ACT Conference - Ontario Association of ACT and FACT

With the culture of constant change, and the rapid move toward a Values-Based Reimbursement environment, who can keep up? This session will assist supervisors and staff with tools to manage this continually evolving world of behavioral healthcare provision.

As we assist those we serve with life changes, practitioners also need support to manage change within our agencies and among our staff. We hope you get the outcomes you want from the change, but also the support you need for the transition!

Learning objectives:

• Identify the differences between Change and Transition, and the pitfalls of neglecting transition while going through change
• Navigate the three phases of Organizational Transition and support others through this process
• Identify three basic tools to manage ongoing change

Target audience: Lead clinicians, managers, supervisors and / or staff

People with serious mental illness have at least a 15 year shorter life span than the general population. A portion of this mortality is attributable to poor access to good quality preventive medical care.

This workshop discusses the role the ACT Team play in improving primary care to their population generally and describes a quality improvement project within our team to reduce cardiovascular risk and promote early detection of breast and colon cancer in our population.

Learning objectives:

• Demonstrate an understanding of the increased morbidity and mortality in people with serious mental illness
• Discuss the opportunities and challenges in improving physical health of people receiving care in ACT teams
• Become familiar with strategies utilized in our ACT team to address the physical health needs of people receiving care in our team

Target audience: Clinicians, administrators, community partners, emergency service providers, individuals with lived experience, primary care providers and researchers

CMHA Kenora Branch embarked on a Quality Initiative two years ago with the intention of transitioning clients who were deemed appropriate out of the ACTT service to more appropriate care. The program's focus was to ensure that the fidelity of the ACT Team Model was adhered to as per the Ministry of Health and Long-Term Care ACTT Standards (2005).

They recruited the Excellence through Quality Improvement Project (EQIP) to assist with QI coaching expertise to navigate them through the Model for Improvement, with the intention of making evidence based program changes and not reactionary ones.

On project inception, the perceived outcome was to transition clients appropriately to a lower level of care as distinguished by the ACTT Transitional Readiness (ATR) tool. As the project progressed, it became evident from the data that stepdown services were not the critical area that required focus. While these transitions were streamlined and improved, the critical need was the delivery of service to higher acuity clients. Approximately a third (27%) of ACTT clients serviced exceeded the level of care mandated by the ACTT Standards. The data revealed that CMHA Kenora Branch had been consistently providing a higher level of care to clients above and beyond the mandate.

Learning objectives:

• Expand the learners' knowledge of implementing evidence informed change
• Understanding our ACTT teams' unique data
• Sustaining change through use of the client and family voice

Target audience: Managers, clinicians, administrators, clients, and families

The important role of the team leader in the dissemination and implementation of high fidelity Assertive Community Treatment (ACT) has gone mostly unexplored. In this presentation, the author will share original qualitative research that addressed three questions: (1) describe the ACT team leaders on high fidelity teams; (2) understand their approach to leadership; and (3) understand what roles they play in promoting high fidelity to ACT as an evidence-based practice (EBP).

Results included themes that ACT team leaders had notable attributes and a personal job match with the roles and responsibilities of an ACT team leader. Additionally, the team leaders performed many prominent functions, had a distinct communication style, paid deliberate attention to team members' well-being, and set a very intentional, positive work environment. Team leaders in the study played critical roles in the promotion of high fidelity ACT services and used ACT fidelity as a guide for service delivery to program participants.

It is the hope that this information on the specific activities of exceptional ACT team leaders will illuminate processes important to the implementation of the EBP of ACT in effort to close the gap between EBP knowledge and actual service delivery. Further, it can serve as a guide for the training and technical assistance provided to new team leaders.

Learning objectives:

• Knowledge as to what characteristics in a team leader may facilitate the implementation of a high-fidelity ACT team
• Increase their knowledge as to the different approaches ACT team leaders take on high-fidelity ACT teams
• Understand the roles some ACT team leaders play in promoting high fidelity to ACT as an evidence-based practice

Target audience: Team leaders, agency leadership and mental health authorities who create policy and provide technical assistance for ACT.

It is well documented that family / natural supports' involvement in care facilitates community integration and recovery for individuals with behavioural challenges yet engaging families/natural supports in care and care planning often presents challenges for providers due to varying expectations for treatment and interpretations of recovery and wellness, challenging family dynamics and limited inter-agency collaboration to manage family related issues.

In this workshop, lessons learned from Assertive Community Treatment providers will be presented including strategies for understanding family systems, the family life-cycle, inter-agency collaboration, and how to create opportunity for collaboration among individuals with behavioural health concerns, their family/natural supports and providers will be presented through presentations of vignettes. The workshop will provide ample opportunity for knowledge exchange among workshop participants.

Learning objectives:

• Be better equipped to understand common reactions and the impact of a loved one's behavioural health challenges on the life of family or natural supports
• Understand family dynamics in the context of behavioral health challenges
• Be exposed to tools that are helpful to engage family and natural supports in treatment and care planning
• Enhance ability to supervise clinicians who are working with families

Target audience: Clinicians and supervisors / team leads

The HARM is a structured clinical judgment tool that guides the assessor(s) to formulate opinions regarding risk of violence. It combines both historical / static and dynamic factors to assess risk as reflected in the literature.

The HARM was created to:

• Predict imminent and short-term risk
• Bring all information to bear in assessing risk
• Foster and document discussion of risk among clinical team members
• Provide a guided, continuous risk assessment and management process

The HARM captures three stages of the assessment: Past, Current, and Future. Each stage flows into the next, so that, in moving through the past and current stages to the future stage, the assessor can arrive at a prediction of a patient's or service user's risk of aggression and formulate risk management strategies.

Introducing the Electronic Hamilton Anatomy of Risk Management (eHARM). An Excel-based tool that has revolutionized the way HARM reports are completed.

Learning objectives:

• An understanding of the HARMS tool
• An understanding of the psychometric uses
• An understanding of the innovative electronic Hamilton Anatomy of Risk Management (eHARM)

Target audience: All clinicians

The Community High Intensity Treatment Team (CHITT) provides services for individuals with serious, complex, and persistent mental illnesses living in the Kingston area. Over recent years, team members have become increasingly aware of unattended existential and spiritual dimensions of the client's care.

This workshop will present and examine findings from a pilot project in which CHITT recruited a Spiritual Health Practitioner (SHP) to serve as full-time member of the team from September 2016 to March 2017. The intent of this project was to explore the following: how the client's spiritual health needs are addressed through the clinical practice of a SHP; the nature of the SHP's clinical and educative consultations with the team, the type of referrals made, and the impact of an SHP upon team functioning.

During the pilot project, information was collected from monthly meetings with the program managers, from the SHP's clinical notes and statistics, and from a qualitative survey. A review of the literature uncovered no articles or resources on the topic of ACTT and the involvement of SHPs

Findings of the project and a discussion of the generalist versus specialist role of the SHP will be presented, recommendations made, and possible models of care suggested. Workshop participants will be encouraged to engage in discussion, exploring opportunities for integrating an SHP into their own ACT teams.

Learning objectives:

• Findings of the project and a discussion of the generalist versus specialist role of the SHP will be presented
• Recommendations made, and possible models of care suggested
• Workshop participants will be encouraged to engage in discussion, exploring opportunities for integrating an SHP into their own ACT teams

Target audience: All clinicians

Flexible Assertive Community Treatment (FACT) is a relatively new model of community mental health service in Ontario. The FACT model originated in Holland - FACT teams have higher caseloads than ACTT and varying levels of service intensity (20% high intensity, 80% low intensity).

In 2015, The Community Mental Health Program at The Royal implemented a FACT team for persons with a Dual Diagnosis. The development of FACT DD was in response to a 2012 Provincial Review of Dual Diagnosis Services conducted in Ontario, which identified there were no community based treatment options to provide service to this population in the Champlain LHIN.

Although all ACT teams carry some Dual Diagnosis clients, we would like to share our experience of implementing and delivering ACT and FACT services to this very specialized population of Dual Diagnosis clients. In particular, we will be looking at differences in staff skill mix, the role of behavioral supports and interventions when working with this population, and how FACT and ACTT fit into the continuum of care for Dual Diagnosis clients.

Learning objectives:

• Participants will understand and have a working knowledge of specialized ACTT and FACTT services. FACTT for Dual Diagnosis clients is a new model of care – the first in Canada.
• The eligibility criteria for the team and intake process for this specialized service including use of a consultation team for FACTT intake
• Clinician skill mix for a specialized DD teams - increased focus on behavioral supports
• Challenges of meeting the FACTT 20 per cent high intensity 80 per cent low intensity of service delivery in an Ontario context
• Dual Diagnosis tools and assessments
• Behavioural interventions and tracking for Dual Diagnosis clients

Target audience: Clinicians, managers, or physicians with an interest in the FACT team model and services for Dual Diagnosis clients.

Community treatment orders (CTOs) are initiated primarily for patients with chronic psychotic illness who lack insight into their illness and the need for an adequate medication regimen. The vast majority of these patients have been diagnosed with schizophrenia.

For more than a decade, numerous articles have described efforts to assess the effectiveness of CTOs. The results have been conflicting, the implication being that the effectiveness of CTOs is unclear and that the issue is complex and controversial. However, as demonstrated in the data and commentary that follow, a valid analysis of the subject demonstrates that the issue is in fact not at all unclear and need not be controversial.

A chart review was performed of 50 patients of three assertive community treatment teams, these patients all subject to a CTO. Thirty-four of the patients demonstrated a marked decrease in time in hospital since initiation of a CTO. Of the remaining 16 patients, the lack of improvement in hospitalization time was demonstrated to have no correlation with their CTOs. CTOs can be of great clinical benefit but only if properly employed and followed by effective treatment.

Learning objectives:

• An understanding of the mandate of community treatment orders in Ontario
• An awareness of the evidnce of the benefits of community treatment orders in Ontario
• An understanding of misconceptions regarding community treatment orders

Target audience: Managers / team leads, clinicians, psychiatrists

This one-hour workshop will encourage ACT team members, managers, administrators, and monitors (without a research / statistics background) to utilize quantitative data to improve outcomes.

Participants will gain an understanding of how to identify data trends related to the successes of ACT programs in regard to housing stability, community tenure, hospitalization and recidivism, employment, etc. This approach can be applied to individual teams as well as to multiple teams across a region.

Presenters from Georgia's Department of Behavioral Health and Developmental Disabilities (DBHDD) will share the challenges and successes experienced in building a state-wide data collection system and the ways in which that data has influenced policy and driven service delivery.

Through interactive and experiential methods, with a dose of humor, participants will:

• Identify target data-points and key performance indicators relevant to their goals for service delivery / outcomes
• Develop a strategy to implement data collection
• Identify how data will be shared and used to improve outcomes in their work settings

Sample data collection tools will be shared with participants.

Learning objectives:

• Identify target data-points and key performance indicators relevant to their goals for service delivery / outcomes
• Develop a strategy to implement data collection
• Identify how data will be shared and used to improve outcomes in their work settings

Target audience: Administrators, managers / team leaders

With a clear focus on being more trauma informed, the need to formalize a response regarding care and support for our clinicians during a traumatic event is clear. This is especially relevant to those on ACT Teams, providing community based services to populations who are often subject to experiences that increase their risk of exposure to adversity.

Has your team experienced multiple client deaths within a short period of time? A team member affected by seeing a perpetrated violent crime? A client that participated in a completed suicide? A team member who was a victim of violence in the context of work? This presentation will review the process that our programs implemented as a clinical response to assist clinicians with managing their own feelings about events of this nature and attending to their own wellness. We will answer the question: Whos’s watching the watchers?

Learning objectives:

• Learn about components and implementation of a trauma support team
• Understand the importance of monitoring wellness and assertively promoting active self-care
• Enhance knowledge of logistical framework to support a prompt response when crises occur within the ACT teams
• Understand challenges in establishing this support for ACT staff members

Target audience: Lead clinicians, managers, and / or supervisors

This interactive and experiential presentation will explore and provide information on the challenges and unmet needs peer workers on ACT Teams presently face. To meet these needs, innovative adaptations to evidence-based peer support programs and ideas for integrating these solutions into regular practice, will be discussed.

This presentation will explore how "Pathways to Recovery", "Wellness Action Recovery Plan", mindfulness, visualization meditation, yoga, stretching and recreational activities can be incorporated into sessions to meet client needs. The hope of this work is to provide inclusive and accessible services to a diverse group of ACT participants.

Learning objectives:

• Learn how to identify challenges and barriers to support peer work within an ACT Team
• Learn how to identify and optimize Peer Support Best Practices and Peer Support Worker strengths and assets
• Learn how to implement peer-based strategies into ACT Team provisions and practices, based on experiences of the West End ACT Team, St Joseph's Health Centre Toronto

Target audience: This presentation is for front-line ACT Team workers and managers and anyone else interested in learning more about peer support on ACT Teams.

Learning objectives:

• Facilitating team discussion of day to day risks related to ACTT service delivery in communities
• Creating balance in the perception of risk among teams
• Review of tools to engage and support discussion, monitoring management of risk on ACTT teams

With the ever-growing challenge of securing affordable, face-to-face, and community-based psychiatric services, Resources for Human Development-Louisiana (RHD-LA)'s ACT teams decided to integrate tele-psychiatry to supplement face-to-face psychiatric services. With tele-psychiatry being new to this team, leadership faced unique challenges, such as:

• Fostering acceptance of tele-psychiatry with current psychiatrists, staff and clients
• Deciding which clients would transition to tele-psychiatry and how
• Establishing expectations for ongoing communication between tele-psychiatrist, fellow psychiatrists and ACT staff for regular client updates and emergencies
• Planning for numerous technological and procedural considerations

To address these challenges, RHD-LA launched a decentralized approach to decision-making and strategic planning that included close partnership with ACT psychiatrists, nurses, staff and clients. This presentation will describe this process and lessons learned in order to provide the audience with tools and practical examples that can be applied locally.

Learning objectives:

• Understand key operational considerations for tele-psychiatry process planning
• Learn about strategies for improving the acceptability of tele-psychiatry to staff and clients
• Understand how to develop ongoing evaluation systems to monitor the efficacy and acceptability of tele-psychiatry

Target audience: Clinical leaders, managers / supervisors, administrators

North Carolina (NC), USA has been under a US Department of Justice Settlement around housing and employment issues with the SPMI population. As a result, ACT has undergone the most transformation NC has seen with this service in decades.

This presentation will focus on the efforts of the state, in partnership with the University of NC Institute for Best Practice to provide Motivation Interviewing (MI) training to ACT staff to improve MI proficiency throughout the state.

From introducing MI to participants, to training specialists, we will discuss the various ways to “slice the pie” in terms of disseminations and sustainable efforts to incorporate MI within all facets of ACT from peer specialists work to clinical supervision.

Learning objectives:

• Learn about a large territory's (NC) effort to train mindfully a workforce in an EBP
• Learn about widely available MI resources for training and cross training
• Learn about innovations in Staff Supervision using MI
• Develop ideas about implementation in Ontario

Target audience: ACT clinicians may appreciate the MI training content and resources. ACT team leaders may want to adopt some of the supervision and cross-training ideas. Clinical managers and agency leadership may like the timeline and structure in bringing MI to their agency. All participants can walk away with some MI expansion planning ideas.

Traditionally, we prefer full or part time employment as an outcome of vocational rehabilitation in mental health care. Employment provides clients with a stable job position, preferably connected with health insurance or pension related benefits, access to the social security system, paid holidays and well-regulated working conditions. On the other hand, entrepreneurship and any kind of business activities are considered as unstable, stressful adventures with no fixed income and benefits that don't fit vulnerable people.

In a rapidly changing economic landscape, we need to take into consideration that the preferred stable employment opportunities are vanishing. Digitalization, automatization, robotics, and the advancement of artificial intelligence are challenging not only traditional blue-collar jobs but also white-collar ones. Entrepreneurial skills, creativity, and enormous flexibility are needed on the future labour market, and we need to embrace these new requirements in vocational rehabilitation, too.

I would like to argue that technology and new economic models can also be very enabling, opening a new horizon for vulnerable people in a transforming labour market, bringing examples from successful initiatives.

Learning objectives:

• To enhance knowledge on future tendencies on the labour market
• To give a new perspective to entrepreneurship
• To explore opportunities and obstacles related to user-led entrepreneurial activities in mental health care in Ontario

Target audience: Mental health professionals, vocational rehabilitation experts, peer support workers, managers, civil servants, researchers

Achieving effective leadership of an ACT Team is a multidimensional process, which requires continuous development of self-awareness, mastery of managerial skills, and deliberate development of clinical expertise. This workshop will examine specific elements of key areas within the leadership role and provide strategies for leadership development.

Learning objectives:

• Identify components of effective leadership
• Examine various methods of acquiring leadership skills and competencies
• Develop an improved understanding of research findings behind effective leadership

Target audience: Mental health professionals, vocational rehabilitation experts, peer support workers, managers, civil servants, researchers

Measurable standards are critical in assessment of evidenced based practices to prevent drift from model delivery as it is intended. Historically, evaluation of Assertive Community Treatment (ACT) has relied on costly, cumbersome, and time-consuming fidelity visits. Beyond the several days of observation, interviews, and chart review, quality measures are infrequently considered in teams' day-to-day practice.

This workshop introduces a novel method of assessing fidelity of ACT teams by moving the assessment from an outside entity to a process of self-assessment conducted by teams themselves using Qualtrics survey software, an online, user-friendly self-assessment of 49 items was created for ACT teams to measure fidelity. Alignment of all items with New York State ACT Standards of Care was reviewed, and a three-item subscale assessing Clinical Transition Activities was added in consideration of the emerging focus on transition from ACT.

Upon completion of the ACT fidelity assessment submitted online, an automated response is made available immediately to the team. The feedback provides the ACT team with an overall score and individual item scores. In addition, the feedback is accompanied with suggestions for improvements including training and suggested quality improvement projects.

To assist the team leaders in completing the self-assessment, an online Learning Community was provided to train team leaders and designated ACT providers in the fidelity process

This workshop will include lessons learned about the self-assessment process to provide a knowledge exchange among team leaders, and the surprising ways in which team leaders have implemented the use of the fidelity assessment in day-to-day practices.

Learning objectives:

• Understand the use a fidelity self-assessment
• How model drift can be prevented using fidelity to ground day-to-day practice
• How a learning community can support in the implementation of new practices

Target audience: Team leader, program manager and policy makers

This two-part workshop will review challenges and strategies for implementing a harm reduction culture in clinical work. Presenter will share their expertise in areas of outreach and engagement.

Presenter will also review with participants a number of barriers and limitations in implementing this model, particularly in ACT teams. Finally, participants will brainstorm specific, practical strategies to start implementing ideas immediately.

Learning objectives:

• Examine how harm reduction applies to ACT Team work
• Distinguish values of and practices in a harm reduction model compared to an abstinence model
• Develop an implementation plan with specific strategies in their daily work

Target audience: Clinicians, managers / team leaders

"Manufacturing Recovery" introduces the concept of Six Sigma quality improvement to recovery-based practice. Although originally created to eliminate errors in manufacturing in the 1980s, it can have powerful results in the mental health sector for individuals, organizations, and communities.

The presentation is divided into three parts. The first is an informative overview of Six Sigma methodology and how it can go hand in hand with the recovery model by recognizing the role of the client as both a customer and stakeholder.

The second portion goes through a case study of a Six Sigma project conducted with an Assertive Community Treatment team to address documentation challenges, which demonstrates the radical and measurable improvements this process can yield.

The final portion of the workshop is a brief discussion of other Six Sigma Projects completed in community mental health as well as discussing potential projects suggested by the audience.

Learning objectives:

• Gain a general understanding of Six Sigma (DMAIC)
• Understand how Six Sigma can be an effective quality improvement tool for recovery based services
• To be introduced to a sample of tools to utilize in the DMAIC process

Target audience: The Target audience would be anyone interested in initiating, leading, or participating in quality improvement initiatives at any level. This includes team leaders, managers, coordinators, directors as well as front line staff and people with lived experience who participate in the services being offered. No previous knowledge of Six Sigma is required, and those with previous knowledge will develop new insights into its functionality.

The cost of substance abuse is significant and goes beyond the individual. Those affected, their immediate family, their community and professionals with a wide range of backgrounds, in an ideal scenario, partner up to find the best approaches within the confines of the current scientific advances as well as financial resources.

Among the many avenues explored in this arena, from an alternative, modern yet ancient tradition, acupuncture lends us a quick and effective tool in the form of a simple five points protocol called NADA. Easy to learn and use, it can bring an individual from the brinks of despair to a state of relative balance within minutes.

Whether in the throes of the addictive substance, in withdrawal, or unrelated emotional turmoil, skillfully placed needles can put one in a better position to stop, think, regroup, and rebalance in order to take the best next steps in a more desirable direction.

A short history of the protocol, research data as well as its possible applicability for an ACT environment will be discussed. Case studies (and demonstrations if applicable) will illustrate the presenter's experience with the intervention.

Learning objectives:

• Understand the history of the use of the NADA protocol
• Understand acupuncture in general and the most recent research findings
• Understand the literature review related to the protocol
• Understand my experience in using the protocol in a community based program offering mental health support services to individuals suffering with serious mental illnesses and addictions

Target audience: Clinicians of all backgrounds interested in expanding their interventions repertoire

Use of self is very important in the work of leadership. Understanding your positionality helps you to understand the power dynamic of providing supervision to someone that may not have the same positionality as yourself.

You will leave this workshop with a better understanding of your positionality and encouraged to help your staff recognize their own stance as it relates to connecting with the clients they serve. Your team will in turn become comfortable enough to help clients identify their own personality and how it impacts their relationship with systems and providers.

Learning objectives:

• Identify positionality
• Understand how their positionality impacts the relationship with their supervisee and consumers
• Identify the intersection between positionalities and ways to develop an authentic relationship with their supervisee and consumers

Target audience: Administrators, manager's / team leaders, psychiatrists

Since 2005, the province of Québec developed a lot of ACT and ICM teams to provide services for people with severe mental health illness. These teams faced many challenges and one of them is to learn to work well together. At that time, most of the teams work alone without using the others to create a good continuum of care for people in services.

The ACT and ICM National Center for Excellence in Mental Health (NCEMH) advisors worked together to provide activities and tools helping ACT and ICM teams to work well together. This session will present what was more helpful.

Learning objectives:

• Learning different strategies to help ACT teams working better with ICM teams
• What a collaboration with ICM teams could bring to an ACT team, the Quebec experience
• How to integrate common tools between ACT and ICM services and the challenge of treatment plans and strength assessment

Learning objectives:

• Network with other peer support workers
• Learn valuable tools to assist them in their daily practice

Learning objectives:

• Understand three different disciplines and the important role they have at the client level and also within the team culture
• Learn about various assessments and physical challenges with our aging act population
• Provide an opportunity for future networking

Learning objectives:

• Learn fundamental strategies to be more effective team leaders
• Share common experiences and network with their colleagues

Expectations are growing on health organizations to involve clients and family in treatment planning and program development (Accreditation Canada)

Social workers play a key role supporting family members and involving them in the care of their loved one when possible.

This workshop will provide an opportunity to identify strategies and initiatives used by social workers and ACT teams to:

1. Provide support to family members (such as groups, counselling and referral)
2. Include clients and families as part of a collaborative care team
3. Monitor and evaluate services and quality with input from clients and families
4. Include client and family representatives on advisory and planning groups

The group will share ideas and challenges as well as areas for further development to bring back to their teams.

• Understanding the role of the psychiatrist on an ACT team
• Discussion of ACT psychiatrist position re physician assisted suicide
• Review of med dosing / poly-pharmacy practices with ACT patients
• Review of relationships with hospitals
• Using CTOs effectively
• Issues related to treatment capacity & forced treatment
• Dangerousness & risk management of ACT patients

1. Review nursing Risk mitigation with to regards marijuana use
2. Understand nursing Risk mitigation with regard to Naloxone use
3. Understand increasing complexity of care issues with aging population bubble, limited and or dwindling resources
4. Understand personal/professional safety issues for Nurses

Learning objectives:

• Develop a better understanding of the role of the Addictions Specialist on an ACT team
• Develop a better understanding of the Strengths Weaknesses Opportunities and Threats of the addiction role on an ACT Team
• Share addiction specialty best practices between ACT Teams