Shifting an assessment tool’s implementation vision over time to stop perpetuating illusions of impact

I was reading Standardized Tools: An Exploration of Implementation Barriers and Enablers, a guidance on implementation in organizations https://www.eenetconnect.ca/to…arriers-and-enablers and for sure found a lot of wisdom on the approach to implementation.  The description of the process in the first vignette rings so true to applying to everyday practice, so thanks for the inspiration.

Reading the implementation guidance document stirred me on the realization as a front line worker for more than a decade working with the OCAN, that this super complex and original vision has evolved and changed in its key purpose from versions 1,2, to 3. The premise and driver of the Ontario Common Assessment of Need (OCAN) was that “client’s don’t have to repeat their stories,” to have continuity of care beyond one organization.

OCAN 2

OCAN 3

 

(image of system flow “consumer at the centre of care”… “easy movement between community mental health services,”  from powerpoint on Overview https://iar.thinkingcap.com/OCAN_tool )

That promise has been removed and that is a credit to the implementers and system planners for being honest and making it more relevant to everyday practice.  It just sticks with the original promises of being relevant to communicating client and worker perspective on recovery planning (with the client’s own words) as well as for the organization’s outcome and performance measurement. But that’s it.  We’ve stopped perpetuating an illusion of the OCAN being integrated into everyday care in the broader health and social care system.

 

Canadian health care law and efforts to connect the “social determents of health”

 

Professor Martha Jackman https://commonlaw.uottawa.ca/en/people/jackman-martha outlines both her actions and perceptions of integrating the SDOH with Health law.  What I found useful to learn, as I have no real understanding of the Canadian Charter on Rights and Freedoms, https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/ was the revelation that not all Canada Health ACT legal battles on rights are about doctors, patients or governments attempting to leverage to a private system.

Reflecting on 40 years of the of Rights and Freedoms, we speak with Professor Martha Jackman from the University of Ottawa about the right to health. In particular, we explore how the right has been litigated on section 7 and section 15 grounds to advance protection over social determinants of health—such as access to food, clean water, and housing—with varying degrees of success. This special episode was produced in collaboration with the McGill Journal of Law & Health.

(2 images: logo of the charter- crest of Canada and shadow image of people on both sides of the flag; SDOH components with layers of: demographics; lifestyle factors, networks and broader macro conditions of culture, economics and environmental)

Please go to the McGill Law Journal to listen to the podcast of April 12, 2022, “Social Determinants of Health and the Charter: Has the Right to Health Been Realized in Canada?” here: https://lawjournal.mcgill.ca/podcasts/ 


Resources to help us understand

This article by Jackman, One Step Forward and Two Steps Back: Poverty, the
Charter and the Legacy of Gosselin could help those of us that need more of a background on the Charter and the state of law decisions. See here: https://socialrightscura.ca/documents/publications/Legacy.pdf

 “ Whereas Canada is founded upon principles that recognize the
supremacy of God and the rule of law …”  Here is a link to a copy of the
charter: https://www.canada.ca/content/dam/pch/documents/services/download-order-charter-bill/canadian-charter-rights-freedoms-eng.pdf

 

An “essential” presentation on accessing the City of Ottawa- Essential Health and Social Services program

Colleen Barclay, BA, RSSW, Case Worker, outlines in nuanced detail the process of accessing this “Essential” program for client care financial supports beyond Ontario Works and ODSP. This is part of the Social Work in Aging and Gerontology, Steering Committee SWAG yearly presentation series Facebook: SWAGOttawa SWAG works with the Ontario Association of Social Workers (OASW) to share practices.

The City of Ottawa’s Response to Vulnerable Seniors The Essential Health and Social Supports presentation, provided by the City of Ottawa (Employment and Social Services), will review the benefits and services available for low-income seniors that are essential to their general health and well-being. The presentation will also discuss the City of Ottawa’s Home Support Services program and Emergency Assistance. Colleen Barclay, BA, RSSW, Case Worker with the Home Support Services Program, will be conducting the presentation and will discuss eligibility requirements that social workers will want to know to help serve their clients.

See the talk here:  https://youtu.be/qqMEqfVS4ps


Essential Health and Social Supports (EHSS) program

  • Urgent dental care and dentures
  • Eye exams and glasses
  • Fuel/gas/hydro arrears, deposits and reconnection fees
  • Rent arrears and deposits
  • Assistive Devices Program (ADP) 25% consumer contribution
  • Bathroom aids
  • Surgical and diabetic supplies
  • Cremations and burials 

https://ottawa.ca/en/family-and-social-services/employment-and-financial-assistance/help-people-not-receiving-financial-assistance

Promising approaches to long-term residential care social work

From Wendy Birkhan, on behalf of Social Work in Aging and Gerontology, Steering Committee SWAG

Susan Braedley presentation on: Long-term Residential Care and Social Workers: Opportunities and Conundrums — 

Description: Reporting on both a scoping review of the Canadian literature on long-term residential care social work and social services work and international comparative research conducted in Canada and 5 other countries, this presentation discusses the opportunities and conundrums facing social workers in Ontario about our role in long-term residential care. Given health human resources shortages, social workers and social services workers have skills and scope-of-practice that can contribute meaningfully in this sector. But social workers have not had a clear, coherent role in Ontario’s long-term residential care. What can we learn from other jurisdictions about promising approaches to long-term residential care social work that enhance quality of life and care?

swag bradewin

(image of Susan Braedley (she/her), MSW PhD, Associate Professor, School of Social Work, Carleton University)

Thursday April 21 at 15:30

Please Register to Participate:

 https://oasw.zoom.us/meeting/register/tZUqdu-rqD8vHtTl8atC8-Wn2oKG75_7I1SE

 

Contact SWAG here:


Dates for 2021/2022 SWAG meetings — Thursdays, all start at 15:30, all on-line

September 23/21
October 21/21
November 18/21
December 16/21 NEW month
January 20/22
February 17/22
March 17/22
April 21/22
May 26/22

“Enhancing work engagement and/or mitigating burnout”… in care organizations

This brief report from EENET https://kmb.camh.ca/eenet/about on the organizational dynamics in providing care may help strengthen your day to day efforts to participate within your organization.  Along with the usual, keep a grip on thyself, it does a good job of incorporating managerial along with front line perspectives to actions at the organizational and systems level.

Research Snapshot: Organizational conditions that influence work engagement and burnout

What did the researchers find?

From the interviews, the researchers summarized their findings into three main organizational contexts related to enhancing work engagement and/or mitigating burnout:   

Work culture that prioritizes person-centered care over productivity and other performance metrics.

In the first theme, the researchers found that organizational culture was driven by high workload from productivity and documentation requirements, and these factors led to burnout and a decrease in client care. Furthermore, the participants felt that understaffing, including delays in filling vacant positions or not filling vacancies at all, impacted their ability to provide all aspects of care that clients needed. Also, participants reported that a lot of these pressures might not have come from management, but from health system level policies and budget constraints, which further led to difficulties managing rapid and sometimes conflicting policy changes.

Robust management skills and practices to overcome bureaucracy.

In the second theme, several sub-themes were identified as follows:

Communication and leader accessibility. The researchers identified that poor communication, at multiple levels, affected participants’ burnout. Participants felt comfortable voicing concerns or asking questions of upper management, but found inadequate communication regarding expectations and policy changes. Managers themselves were also impacted by poor communication. Some participants liked that their supervisors had regular contact with staff and appreciated upper level managers who had “open door” policies, such as having monthly lunch with staff, which connected them to the organization.

Streamlining processes to maximize efficiency. The researchers noted the main contributor to inefficient work systems was bureaucratic requirements around documentation. There was a need for better coordination between departments to make processes flow better.

Empowering managers with good leadership skills. The researchers identified several key leadership skills that were helpful in promoting work engagement. Managers who were most helpful supported employee autonomy, held employees accountable, accepted and acted upon feedback, and built trusting, supportive relationships with their staff. Burnout occurred when managers elicited feedback through huddles or other forums but the feedback was not acted upon, often due to a lack of authority by staff or managers. Furthermore, the researchers discovered that managers who were overcommitted or had a high workload were inattentive.

Opportunities for employee professional development and self-care.
In the third theme, the researchers discovered that time was needed for training and professional development, including mentoring, continuing education or retreats. Participants wanted management to prioritize time dedicated to self-care, especially practicing mindfulness, relaxation, prioritizing tasks for minimal disruptions and preserving time for lunch. They also wanted management to focus on efforts to help separate work and personal life by giving participants vacation and time away from work to re-energize and focus. Overall, some participants noted that managers could proactively encourage self-care, but others acknowledged the struggle to take time off and meet high productivity demands.

https://kmb.camh.ca/eenet/resources/research-snapshot-organizational-conditions-that-influence-work-engagement-and-burnout

This EEnet  Research Snapshot is based on the article “Organizational Conditions That Influence Work Engagement and Burnout: A Qualitative Study of Mental Health Workers” published in Psychiatric Rehabilitation Journal in 2021. https://doi.apa.org/doi/10.1037/prj0000472

Strengthening the Strengths Model in community mental health recovery practices

Maryann Roebuck’s linkedin.com/in/maryannroebuck research A Qualitative Study of the Working Alliance in the Strengths Model of Case Management with People with Severe Mental Illness written with Tim Aubry and Stephanie Manoni-Millar examines client perceptions of the working alliance to advance client recovery in the unique context of community based care settings.

This paper is a useful resource to reflect, have a relook on practice, and think about how we are doing with the push and pull, the dance of sorts with individuals we serve in our helpers role in community based “case management.”

strengths imagehqdefault

(image of components of Strengths based approach is from https://www.scie.org.uk/strengths-based-approaches/guidance)

Working Alliance that supports change in community setting

….Some proposed underlying mechanisms of change within the working alliance include having clear goals, having small caseloads, affirming a person, mutual respect, adopting structured interventions, and being a responsive case manager …

… Research also shows that the working alliance in mental health case management may be different than the therapeutic alliance in psychotherapy. The community-based setting of mental health case management makes the practice more task-focused, and involves providing access to services and helping people to remain in the community (McCabe & Priebe, 2004)

Components of implementing the Strengths Model

….Strengths model case managers base their practice around six principles:

(1) There is an overall focus on individual strengths rather than pathology or deficits;

(2) The community is viewed as an oasis of resources;

(3) Interventions are based on client self-determination;

(4) The case manager-client relationship is primary and essential;

(5) The primary setting for the work is in the community, not in an office;

(6) People can recover, reclaim and transform their lives (Rapp & Goscha, 2012).

strengths model ecology 10597_2021_903_Fig1_HTML

(image: conceptual diagram of study findings – key elements of study concepts, including base foundation of: Community Mental Health Field and Organizational Context and headings of: Strengths model influence, influencing factors, Key elements of working alliance and reported life changes.  All of this described in article text body)

See the article (free access) article here: https://link.springer.com/article/10.1007/s10597-021-00903-9


While post here is about encouraging use of this article to reflect on our individual practice, below are links to  background webinars about how this article fits into  a broader research initiative on the strengths model and more details on implementation within organizations and broader care systems.  

Webinar: Implementing strength-based case management: The value of fidelity monitoring https://vimeo.com/654657660

Eric Latimer, Tim Aubry, Janet Durbin, Maryann Roebuck “Evaluating the strengths model of case management for people with severe mental illness: Results of a multi-province study

https://www.youtube.com/watch?v=QyMZKExVlLE

Linking codes of ethics to Anti-Indigenous racism practice

What ever is your ethics guideline, this discussion of application to help us think of our everyday practice – is useful for reflection. Its refreshing in its approach to have a dialogue, rather than pulling out a grid, though guided by ethics principles. As Cheryl McPherson https://www.linkedin.com/in/cheryl-mcpherson-632b0539/?originalSubdomain=ca says:

“The oral traditions and storytelling are important to me. I believe using this format helps decolonize the College’s practice resources.”

The Ontario College of Social Workers and Social Service Workers framing of the term “Anti Indigenous Racism” helps us to move out of simply talking about individual troubles to bring us to taking a social stance, for the individuals we support in practice.

See the talk here: https://www.ocswssw.org/ocswssw-resources/ethical-and-competent-responses-to-anti-indigenous-racism-1/

series

Call for public comments: mental health and addiction service organizational standards

This consultation by Health Standards Organization (HSO) https://healthstandards.org/ on standards for mental health and addiction services seems, rather important if the weaving of: care system change, organizational accreditation and practice change are in play, NOW.

• Population health, service planning, and design
• Prepared and competent teams
• Access to services
• Client rights and ethical considerations
• Timely, comprehensive, and coordinated services
• Medication and prescribing practices
• Quality improvement …

(image: cover of report stating a draft for review and TM “people powered health”)

About the standards

CAN/HSO 22004:2021(E) Mental Health and Addiction addresses the provision of high-quality and safe mental health and addiction care and services. The standard is applicable to all health and social service organizations providing mental health and/or addiction services.

The standard is intended to be used as a tool to improve the quality, effectiveness and outcomes related to programs and services for people who experience mental health illnesses and addictions. This standard also aims to address barriers to care that people with mental health illnesses and/or addictions often face when trying to access services such as lack of timely, relevant support; stigma; and difficulty navigating multiple intersecting systems and sectors.

The standard follows the client’s health and wellness journey through the health and social service system, including in-patient and community-based settings.

Divided into seven sub-sections, CAN/HSO 22004:2021(E) Mental Health and Addiction will provide criteria and guidelines to assess the quality and safety of health and social service organizations providing mental health and/or addiction services. The sub-sections are:
• Population health, service planning, and design
• Prepared and competent teams
• Access to services
• Client rights and ethical considerations
• Timely, comprehensive, and coordinated services
• Medication and prescribing practices
• Quality improvement …

Go to the Review site here: https://healthstandards.org/public-reviews/


About The Health Standards Organization (HSO) 

What is HSO?

HSO stands for Health Standards Organization. Formed in February 2017, our goal is to unleash the power and potential of people around the world who share our passion for achieving quality health services for all. We are a registered non-profit headquartered in Ottawa, Canada.

What does that mean?

Our focus is on developing standards, assessment programs and other tools to help care providers do what they do best: save and improve lives. Recognized by the Standards Council of Canada, we are the only Standards Development Organization solely dedicated to health and social services.

Where did HSO come from?

HSO is building on the strength of nearly 60 years of experience by Accreditation Canada, Canada’s leading health care accreditation body.

In 2016, we consulted more than 700 stakeholders across Canada and around the world to understand how best to put our collective learnings to work. Key takeaways from this review included:

  • Standards development must be separate from conducting assessments in order to be the best-in-class at both

  • The accreditation process must be more accountable and transparent, with a stronger focus on outcomes and consistency

  • Standards and assessments need to be easily actionable, clinically relevant, and tailored to local contexts

  • Patients (and their families), practitioners and policy-makers all play critical roles in improving health globally

Go to their site here: https://healthstandards.org/about/

hso-logo-red

COVID and shifting program approaches: Lifestyle Enrichment for Senior Adults (LESA)

From Wendy Birkhan, on behalf of Social Work in Aging and Gerontology, Steering Committee SWAG

Speaker: Kim Greenwood will provide general information about the Lifestyle Enrichment for Senior Adults (LESA) and focus on:

  • changes made to the program due to Covid
  • general observations made by counsellors about the impact of Covid on substance use and problem gambling.

THURSDAY, 16 DECEMBER 2021 AT 15:30

Registration Link 


Background on LESA

Lifestyle Enrichment for Senior Adults (LESA) is a substance abuse and problem gambling counselling service for older adults offered across the City of Ottawa. Support is provided for adults aged 55 and older who are concerned about their alcohol or drug use or problem gambling. Services include: intake and assessment of goals and needs; individual counselling; group counselling; supports to address barriers to making change 

LESA is a specialized community- based treatment program supporting adults over the age of 55 in their efforts to stop or reduce:

  • Misuse or abuse of alcohol, drugs and medications
  • Problem gambling that negatively affects physical or mental health, finances, social, family or work life.

Our client-centered programs aim to improve physical, psychological, and environmental health.  Our unique approach incorporates knowledge about the normal aging process, substance and behaviour dependency, and holistic health

lesa@centretownchc.org

from: https://capsa.ca/lifestyle-enrichment-for-senior-adults-lesa/

 

Contact SWAG here:

 


Dates for 2021/2022 SWAG meetings — Thursdays, all start at 15:30, all on-line

 
December 16/21
January 20/22
February 17/22
March 17/22
April 21/22
May 26/22

Community Navigation of Eastern Ontario, aka 211: a critical ingredient to connecting people/community/services

Community Navigation of Eastern Ontario is an anchoring ingredient that can contribute to our efforts to articulate our community based systems of health and social care. Beyond information being nestled, somewhere.

Mission Our purpose is to make lives better by connecting the community to the resources they need. Every day.

Vision To be the primary source of information to access social and community services in Eastern Ontario.

Who We Serve While we serve anyone looking to access community services and information, our primary focus remains on vulnerable populations. We also serve social and community organizations in Eastern Ontario.

How We listen, we search, we guide, we connect. We empower.

Our Values We are compassionate, empathetic, respectful and try to be helpful at all times. We also guard personal information with great care.

Go to the website here: https://cneo-nceo.ca/about-us/mission-vision-values/

cneo-nceo_b

(image: bilingual logo of Community Navigation of Eastern Ontario)

The data base itself, community bulletins, and the opportunity for live interchange via 211 provides the opportunity for building a dynamic structure for information sharing across our organizations and systems. I think this means we all need to prioritize our approaches to information sharing and connecting, beyond a unidirectional approach. Instead a two way street, each day.

(image of 211 telephone number)

Community Navigation of Eastern Ontario (CNEO), formerly Community Information Centre of Ottawa, has been offering information and referral services since 1964. A little over ten years ago, we were offered the license to operate the 211 information and referral line for eastern Ontario (United Counties of Prescott & Russell, United Counties of Stormont, Dundas and Glengarry, City of Ottawa, Lanark County, United Counties of Leeds and Grenville, City of Kingston and County of Frontenac, County of Lennox & Addington, County of Hastings, Prince Edward County, and Renfrew County). 

CNEO currently offers the 211 service (which we are the most well-known for), the community bulletin, seasonal lists, and database maintenance services. 

For agencies looking to create a record with us: https://211ontario.ca/new-listing/

For information on our community bulletin: https://cneo-nceo.ca/info/bulletin/