Canadian Behavioural Support Systems: A Conversation about Care

Transcription

1 Canadian Behaviural Supprt Systems: A Cnversatin abut Care Part 2: July 29 th, 2010 Meeting Summary The Canadian Behaviural Supprt Systems: A Cnversatin Abut Care, Part 2 was held n July 29 th, This virtual meeting, c-hsted by the Canadian Dementia Resurce and Knwledge Exchange (CDRAKE) and the Alzheimer Knwledge Exchange (AKE) cnsisted f a 3-hur cntinuatin f the cnversatin started n June 7 th in Trnt. The participants included inter-prfessinal and inter-sectral key leaders n the tpic frm acrss Canada, wh attended the Part 1 meeting n June 7 th. Canadian BSS Cnversatin: Reminder f Functin This meeting was secnd in a series f knwledge exchange pprtunities aimed t cnnect peple, knwledge and resurces related t behaviural supprt systems t assist with the transfer f knwledge t practice and imprved patient care. Within the cntext f behaviural supprt systems, these exchanges will: Cnnect leaders f dementia care Prfile leading behaviural supprt system practices Prmte cllabratin, netwrking and exchange f knwledge Assemble and create resurces t supprt practice Disseminate knwledge f behaviural supprt systems and resurces Meeting Objectives and Agenda The primary fcus f Part 1 and Part 2 f the frum was t prvide an pprtunity fr participants t share their prvincial and territrial behaviural supprt system practices, innvatins, resurces, prcedures and plicies, which will assist all participants t leverage their cllective wisdm and knwledge t bth set Canadian pririties and replicate successes in their lcal cntexts. Part 2: July 29, 2010 Agenda Items Develping a Blueprint fr Canadian BSS: What is yur dream? Building a Rad Map: Identifying the Gaps, Causes and Next Steps

2 Objectives Identify and priritize critical cmpnents f the best case Canadian Behaviural Supprt System Identify pprtunities fr imprvement based n gaps between current and desired system perfrmance Identify next steps fr cntinuing the cnversatin thrugh cllabratin and exchange Ppulatin At this meeting, the ppulatin in questin was cnfirmed t be lder persns with cgnitive impairment r changes assciated with mental health, dementia, neurlgical cnditins r addictins. Guiding Principles Participants identified the need fr guiding principles t infrm the directin f gals f the Canadian BSS discussins. These principles are adpted frm the Ontari BSS Prject (Older Adults Behaviural Supprt Systems, Dudgen and Reed, 2010) and are fundatinal t prviding quality, persn-centered care: 1. Behaviur is cmmunicatin: The fundatinal underlying assumptin within the Canadian BSS discussins is that ne can minimize challenging behaviur by understanding the persn and by adapting the envirnment r care t better meet the individual persn s unmet needs. It is believed that behaviurs are an attempt t express distress, prblem-slve r cmmunicate unmet needs, and that mst ften challenging behaviur is nt meaningless, unpredictable, r nly manageable thrugh chemical r physical restraints. 2. Respect: All persns must be treated with respect, regardless f the situatin and are accepted as ne is, regardless f age, health status, behaviur, etc. Respect and trust shuld characterize the relatinships between staff and clients and between prviders acrss systems (Principles f the Natinal Framewrk n Aging: A Plicy Guide Health Canada, 1998). The cultural diversity f peple being served requires culturally cmpetent appraches t be effective. Practices must value the language, ethnicity, race, religin, gender, beliefs/traditins, and life experiences f the persn t be relevant t the individual being served (CMHA, MH Refrm 2010); practitiners must knw the persn t better understand the presenting behaviurs and triggers (Kitwd, 1997). 3. Relatinship-based: The develpment f meaningful relatinships must be encuraged t incrprate the bradest range f infrmatin and expertise

3 available; invlve lder persn and caregiver/family/scial supprts in persnal care and life gals (ADRD Planning Framewrk Equality f vice and partnership in decisin-making reflected in persnalized care plans Mental Health Cmmissin) 4. Cllabrative Care: Cllabrative care suggests that accessible, cmprehensive assessment and interventin requires an interdisciplinary team apprach; whereby the team believes that they achieve mre by wrking tgether, recgnize skills that are cmplementary and functins f members that are interdependent. This apprach is based upn prfessinals frm different disciplines cperatively evaluating the client and family needs and develping a jint single plan f care (CCMHI, lit review). 5. Least Restrictive and Supprtive Envirnments: This cncept prmtes preventive interventin t maintain well-being by creating supprtive physical and scial envirnments that adapt in respnse t changing needs. These envirnments shuld be familiar and hme-like t increase feelings f security and safety and allw senirs t remain as independent as pssible withut placing undue burdens n families. Als key t this guiding principle is the use f nn-pharmaclgical psychscial interventins whenever pssible 6. System Crdinatin and Integratin: Systems are built upn existing resurces and initiatives and develp synergies amng existing and new partners t ensure access t a full range f integrated services and supprts; the prvisin f supprts is flexible and based n need nt funding/mandate sils. 7. Accuntability: The service system is accuntable t peple being served; health and scial service prviders are accuntable t each ther and t the funder t define perfrmance expectatins and fulfill respnsibilities fr value (effectiveness/cst) and sustainability; funder accuntable t system t prvide plicy directin and adequate resurces. Cmpnents f a Canadian BSS Thrugh discussin, participants in the July 29 th meeting determined a list f cmpnents they deemed critical t a Canadian Behviural Supprt System. A high-level summary f the critical cmpnents f a BSS, as put frward by the grup n July 29 th, is listed belw. The full transcript frm the July 29 th webinar is available. 1. Caregiver Supprt (e.g. crisis supprt, night prgrams, caregiver stress screening and peer supprt, and telephne supprt line) 2. Relatinship / Persn Centered Apprach (e.g. system that supprts the dyad, respecting family / individual chices that invlve risk, supprt fr self-management and enabling PWD and family t be active members f care)

4 3. Technlgy Supprt (e.g. utilizing technlgy t mnitr and supprt persns with dementia in the hme) 4. System Integratin (e.g. infrastructure that allws smth transitins acrss the cntinuum f the disease, inter-sectral cllabratin, cmpnents can be replicated acrss jurisdictins, mst respnsible agency/wrker fllwing the client thrugh the system, system navigatr) 5. Accuntability (e.g. medicatin management prtcl, prviding care as lng as pssible-even in private facilities, cnsistent minimum standards) 6. Educatin / Training (e.g. cntinuus develpment f renewal and capacity building within wrkfrce, valuing bth expert and frnt line staff, training mdules t supprt respnsive behaviurs) 7. Cntinuus Quality Imprvement (e.g. cmmn measurable perfrmance indicatrs, natinal cllectin f data, cncrete metrics t demnstrate value f cmpnents, evaluatin embedded in prcesses) 8. Supprtive access t resurces (e.g. nline knwledge bank f resurces, nging envirnmental scanning, funding frmulas, framewrks fr resurce allcatin, health equity in terms f access t care and services) Pririties Given the critical cmpnents f a Canadian BSS, participants identified their tp pririties fr actin, summarized, in rder f preference, belw: Tp 5 Pririties 1. BSS Natinal Guidelines 2. Maximize RAI and wrk with CIHI t slve data issues 3. Lcal system navigatin 4. Innvatin database 5. KT strategies t share leading practice Additinal Pririties 6. Change cnversatin abut respnsive behaviur 7. Cmmn learning set fr caregivers and frntline 8. Systems level cmmunicatin and language fr advcacy 9. Advcating fr persn-centered care with KT and evaluatin embedded 10. Natinal system f nline supprt grups supprted by paid prfessinals 11. Audit tl / lens that allws peple t self-evaluate 12. Develp a natinal framewrk fr system navigatin

5 The participants reached cnsensus that by fcusing n the first pririty f develping Natinal Guidelines fr a Canadian BSS, several f the ther pririties may be achieved. As such, the next cnversatin in this series f knwledge exchange events will fcus n pririty #1. Next Steps Innvatins, Prjects and Activities This list will cntinue t be develped and added t as infrmatin is received, hwever, at this time, participants wanted access t the fllwing resurces as identified thrugh ur discussin n July 29 th : 'Develping Resurces t Supprt Caregivers f Older Adults' the cntact is PennyMacCurt@shaw.ca was develped t prmte wrking in cmmunity mental health and acts as a jb psting mechanism as well, perhaps smething similar t prmte wrking with lder peple etc. Ontari BSS Prject: Next Canadian BSS Cnversatin An in-persn think tank, fr which we have received funding frm the Alzheimer Sciety f Canada and the Canadian Dementia Knwledge Translatin Netwrk, will be held in Nvember, 2010 in Mntreal, QC (as determined by the participants f the July 29 th meeting). In rder t determine a date fr the next in-persn knwledge exchange event, participants are asked t fllw the instructins belw: Click n this link, r cut and paste int yur brwser, t indicate: Yur availability fr a fall in-persn Natinal BSS think tank Activities frm yur wn prvinces that fall under the prpsed pririties Additinal resurces yu wuld like distributed t the grup prir t the fall think tank t help infrm that discussin Any additinal questins yu may have Virtual Advisry Panel Participants are asked t send this link t any clleagues wh may be interested in jining the Natinal BSS Virtual Advisry Panel. As a member f this grup they will be asked t review draft dcuments prduced by the Natinal BSS grup and t prvide feedback, likely thrugh survey sftware r ther virtual means.