Behavioural Supports Ontario (BSO) Hamilton Niagara Haldimand Brant - - PowerPoint PPT Presentation

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Behavioural Supports Ontario (BSO)

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

Presentation to the HNHB LHIN Board of Directors May 30, 2012

Agenda

• Overview of BSO Project
• HNHB LHIN BSO Governance Structure
• HNHB LHIN Phase 1 Report
• Long-Term Care Home (LTCH) BSO Capacity Building
• Next Steps

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BSO Project

Overall Goal:

• To enhance services for older adults with complex behaviours,

wherever they live, through the development and implementation of new models of care that focus on:

• quality of care
• quality of life.
• Focus of the strategy is not on new or increased resources, but

rather on determining how all resources - new and existing - can be realigned to better service our clients.

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BSO Project - Framework

• System Coordination and

Management

• Integrated Service Delivery –

both intersectoral and interdisciplinary

• Knowledgeable Care Teams

and Capacity Building

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Source: Ontario BSS A Framework for Care. January 2011. Alzheimer Society of Ontario, Alzheimer Knowledge Exchange , Ontario LHINs

Better integration + collaboration = better care and outcomes + better value + lower risk

HNHB LHIN BSO Governance Structure

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“ I AM WHO I AM, SO HELP ME CONTINUE TO BE ME”

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Older people with cognitive impairments due to mental health problems, addictions, dementia, or

• ther neurological

conditions that exhibit responsive or challenging behaviours.

HNHB LHIN Phase 1 Report

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HNHB LHIN Improvement Plans – Actioned in Phase 1

BSO Connect • BSO Connect - single point of entry ICL

• Integrated Community Lead (ICL)

Community Mobile Team

• BSO Community Mobile Team

Primary Care • Primary Care Toolkit Long Term Care Home

• LTCH BSO Mobile Team

HNHB LHIN Process

December 2011 – March 2012 Four Subcommittees Increased Project Management Resources Support three Buddy LHINs February 2012 - Models tested - QI PDSA cycles March 2012 - Models revised to guide implementation in phase 2 April - June 2012 – Implementation & Continued Testing

Enablers

• BSO Framework and principles – vision for change
• Focused change for target population
• Readiness for change and commitment among system partners
• Timelines – created momentum and sense of urgency
• BSO Implementation strategy – province-wide with processes that fostered collaboration
• LHIN lead project management model – Internal and Provincially (Coordinating Reporting Office)
• Expert support – Health Quality Ontario, Provincial Resource Team and Alzheimer’s Knowledge

Exchange

• Over 170 LHIN stakeholders with the vision and courage to think outside of the box and lead

change.

HNHB LHIN BSO Community Model

Three components:

• BSO Connect
• ICL
• Community Mobile Team

Integrated Community Lead Community Outreach Team BSO Connect

BSO Connect

Model :

• Single point of information & referral
• “Warm” connection
• No wrong door.

Current :

• Client/caregiver provided numbers of

services/agencies to connect with

• Difficult to navigate services.

BSO Connect - New Approach :

• Client/caregiver actively referred
• Services ‘pulled’ toward client.

Impact for Frank Frank, a retired gentleman who is very self aware and articulate individual who knows his needs called BSO Connect. Frank shared he had a couple of changeable psychiatric conditions that had gotten worse and prevented him from seeing his doctor (fear of public places and verbal aggression when in manic state). Frank shared additional stressors his mother & spouse were in LTCH and his two adult children had clinical depression. Previously, Frank had called CCAC for support & was provided with numbers to call. Frank had difficulty getting to his doctor (fear of public places), had called his pharmacist but did not get any help. Shared his frustrations about the ‘system”. With Frank’s permission, BSO Connect staff connected Frank with a community support agency - Supportive Independent Living program in Niagara. Outcome : BSO Connect pulled support to the client by calling agency on his behalf & making the referral . Frank will receive support to assist him manage his health care needs.

Integrated Community Lead (ICL)

Model:

• Single point of contact for BSO clients
• Plan & coordinate supports & services
• Memorandum of Understandings.

Current:

• Multiple assessments
• Overlapping services
• Stress & frustration for client(s).

ICL - New Approach:

• Lead role to coordinate services
• Collaborations reduce client frustrations
• Client has one lead agency/person to call.

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Clie Client

Agency A Primary Care Hospitals Agency B Agency

C C

ICL Primary Care Agency B Hospitals Agency C

Clie Client

Community Outreach Team

Model:

• Enhance existing community crisis systems
• New BSO resources - Regulated Health Professionals

& Intensive Geriatric Service Workers. Current:

• Crisis teams are not always aware of resources

available or approaches to deescalate behaviour

• Limited follow-up capabilities
• Not expert in geriatric & mental health as it relates to

responsive behaviours. BSO COT - New Approach:

• 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.

Impact for Josie Salim is an elderly man with a diagnosis of Alzheimer's. Josie is Salim’s partner and primary caregiver and is getting burnt-out as Salim wakes up frequently during the night, attempts to leave and does not recognize Josie. Josie has been intentionally taking Salim for walks at night but Salim does not always settle. BSO Outreach met with Josie to explore options to assist in reducing her burnout:

• Prevent Salim from wandering i.e. curtain over

doors, light on in bathroom.

• Arranged for Salim to attend Adult Day Program,

enabling Josie to get some rest from care-giving.

• Connect Josie with Alzeheimer Society for “Safely

Home”, telephone support, counseling & friendly visiting. Outcome: Josie is more rested, remains healthy & enjoys her husband’s company again.

HNHB LHIN LTCH Mobile Team

Three Main Functions:

• Protocols for Escalating Behaviours
• Scheduled and Episodic Care
• Transitional Pathways.

HNHB LHIN BSO LTCH Mobile Team

Escalating Behaviours

Development of evidence-based protocols for management of escalating behaviours for LTCH residents with responsive behaviours

Scheduled and Episodic Care

Resident specific assessments and assist in developing care plans Model care through “hands on” demonstration Capacity Building

Transitional Pathways

Draft standardized pathways developed for transitions to and from LTC, for clients with responsive (or history

• f) behaviours

HNHB LHIN BSO LTCH Mobile Team – Key Features

Model:

• Provides a “team” of resources to LHIN’s 86 LTCH (41 new LTCH staff) Coaching and Mentoring.

Escalation protocols:

• Provides evidence based standardized protocols that LTCHs may use to assist them manage the care
• f residents with responsive behaviours.

Scheduled and Episodic Support:

• Support staff with assessments/tools and collaborate with staff to develop and implement care plans.
• BSO staff scheduled to be at a LTCH when behaviours are most challenging (i.e. morning care).
• New peer to peer opportunities - BSO staff work side by side with peers to model approaches to

de-escalate behaviours through daily activities.

• Follow up with LTCH on effect of care plan on de-escalating behaviours.
• Increase knowledge transition and capacity building.

Transitions Scheduled and Episodic Support:

• Support resident, LTCH and hospitals with transitions in care.
• Schedule to be in the LTCH when residents transitioned.

BSO LTCH Mobile Teams

Hamilton - 1 RN, 4 RPN, 8 PSW Burlington -1 RN, 2 RPN, 2 PSW Haldimand & Norfolk - 1 RN, 2 RPN, 2 PSW Brant - 1 RN, 2 RPN, 2 PSW Niagara - 1 RN, 4 RPN, 8 PSW

LTCH MOBILE

• 41 interdisciplinary staff divided into 5

teams:

• Mobile Team Lead (RN)
• Clinical coach (RPN)
• Care Support Worker (PSW)

Primary Care Toolkit

Model:

• Create toolkit for primary care providers.
• To improve early identification and

management of clients with responsive behaviours.

Current :

• Variable use of treatment strategies based on

setting and resources.

• Delay in identification and management.
• Inconsistent referrals to specialized geriatrics.
• Many complex toolkits, not well utilized.

Opportunities:

• Allows view of client for future comparison.
• May be used in regions/areas with less

specialty geriatric services.

• Pathway identifies a single link to

community supports .

• Primary Care Collaborative Lead.

Next Steps

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Primary Care:

• Identify Family Health Teams and

Community Health Centres to utilize Toolkit.

• Specialized Geriatric Clinic.
• Receive feedback from NSM LHIN.
• Trial in retirement and LTCHs, geriatric
• utreach and new BSO teams.

Community:

• Implementation of all three Models from

April to July.

LTCH:

• Involvement in existing outreach residents from

April to May.

• BSO staff accepting referrals - staged roll out in May and

June. Continued evaluation of all models through Summer 2012

LTCH BSO Capacity Building

• In February 2012, LHIN approved use of 2011-12 surplus BSO staffing funding to support

back fill of LTCH staff to enable staff to attend training sessions in approaches to manage escalating behaviour:

• Gentle Persuasive Approach
• Gentle Persuasive Approach Coach
• Montessori Methods.
• Condition of funding all training must occur before March 31, 2012.
• Expression of interest sent to all 86 LHIN LTCHs, 56 LTCHs responded requesting backfill

for over 1,200 staff.

• LHIN approved backfill for 712 staff to attend training.
• Over 600 LTCH staff trained in these techniques prior to March 31, 2012.

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HNHB BSO Project - Key Accomplishments – Phase 1

• Completed development and initial testing of all Models.
• 41 / 41 BSO LTCH staff recruited (five RNs, 14 RPNs, 22 PSWs).
• 15 /15 BSO community staff recruited.
• 68 / 86 LTCHs signed MOUs for BSO Mobile Team .
• Over 600 LTCH staff participated in LHIN-funded training (GPA or Montessori) during six

week period. Phase 1 Report on Progress available: BSO in HNHB LHIN

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Questions?