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Disclosure. The Implementation of a Specialized Geriatric Mental Health Outreach Program (GMHOP): Responding to the Needs of Long Term Care Homes. Joanne Walsh, RN, MHS Anne Stephens, BScN, MEd, GNC(C) . 2nd National Canadian Coalition for Seniors’ Mental Health Conference, 2007.

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  1. Disclosure The Implementation of a Specialized Geriatric Mental Health Outreach Program (GMHOP): Responding to the Needs of Long Term Care Homes Joanne Walsh, RN, MHS Anne Stephens, BScN, MEd, GNC(C) 2nd National Canadian Coalition for Seniors’ Mental Health Conference, 2007

  2. 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: ayau@toronto.ca Sandra Pitters: Chair, LTC-MH Implementation Committee Angelina Yau: Project Manager, LTC-MH Implementation Disclosure

  3. Presentation Overview • Background • Toronto Region Psychogeriatric Framework • GMHOP development & implementation: key elements for success • Challenges and benefits • Q & A

  4. MOH LTC Toronto Region Steering Committee established in November 2005 Response to the recommendations arising from the Casa Verde inquest report in June 2005 Part of the Toronto Region’s LTCH Bed Strategy to address the needs of individuals requiring specialized programming related to significant behavioral response issues Background

  5. Latent Failures Latent Failures Latent Failures Active Failures Failed or Absent Defenses Reason, J. “Education and debate. Human error: models and management.” British Medical Journal. 2000 Mar 18; 320 (7237): 769. Mishap Model of System Failure

  6. 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 Toronto Region Psychogeriatric Framework

  7. System Integration & Coordination EMS Tertiary Care Emergency Dept. LTCH LTC Team Resident & SDM Hospital In-patient GMHOP PRC CCAC Adapted from Toronto Region LTC MH Psychogeriatric Framework Report 2006

  8. Implemented in April 2006 Funded by the Ontario Ministry of Health and Long Term Care (Federal Accord Funding) Designated seven LTCH Geriatric Mental Health Outreach Program (GMHOP)

  9. The team consists of: - 1 full time mental health - 1 part time geriatric psychiatrist Team Composition

  10. Target Population • Seniors (55 and over) with serious mental illness and severe behavioral problems living in long term care homes

  11. Consultation model - Assessment - Treatment recommendations - Follow up - Referral to other services - Family/SDM support and education - Education of LTCH staff related to clinical consultation Services

  12. Key Elements for Success • Ensure organization’s commitment • Incorporate evidence based practice • Establish trusting relationships • Develop mutually agreed upon modes of communication • Work in partnership with the various service providers • Clarify roles • Evaluate the program

  13. Ensure the program is in alignment with the organization’s vision, mission and values Identify champions Get stakeholder buy-in Ensure Organization’s Commitment

  14. 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 Incorporate Evidence Based Practice

  15. Initiate meeting with LTCHs at the outset to introduce self, discuss expectations, roles and responsibilities Meet regularly with LTCHs to review program implementation and progress and to resolve issues Establish collaborative relationships with service providers (i.e. DOCs, attending physicians, solo practitioners, front line staff, PRCs) Participate in case conferences and Professional Advisory Committees Establish Trusting Relationships

  16. 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) Develop Mutually Agreed Upon Methods of Communication

  17. Recognize that old and new “pieces” are coming together to form a new paradigm of care Understand that all “pieces” need to “fit” together to make it work and that some of the “fits” aren’t easy to “fit” Work in Partnership with the Various Service Providers

  18. Putting the Pieces Together

  19. Define roles and responsibilities of GMHOP and LTCH (e.g. information sharing, follow up on recommendations) Establish conflict resolution process Clarify Roles and Responsibilities

  20. Satisfaction surveys Common Data Set (CDS) MOHLTC Research Grant to evaluate Toronto GMHOPs Evaluate the Program

  21. Recruiting appropriate staff Gaining trust “Customizing” the program to meet the different characteristics and needs of LTCHs Interfacing with long term care system Challenges

  22. Benefits • Infusion of specialized geriatric mental health expertise • Support/resource to LTCHs • Timely interprofessional assessments, recommendations and follow up • Avoid unnecessary hospital admissions • Working towards an integrated system of care • Opportunity for inter-professional education and research

  23. Q & A

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