The Ontario Common Assessment of Need (OCAN)
The OCAN is a standardized, consumer-led, assessment tool used in the community mental health sector. It identifies individuals’ needs, helps match those needs to existing services and helps identify service gaps. Aggregated OCAN data are also intended to support quality improvement planning at the program, organization and provincial levels.
CMHA Toronto is leading a number of studies using the OCAN to better understand the need profiles of different service populations accessing community mental health services and to measure the outcomes of these services.
Understanding the Needs of People Accessing Community Mental Health Services
Examining the Effects of COVID-19 on Community Mental Health Service Users – In Progress
There is an urgent need to better understand how the COVID-19 pandemic and social distancing policies have impacted the reported needs of people enrolled in community mental health programs. To address this knowledge gap, CMHA Toronto is leading a study using provincial OCAN data to explore the effects of COVID-19 receiving community mental health services. Findings from the study may help inform the planning of services and tailoring of interventions for groups most impacted by the pandemic and social distancing policies.
For more information about this study, contact Frank Sirotich at email@example.com.
Identifying the Needs of People with Serious Mental Illness Receiving Community Mental Health Services
In order to tailor services to the needs of people living with a mental illness it is important to have a clear understanding of what these needs are and how they vary across populations accessing community mental health services. In collaboration with the Centre for Addictions and Mental Health and a number of community mental health providers, CMHA Toronto is leading a study which involves analyzing de-identified provincial and/or regional OCAN data to provide a system-level picture of the needs of individuals receiving community mental health services. The project may help advance understanding of gaps in the continuum of community mental health services and provide empirical evidence to inform the tailoring of services to the needs of specific populations receiving these services. The project will identify service needs associated with high inpatient use, repeat emergency department visits, and criminal justice involvement. It will also identify the need profiles of service users who may have more complex needs such as individuals with co-occurring conditions (e.g. a mental health issue and an intellectual or developmental disability, or co-occurring mental health and chronic physical health conditions).
Stakeholder Consultations to Improve the OCAN tool
Irma Molina, Peer Program Evaluation Project, 2018.
In 2017, the Community Care Information Management (CCIM), a Crown agency that led the implementation of the OCAN in the community mental health sector, initiated the process of updating the OCAN in order to enhance the value and the quality of client information being collected.
Revisions to OCAN version 2.0 were based on multi-stakeholder consultations, including input from people with lived experience of mental health issues. Three focus groups were held in the Greater Toronto Area and were coordinated by the Peer Program Evaluation Project team at CMHA-Toronto. The purpose of the focus groups was to collect service user and peer feedback on the recommended changes to the self-assessment component of OCAN.
OCAN version 3.0 was finalized by the Ministry of Health in September, 2017. Trigger questions for the 24 OCAN need domains in the self-assessment and staff assessment versions of the tool were changed to better meet the objectives of identifying areas of client need and determining the kind of support required.
Unmet needs of adults in community mental health care with and without intellectual and developmental disabilities: A cross-sectional study
Anna Durbin, Frank Sirotich, Yona Lunsky, Janet Durbin
Community Mental Health Journal, 2017; 53:15-26
This cross-sectional study compared the clinical and need profiles for clients with and without intellectual and developmental disabilities (IDD) in seven mental health case management programs. Individuals with IDD had greater needs related to self-care, education, transportation and information on their condition and treatment.
Needs among persons with human immunodeficiency virus and intellectual and development disabilities in community mental health care: A cross-sectional study.
Anna Durbin, Frank Sirotich, Yona Lunsky, Kay Rosslein, Janet Durbin
Journal of Intellectual Disability Research, 2017; 61:292-299.
The experience of having human immunodeficiency virus (HIV) is often associated with co-occurring mental health issues. Community mental health services are an important source of support for persons with HIV living in the community. Persons with intellectual disability (ID) are vulnerable to HIV and may have unique support needs beyond those without ID receiving community care. This study compared support needs of men with HIV in community mental health programmes, with and without ID. Individuals with ID were more likely to have basic needs (e.g. food, benefits), functional needs (e.g. self-care, looking after the home), but were less likely to have needs related to sexual expression. The limited differences between groups suggests that with moderate additional targeting, community mental health programmes for persons with HIV may be appropriate for men with ID.
English language abilities and unmet needs in community mental health services: A cross-sectional study.
Anna Durbin, Frank Sirotich, Janet Durbin
Journal of Behavioral Health Services & Research, 2017; 44:483-497.
Language has been described as medicine’s most essential technology and its principle instrument. For clients living with a mental illness, language barriers can be particularly problematic since mental health diagnostic and management processes rely more on communication than on objective tests. To the authors’ knowledge, no studies have investigated the relationship between language disparities and care needs for clients receiving case management services. This study compared the support needs for English speakers and people with limited English proficiency (LEP) receiving case management services. LEP clients had higher rates of unmet needs. These disparities were particularly high for the management of basic needs and health issues where case managers may have a supporting role that involves leveraging available resources rather than a direct service role. These findings suggest a need in Ontario for system-wide measurement of unmet needs related to linguistic disparities and programs targeted at reducing these inequities.
Unmet needs among men with human immunodeficiency virus in community mental health care: A cross-sectional study.
Anna Durbin, Frank Sirotich, Tony Antoniou, Kay Roesslein, Janet Durbin Yona Lunsky
AIDS Care, 2016; 28: 1-6.
While community-based mental health services play an important role in caring for persons with HIV (human immunodeficiency virus) and co-existing mental health disorders, the extent to which their support needs are addressed in this setting is unknown. Accordingly, this study examined if HIV infection was associated with unmet support needs among men living with and without HIV receiving community mental health care. Compared to HIV-negative men, men with HIV were more likely to have mood and concurrent disorders, and intellectual and developmental disabilities. Men with HIV had greater unmet needs related to food, money management, psychological distress, drug use and safety to self. Further research is required to develop and evaluate interventions to best support people enrolled in community mental health programs living with HIV and mental illness.
Examining the need profiles of patients with multiple emergency department visits for mental health reasons: A cross-sectional study.
Frank Sirotich, Anna Durbin, Janet Durbin
Social Psychiatry and Psychiatric Epidemiology 2016; 51: 777-786.
This study examined the socio-demographic, diagnostic, and service need characteristics associated with repeat emergency department (ED) visits among individuals enrolled in intensive case management programs. Approximately 6% of intensive case management clients had two or more ED visits over a 6-month period. Repeat ED visits were associated with young age, a mood disorder, being in service less than one year and unmet needs related to psychotic symptoms, substance use and safety to self/others. The repeat ED user group within case management may have distinct need profiles that require different treatment responses. Moreover, clinical needs rather than psychosocial needs have the greatest relationship with repeat psychiatric ED utilization. These unmet needs suggest areas for future interventions aimed at reducing the use of ED services for mental health reasons and improving care for patients who repeatedly present at the ED.
Identifying the Needs of Complex Health Populations Receiving Community Mental Health and Addictions Services: An Analysis of Ontario Common Assessment of Needs (OCAN) Data for Case Management and Supportive Housing Programs
Frank Sirotich, Anna Durbin
CMHA Toronto, 2014.
In order to support implementation of its 2013-2016 Integrated Health Service Plan, the TCLHIN commissioned this study to better understand the characteristics and need profiles of individuals with mental health issues and complex care needs. Analyses of OCAN data for case management and supportive housing services were undertaken to better understand the needs of the following service populations:
- Individuals with a concurrent disorder (i.e. mental illness and substance use disorder)
- Individuals with a mental health and chronic physical health condition
- Individuals with repeated emergency department visits
- Individuals with repeat mental health inpatient admission
- Individuals with multiple chronic conditions and/or psychosocial challenges related to homelessness and/or high utilization of emergency department and inpatient services.
Findings from this study were used to support regional planning initiatives.
Measuring the Outcomes of Community Mental Health Services
Developing Mental Health Quality Indicators (MHQIs) for Community Mental Health Services Based on the OCAN – In Progress
Quality indicators to measure outcomes of community mental health services across providers are infrequently used because most jurisdictions lack standardized clinical data sources which are necessary to develop shared indicators. Consequently important information about the effectiveness and impact of these mental health services often remains unknown. However, the implementation of the OCAN affords an opportunity to leverage standardized data to develop and pilot MHQI in order to support improvement efforts for community mental health services.
In collaboration with CMHA Ontario and approximate 10-15 community mental health providers, CMHA Toronto is leading a study using provincial OCAN data which will:
- Pilot MHQIs derived from the OCAN with community mental health providers
- Evaluate the feasibility of using these MHQIs for caring out outcome measurement of community mental health services, and
- Support providers to improve the quality of their OCAN data
For more information about this study, contact Frank Sirotich at firstname.lastname@example.org.
Lessons from a Canadian province: examining collaborations between the mental health and justice sectors.
Carolyn S Dewa, Lucy Trojanowski, Chiachen Cheng, Frank Sirotich
International Journal of Public Health, 2011; 57:7-14.
This study examined the factors that program developers perceived as important to the successful collaboration between the mental health and justice sectors in seven Ontario court diversion programs. The primary factors identified involved partnership development, adjustment to broader mandates and addressing ongoing challenges.
The criminal justice outcomes of jail diversion programs for persons with mental illness: A review of the evidence.
Journal of the American Academy of Psychiatry and the Law, 2009: 37:461-472.
Diversion programs are initiatives in which persons with serious mental illness who are involved with the criminal justice system are redirected from traditional criminal justice pathways to the mental health and substance abuse treatment systems. This article is a review of the research literature conducted to determine whether the current evidence supports the use of diversion initiatives to reduce recidivism and to reduce incarceration among adults with serious mental illness with justice involvement.