Appendix 1. Tiered Care

Transcription

1 Appendix 1 Tiered Care A tiered system provides a way of thinking of the range of services across mental health and addictions and related services. The intention is that a person/family could access services across the five tiers depending on need, and up or down the tiers (stepped care) as their needs change. The outline and definitions below from the Alberta Health Services; Addictions and Mental Health, Integrated Service Delivery Framework, September 2009 provides a good framework for this concept. Tier 1 reaches the most people, with each subsequent tier offering more focused, often more specialized, and generally more intensive services for an increasingly smaller population. Important features of tiered model of service Clients and their families may enter at any point and then move within these tiers, based on their needs (for example, detoxification facilities offer an acute treatment service and are often an entry point for people who need a variety of other addiction and mental health services). The tiered model does not prescribe any direction of movement through the system, does not preclude skipping tiers (for example, moving from Tier 4 to Tier 2), and does not imply that any level of service is more important than any other.

2 The five tier framework is not intended to be distinct, separate levels of service. For example, the support of family and communities identified in tier 1 is also critical in services at all tiers. Similarly, a single client may require services from more than one tier such as attending a self help group at the same time as counselling for depression is received. The model emphasizes the importance of consultation, liaison and referral between tiers in creating and maintaining an effective continuum of care. Prevention and health promotion happen at every service level. Cross level supports (for example, housing supports, educational and vocation supports) are needed at all levels. A given staff member may have responsibilities across two or more tiers. A given function (for example, assessment) may happen in several tiers. Where specific services reside in this model will become clearer as the framework is implemented. Guiding concepts of the tiered model Any door is the right door: A person may enter the continuum of addiction and mental health services and supports at any of the five tiers and, upon entry, should be linked to other needed services and supports, either in the same tier or in a different tier. Co ordination of these links is the responsibility of the system, not the individual. In practice, this would mean that screening people for substance use and mental health problems should be routine for as many health providers as possible and that there should be ready access to comprehensive assessment services if needed. Availability and accessibility: Services in all tiers should be available and accessible within reasonable travel time of each person s community, or should be facilitated by different means (for example, telehealth, online or mobile services). Matching: A person should be matched to services of the intensity appropriate to his or her needs and strengths. Matching implies a need for standardized screening and assessment tools, and for processes that allow for each person s informed choice of the type of care that works best for him or her (based on culture, language or other factors). Choice and eligibility: If more than one service meets a person s needs, the person should be able to choose from those for which he or she is eligible. A person should be able to step between tiers based on changing need (stepped care), though the focus might be in a particular tier at any given time. Flexibility: A person should be referred from a lower tier to a higher tier (stepped up) or from a higher tier to a lower tier (stepped down) as appropriate to his or her needs.

3 Responsiveness: The type of support each person needs will change over time. In responding to these needs, the goal is to help people move to services in lower tiers and ultimately to be healthy independently of our services. Collaboration: Providers of distinct services and supports must work together at the clinical level (for example, through shared service protocols) and at the administrative and organizational levels (for example, through partnerships and inter agency agreements). Collaboration should always include the person seeking help. Co ordination: To facilitate service delivery as well as planning, monitoring and evaluation, health information systems must make it easy to share clinical information without compromising client or patient privacy. A tiered model and stepped approach requires not only strength and connectivity across Mental Health and Addictions Services but collaboration across the human service sector in the region and provincially. Tiered Care and within this a stepped care approach, provides a way of thinking to be the most responsive to the needs of persons and families as their needs dictate.

4 Appendix 2 GUIDING PRINCIPLES and SHARED VALUES Guiding principles and values have been identified within the National Treatment Strategy and work of the Alberta Health Services Mental Health and Addictions. Borrowing from that work, Mental Health and Addictions Services in Saskatchewan embraces the following principles: Be person (client, patient) and family centred. Eliminate or at least reduce barriers within and between Mental Health and Addictions Services programs, and where necessary, with other health and social services. Provide continuity and connectedness across programs to meet the immediate needs of clients and families and to respond to changing needs over time. Be accessible along the continuum of mental health and substance misuse programs and services. Be comprehensive and efficient within the mandate and resources available. Be effective in meeting client, patient and family needs. The Saskatchewan Mental Health and Addictions Services system also shares a common set of values to ensure that services are: Aligned: Services are planned and designed to align within the broader health services vision and system, to ensure collaboration, comprehensiveness and leverage, and eliminate duplication. Accessible: People with substance misuse or mental health problems can access either a substance misuse service or a mental health service, and be provided with or connected to the unique combination of services they need. Prevention, health promotion and clinical services and programs are delivered or accessible in rural, urban and northern communities across the province and are relevant to local needs. Consumer driven: Services are responsive to clients and families needs; transitions across multiple providers and care settings are properly managed; people using the system have input, and system design and delivery are driven by the goal of optimizing client outcomes. Community driven: Prevention and health promotion services build on the readiness and unique needs, strengths and capacities of communities. Those who are intended to benefit most from services will participate in and advise on the design, content and delivery of those services. Sustainable: Services are designed within available resources to have fundamental capability to meet the substance misuse and mental health needs of clients and communities at both a system and local service delivery level. Enhancements to existing services will maximize capacity within available resources. Accepting: Everyone in the health system, particularly the health care provider, is welcoming, nonjudgmental, hopeful, culturally sensitive, respectful and client centred. Services are designed and

5 delivered in a culturally appropriate manner. Staff within the system is committed to reduce stigma and discrimination. Client centred: Services are individualized to accommodate the specific needs, goals, and cultural perspectives of people in different stages of change, regardless of whether the concern relates to addiction, mental health or both. Informed choice is a key element. Recovery based: Services are based on the belief that every person, regardless of degree of disability, has the capacity for recovery. Strength based: Services focus on the positive, recognize the strengths and skills of people, and aim to promote and enhance health and human potential. Collaborative: Services will work closely with other professionals and partners within, across and outside of health to support change among specified client groups and target populations, and within settings that are appropriate to those populations. Attentive to risk and protective factors: The scope of health promotion and prevention services exists from preconception to end of life. Key life transition points provide important opportunities to address common risk factors for and protective factors against mental illness and addiction. Evidence informed: Services reflect the importance of the partnership between science and practice. Services support the application of evidence and consensus based practices, and evaluation of existing programs and service efforts. Innovative: Services continually explore new approaches, including new staffing models, and strive to be innovative and responsive to emerging trends and practices, recognizing that the evidence base for integrated services is growing and emerging. Creativity, e.g. internet use, will be encouraged in order to develop and improve methods. Accountable: Substance misuse and mental health services are driven by a common vision, goals and objectives. Services are evaluated and performance outcomes monitored and applied to enhance services.

6 Mental Health and Addictions Services Framework RESOURCES 1. The National Treatment Strategy Tiered Care October 2008, A Systems Approach to Substance Use in Canada Recommendations for a National Treatment Strategy. 2. Toward Recovery and Well Being, A Framework for a Mental Health Strategy for Canada November The Alberta Health Services framework document (Alberta Health Services Addiction and Mental Health Integrated Service Delivery Framework, September 2009). 4. The Saskatchewan Mental Health and Addictions Services framework document (Mental Health and Addictions Integrated Service Delivery Framework, draft November 2010). Mental Health and Addictions Integration Framework In addition to those listed above: 1. On the Integration of Mental Health and Substance Use Services and Systems: Main Report Brian Rush, Barry Fogg, Louise Nadeau and April Furlong, December Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada; Ten Key Principles for Successful Health System Integration; Esther Suter et.al ;Healthcare Quarterly Vol. 13, October Substance Abuse and Mental Health Services Administration 5. Addressing Integration of Mental Health and Addictions; paper presented by the Canadian Mental Health Association, May Every Door is the Right Door; Towards a 10 Year Mental Health and Addictions Strategy (Ontario), A Discussion Paper, July How can we build skills to transform the healthcare system?; Helen Bevan, Journal of Research in Nursing, 2010