@bfo-ottawa.org

http://www.bfo-ottawa.org/

Finding reconciliation and not having reforms perpetuate the poison of colonialism

Over recent years in the context of reconciliation with Indigenous Peoples be it indicated  by acknowledgements at the get go of meetings or announcements of policy’s and initiatives, there has remained a sense for me we are not going about reform and change very well.  Mary McPherson’s drawing “Reconcile What?” helped to wake me up.

(Mary McPherson drawing from https://www.behance.net/marymcpherson )

How do we bridge: understanding with action that advances Indigenous Peoples in our society?  Where have I got it wrong and right on the steps, – because I have it both ways.

Here are some approaches that I use to engage and learn from:

Reconciliation: The False Promise of Trudeau’s Sunny Ways: Under the Liberals, statements of moral feeling have been elevated to a governing strategy

…What appeared to be a sweeping transformation was, in fact, a skilful technique for managing the status quo: everything would appear to change in order for things to remain the same. It was the changeless change that the Liberals so excelled in. The outcome would be stamped as reconciliation but would, in fact, be what Indigenous peoples had been fighting in each generation: being consigned to small land bases, shorn of any say over developments in their traditional territories, with the right to administer their own poverty. This relationship wouldn’t be nation-to-nation. It would be nation-to-municipalization. Nation-to-glorified-reservation. Nation-to-dressed-up-subjugation. …

https://thewalrus.ca/the-false-promise-of-trudeaus-sunny-ways/?fbclid=IwAR3GkAq0qnINGDHuHXXaU6ai6fOzfhhePZ0RMHH9o0usz8fPkDw6TuWFmpc


Yellowhead Institute

…For too long, the relationship between First Nation peoples and Canadians has been characterized by inertia: the same old, paternalistic and racist policies and the corresponding apathy and neglect. Yet, the resistance of Indigenous peoples continues to grow and today, there is an acceptance on behalf of governments and Canadians that change is required. This is a tremendous opportunity. The challenge is ensuring the direction of change is towards the transformational. Yellowhead Institute can play an important role here, scrutinizing government policy, advocating for the rights of First Nation peoples, and models of change that support First Nation jurisdiction. …

https://yellowheadinstitute.org/about/


        Russell Diabo

…Since the federal election of 2015, the Trudeau government has embarked on a top-down, nontransparent approach to federal Indigenous policy. There are reportedly 40 to 50 “exploratory tables” with Indigenous groups. We don’t know the topics or with whom the federal government is holding discussions, but these discussions are supposed to feed into an equally opaque Working Group of Ministers on the Review of Laws and Policies Related to Indigenous Peoples.

The discussion results are to be presented to a “bilateral mechanism” — federal cabinet committees based on political agreements with three national Indigenous organizations representing the Inuit, Métis and the Assembly of First Nations, a Chiefs’ organization. This stealth approach to change policy and law bypasses the legitimate rights holders: the Indigenous peoples. They are the ones who have a right to self-determination, not the national Indigenous leadership groups. …https://policyoptions.irpp.org/magazines/september-2017/when-moving-past-the-indian-act-means-something-worse/

https://www.russdiabo.com/resources


        Whose Land Is It Anyway? A Manual for Decolonization

…Now that we have proven that we will not accept annihilation, we find ourselves in an era of reconciliation. Reconciliation? Like many of my sisters and brothers, I have trouble understanding what it is that we are trying to reconcile. Is the time for fighting over? Have we come through to the other side of the nightmare that is history? Have we decolonized this country? Reconciliation: the invitation from Canada to share in the spoils of our nations’ subjugation and dispossession. What a tainted gift, and such a false promise. Reconciling with colonialism cannot heal the wounds the colonizers have wrought on our collective existence. The essential harm of colonization is that the living relationship between our people and our land has been severed. By fraud, abuse, violence and sheer force of numbers, white society has forced us into the situation of being refugees and trespassers in our own homelands and we are prevented from maintaining the physical, spiritual and cultural relationships necessary for our continuation as nations. …

https://fpse.ca/decolonization_manual_whose_land_is_it_anyway


Dennis McPherson

Indian on the Lawn: How are Research Partnerships with Aboriginal Peoples Possible?

… The culture is then, in a sense, transforming itself in a normal and healthy way. In my own research I have found that underlying the diversity of Native American cultures is a pattern of Indigenous thought that is itself a form of transformative philosophy. (19) When Native researchers write about their own cultures they are not only transforming those cultures, they are also transforming themselves, for they are given the opportunity to discover and transform their own prejudgments. As Crusius notes, “we cannot even know our own history, the complex conventions we have internalized; for the most part we can only live it/them, for we are it/them.” (20) Native researchers in learning more about themselves by writing about their own culture are keeping that culture alive by actually making the culture conscious of itself. …

http://www.netnewsledger.com/2013/03/11/indian-on-the-lawn-how-are-research-partnerships-with-aboriginal-peoples-possible/


More suggestions?  Please add to comments section, thanks.

The planned Social Welfare Cuts and the Recovery Model; anti stigma and policy on the Social Determinants of Health are set back, stumble

Editorials of the summer from the Thunder Bay Chronicle Journal, St. Catherine’s Standard and Toronto Star seek to sort out the good and bad of the expected income benefits policy reforms by the Ontario Ministry of Children, Community and Social Services.  While there is the potential of discussion sounding too political on government decisions, there are also facts about these actions that impact on the decades of building effective resources to advance the Recovery Model, but how to find them?

Groups like the Income Security Advocacy Centre (ISAC) have sifted and tried to sort out the meaning, from the early days of the announcement of the cuts. Still it is hard to know, what the plan and policy direction will result in.  One comment on a post I received was from an ODSP participant on a ministry advisory committee who disputed the description of ISAC of the new criteria for admission to ODSP .  Fair enough then that much of policy is a work in progress, but a few things clarified for me when I looked at the summer editorials.

The beginning of the editorials initially focus on the cut of the Ontario Basic Income pilots which I dismissed to myself as more of an aspiration concept in the first place rather than province wide policy and an unsurprising ideological conservative/liberal fight on how to address poverty.

But then came  the explanation of admission criteria changes to ODSP:

… And a plan to change the definition of disability for those seeking support under the Ontario Disability Support Program (ODSP) threatens to force thousands of people with mental illness, HIV, multiple sclerosis and other episodic disabilities onto Ontario Works, a program with much lower benefits.

The province says a narrower definition is needed to align more closely with definitions used in federal income-support programs. But this makes no sense when Ottawa is broadening its understanding of disability to coincide with new federal accessibility legislation.

Then news of the income claw-back plan:

… The other change we are told is coming in December involves rules around the amount of money people on welfare can keep when they work before facing benefit claw-backs. The increase to $300 from $200 is helpful. But hiking the claw-back rate from 50 per cent to 75 per cent is hardly an incentive for people to find more work.

Here is the link to the editorial: (hopefully no paywall) https://www.thestar.com/opinion/editorials/2019/08/04/ontario-shouldnt-make-life-harder-for-the-poorest.html


Related image

(Graphic from: https://nccollaborative.org/social-determinants-of-health/)

The culmination of these points helps to clear the policy direction fog, I and maybe others are experiencing. Our efforts: individual, organizational, the national commission on mental health reform; stumble and have set backs.  My question is how do we as advocates maintain recovery approaches to care amongst the politics and fog surrounding policy and government operations?

The Mental Health Commission’s Out of the Shadows – laid out goals that involve multiple layers, dare I say intersections of government levels and civil society.  And it is not as if other levels and moments of government are not setting back the Recovery Model.

For example:

  • I think of the City of Ottawa social services branch cutting bus passes for people living in psychiatric boarding homes – to the point of only allowing people to be able to ask staff for a bus ticket for medical appointments only. Clearly the fog surrounds us where ever we stand in the system.
  • I think of the minimum wage legislation of a few years ago, that helped a client I work with, who celebrated the value of his efforts yet; set him falling backwards when the policy was not connected to provincial housing policy— his rent geared to income apartment, thus owing $ and ultimately being negatively impacted in the long term.

The answer to my query is likely, “just keep chipping at it.” But it sure would be useful to aim for systems discussions of the whole, rather than perpetuating the fractured, siloed approach, the very approach that our leaders are aiming to address.

Principles of care can be bridged to the context of community development; “Hippocratic Oath for Community Workers”

This article by Jim Diers https://www.tamarackcommunity….est/author/jim-diers posted in Tamarack  https://www.tamarackcommunity.ca/  lays out guideposts for community system and planning interventions.

… We need to acknowledge the ways in which we often inadvertently harm the very communities we are trying to help and pledge to work in ways that contribute to their health. Here, then, is an outline of principles I would like to see included in a Hippocratic Oath for community workers whether they are social workers, recreation coordinators, clergy, community police, public health workers, planners, educators, service learning students, outreach staff, organizers or other community-based professionals. …

Hippocratic Oath

 


I think Assertive Community Treatment (ACT) workers are also woven into community work.  We need to keep an eye on these principles.

Our role in community work is not well acknowledged as critical to actual care, and our efforts to have a sustainable health care system.

One effort to acknowledge the links of ACT with community development and system planning is shared here:

Assertive Community Treatment as Community Change Intervention

Abstract: Individuals with severe mental illnesses (SMI) are a vulnerable population, struggling to cope with fragmented and often unwelcoming community service systems. Research has examined Assertive Community Treatment (ACT) as an intervention for SMI individuals, but little research has explored ACT’s potential as a community system change intervention. Using focus groups with ACT teams, we explored changes in community service systems as a result of ACT teams’ presence. Changes identified included increased understanding of SMI; increased access to services; and increased collaboration across service systems. Processes by which these changes occurred included knowledge communication, negotiation, renaming by association, and ongoing relationships.

Assertive Community Treatment (Scheyett)

Embracing the idea we are working within a system, article from INTEGRATION AND IMPLEMENTATION INSIGHTS – helps us to move to long term action within our systems

Helpful article from INTEGRATION AND IMPLEMENTATION INSIGHTS for front line mental health workers trying to work in advancing… practices for the communities we serve. The authors put substance to the idea of thinking beyond the individual, ringing true of the breadth involved with care system change that aims for “the long term” instead of “quick changes.”

” move from a focus on separate dramatic events to a focus on the persistent, often almost continuous, pressures giving rise to the discrete events we see.”

11-Figure4-1

Our mental health care system feels like a super tanker on the ocean that is trying to turn direction – but it needs a lot more than high level planners thinking of the long term.  Anyone in eenetconnect world had any experience with the kind of approach Richardson and Anderson offer to help groups map out decisions to advance practice change?

The fields of systems thinking and system dynamics modelling bring four important patterns of thought to such a group decision and negotiation:

  1. thinking dynamically;
  2. thinking in stocks and flows;
  3. thinking in feedback loops; and,
  4. thinking endogenously.

See the article here: https://i2insights.org/2019/07…for-group-decisions/


I realize for system planners, my question about how people approach understanding systems may be a basic question,  I am curious how from a front line practice perspective, as a cog in the system workers are:

  • engaging in framing  systems in their minds
  • acting and interacting with planners on long term system change
  • bridging our everyday care within a system model

An example — gaps, unmet needs, planned actions, goals are embedded in our organizations and systems focus of care to advance the recovery model .  The Ontario Common Assessment of Need (OCAN) is framed as a key activity with individuals (clients) and posited by our care system to advance system change and measure performance. http://eenet.ca/tags/ocan

 ocan data use

The two above images are from the eenetconnect.caOCAN Community of Interest (COI) which is a good example of creating a resource for thinking systems. https://www.ee