EVALUATION OF THE ONTARIO COMMON ASSESSMENT ... - CCIM

EVALUATION OF THE 

ONTARIO COMMON ASSESSMENT OF NEED (OCAN) IN 

ABORIGINAL MENTAL HEALTH PROGRAMS 

PROLOGUE BY THE CMH CAP TEAM 

As part of gathering learnings about implementing OCAN within the NE LHIN, the project engaged with 

independent researchers to conduct an evaluation of how best to implement OCAN within the Aboriginal 

population. 

The evaluation involved a survey, focus groups and interviews with staff, service providers and clients at 

James Bay General Hospital Community Mental Health Program, Noojmowin Teg Health Centre and 

Mamaweswen, the North Shore Tribal Council who were participants in the NE LHIN OCAN implementation 

pilot. 

The focus was mainly on learning how well OCAN fits Aboriginal mental health programs, identifying 

implementation best practices, determining the needed cultural supports and the barriers and challenges 

experienced by those who did not use OCAN. 

The following report cites that the concept of a common assessment tool was supported by participating 

providers. However, a recommendation was made to devise cultural supports to better reflect the Aboriginal 

individual’s journey and community realities in order to improve uptake and implementation of OCAN. CMH 

CAP is currently in the process of investigating how this could best be accomplished.

EVALUATION OF THE 

ONTARIO COMMON ASSESSMENT OF NEED (OCAN) IN 


March 2010 

Evaluation Report of the 

OCAN Implementation in 

Aboriginal Mental Health Programs 

in the Ontario North East 

Local Health Integration Network 

Submitted to: 

Canadian Mental Health Association, Ontario Division on behalf 

of Community Care Information Management 

Submitted by: 

Mariette Sutherland, B.Eng. 

Whitefish River First Nation 

Birch Island, Ontario, P0P 1A0 

and 

Marion Maar, PhD 

Faculty of Medicine, Human Sciences Division 

Northern Ontario School of Medicine, Sudbury, Ontario

OCAN Evaluation for Aboriginal Mental Health Programs 

Table of Contents 

INTRODUCTION .....................................................................................................................................................................5 

BACKGROUND........................................................................................................................................................................6 

THE COMMUNITY CARE INFORMATION MANAGEMENT (CCIM) PROGRAM.............................................................................6 

COMMUNITY MENTAL HEALTH AND ADDICTIONS (CMH&A) ................................................................................................7 

ONTARIO COMMON ASSESSMENT PROJECT .............................................................................................................................8 

EVALUATION OF THE OCAN PILOT IN MAINSTREAM MENTAL HEALTH PROGRAMS .................................................................9 

EVALUATION OF THE OCAN PILOT IN ABORIGINAL MENTAL HEALTH PROGRAMS ..................................................................9 

The Evaluation Team..........................................................................................................................................................9 

PURPOSE OF THE EVALUATION OF THE OCAN IMPLEMENTATION IN ABORIGINAL MENTAL HEALTH 

PROGRAMS............................................................................................................................................................................10 

OBJECTIVES OF THE EVALUATION ..........................................................................................................................................10 

OUR APPROACH TO THE EVALUATION ...................................................................................................................................10 

EVALUATION QUESTIONS................................................................................................................................................13 

EVALUATION METHODOLOGY ......................................................................................................................................16 

OVERVIEW OF METHODS .......................................................................................................................................................16 

TIMELINES AND PARTICIPANTS AT EACH PARTICIPATING SITE ..............................................................................................17 

OVERVIEW OF PRESENTATION OF FINDINGS...........................................................................................................18 

RESULTS FOR THE JAMES BAY COAST SITES............................................................................................................19 

DESCRIPTION OF THE JAMES BAY COAST COMMUNITIES.......................................................................................................20 

THE SERVICE CONTEXT: THE JAMES BAY COMMUNITY MENTAL HEALTH PROGRAM ...........................................................21 

OVERVIEW OF THE OCAN IMPLEMENTATION AT THE JAMES BAY COAST.............................................................................22 

Providers’ Understanding of OCAN.................................................................................................................................22 

Perceived Adequacy of OCAN Staff Training and Support ..............................................................................................23 

Current status of OCAN implementation..........................................................................................................................23 

OCAN’S FIT WITHIN THE SERVICE DELIVERY MODEL AT JBCMHS .......................................................................................24 

Perceived importance of a standardized assessment tool.................................................................................................24 

The realities of implementing OCAN into the daily workflow ..........................................................................................24 

Fit of the automated OCAN tool.......................................................................................................................................25 

Fit of OCAN with Aboriginal client population and presenting concerns........................................................................25 

Fit of OCAN within Cree Language and Culture .............................................................................................................26 

RESULTS FOR NORTH CENTRAL ONTARIO REGION SITES ..................................................................................27 

DESCRIPTION OF NORTH SHORE AND MANITOULIN COMMUNITIES .......................................................................................27 

SERVICE CONTEXT: N'MNINOEYAA ABORIGINAL MENTAL HEALTH SERVICES.....................................................................28 

OVERVIEW OF THE OCAN IMPLEMENTATION AT N'MNINOEYAA ..........................................................................................28 




OCAN’S FIT WITHIN THE SERVICE DELIVERY ON THE NORTH SHORE ....................................................................................29 


The realities of implementation of OCAN into the daily workflow...................................................................................30 

Cross jurisdictional issues................................................................................................................................................31 

Sutherland & Maar - March 2010 Page 2




Fit of OCAN with Aboriginal Culture...............................................................................................................................33 

SERVICE CONTEXT: NOOJMOWIN TEG HEALTH ACCESS CENTRE ..........................................................................................34 

OVERVIEW OF THE OCAN IMPLEMENTATION AT NOOJMOWIN TEG ......................................................................................34 




OCAN’S FIT WITHIN THE SERVICE DELIVERY ON MANITOULIN ISLAND.................................................................................35 


The realities of implementation OCAN into the daily workflow.......................................................................................35 

Cross jurisdictional issues................................................................................................................................................36 


Overall workers stated that piloting the OCAN has lead to valuable networking with the NE LHIN and with other 

Aboriginal mental health services programs....................................................................................................................37 


Fit of OCAN with Aboriginal Culture...............................................................................................................................37 

IMPLICATIONS FOR OCAN IN ABORIGINAL MENTAL HEALTH SERVICES .....................................................38 

IMPLICATIONS FOR OCAN IN ABORIGINAL MENTAL HEALTH SERVICES .....................................................38 

COMPARISONS AND CONTRASTS REGARDING OCAN EVALUATION FINDINGS IN THE DIFFERENT ABORIGINAL CULTURES AND 

SERVICE CONTEXT..................................................................................................................................................................38 

Contrasts: .........................................................................................................................................................................38 

CULTURAL INCONGRUENCE RELATED TO SPECIFIC DOMAINS................................................................................................39 

Domain 1: Accommodation ..............................................................................................................................................39 

Domain 2: Food................................................................................................................................................................39 

Domain 17: Sexual Expression.........................................................................................................................................39 

Domain 21: Phone............................................................................................................................................................39 

Domain 22: Transport......................................................................................................................................................40 

Domain 23: Money ...........................................................................................................................................................40 

General comment on open ended questions......................................................................................................................40 

Open ended Question on Hopes and Dreams...................................................................................................................40 

Open ended Question on Spirituality................................................................................................................................40 

MISSING ELEMENTS...............................................................................................................................................................40 

Abuse history ....................................................................................................................................................................40 

Experience of discrimination and/or racism.....................................................................................................................41 

Education..........................................................................................................................................................................41 

SUGGESTIONS FOR FUTURE IMPLEMENTATION OF OCAN IN ABORIGINAL HEALTH SERVICES 

CONTEXT ...............................................................................................................................................................................42 

OPPORTUNITIES FOR FUTURE SUPPORT OF OCAN IMPLEMENTATION IN ABORIGINAL MENTAL HEALTH SERVICES .............42 

1. Readiness for the Implementation of a Common Assessment Tool...............................................................................42 

2. Training ........................................................................................................................................................................43 

3. Client population ..........................................................................................................................................................44 

4. Reliability, validity and cultural safety of the current version of the OCAN in Aboriginal mental health services .....44 

5. Automation ...................................................................................................................................................................45 

IMPORTANT CONTEXT OUTSIDE OF OCAN – SYSTEM IMPEDIMENTS......................................................................................46 

6. Impact on clinical and administrative processes..........................................................................................................46 

7. Policy implications .......................................................................................................................................................47 



APPENDIX A: FOCUS GROUP AND INTERVIEW QUESTIONS FOR PROVIDERS/STAFF..................................49 

[PROVIDER PERSPECTIVES] ................................................................................................................................................49 

[FUTURE IMPLEMENTATION OF THE OCAN].....................................................................................................................50 

APPENDIX B: SURVEY TOOL FOR PROVIDERS/STAFF ............................................................................................51 

APPENDIX C: INTERVIEW QUESTIONS FOR CONSUMERS.....................................................................................55 

[CLIENT PERSPECTIVES] .....................................................................................................................................................55 

[FUTURE IMPLEMENTATION OF THE OCAN].....................................................................................................................56 

APPENDIX D: LETTERS OF INFORMATION AND CONSENT FOR PARTICIPANTS ...........................................57 

APPENDIX E: SURVEY RESULTS ....................................................................................................................................61 



OCAN in Aboriginal Mental Health Services 

A Report on the Pilot Implementation of OCAN in Aboriginal Mental Health Programs in the 

Ontario North East Local Health Integration Network 

INTRODUCTION 

In 2008, the North East Local Health Integrated Network (NE LHIN) became the first LHIN to initiate a LHINwide 

implementation of an automated common assessment tool, the Ontario Common Assessment of Need 

(OCAN) to all its Community Mental Health (CMH) Programs. This implementation pilot of OCAN plays a key 

role in shaping the provincial framework for future use of the OCAN. Reflecting Ontario’s diversity in the NE 

LHIN, the OCAN will see use with Aboriginal, Anglophone and Francophone consumer populations and their 

service providers. In this document we report on the experience of the Aboriginal mental health services 

stakeholders with respect to the OCAN implementation in diverse regions of Northern Eastern Ontario. This 

evaluation of the pilot implementation of the OCAN in Aboriginal mental health programs was conducted 

during the winter of 2009/2010. 

The evaluation research was conducted by Mariette Sutherland (Consultant, Whitefish River First Nation) and 

Dr. Marion Maar (Faculty, Northern Ontario School of Medicine). Over the past 10 years, these researchers 

have collaborated on numerous mental health research projects within the Aboriginal communities and 

organizations, including First Nation health service organizations based in Northern Ontario, as well as 

provincial Aboriginal territorial organizations (PTOs) and provincial and federal government departments. 

This OCAN evaluation report of Aboriginal mental health programs is detailed in the following sections: 

Background to the OCAN in the NE LHIN and previous OCAN evaluation research 

Purpose of this evaluation & evaluation questions 

Methods and timelines of the evaluation 

Description and results for Ontario regions in the Far North and North Central area 

Discussion of results and implications for OCAN implementation in Aboriginal mental health services 

Recommendations for OCAN implementation in Aboriginal mental health services 

Appendices of research instruments 



BACKGROUND 

In this section we provide background on (1) Ontario’s relevant health information management programs, (2) 

community mental health programs in Ontario, (3) the Ontario Common Assessment of Need (OCAN) and (4) 

previous evaluation research of the OCAN implementation in mainstream services. 

The Community Care Information Management (CCIM) Program 1 

Since 2005, CCIM has played a critical role in improving the health care system for providers, residents, and 

consumers across the Long-Term Care, Community Mental Health & Addictions (CMH&A), Community Care 

Access Centres (CCACs), Community Support Services sectors and, more recently, Small & Chronic Care 

Hospitals and Community Health Centres. The implementation of common assessment tools and business 

systems solutions along with two integration initiatives enables access to standardized information for 

evidence-based care planning, operational improvements, and funding decisions that directly support the 

delivery of better health care to clients at home and in our communities. 

The RAI-MDS 2.0 common assessment tool in Long-term Care Homes and the OCAN tool in Community Mental 

Health agencies assist consumer-led decision-making at an individual level and make sharing information easy 

and timely across the sector. The purpose is to implement standard assessment practices that improve business 

processes and client care management by identifying needs, helping match needs to existing services and 

identifying service gaps. 

Also within the CCIM Common Assessment stream, an Integrated Assessment solution is being created, which 

will allow health care professionals to see community-based assessment data to help inform the treatment 

planning for people in their care. Plans are being made to begin a pilot in two or three volunteer LHINs this 

summer, prior to a provincial rollout. 

Two business systems solutions are being rolled-out in the CMH&A, Community Support Services, and Small & 

Chronic Care Hospitals sectors. A financial and statistical software solution (MIS) is currently being 

implemented in organizations to create consistent, reliable internal processes and systems and to meet 

external Ontario Healthcare Reporting Standards (OHRS) reporting requirements. This solution is also in the 

initiation stage in the Community Health Centres sector. The human resources and payroll software solution 

will make it easier for organizations to track the valuable services provided to clients and enable 

organizations to automate and streamline their payroll and human resources processes for improved 

efficiency, accountability and reporting. Both systems will make standardized reporting possible at the local 

level for Health Service Providers, Local Health Integration Networks (LHINs) and the Ministry. 

The Integrated Data Strategy is an overall initiative that builds on the past and present work being done in 

the Business Systems and Common Assessment project streams regarding the implementation of standardized 

data, tools, and processes across the community care sectors. Currently, information is being reported 

individually by these streams to reflect the sectors’ clinical, financial and HR information. The Integrated Data 

Strategy aims to combine this information to more clearly demonstrate the relationship between needs, 

services, outcomes, and cost. 

1 Information provided in the sections (i.e. CCIM, CMH&A and OCAN) are adapted from materials provided by the Ministry of 

Health and Long Term Care. 



All this is built on a foundation delivered and supported by the Solutions Group with its extensive expertise 

and focus on continuous development and service delivery through its core competency areas – Architecture & 

Integration; Standards; Security, Privacy and Risk Management; and Transition. 

A key success factor for CCIM is that every project team and initiative has the appropriate level of business 

and technical expertise to facilitate effective project planning and implementation. 

Community Mental Health and Addictions (CMH&A) 

The community mental health sector is a diverse sector providing a range of community mental health services 

by over 300 not-for-profit organizations of various sizes and in a variety of settings in Ontario. 

CCIM supports the CMH&A with tools to improve business processes and enhance the management of client 

care. CCIM is working with sector leaders to pilot and implement three projects that will help achieve this 

goal. 

1. CMH CAP is implementing a streamlined assessment process that will standardize current practices 

across the province. OCAN is a standardized, consumer-led decision-making tool that allows key 

information to be electronically gathered in a secure and efficient manner. 

Since the initial consultation with the CMH sector in December 2007, the project continues to work 

province-wide with sector stakeholders through information exchanges and consultations, steering 

committees and working groups to promote best practices across the sector. Most importantly, 

consumers are playing a critical role in the constant development and improvement of common 

assessment practices. Lessons learned from implementation pilots as well as research formed the basis 

for the CCIM CMH CAP Steering Committee’s recommendations to the Ministry of Health and Long- 

Term Care for province-wide implementation. 

2. The Human Resources Information Systems CMH&A project will provide a Payroll and HR software 

solution that is integrated with the current MIS/OHRS-compliant financial solution offered by the 

CMH&A MIS project. This information is needed by the LHINs, the Ministry and by service providers to 

have better indicators for evidence-based resource planning. The project aligns with multiple LHIN 

priorities. 

3. The Community Mental Health and Addictions Management Information Systems Project (CMH&A MIS) 

has standardized reporting within the CMH&A sector, providing integrated long-term financial and 

statistical information that is accurate and consistent across the mental health spectrum. The project is 

in Phase 3, which will introduce a financial and statistical management software solution to ensure 

there are reliable processes and systems in place within organizations for full MIS integration and 

ongoing reporting. 

These three complementary CCIM initiatives are building an improved, comprehensive solution for the sector 

by producing the following benefits: 

Client-focused, more individualized care delivery by streamlining intake processes and removing 

duplicate administrative processes 



Improved quality of information for planning and decision-making 

Standardized, consistent and reliable data and technical and business processes 

Enhanced information aids benchmarking, policy development and sector planning. 

Ontario Common Assessment Project 

Sponsored by CCIM and supported by the MOHLTC, the goal of CMH CAP is to streamline the assessment 

process by standardizing current practices in the form of an automated common assessment tool for use by 

community mental health providers. The project has finalized the automated common assessment tool, now 

called Ontario Common Assessment of Need (OCAN). OCAN is comprised of the Camberwell Assessment of 

Need (CAN-C) and additional data elements. This tool allows key information to be gathered quickly from 

both people seeking service and providers while ensuring consistent assessment practices across the province. 

OCAN provides consumers with an active role in their service planning, while supporting community mental 

health programs to share and re-use consumer-consented information in a way that provides structure and 

focus for comprehensive assessments. OCAN is designed to enable consumer-led decision making at the 

individual level of service; reduce repetitive information gathering; standardize, streamline and unify 

assessments; and provide an aggregate view of the mental health sector to support informed health care 

planning and decisions. 

In the fall of 2008, the North East Local Health Integrated Network (NE LHIN) expressed interest in being the 

first LHIN to implement OCAN to all its Community Mental Health (CMH) Programs. The NE LHIN 

implementation approach is a LHIN-wide implementation pilot of OCAN, and is playing a key role in shaping 

the provincial framework for future LHIN-wide use. 

This pilot implementation offers a landscape for developing a strategy that reflects Ontario’s diversity. 

Throughout this pilot, OCAN will see use with Aboriginal and Francophone consumer populations in the NE 

LHIN and their service providers. 

Stage One - piloting of OCAN was completed in 2008 and involved 16 community mental health 

organizations throughout Ontario. A number of reports summarizing the lessons and outcomes of that work are 

available for review. 

The project is currently in Stage Two, testing LHIN-wide implementation of OCAN in community mental health 

programs in Northeastern Ontario. A number of Aboriginal organizations and/or Aboriginal mental health 

programs are involved in this pilot implementation. 



Evaluation of the OCAN Pilot in mainstream mental health programs 

In 2008, the Community Mental Health Common Assessment Project CMH CAP commissioned Caislyn Consulting 

Inc. to conduct an independent evaluation study of the OCAN pilot in sixteen participating mental health 

programs to examine the following: 

The impact of the CMHCA approach on people seeking services and community mental health 

providers 

Emerging best practices regarding use of OCAN 

Feedback on the prescribed methods of the OCAN process 2 

The comprehensive report documented and described a number of key learnings about how the OCAN is 

being implemented in 16 selected pilot sites and suggested areas for improvement that could be further 

explored. 

Evaluation of the OCAN Pilot in Aboriginal mental health programs 

The CMH CAP released a request for proposals (RFP) in the fall of 2009 to evaluate the implementation of 

OCAN in Aboriginal mental health programs in selected Aboriginal mental health programs in the Ontario 

North East Local Health Integration Network. 

The Evaluation Team 

The CMH CAP commissioned the authors of this report (Mariette Sutherland and Marion Maar) to conduct this 

evaluation. The results of the evaluation and related recommendations are provided in this document. 

Mariette Sutherland is a health services research consultant from Whitefish River First Nation. Mariette’s work 

is focused on the planning and evaluation of health services for Aboriginal people in Ontario. Dr. Marion 

Maar is a fulltime faculty member at the Northern Ontario School of Medicine in Sudbury. Marion’s research 

focuses on Aboriginal health issues, including chronic care, mental health and e-health applications. 

2 2008. Kate Pautler. Common Assessment Evaluation Study Final Report. Caislyn Consulting Inc. 



PURPOSE OF THE EVALUATION OF THE OCAN IMPLEMENTATION IN 


Objectives of the evaluation 

The goal of the evaluation was “to undertake an evaluation study examining the processes and content of the 

OCAN as it relates specifically to the Aboriginal populations in the Ontario NE LHIN CMH CAP pilot project.” 

CMH CAP developed the following OCAN evaluation objectives: 

Analyzing the degree of fit of the OCAN tool for completing assessments by staff and consumers 

within Aboriginal mental health programs. 

Using a variety of data collection methods, giving due consideration to the administrative burden 

on Community Mental Health organizations, clinicians and consumers, as well as the evaluation 

questions, timeframe, and budget. 

Determining what best practices were used during the process of completing OCAN. 

Collecting and using existing and proven or best practice tools. The Selected Proponent shall work 

with the project to propose, discuss and advise on the merits of validated tools for addressing 

quality, access, acceptability and cost. 

Evaluating what cultural supports need to be in place for both staff and consumers in completing 

the tool and incorporating OCAN processes in Aboriginal mental health programs. 

Examining barriers and challenges for using OCAN in Aboriginal programs that did not elect to 

participate in the NE LHIN pilot. 

Our Approach to the Evaluation 

Our approach to the evaluation was collaborative with the CMH CAP team. Furthermore, we used a 

participatory evaluation framework with Aboriginal stakeholders and participants. 

We utilized a variety of data collection methods, to document the experience of Aboriginal Mental Health 

organizations, clinicians and consumers. We were guided by the following conceptual framework: 

Building on what has been done already: The evaluation plan developed for Aboriginal mental 

health programs was designed to build on the previously completed evaluation of OCAN in 

mainstream mental health programs conducted by Caislyn Consulting in 2008. The framework used 

in that evaluation incorporated many aspects that are also relevant within the Aboriginal context. 

Therefore, similar - or at times even identical - evaluation questions were used whenever possible. 



This approach allowed for clear comparisons of the implementation of OCAN in mainstream and 

Aboriginal programs on several levels. 

Identifying unique aspects of Aboriginal services: While some aspects of the implementation of 

OCAN apply to Aboriginal programs as well as mainstream programs, there are other aspects that 

are unique to the Aboriginal service context. We therefore developed a research plan that 

included a review and examination of differences in the implementation of OCAN in Aboriginal 

mental health programs that may be a result of the diversity of Aboriginal peoples, cultures, 

service environments and geography. In addition, we examined potential differences in service 

provision in First Nations communities, funding and jurisdictional issues, cultural safety in mental 

health as well as historic issues. 

Cultural Safety: Cultural awareness, competence, sensitivity and safety have different meanings 

that their use is not always consistent in the academic literature. The concept of cultural safety 

originates with the Maori People of New Zealand, and embodies a concept that goes beyond 

providers learning about cultural differences. It describes an approach to service provision that 

incorporates provider self-reflection and understanding of power differentials that often exist 

between Aboriginal clients or patients and health services providers. Therefore it is vital that in 

culturally safe services, it is the client who defines "safe services” 3 4 . Of great importance to many 

Aboriginal people in the North Eastern Ontario is service provider acceptance of beliefs, religions, 

backgrounds, and history, and a focus on building on the strengths of Aboriginal people 5 . 

Respect for Aboriginal perspectives on research: Aboriginal people often feel that they have 

been over researched and are thus frequently critical of government or university interests in 

conducting research within their communities. Research initiated by outsiders may raise concerns, 

particularly when the topic of research is sensitive such as mental health research. Researchers who 

work in Aboriginal communities often come in contact with communities and individuals who have 

participated in research projects and have felt harmed or violated, despite the fact that research 

protocols received ethics approval from a university or hospital-based research ethics board (REB). 

Aboriginal people commonly see the lack of collaboration and community focus in research design 

and implementation as an ethical issue that must be resolved. 

Our evaluation team was committed to a research approach, informed by and respectful of cultural 

values of the Aboriginal people and communities who participated in this evaluation. We strived 

for transparency in the research process and sought feedback on evaluation instruments and 

methods from each participating organization. For example, we encouraged review and feedback 

on interview questions for clients from representatives from the Aboriginal community and partners 

3 Ramsden I: Cultural safety. N Z Nurs J 1990, 83(11):18-19. 

4 Varcoe C, McCormick J: Racing around the classroom margins: Race, racism and teaching nursing. In Teaching nursing: 

Developing a student-centred learning environment. Edited by: Young L, Paterson B. Philadelphia: Lippincott, Williams & 

Williams; 2006:437-466. 

5 2009 Maar, M.. , B. Erskine, L. McGregor, M. Sutherland, D. Graham, T. Larose, M. Shawande, and T. Gordon. Innovations on 

a shoestring: A Study of a Collaborative Community-based Aboriginal Mental Health Service Model in Rural Canada. 

International Journal of Mental Health Systems 3:27. Accessible at www.ijmhs.com/content/3/1/27 



involved in this evaluation prior to implementation. We also respected all advice regarding the 

recruitment of participants for this project. In particular, issue surrounding the recruitment of clients 

(consumers) was discussed with providers at each site. Clients perspectives were only included in the 

evaluation if providers felt it was appropriate for outside evaluators to interview clients. Cultural 

safety of clients was of utmost importance. Focus groups with clients were found to be 

inappropriate due to confidentiality issues related to this method in small communities. Interviews 

with clients were only conducted if approved and supported by local providers. We learned that in 

this service environment, many mental health services clients simply do no trust outsiders enough to 

volunteer for an open discussion of their experience with the OCAN. In those cases where client 

interviews were deemed appropriate, local mental health workers explained the process prior to 

the interview to their clients; and often participated in the interviews along with their clients as well 

as participated in follow up debriefing discussions with the evaluation team interviewers. Follow up 

debriefings were also offered to clients. 

. 



EVALUATION QUESTIONS 

Generally speaking, a process evaluation examines if a program or process is implemented and running as 

envisioned when it was designed. This evaluation went beyond the normal parameters of a process evaluation 

to also elucidate cultural and systems challenges and facilitators associated with OCAN implementation in the 

Ontario Aboriginal mental health service systems. Therefore the evaluation was designed to answer questions 

related to OCAN that focus on 

• the fit of the design of the OCAN for Aboriginal services, providers and clients, as well as 

• the relative success of the implementation of the OCAN in Aboriginal programs. 

In short, the overarching question of the evaluation was 

How well was the OCAN implemented in Aboriginal populations in the Ontario NE LHIN CMH CAP 

pilot project? 

Table 1 provides a detailed overview our evaluation approach including: 

1. evaluation questions used in this project; 

2. their relationship to evaluation questions posed in the evaluation of OCAN in mainstream 

services (as conducted by Caislyn Consulting Inc. in 2008); 

3. additional questions posed to address the unique circumstances faced by Aboriginal mental 

health services; and 

4. tools used to address each question. 



Table 1: Research domains, evaluation questions, methods and tools 

Research Domain 

Evaluation question from 

evaluation of mainstream 

(non-Aboriginal) Services 

by Caislyn 

Additional evaluation 

questions/objectives specific to 

Aboriginal services and culture 

Methodology and tools to 

collect this information 

Service Context (not covered) What is the service context of the OCAN 

in Aboriginal programs? 

What kind of mental health services 

exist? What are the main mental health 

concerns observed? 

Were there any cross jurisdictional 

issues that affected implementation? 

Program reports (to be 

requested from participating 

projects 

Key informant interviews 

(using staff interview schedule 

in Appendix) 

Was the OCAN implemented by all 

workers and as planned? 

Is integration/lack of integration of 

federal and provincial services affecting 

the implementation of OCAN? 

Were there any other issues that 

affected implementation? 

Provider perspectives 

What did assessors value in 

the common assessment 

approach? 

How did the common 

assessment compare with 

existing assessment 

processes? 

Did assessors think they were 

well prepared to implement 

use of the tool? 

How was OCAN introduced to clients? 

Which domains were particularly useful? 

Which domains - if any - were 

problematic or culturally inappropriate? 

Were translation services required? 

Where there concerns regarding the 

collection of electronic mental health 

information? 

Focus groups using staff focus 

group guide (see Appendix) 

Survey (using Survey Monkey 

tool in Appendix) 

How satisfied are assessors 

with the CA tool? 

Client perspectives 

Did participants appreciate the 

self assessment approach? 

What supports did participants 

find effective to completing the 

self-assessment? 

What features of the CA tool 

did participants endorse? 

How satisfied were 

Which domains were particularly useful? 

Which domains - if any - were 

problematic or culturally inappropriate? 

Were translation services required? 

Where there concerns regarding the 

collection of electronic mental health 

information? 

Key informant interviews with 

clients (if seen as appropriate 

by project staff) 

Client interview schedule (see 

Appendix) 



Research Domain 

Evaluation question from 

evaluation of mainstream 

(non-Aboriginal) Services 

by Caislyn 

Additional evaluation 

questions/objectives specific to 

Aboriginal services and culture 

Methodology and tools to 

collect this information 

participants with the process? 

Future of the OCAN 

process 

Is technology working in the 

common assessment 

process? 

What programs are best 

suited for implementation of 

the common assessment? 

What changes should be 

made to the CA tools and tool 

use? 

Are additional domains 

required/desirable for Aboriginal people? 

Are reports useful to program planning 

and reporting? 

Is integration/lack of integration of 

federal and provincial services affecting 

the implementation of OCAN? 

Focus groups, using staff 

focus group guide (see 

Appendix) 

Survey (using Survey Monkey 

tool in Appendix) 

Client interview schedule (see 

Appendix) 

What training and resources 

are essential to future 

implementation of the CA 

process? 



EVALUATION METHODOLOGY 

This evaluation was a process evaluation of the pilot implementation of OCAN in Aboriginal mental health 

services. The evaluation was designed to allow for comparisons with the OCAN evaluation in mainstream 

mental health programs where possible while focusing on the unique aspects of Aboriginal culture and 

experiences. 

Overview of Methods 

We used mixed methods in this evaluation, however our main focus was on the collection of in depth, 

qualitative data. This was done for the following reasons: 

1. Research shows that questionnaires based research has only limited success with Aboriginal 

communities. 

2. Little is known about the fit of OCAN within Aboriginal culture and services, therefore open ended 

qualitative research allows researchers to explore topics that are brought up by participants, but 

were not anticipated by researchers. 

3. The unique cultural, service and geographic context of the OCAN implementation within Aboriginal 

mental health services is best captured and understood through the richness of qualitative research 

data. 

In summary, we conducted a review of local Aboriginal mental health program documents, interviews, focus 

groups and a short survey with providers/staff, as well as key informant interviews with clients as follows: 

1. Mental health services document review 

At each site we reviewed service information, regional and local program descriptions and any other reports 

made available to the evaluation team by local staff, prior to or following the site visits. 

2. Focus groups and interviews with service providers/staff 

Interviews and focus groups were audio recorded and thematically analyzed by the researchers. Summary 

reports for each site were sent back to participants to allow staff to verify the accuracy of the research teams 

findings. 

3. Short survey with service providers/staff 

We also used a survey tool using Survey Monkey to collect survey data from providers/staff to obtain 

quantitative data on key features of the OCAN implementation. This tool was developed to allow direct 

comparisons to the OCAN evaluation conducted with mainstream service providers. We provided the option 

of internet based contributions and paper surveys to ensure remote sites had equal opportunity to contribute 

to all areas of the evaluation. 

4. Interviews with clients 

Interviews with clients were also audio recorded. Clients’ experiences with the OCAN tool were thematically 

analyzed. 

Given that many Aboriginal communities have had poor experiences with research in the past, the researchers 

implemented a detailed informed consent process ( see Appendix D). All participants provided either written 



or verbal consent to participate in the evaluation after reviewing all sections in the letter of information 

(Appendix D). 

Timelines and Participants at each Participating Site 

Data was collected during site visits conducted during February and March 2010. A total of 26 

providers/staff and 8 clients participated in the evaluation. Details for each site visit are provided in Table 2. 

Table 2: Timelines and Participants at each Participating Site 

Site Timelines for site visit Number of staff participants Number of consumer 

participants 

Interviews/focus 

groups 

survey 

James Bay Community 

Mental Health Program 

34 Revlon 

Moosonee, ON 

P0L 1Y0 

PH: 705-336-2164 

FAX: 705-336-2746 

Noojmowin Teg Health 

Centre 

Postal Bag 2002, Hwy 

540 

48 Hillside Rd., Aundeck 

Omni Kaning 

Little Current, Ontario 

P0P 1K0Phone: (705) 

368-2182 

North Shore Tribal 

Council 

Gloria Daybutch 

Box 28, Cutler, ON P0P 

1B0 

(705) 844-2021 

Feb 2-5, 2010 10 8 8 

Feb 10, 2010 4 2 0 

March 24, 2010 9 9 0 

April 19, 2010 3 3 0 



OVERVIEW OF PRESENTATION OF FINDINGS 

The evaluation of the implementation of OCAN in Aboriginal mental health services included culturally, 

geographically and politically diverse Aboriginal regions in Northern Eastern Ontario. It should not come as a 

surprise that while we found some common themes, we also found distinct differences between sites, mainly 

based on the degree of isolation, languages spoken by staff and clients and the state of development of 

mental health services. Lumping these diverse realities into a single “results sections” would belie the diverse 

contexts, experiences and service realities of participating Aboriginal mental health services staff and clients. 

Furthermore we believe that specific information on the influence of geography, culture, language and the 

Aboriginal mental health service context is valuable information to determine the future of OCAN in 

Aboriginal mental health services. 

It is important to note that Aboriginal communities in Canada have experienced profound disruptions to their 

traditional lifestyles over several generations. Many communities have experienced major epidemics, losses of 

languages and lifestyles and multi-generational abuse within the residential school systems. A large body of 

research shows that these historical events have resulted in higher rates of mental illness, family violence, 

suicides and addictions in Aboriginal communities when compared with the mainstream population 6 . The 

impact of these events on the health and the determinants of health of Aboriginal populations has often been 

profound, however it has not necessarily affected communities in a uniform manner. We provide related 

background information relevant to the implementation of OCAN throughout this report. 

To avoid generalizations related to Aboriginal people and Aboriginal mental health issues, we divided the 

results section into 2 sections, representing the cultural and geographic areas where we conducted the 

evaluation. 

1. West Bank of the James Bay Coast; 

2. North Central Ontario, encompassing Manitoulin Island and the North Shore of Lake Huron; 

We paid particular attention to describe the geographic, cultural and service context in each of these areas 

to demonstrate the impact of these factors on the OCAN implementation. 

Following the results sections we discuss the findings and report on related implications for the 

implementation of OCAN in Aboriginal mental health services. Our discussion is focused on the following topics 

related to OCAN and its implementation: 

1. Aspects of OCAN that are easily compatible with Aboriginal services, and therefore should be 

continued; 

2. Aspects of OCAN that are not congruent with Aboriginal services and could be modified; 

3. Aspects of OCAN that are difficult to reconcile with Aboriginal services and require significant 

alteration. 

Finally we list recommendations for the implementation of OCAN in Aboriginal mental health services. 

6 For example see: Kirmayer LJ, Guthrie Valaskakis G. , (Eds.). Healing Traditions: The Mental Health of Aboriginal Peoples in 

Canada. Vancouver: UBC Press; 2009. Brave Heart MY, De Bruyn LM. The American Indian Holocaust: Healing historical unresolved 

grief. American Indian and Alaska Native Mental Health Research. 1998;8(2):56–78. 



RESULTS FOR THE JAMES BAY COAST SITES 

The James Bay Community Mental Health Program (JBCMHP) on the James Bay Coast in the Far North of 

Ontario took part in this evaluation of OCAN. This program provides services to Aboriginal people who live 

on-reserve in five Cree communities along the western coast of James Bay as well as one off-reserve 

community: 

1. Attawapiskat First Nation 

2. Kashechewan First Nation 

3. Fort Albany First Nation 

4. Moose Cree First Nation (Moose Factory) 

5. Peawanuck First Nation (Weenusk) 

6. Moosonee (off reserve town) 

Figure 1: Map of Ontario with James Bay Communities 7 

7 Atlas of Canada, accessible on the Natural Resources Canada website at 

www.atlas.nrcan.gc.ca/site/english/maps/reference/provincesterritories/ontario/referencemap_image_view 



Description of the James Bay Coast Communities 

There is no road access to the James Bay communities from the more southern towns of Ontario. However 

there is rail way service to Moosonee and there are air strips in all communities except Moose Factory. A 

ferry runs from Moose Factory to Moosonee in the summer and a helicopter service operates between these 

communities during freeze up and break up of the ice. Ice roads connect all the communities except 

Peawanuck starting in late winter 8 . Compared to other inhabited areas in north eastern Ontario the climate is 

harsh, with long dry winters with temperatures often reaching -40 degrees Celsius and short summers. The 

communities frequently have to deal with the effects of severe flooding and at times evacuation of their 

communities during the breakup of the spring ice. 

Moosonee is located on the Moose River 12 miles south of James Bay. Approximately 3,500 people live in 

Moosonee with about 85% being Cree. The main language spoken in this town is English with Cree as a 

second language. The town is not connected to the road system in Ontario, however it is accessible by a 4-5 

hour train ride from Cochrane, Ontario, the closest town accessible by train. Scheduled air service is provided 

by Air Creebec based in Timmins. In addition there are several small charter air companies based in 

Moosonee 9 . During the winter months, ice roads lead to the communities of Attawapiskat, Kashechewan, Fort 

Albany, Moose Factory. 

Moose Factory is located near the mouth of the Moose River on an island approximately 13 miles long. The 

neighbouring community of Moosonee which is located on the mainland approximately 5 km from Moose 

Factory is accessible by boat in the summer and by ice road in the winter. The total population is about 

2700 10 . 

Kashechewan is located on the north side of the Albany River at a distance of about 130km from Moosonee. 

It is accessible by year-round air service and a winter ice road. The majority of the people speak Cree as a 

first language and Cree is spoken in most homes. 

Fort Albany is located on the south side of the Albany River at approximately 128 km from Moosone by air. 

It is accessible by air year-round air service and a winter ice road. The majority of the people speak Cree as 

a first language and Cree is spoken in most homes. 

Attawapiskat is located approximately 260 km north of Moosonee (20 minute flight), near the mouth of the 

Attawapiskat River. It has an on-reserve population of approximately 1500 people. Air Creebec has 

regularly scheduled flights to Attawapiskat. In addition there is a winter road connecting the community to 

Mossonee and more northern communities in the winter and a barge runs during the summer. The majority of 

the people speak Cree as a first language and Cree is spoken in most homes. 

Peawanuck is at a distance of about 520 Km from Moosonee and is the most northern community services by 

JBMHP and has about 300 residents. It is accessible by year-round air service and by barge during the short 

8 Weeneebayko General Hospital website, accessible at www.wha.on.ca 

9 Moosonee website accessible at www.moosonee.ca 

10 Moose Cree website accessible at www.moosecree.com 



time of open water (September). Recently, a winter road to Gillam, Manitoba has been prepared; it is the 

world’s longest winter road 11 . 

The Service Context: the James Bay Community Mental Health 

Program 12 

Alemotaeta, the James Bay Community Mental Health Program, is committed to establishing a healthier and 

happier environment for the people in each community along the James Bay Coast. The program provides 

services with a holistic approach, in a manner that recognizes the local cultures, heritages and traditions. 

Individuals, families and whole communities are offered ongoing support and developmental assistance to 

honestly face the aspects of their lives which stop them from being fully healthy, physically, emotionally, 

mentally and spiritually and to develop their strengths in living a more balanced life. The program networks 

with other community resources and agencies within the local communities and outside area. 

The program offers front-line services that are always respectful of the culture and language of the people. 

The service provides continuity of care for those people over the age 16 living in the James Bay area, 

particularly those struggling with depression, concurrent disorder, court support & diversion, follow-up and 

after care, grief, addiction to alcohol/drugs, effects of abuse, problems with relationships, low self-esteem, 

Moderate Mental Illness and Severe Mental Illness. The following service providers are available: 

Mental Health Counselor (available in all sites): To provide a variety of appropriate client-directed 

counseling services. 

Regional Team Leader: To provide counseling and professional support for program staff and community 

partners. To provide counseling and referral services for individuals, couples and families as appropriate. 

Regional Clinician Worker: To provide community based counseling services to persons with mental illness 

which are culturally relative, accessible, and effective in the client’s home community as part of the program’s 

clinical team. To provide joint clinical counseling with a Community Counselor in the coastal communities served 

by the James Bay Community Mental Health Program. 

Regional Concurrent Disorder Worker: To provide culturally appropriate assessment, crisis management, 

supportive counseling and referral services in their language of choice in home community for clients with SMI 

(Serious Mental Health Illness) and/or CD (Concurrent Disorders - a major mental illness in combination with 

addictions issues and substance misuse). 

Regional Court Worker/Case Manager: The primary goal of the program is to divert people with mental 

illness away from or out of the criminal justice system to more appropriate community mental health services. 

Regional Crisis Intervention/Early Episode Clinician: Provides comprehensive case management and crisis 

services to clients that are experiencing early psychosis. 

11 Peawanuck website accessible at www.peawanuckcree.myknet.org/index.html 

12 Adapted from the James Bay Community Mental Health Services Program literature, prepared by James Bay Community 

Mental Health Services Program staff 



Addictions Worker: The program provides intake, assessment, referral, community treatment, group 

intervention, public education and community awareness to adults, youth, family members and Problem 

Gamblers. 

The head office is located in Moosonee and regional specialized workers fly into the coastal communities to 

provide outresearch services; workers also provide sessions to clients over the phone. Due to the geographical 

barriers, workers see their clients only rarely in person (often 1-3 times per year) and some workers have 

never met some of their clients in person. Larger coastal communities have, in addition to visiting workers, also 

a full time worker in the community. Telehealth/telepsychiatry facilities are only accessible in Moosonee and 

Moosefactory, there is no telemedicine within the coast communities. Internet access is unreliable with slow 

connections when it is working. Phone access to the communities normally works, however even this connection is 

at times quite poor. 

The services are geared to address the broad range of need of the client population, including: family issues, 

crisis, court referrals for anger management, suicidal ideation, mood disorders, depression, trauma, Post 

Traumatic Stress Disorder and anxiety disorders. These presenting concerns are in most cases complicated by 

intergenerational trauma, that may include residential school trauma, physical and sexual abuse and other 

issues. Substance use is mostly confined to alcohol. Suicidal ideation is a major concern and suicide waves have 

occurred in some communities in the recent past. 

The current client case load for JBCMHS is approximately 600 -700 clients, however many more contact this 

team for brief mental health services and these clients often return for further brief services after a period of 

time. 

Common presenting concerns according to staff are: family issues, crisis, court referrals (e.g.,: for anger 

management) mood disorders, depression, anxiety disorder, trauma, complicated trauma, Post Traumatic 

Stress Disorder, suicidal ideation is a major issue as well as addictions to alcohol. 

During our site visit, local staff explained that need for services and travel demands are overwhelming for 

workers. 

Overview of the OCAN Implementation at the James Bay Coast 

In this section we report on successes and challenges of implementing OCAN in the JBCMHS program. 

Providers’ Understanding of OCAN 

Providers explained that their interest in participating in the OCAN pilot was rooted in their desire to be 

involved in important new initiatives that were implemented elsewhere in the province or region. They 

generally expressed a deep appreciation of the opportunity to provide feedback on an initiative that could 

potentially be rolled out in Aboriginal mental health services in the future. The James Bay service area is 

geographically quite isolated and providers felt that participating in the OCAN pilot might result in better 

connection and networking with other programs within the LHIN and the province as a whole. 

Providers clearly understood that the OCAN is a standardized tool that has been piloted in mental health 

programs in North Eastern Ontario, including some Aboriginal mental health services. They also understood 

that OCAN has not been used in Aboriginal services previously and that their feedback on the fit of OCAN 

with Aboriginal people and services was sought as part of the evaluation phase. 



Staff generally felt that the evaluation was perhaps scheduled too early to provide definitive feedback on 

the fit of OCAN within the daily business of local service system, and more importantly the fit with the culture 

and presenting concerns of Aboriginal clients in the James Bay area. One provider even stated “it is too soon 

to tell if it is working, come back again next year!” 

The research team explored the underlying reasons for this sentiment throughout the two days spent on site. 

However one theme emerged almost immediately: While providers were initially interested in OCAN because 

it is a standardized tool and used elsewhere in North Eastern Ontario, they also reported that they 

increasingly questioned if OCAN information from the James Bay coast clients can be “read” accurately by 

service providers elsewhere in the province to reflect the clients story. There were concerns that the OCAN 

may not accurately portray the needs of the individual client or client population. Essentially, providers were 

questioning the reliability and validity of the tool within the Aboriginal client population of the James Bay 

area. We will elaborate more on this sentiment in the following sections. 

On a more positive note, providers shared the hope that the OCAN would collect the necessary evidence to 

support program development. Staff generally felt that the JBC mental health program is servicing many 

clients with extremely high needs and without the necessary range of specialized mental health services and 

resources. 

Perceived Adequacy of OCAN Staff Training and Support 

Staff felt that the OCAN training they received was a good start, however they agreed that it “felt rushed” 

and that is was too short. Most importantly the client scenarios used during the training session were not seen 

as very helpful since they did not match the reality of the Cree client population on the James Bay coast. For 

example, staff therefore felt they were not sufficiently prepared during the training sessions to implement 

OCAN in a service environment with clients who are predominantly Cree speakers and culturally quite 

different from mainstream Canadians. Only some providers are fluent speakers of Cree and translation is 

frequently required to complete the OCAN. Providers experienced that the OCAN was very challenging to 

translate into Cree, since many of the concepts were based on Western culture or clinical mental health 

concepts that are difficult to translate into Cree. Frequently concepts used in OCAN and OCAN training do 

not exist in the Cree culture or language. Furthermore, some areas of the OCAN ask very direct and intrusive 

questions of the client, which is incongruent with Cree cultural norms and even violates cultural protocols. 

Providers felt that training session should include focused discussions on how to address these specific cultural 

issues, so that workers would not have to individually work this out through trial and error. 

Providers felt that the OCAN telephone support line was very helpful and allowed for quick access to more 

general questions related to OCAN use. 

The OCAN portal on the other hand has caused some difficulties. Providers report intermitted problems with 

(a) gaining access to the portal, (b) finding information and (c) downloading information. 

Current status of OCAN implementation 

Staff explained that most clients will see staff sporadically and often only during a crisis and it is therefore 

difficult to implement the OCAN with many of their clients. One provider explained: “mental health 

management is a very hard concept to get across to most of our clients”, as they are often struggling with 

many issues and are unable to focus on managing their mental health. After several attempts with various 



clients, the staff members decided that, for the purpose of the OCAN pilot, to select clients with SMI who are 

relatively stable and are actively trying to manage their health and with whom they had already established 

a rapport and relationship. Staff felt these clients would be more suitable and able to work with an 

assessment tool. Providers also explained that several of the OCAN questions were seen as very intrusive by 

clients and required significant rapport and established trust between the provider and the client, which may 

take months or even years to establish in this client population. 

In contrast, providers felt that the tool was much less suitable for clients with addictions or those with trauma 

issues. 

OCAN’s fit within the service delivery model at JBCMHS 

Perceived importance of a standardized assessment tool 

Providers and clients alike agreed overwhelmingly that the implementation of a good and culturally 

appropriate standardized mental health assessment tool is very desirable for many reasons. For example, 

participants explained that the client population is fairly transient. For example a client may move to receive 

service in the more southern towns such as Timmins. It is seen as a very positive if the client could transfer their 

records and assessments and would thus not have to tell their story again. Clients we spoke to were also very 

open to sharing their OCAN data for this purpose. 

However providers questioned if the OCAN is truly collecting the right information to realize this potential. 

They felt that significant aspect of relevant information on their clients is not collected by the OCAN; while 

other information may be misleading without in-depth knowledge of the realties of coastal community life. 

Providers did not have a previous standardized assessment tool, since they felt that available assessment tools 

generally do not fit well with Aboriginal clients and their experiences. Instead staff often “cut and paste” 

various assessment tools in their intake (eg.: CAGE tool to assess alcohol use). 

The realities of implementing OCAN into the daily workflow 

OCAN is creating significant duplication of work for staff at this point. The self assessment as well as staff 

assessment has only been used in paper format so far and must be entered at a later point, due to the 

multiple technological and human challenges of using an automated tool in the James Bay communities. Staff 

members provide services by outreach to communities, either by phone or in person. When traveling to the 

communities, staff do not receive laptops to access the automated OCAN tool. Furthermore staff believe that 

they currently require an internet connection to input data into the automated OCAN tool; however coastal 

communities do not have high speed internet connections, making on site data entry impractical. 

Providers have also found that the clients generally cannot fill out the self assessment independently as many 

clients have only about a grade 3 education and have difficulty reading and writing. Finding a family 

member or friend to help clients with the self assessment creates major challenges, because clients are often 

not willing to disclose the self assessment to family friends, or even a local (paraprofessional) community 

worker. Clients seek out JBCMHS providers precisely because of the perceived level of confidentiality offered 

by this team who do not have the close community or families ties of community workers. The OCAN provider 



therefore normally helps the client fill out the consumer self assessment form. This can take quite some time, 

ranging from 30 minutes to about 2 hours. 

Clients and providers agreed that the coding is very difficult and confusing for clients, since codes such as “No 

Need”, “Met Need” and “Unmet Need” are very abstract concepts and do not directly answer the questions 

posed in the tool. 

When staff have to complete the OCAN over the phone these challenges are often compounded. Since the 

need for services is much greater than available resources, staff are often reluctant to spend an additional 

session on the OCAN, knowing that they have only few sessions with their clients in a given year. 

Fit of the automated OCAN tool 

Clients are generally accepting of the idea of having their information recorded in electronic format and 

potentially shared with other providers. Still, there are some trust issue related to the electronic record for 

some clients. At times, there is a need to keep paper records only, to ensure that the information is accessible 

only to one worker. This is an important issue due to the many family relationships in small communities, where 

electronic records might become inadvertently accessible to family members in the future who work in the 

system in the future. As on provider explained : “every one is related to everyone around here”. Consequently 

some mental health services clients are reluctant to be linked into a server at the hospital. 

Electronic medical records are currently being introduced within the health system at the James Bay Coast the 

system is ready for electronic records, although providers reported that there are currently frequent glitches 

to access electronic records. 

In order for clients to enter their own information, a computer dedicated to OCAN is seen as necessary, 

however even then providers believe direct entry is not feasible since they frequently have to rephrase the 

questions for clients in the self assessment tool to make them more appropriate for this population. 

Fit of OCAN with Aboriginal client population and presenting concerns 

The providers generally felt that a weakness of the tool is that it is too prescriptive in some areas without 

covering other areas adequately which are seen as essential in this client population. One provider stated: “it 

feels like you are putting the client into a box as you are fitting them into the categories of the OCAN” and 

there is resistance to do this from both providers and clients. Another criticism was that OCAN “doesn’t feel 

holistic [when used with a client] , although it is presented as a holistic tool”. 

Providers felt that OCAN is most useful for clients with SMI who are stable. There was agreement that it was 

difficult to use with clients with the following presenting concerns: 

• intergenerational trauma, including residential school trauma 

• people in crisis 

• clients who see workers “just to unload” because they have problems and no one to talk to 

• brief intervention with clients, who will potentially not be seen again for a year(s) 

• grief issues and complex issues 



Fit of OCAN within Cree Language and Culture 

Most of the Aboriginal people in the James Bay area speak Cree as a first language. While their comfort 

level with English varies, it is clear that most people prefer to speak Cree. Furthermore, translation from Cree 

into English and vice versa is difficult, particular with more abstract clinical/ Western concepts that may not 

have an equivalent counterpart in the Cree language or culture. Providers explained that many aspects of the 

OCAN are very difficult to translate. When the self assessment has to be translated it will often take 2 

sessions to complete. 

Those providers who are not bilingual rely on local staff or community members to act as translators (i.e. not 

designated and trained medical translators) and are unsure of the accuracy of the translation. Concepts that 

pose particular challenges are related to the scoring of met/unmet needs. Interviews with clients confirmed 

that the scoring concepts were very difficult to grasp. Some items are very difficult to translate and include 

the medical section, legal language and sexual terms. 

The tool has not yet been translated for Cree speakers and workers indicated that a OCAN tool translated 

and written in Cree syllabics is not desirable, since fewer and fewer people read syllabics. In addition, the 

different dialects would also pose a problem. 

There were also very specific difficulties with the translation of question 17, related to sexual expression. 

Fluent providers explained to us that words related to the domain of sexual expression have been lost from 

the Cree language in this geographic area. The reason cited was that local population went through at least 

four generations of residential schools, and one of the many impacts was that Cree words with a sexual 

meaning had became taboo and were even largely lost form the vocabulary. When translating the question 

into Cree, there is no fitting word that can be used for sexual expression, instead the translator has to actually 

describe a sexual act. Both providers and clients concurred that this was not only problematic, but highly 

offensive to many clients. We found that during interviews clients would only very reluctantly refer to the 

sexual expression domain. Most only euphemistically referred to it as “question 17” however would not use 

the words “sexual expression”. This strongly supports our conclusion that the question is problematic with this 

population. 

Furthermore, providers repeatedly told us that this kind of personal question cannot be asked by providers if 

they have not established a long rapport with the client previously. All clients had known and worked with the 

providers for over a year. Posing personal assessment questions early on in the therapeutic relationship was 

seen as culturally inappropriate and would interfere with the development of a trust relationship. One 

provider explained: “clients will sometimes just answer a question to be polite. They will then change the 

answer much later”. This provider explained that client will only answer personal questions accurately once 

trust has been established over a period of time. When clients are asked why they did not share certain 

information early they are known to reply to their workers “I didn’t know you then!”. 

Overall, those clients who completed the assessment told us that it helped the relationship with their worker 

and it helped to talk to the worker about what services were needed. 



RESULTS FOR NORTH CENTRAL ONTARIO REGION SITES 

The two participating programs are delivered by two provincially funded Aboriginal Health Access Centres. 

N'Mninoeyaa Aboriginal Mental Health Services provides mental health services to the communities of the 

North Shore Tribal Council located between Sault Ste Marie and Sudbury on the northern shore of Lake 

Huron. Noojmowin Teg Health Access Centre’s mental health team provides services to island communities in 

the Manitoulin District. Both organizations provide holistic culturally based services on and off reserve in rural 

North Central Ontario. The urban centers of Sault Ste. Marie and Sudbury are accessible by road from all 

communities. Manitoulin island communities are accessible year-round by a swing bridge. Driving distance to 

the urban centres ranges from 20 minutes to 3 hours. Figure 2 shows a map of the North Shore of Lake Huron 

and Manitoulin Island. 

Figure 2: Map of Manitoulin island and North Shore of Lake Huron 

Description of North Shore and Manitoulin Communities 

N'Mninoeyaa Aboriginal Mental Health Services provides services to seven First Nations of the North Shore 

Tribal Council as well as at the Indian Friendship Centre in the town of Sault Ste. Marie. The communities are 

located along highway 17 (see Figure 2): 

1. Batchewana First Nation 

2. Garden River First Nation 

3. Thessalon First Nation 

4. Mississauga First Nation 

5. Serpent River First Nation 

6. Sagamok Anishnawbek 

7. Atikameksheng Anishnawbek (Whitefish Lake First Nation) 

8. Sault Ste. Marie Indian Friendship Centre 



Noojmowin Teg Health Access Centre provides services to seven First Nations on Manitoulin Island, as well as 

the off reserve Aboriginal population in the Manitoulin District. The communities include: 

1. Aundeck Omni Kaning 

2. M'Chigeeng First Nation 

3. Sheguiandah First Nation 

4. Sheshegwaning First Nation 

5. Whitefish River First Nation 

6. Wikwemikong Unceded Indian Reserve 

7. Zhiibaahaasing First Nation 

8. Off reserve population in the Manitoulin District 

Service Context: N'Mninoeyaa Aboriginal Mental Health Services 

N'Mninoeyaa Aboriginal Mental Health Services provide both traditional and contemporary mental health 

counseling and treatment services to adult individuals (18 and over) with significant mental health challenges. 

Services are provided by outreach to communities. A Mental Health Program Coordinator works with an 

Aboriginal Mental Health Sub-committee, made up of one representative from each community including the 

Indian Friendship Centre, to provide program support, planning and guidance in implementing the regional 

mental health program 13 . 

Outreach services are provided at the community level, where other, less specialized (mainly federal), services 

also exist, such as the NNADAP and community mental health workers. Generally, the local workers provide 

brief services as well as referrals to outside services and visiting professionals. 

The visiting mental health staff complement includes a psychologist for Garden River, Batchewana, and the 

Indian Friendship Centre of Sault Ste. Marie on a purchased service contract , 3 hours per week per 

community; a purchased service Mental Health Therapist working in Atikameksheng Anishnawbek (4 hours per 

week); and a full time employee, Mental Health Case Worker for Sagamok Anishnawbek, Serpent River, 

Mississauga and Thessalon First Nations, providing services one day per week in each community. 

Overview of the OCAN Implementation at N'Mninoeyaa 

In this section we report on successes and challenges of implementing OCAN in mental health services with 

N'Mninoeyaa Aboriginal Mental Health Services and partner community sites. 


The providers had a clear understanding of the roll of OCAN in the NE LHIN and that it is currently pilot 

tested in Aboriginal mental health programs. Providers were very interested in sharing their experience with 

the OCAN tool in Aboriginal programs and also to influence the implementation of an assessment tool in order 

to establish a good fit with Aboriginal services. Participants also understood that the OCAN is based on a 

established assessment tool. 

13 Information adapted from North Shore Tribal Council Annual Report 2008-2009 accessible at 

www.mamaweswen.ca/arjul8-compiled4web.pdf 



The providers generally welcome the concept of a standardized assessment tool. They had formulated a very 

concrete and strategic picture of their requirements for a standardized assessment tool and how such a tool 

could benefit clients and service development. 


A service coordinator took part in the “train the trainer” session provided by the CMH-CAP OCAN trainers. 

Local staff including two NSTC visiting mental health providers were then subsequently trained. The community 

level providers felt that the locally conducted training was quite good, however a refresher course was very 

necessary, particularly since the OCAN had not been used by many providers nor for all clients at this point. 

Workers believed that the client cases provided during the training sessions would benefit from an Aboriginal 

specific cultural component, as Aboriginal clients’ interaction related to the OCAN assessment tool vary 

considerably from the provided example cases. Developing Aboriginal client cases would better prepare 

workers to respond to the barriers and concerns perceived by many Aboriginal clients with respect to the 

OCAN. 


At the time of this evaluation, staff has not been able to complete any of the staff or consumer assessments in 

all but two of the participating sites. None of the sites had been able to make significant progress 

implementing the OCAN in their service delivery model. Those sites that had completed some assessments had 

only managed to complete very few. The challenges related to the OCAN implementation are described in 

the following sections. 

OCAN’s fit within the service delivery on the North Shore 


Providers explained that there was lots of excitement, when the OCAN pilot was first discussed. The lack of a 

standardized assessment tool had long been perceived as a problem. In particular this lack of a standardized 

assessment tool has resulted in clients having to tell their story over and over. One worker explained that 

“clients are assessed to death” in the current system. The notion of a culturally appropriate standardized 

assessment tool is therefore strongly supported by staff as is the basic concept of an assessment tool with a 

broad range of domains designed to provide a holistic overview of each client’s individual situation. 

Furthermore, the prospect of collecting and accessing standardized information that can be summarized to 

provide current statistics on services and needs of clients is seen as a very important incentive to participate in 

the implementation of a standardized electronic assessment tool. Workers believed this would help in more 

strategic and evidence based development of mental health and supportive services. Finally, the 

implementation of a comprehensive assessment tool within the mental health services is also seen as 

contributing to building skills and capacity at the community level. 



The realities of implementation of OCAN into the daily workflow 

At the NSTC, the OCAN pilot was initially planned to occur with all client services funded under the NE LHIN. It 

was not to be restricted to clients with SMI or other groups; rather all providers and clients were to be invited 

to use the OCAN. It was also planned that a local worker was to complete the OCAN if he/she referred a 

client to a visiting professional (funded under the LHIN). Mangers believed that this approach would then 

encourage the use of OCAN as a case management tool. If however the client was not referred by the local 

worker, then the visiting professional was to complete the OCAN. 

While this approach was very well thought out, when it came to implementation, this model posed several 

unexpected but significant challenges in all of the service locations. Time and resources constraints were 

identified as a major barrier to completing OCAN, because visiting professionals have just a few hours per 

week to spend on client contact in each community. The services provided by visiting specialists are seen as 

scarce and urgently required by clients and providers. As a result, most visiting professionals feel that it does 

not make sense to use the few hours they have to provide direct services to complete the OCAN. Specialized 

providers were clear, that they would need to reduce their client load in order to implement OCAN. This 

sentiment is compounded by the fact that providers believe the OCAN does not provide any immediate 

benefit to their clients needs at this time. Most visiting providers feel that a better approach would be to have 

an intake worker complete all of the OCAN assessments. 

Some of the local (some federally, some provincially funded) community workers also faced barriers with 

clients when they attempted to complete the OCAN for the visiting professionals. Local workers who had in the 

past not been involved in the circle of care with visiting professionals faced resistance from clients. When they 

invited clients to participate in the OCAN, clients often perceived this as a significant and undesirable 

deviation from the way services were previously provided. Given the small community size, clients are 

frequently uncomfortable revealing in-depth sensitive information to local workers. Therefore, many clients 

refused to complete the OCAN in those cases. 

Furthermore workers reported that some clients were opposed to participate in OCAN right from the start, 

while others were initially willing to complete OCAN, but later did not want to follow up. “They just keep 

putting it off” explained one worker. Workers felt that for many of their clients the word “assessment” 

represented a significant barrier. Some clients were suspicious of reasons for the assessment, because trust in 

the health care system is an issue with many Aboriginal clients. Clients frequently questioned the worker: “Why 

all of a sudden do you want all this information?” or “You already know me! Why are you asking this” As the 

OCAN tool is explicitly voluntary and cannot become a barrier to access to services, many workers did not 

feel that they should press their clients any further. Many new clients already have to complete multiple 

lengthy forms for referrals etc. At this point, the OCAN cannot be shared with other services such as treatment 

centres or hospitals. From the perspective of clients and providers, OCAN therefore currently adds to an 

already overwhelming bureaucracy. 

Much more client awareness and client education is required to make the OCAN acceptable to Aboriginal 

clients. In addition, realistic client scenarios during the training sessions would better prepare worker to 

respond to the concerns Aboriginal clients might have regarding OCAN. Furthermore, implementation of 

OCAN in the hospital and addictions treatment, coupled with implementation of OCAN information sharing 

protocols are necessary to realize the potential important benefits associated with OCAN in these Aboriginal 

communities. 



Cross jurisdictional issues 

As previously outlined, the OCAN implementation was planned for visiting professionals program funded by 

the NE LHIN only. Other services providers, working in the same service environment, but funded under 

Ontario’s Aboriginal Healing and Wellness Strategy or federal funded services (First Nations and Inuit Health 

Branch), were not included in the pilot implementation in all but one community due to jurisdictional issues. 

However the specialized services of the visiting professionals funded under LHIN are seen as particularly 

scarce and urgently required by clients in all communities. As a result, the specialized workers are very 

reluctant to spend their time on the completion of OCAN when their direct services allocation are felt to be 

already insufficient at the community level. Most of these workers believe that a lengthy standardized 

assessment tool is more appropriately completed by an intake worker. However there are no intake workers 

funded under the NE LHIN to complete the assessment. 

Contrary to this, some community workers felt OCAN was too detailed to be completed by an intake worker. 

Instead it may be best implemented as a case management tool if the local worker could act as the case 

manager, not as an intake worker. Under this model the specialized provider would act as a secondary 

provider with case management functions provided at the community level. 

NSTC stakeholders explained that further formal integration of the various funding streams is necessary to 

support the implementation of a common assessment tool and to harness the benefits of the tool. Currently this 

integration is still lacking and as a result there are significant cross jurisdictional challenges that hinder the 

implementation of a common assessment tool. Furthermore, there is a concern that OCAN is a LHIN funded 

project, and that data entered by federally funded service providers would skew the OCAN data 

significantly, since it is as a tool that can be used to identify need. Furthermore, the OCAN software is 

required by all Aboriginal mental health offices if integration is to occur, however there is no funding for this 

from the federal funding streams for the federally funded workers. 

Workers emphasized that they see the potential benefits of a common assessment tool, particularly as a case 

management tool, however due the lack of integration of OCAN within the broader Aboriginal mental health 

services, these benefits are currently not yet realized. 


An automated tools fits very well with the North Shore Tribal Council strategic directions and current service 

environment. An ehealth project called the Giiwednong Health Link Project is currently underway and involves 

First Nations in the Manitoulin Island/North Shore region. From the perspective of the health directors, OCAN 

could be “just one more tool to add to this project”. 

However this does not mean that e-health records are completed accepted at the client level. Responses to e- 

records are still mixed. For some providers and clients it is a normal part of doing business, others are 

resisting it. Often, younger people are more open to this than the older generation. Workers believed that 

some of the younger clients would be able to enter their data into the automated self assessment tool directly 

in the future. Some younger clients might even be more open to provide information on the more intrusive 



subjects such as sexuality, since an automated tool may be less intimidating to clients when answering sensitive 

questions. 

Those who are resisting e-records report feeling uncertainty and even fear of who might access the records. 

Questions such as “Who might see it? Is it secure?” are currently raised by some clients and providers. Some 

providers are also concerned about: “What happens if the computer shuts down? Where are the records?” 

However from the perspective of most providers e-records ‘”just make sense”. 

Privacy issues regarding e-records still need to be carefully resolved, so that only those providers who need 

to know information have access. This is of course necessary in order to comply with privacy laws, but 

furthermore, in small rural communities there is the added issue that familial relationships may exist between 

clients and health care providers. Clients therefore often want to be assured that their records can only be 

accessed by specific individuals to ensure that professional and personal boundaries are not crossed. The 

circle of care must be clearly articulated. 

Many clients are not familiar enough with computers to enter their own data. They would require training to 

enter their own data. Providers were also concerned that clients might be able to navigate to other areas of 

the computer; i.e. that the data entry process is not secure. 

Workers therefore identified the need to develop protocols regarding the ownership of the data, storage 

and access. One worker summarized the sentiment of many workers as follows: “The e-health record fits 

generally very well with mental health services here, it would be an ideal way to provide services if it was 

very secure and also accessible to workers as necessary.” 

The current lack of integration with the mandatory Roxy database is leading to significant duplication of data 

entry for OCAN. 


Providers explained that many of their clients require urgent support, “they need something done, they need 

to talk, they may have multiple concerns” and in those situations the OCAN takes too long. Although it is 

helpful to have access to the information in the OCAN domains, there are too often very immediate concern 

that are very urgent. Workers felt that to present the option of OCAN in those cases is “disrespectful to the 

client”. Similarly, workers felt that particularly for clients in crisis or clients who have experienced trauma the 

OCAN is not an appropriate assessment tool. One worker explained: “We know it took a lot for the client to 

came in [to our office]. Once the clients begins to talk, bringing up OCAN… it would close them up.” Workers 

were also clear that OCAN does not support case management in the current service environment. Another 

worker explained: “We don’t have services here to refer them to, so why ask all the question? If we ask the 

client ‘what would you like to do about this?’ They will say “what [service] is available? Nothing!” 

For many clients, the literacy level is a barrier to complete the OCAN, particularly since the coding of “unmet” 

need and “met need” is very abstract. It becomes very confusing for them. Furthermore providers felt that 

younger clients were at times embarrassed by the topics covered in OCAN. Embarrassment is also an issue for 

clients with low literacy, because they may not understand the questions and for some elders. 

Some providers felt that it is difficult to add all of the relevant medications used by their clients since many of 

them also have significant physical health problems. Omitting some might lead to adverse reactions, however 

listing all is very time consuming. Workers also suggested that a question be included to capture traditional 

medicines that a client may be taking as well. 



Fit of OCAN with Aboriginal Culture 

Workers challenged the notion that OCAN is a valid and reliable tool in indigenous populations. The OCAN 

has a clearly “Western and clinical feel” and workers feel they have to “sell somebody else’s culture when 

they implement OCAN” with their Aboriginal clients. One workers stated: “If it was designed to truly fit the 

Aboriginal communities then it would work, but if you take a Western tool and implement it in First Nations 

then you have missed the boat, and are implementing a tool that does not fit”. 

Workers were in agreement that OCAN would need some adjustment to fit with Aboriginal clients and their 

worldview. Workers suggested that OCAN could be adapted to the Aboriginal concept of the medicine 

wheel, to show clients how the wheel might be off balance when certain aspects are lacking. This approach 

would also support the visual learning orientation of many Aboriginal clients, and allow them to see where a 

healthy balance is lacking in their lives. 

Some workers felt that the idea of asking clients to rate the many domains of information upon intake is not 

compatible with clients’ culture, particularly since the questions are seen as intrusive. “It is a foreign idea.” 

Further, the OCAN as an “assessment tool” seems to resonate negatively with clients who view this as a means 

only of describing in almost clinical fashion a listing of deficits. Some suggested that clients might be more 

receptive to participate if the OCAN was described or depicted as a “personal wellness inventory” and the 

domains structured around the “medicine wheel” concept. A medicine wheel, which is also broad and holistic 

would be more accepted, because the approach is more familiar. 

Overall though workers did appreciate the broad spectrum of information collected with OCAN and believed 

that it has the potential to capture aspects that might otherwise be overlooked. 

Two questions were seen as particularly problematic: (1) the question on sexual expression and (2) the 

question on psychotic symptoms. The question on sexuality is often too intrusive for Aboriginal clients, although 

it might be significant. The worker needs to be skilled and know when and how to approach this subject. The 

question on psychotic symptoms needs to be carefully explored within the context of Aboriginal culture. 

Aboriginal spirituality can be expressed or experienced through visions or voices, and great care must be 

taken not to confuse this with psychotic symptoms. 

Some workers felt that all references to immigration status should be removed for use with indigenous 

populations. 



Service Context: Noojmowin Teg Health Access Centre 

Noojmowin Teg Health Access Centre offers a blend of traditional Aboriginal approaches to health and 

wellness along with contemporary primary and mental health care in a culturally appropriate setting 14 . 

Services are provided through outreach to seven First Nations communities as well as the off-reserve 

Aboriginal population in the Manitoulin district. Services are provided in partnership with six federally funded 

community health centres and two federally funded health services organizations within the First Nation 

communities. Each centre is visited regularly by this agency’s team of health practitioners. 

Noojmowin Teg provides mental health services through integrated services with Mnaamodzawin Health 

Services (MHS), a second regional Aboriginal health organization. MHS is a regional provider of First Nations 

community health services funded by Health Canada’s First Nations and Inuit Health Branch. Both 

organizations emphasize community-based Aboriginal approaches to mental health care and share a home 

office. Service integration in mental health, such as common intake, case coordination and seamless services is 

a common goal and was initiated with the formation of an interdisciplinary mental health care group, known 

as the Knaw Chi Ge Win (New Beginnings) team 15 . The OCAN tool however is used only by providers 

employed by Noojmowin Teg’s psychology services. Specifically OCA is currently used by 3 staff members 

who provide services to clients with a variety of issues ranging from addictions, mood disorders and anxiety, 

depression, bipolar, eating disorder, SM as well as domestic violence, intergenerational abuse, residential 

school abuse. These 3 providers have individual specialty areas: 

• One psychologist who provides treatment and cognitive behavioural therapy with a focus 

parenting issues with adults and children. 

• One psychologist with a focus on personality disorder 

• One psychological associate focusing on cognitive behavioural therapy and supportive 

counseling. 

Overview of the OCAN Implementation at Noojmowin Teg 

In this section we report on successes and challenges of implementing OCAN in psychology services at 

Noojmowin Teg Health Access Centre. 


The providers had a clear understanding of the rollout of OCAN in the NE LHIN and that it is currently pilot 

tested in Aboriginal mental health programs as well. Providers were very interested in sharing their 

experience with the OCAN tool and also very interested in hearing about the experience of other Aboriginal 

14 Information about Noojmowin Teg Health Access Centre is adapted from the Noojmowin Teg Website accessible at 

www.noojmowin-teg.ca 

15 2009 Maar, M.. , B. Erskine, L. McGregor, M. Sutherland, D. Graham, T. Larose, M. Shawande, and T. Gordon. 

Innovations on a shoestring: A Study of a Collaborative Community-based Aboriginal Mental Health Service Model in Rural 

Canada. International Journal of Mental Health Systems 3:27. Accessible at www.ijmhs.com/content/3/1/27 



sites. Participants also understood that the OCAN is based on a validated assessment tool, i.e. the 

Camberwell tool. 


The coordinator took part in the complete 5 day training session, composed of the coordinator training 

followed by the train the trainer session. The provider believed the training was extensive and sufficient to 

implement OCAN. However workers emphasized that there is high turnover in the Aboriginal mental health 

field and access to regular training is important. 


The staff assessment is completed for each new adult client, however the self-assessment is completed only 

when necessary or deemed appropriate. The providers explained that OCAN appears to work well for 

people who need case management however, this is only a small portion of the case load at this site. 

Most clients access services specifically for mental health issues. Providers stated that their clients receive 

social support services from other agencies in their First Nation community, these include housing and other 

domains covered in the OCAN. They believe that clients are not looking to them as mental health providers 

for that type of service coordination. One provider explained it this: “by the time the clients get to me, they 

don’t want to get into [the OCAN domains], they know who to talk to if they need those services. They come to 

me for mental health counseling”. 

OCAN’s fit within the service delivery on Manitoulin Island 


Providers felt that a standardized assessment tool generally would be quite valuable, particularly if the 

information could be easily shared with other providers, such as hospitals, on-reserve social services providers 

and federally funded mental health services provides (Under First Nations and Inuit Health Branch). The 

importance of having access to a broad range of information related to each client was also seen as 

important as it could improve care. 

However workers cautioned that standardization would only lead to improved care if the information 

collected is relevant to the providers and culturally appropriate for clients. 

The realities of implementation OCAN into the daily workflow 

OCAN is creating significant duplication of work for staff at this point. Providers are concerned that the staff 

assessment has significant over lap with the CDS data set which they already enter into the Roxy data base 

as mandated by the LHIN. 

The providers explained that “OCAN overlaps and didn’t add anything to the normal intake we normally do.” 

Providers also felt that it is best used as tool during the intake process when clients are referred by federally 

funded workers. Once the clients are scheduled for appointments with specialized providers “they are not 

expecting to talk about the OCAN domains, they are expecting treatment!” 



Providers felt that OCAN takes up a lot of time and implementing OCAN with all of their clients would 

negatively impact the number of clients they can see in their clinical practice. They are generally very hesitant 

to do this, given the high need for services in the communities. They also felt that their old process was well 

designed to bring up difficult issues for discussion with clients at the appropriate time. OCAN did not add any 

new value from their perspective and even brought up some difficult topics at potentially inappropriate times 

in the therapeutic process. 

However they also indicated that given some modifications the OCAN could be completed at intake, by an 

intake worker. 

Cross jurisdictional issues 

Cross jurisdictional issues are a significant barrier to the implementation of a common assessment tool. The 

federal funded service providers within the local Aboriginal mental health network are currently considering 

implementation of a different assessment tool for mental health services. Social services providers on reserve 

are also federally funded and are not using OCAN either. At this time there is no opportunity to share the 

OCAN information and each organization is creating silos of information that are not useful to other service 

providers. 

Staff believed that the lack of crossover of the information systems between federal and provincial services 

was a significant barrier to the implementation of OCAN in Aboriginal mental health services. It means they 

can do very little with the information collected with OCAN. “It is not useful to the federally funded workers, 

since it would need to be translated into another format” because they do not share the software. 


The idea of an automated tools fits very well with the Noojmowin Teg Health Access Centre service 

environment. In fact electronic records have been implemented and the expansion of electronic records is a 

strategic direction. An ehealth project called the Giiwednong Health Link Project is currently underway. The 

project is described as follows: 

“Giiwednong Health Link (GHL) represents a collective of health care organizations that are establishing a 

centre of excellence to use technology to support holistic health care services to First Nation community 

members in the Manitoulin Island/North Shore region. Noojmowin Teg is the Project Secretariat of this multistakeholder 

project to develop an integrated and centralized knowledge base to manage health information. 

The GHL is a complex project involving the development of broadband network capacity, applications and 

software, capacity development, information management policy and governance framework” 16 . 

Workers felt that clients as well as the organization are ready for the concept of e-health records, although 

there is some concern about government access to private records and data sharing between governmental 

sectors. However workers also cautioned that some of their clients may not be informed enough of electronic 

records to raise any concerns at this point. 

16 Website of Noojmowin Teg Health Centre at www.noojmowin-teg.ca 



Workers also felt that the circle of care needed to be more clearly defined with respect to OCAN to ensure 

all are clear regarding current and future access to OCAN records, which are potentially more easily shared 

than paper records. 

Overall workers stated that piloting the OCAN has lead to valuable networking with the NE LHIN and with 

other Aboriginal mental health services programs. 


The workers felt that generally the OCAN implementation has had limited success only, and this is a direct 

result of the lack of integration of services and the OCAN tool. 

Providers explained that while the information provided could be useful for various sectors, those sectors do 

not have access to the information due to jurisdictional issues. On the flip side, clients expect mental health 

counseling from them. They do not want to complete the OCAN by the time they are coming to receive 

specialized mental health services. One worker explained: “clients feel it is wasting their time, they didn’t 

come in to talk about this.” They want services. One worker described this as follows: “it can’t all be about 

recovery! Some treatment is necessary!” 

Workers also explained that while they supported the domains in general, they felt the anchor questions 

frequently posed a problem for their client population and would need to be rephrased to make them 

appropriate and useful, particularly sections on food, transportation, sexual expression and psychotic 

symptoms (concrete recommendations are provided in the final section of the report). 

Providers also found the literacy level of many clients is low, and they consequently experience difficulties 

with the interpretation of the consumer section and the scoring in particular, which providers felt required a 

particularly high literacy level. Consequently, clients frequently have difficulty with the met needs/unmet 

needs scoring, and find it very confusing. 

Similar to providers elsewhere, providers at Noojmowin Teg felt that the OCAN was a poor fit for clients with 

trauma or abuse history, however many of their clients have experienced these issues. 

Fit of OCAN with Aboriginal Culture 

Workers believed that the questions were generally too direct and there were too many of them; both 

aspects make the OCAN culturally inappropriate. 

Workers also felt that certain aspects of the OCAN such as the question in the consumer tool that prompts the 

client to describe his/her “mental health” is not well understood as the term because “mental health is just not 

in people’s vernacular”. 

The open ended questions were also at this site very well received, although suggestions for change were 

similar to those suggested at other sites, most notability including again the question on spirituality. Spirituality 

it is a very important thing for this many clients in this population., but clients frequently interpret is this 

question as referring to “native spirituality”. One participant explained: “People who are devout catholic will 

often not identify as spiritual, but will say they are religious. So why not include ‘religious’ in this question?” 



IMPLICATIONS FOR OCAN IN ABORIGINAL MENTAL HEALTH SERVICES 

Comparisons and Contrasts regarding OCAN evaluation findings in 

the different Aboriginal cultures and service context 

Common issues related to OCAN: 

Despite distinct differences in Aboriginal cultures and mental health service model that we observed at the 

three participating sites, participants identified many issues related to OCAN consistently. Common issues 

included: 

1. The concept of a common assessment tool is very much supported by providers. 

2. A common assessment tool should be able to address trauma and abuse history and related need for 

services of Aboriginal clients. 

3. A common assessment tool must be culturally safe. 

4. In order to prepare mental health workers to complete an assessment tool with Aboriginal clients, there is 

a need for culturally specific, realistic case scenarios to be used during the worker training sessions. 

5. Specific to OCAN, several questions include the terms and language that are not commonly used should 

be rephrased for Aboriginal clients. 

6. Several sections of the OCAN appear to be neither reliable or valid in Aboriginal populations, because 

of cultural, language and literacy differences, the questions are interpreted differently. 

7. Lack of integration of provincial and federal mental health services is a significant barrier to realize the 

potential benefits of a common assessment tool. 

Contrasts: 

This evaluation found few if any substantial contrasts between the various Aboriginal mental health services 

sites. Differences that we did find were more a matter of degree or how strongly participants felt about 

certain issues. The topics of concern as well as community aspirations for a common assessment tool were 

surprisingly similar. The differences we found can be summarized as follows: 

1. Level of proficiency in the English language varies dramatically within and among Aboriginal communities 

in north eastern Ontario. This has a major impact on the suitability of OCAN for this population, because 

clients who are not very fluent in English have a much more difficult time with OCAN than those who are 

fluent English speakers 

2. Implementation models have varied in each community, and this has provided good information on the 

feasibility of various approaches to the OCAN implementation in Aboriginal mental health services. 



Cultural Incongruence related to Specific Domains 

Several domains were consistently described as problematic within Aboriginal communities. They are 

identified and discussed below. 

Domain 1: Accommodation 

Crowding is a serious and longstanding issue particularly in the coastal James Bay communities, but also in 

other Aboriginal communities. Living in small reserve homes are often extended families of a dozen people or 

more and this is common enough to be regarded as “normal”. There are no plans or funds for additional 

housing developments and no waiting lists for clients to receive better housing. Therefore, if a client has a roof 

over their head, both the client and the provider will score this section as “no need”. However this serious level 

of over crowding would elsewhere be regarded has an “unmet need”. Providers are concerned that 

aggregate data will therefore show “no housing needs”, when actually quite the opposite is true. 

Moreover, while many clients have a place where they can stay, they are often living in constant conflict with 

individuals who are sharing the same accommodation, which in turn negatively affects their mental health. 

While this is a unmet housing need, it appears that it is not captured as an unmet need. 

On the positive side, many providers felt that this question allowed them to explore the living conditions of 

their clients in more detail and felt they gained important information. 

Domain 2: Food 

In the North Central area providers felt a more important question to ask here is not if a client has enough 

food, rather it is more about access to healthy foods. The issue that has to be frequently addressed by 

workers is that the client does not have enough money to buy healthy and nutritious foods. This is particularly 

important if the client also has a chronic illness such as diabetes. 

Domain 17: Sexual Expression 

The question can be very offensive particularly with clients who are predominately speakers of an Aboriginal 

language. All providers agreed that this question could only be broached with those clients where significant 

trust had been established over a period of time, but not early on in the interaction. Some providers believed 

it could take years under this service model to establish enough trust and rapport with a client. 

Some staff members felt comfortable with the question on sexual expression as it provided an opportunity to 

address this subject with the client. Most clients who were very fluent in English appeared to be open to this 

question, particularly if it was adapted to be more indirect. For example one provider suggested it should be 

phrased as follows: “I want to ask you about sexuality…are there any issues you want to discuss?” 

Other workers had a specific concern with the sequence of question 16 and 17, which, they believed could 

lead to transference with clients for whom sexuality poses an issue. 

Domain 21: Phone 

This question is often insulting to clients as all clients appear to know how to use the phone. The question should 

reflect access to phone. Many clients do not have access to a phone. That is the piece of information that is 

actually critical. 



Domain 22: Transport 

This question is not reflective of Aboriginal communities. It reinforces that OCAN is not developed to fit 

Aboriginal people and alienates clients. Although some feel that the question is funny it nevertheless reinforces 

the notion that OCAN is for “people from the south” In the James Bay area for example, the mode of 

transportation is the plane or a local taxi. The wording in the self assessment tool should be changed for this 

population. Some providers felt that the anchor question missed the point. Public transportation does not exist 

in most Aboriginal communities and many clients do not have a ride to attend their appointments. 

Domain 23: Money 

This domain is very useful to providers, identifies lack of resources for basic needs quite frequently. 

General comment on open ended questions 

The open-ended questions are well received and are felt to be affirmative to the client. Some adjustments are 

suggested however. 

Open ended Question on Hopes and Dreams 

This question was generality liked by both providers and clients. However providers explained that many of 

their clients need help with this question, since they may have never had hopes or dreams. The question then 

becomes overwhelming if asked as suggested in the training sessions. Providers at one site have therefore 

revamped the question to “What are your hopes for today or for this week?” 

Open ended Question on Spirituality 

The question “Is spirituality an important part of your life?” is ambiguous within this population as well as with 

providers. Sometimes it is a difficult question to address. One provider stated that the response to “the 

spirituality question depends on the person and the community, as some people are reluctant to speak about 

their traditional beliefs. You need to know the person well, to bring these topics up, but some of our clients we 

have never met before…”(i.e.: only have spoken over the phone, as services are phone-based in some 

communities). 

Many participants (such as the person described in the last paragraph) interpreted the word “spirituality” as 

“Indigenous spirituality” which is contrasted against “Christian religious beliefs” which are strong in the 

communities. We found however that other participants did not make a distinction between “spirituality” and 

Christian beliefs. 

These are important distinctions for many clients living in Aboriginal communities. Due to the legacy of the 

residential school system and related spiritual abuses, some clients may find the question offensive and 

distressing. Question could be rephrased to include “Are traditional beliefs, spirituality or religion an 

important aspect of your life?” 

Missing Elements 

Abuse history 

Providers felt that important areas of information are missing from OCAN and that these gaps will prevent 

the ideal of “clients not having to tell their story twice”. Specifically, about things that can strongly affect their 



lives. For example, one provider stressed: “the OCAN asks about accommodations. While clients may have a 

roof over their head living with family, what if they are not getting along with the family members they are 

living with”. This is very important information that is not captured. Furthermore, “questions about sexual abuse 

history is important, but it is not covered”. 

Experience of discrimination and/or racism 

Many of the Aboriginal clients have experiences racism and discrimination and the literature shows this is 

closely linked to mental health. This is an important aspect to explore with many clients. Providers were 

unaware that this was part of OCAN assessment. 

Education 

A basic question covering education and English literacy would be useful. 



SUGGESTIONS FOR FUTURE IMPLEMENTATION OF OCAN IN ABORIGINAL 

HEALTH SERVICES CONTEXT 

Opportunities for Future Support of OCAN Implementation in 

Aboriginal Mental Health Services 

In this section we provide concrete suggestions for activities that, based on our evaluation research, have the 

potential to support future roll out of OCAN in Aboriginal communities. We provide a rationale with each 

recommendation. 

1. Readiness for the Implementation of a Common Assessment Tool 

RECOMMENDATION 1: 

Continue to invite Aboriginal Mental Health Services to participate in the ongoing 

development and implementation of the OCAN as a LHIN-wide/province-wide 

assessment tool. 

Rationale: 

Participants were very receptive to the idea of a common assessment tool that captures important and 

consistent information about their clients. 

Their reasons for participating in the pilot were related to the perceived overall benefits including: 

The ability to enhance client centred, individualized care 

Streamlined intake and less duplication of administrative processes with the ability to have client 

information follow clients as they move between health care settings and communities 

Access to information to portray community and system needs as well as improved quality of 

information for local planning and decision-making 

Standardized, consistent and reliable processes and data on par with health services elsewhere in 

the province 

While communities perceive the OCAN as having the potential to improve their health service delivery, there 

are a number of impediments with OCAN in Aboriginal mental health services which limits its applicability in 

its current form and process. 



In particular, programs endorse widening the use of OCAN within other Aboriginal mental health programs 

only if there is a commitment to resolve key cultural issues as well as cross jurisdictional impediments to health 

information sharing. Results of the survey (see Appendix E) illustrate the hesitation of participating program 

staff to recommend the adoption of the tool as it exists currently in other Aboriginal mental health programs. 

One participant has suggested the following: 

“standardized assessment is a useful aspiration for communication between mental health services 

providers but some items in this tool are not capturing helpful information. We need a long term 

research strategy to amend and validate an improved version of this tool that will tap into Aboriginal 

health needs” 

We expand on this assertion in the following Recommendations. 

2. Training 


Develop Aboriginal service specific training modules and support groups, including: 

► Aboriginal specific cases for training that reflect the Aboriginal service environment, 

client realities as well as culture and language and literacy issues. 

► Opportunities for Cree speaking programs and staff to enhance their OCAN lexicon 

and vocabulary and develop translation aids to better support effective interpretation 

at the community level. 

► Refresher training at more frequent intervals. 

► Ensure that the portal is user-friendly and accessible for providers with good 

instructions on how to access and navigate the portal. 

Rationale: 

Program staff described a number of training enhancements that could better support Aboriginal program 

participation in the implementation of OCAN. For example, workers found they were met with language and 

cultural challenges when they implemented OCAN, and they were not prepared for these challenges based 

on the case scenarios. Participants were clear they did not expect nor want OCAN to be translated into 

Aboriginal languages, however they felt they needed to brainstorm with other Aboriginal mental health 

services providers on how to best present, communicate, interpret and implement OCAN. 

As discussed, providers felt that many of their clients were not willing to use OCAN, and therefore they filled 

out few assessments in a particular time period. Refresher courses would help those staff members who are 

relatively inexperienced with OCAN due to their relatively infrequent use. Online tutorials for Aboriginal 

mental health service providers may be one way to address this issue. 



3. Client population 


In the Aboriginal Mental Health System, the implementation of a common assessment tool 

should focus on stable long-term clients, who have established trust relationships with 

service providers. 

Rationale: 

Although the OCAN is proposed as an assessment tool having universal applicability for all clients seeking 

mental health services, based on their experience and knowledge of their clientele, Aboriginal program 

participants suggest that OCAN implementation is not realistic for some of their clients. They believe that 

OCAN does not fit with the following presenting concerns: 

clients who are presenting in crisis, because they are not able to focus on OCAN due to more 

pressing immediate concerns. 

clients who are accessing brief services and are unlikely to return for months or even years. They 

will generally refuse to take the time to complete the OCAN. 

clients with abuse or trauma histories and presenting concerns, because OCAN is presently not 

designed to capture important culturally safe services provided to these clients, nor is it effectively 

capturing the relevant circumstances of these clients. 

Programs note that they’ve had most success with this tool with stable, long term clients with whom they’ve 

already established a relationship and note its usefulness potentially in case management. 

4. Reliability, validity and cultural safety of the current version of the OCAN in Aboriginal 

mental health services 


Develop a process to modify specific aspects of OCAN’s interface, protocols and several 

domains for use with Aboriginal Mental Health Services to ensure cultural safety of the 

tool. Focus on keeping the main data elements consistent in OCAN. 

Rationale: 

OCAN has not been validated in Aboriginal communities in Canada, nor any other Indigenous communities. 

Our research provides evidence that puts the validity and reliability of several OCAN domains with 



Aboriginal consumers in question. Furthermore, cultural safety is not adequately addressed for Aboriginal 

consumers. Participants described a number of limitations with both the OCAN tool and overall assessment 

process that are not aligned with Aboriginal cultural norms, language, spiritual belief systems and geographic 

and socioeconomic realities. In addition, the tools is at times incompatible with the historical and colonial 

impacts on people, their community and culture. 

We believe the tool’s interface and protocols for use can be modified while keeping the main data elements 

consistent in OCAN. Program participants feel strongly that if the tool is to be used with other Aboriginal 

populations or communities these improvements are necessary to better align with the Aboriginal experience 

in mental health service delivery. 

In particular, participants advocated that an Aboriginal driven process be instituted to develop an interface 

and data capture process for the tool that better reflects the Aboriginal populations for which it may be used. 

Such an interface and process might incorporate the following aspects: 

A culturally safe assessment protocol that is designed in concert with the community being served, is 

more reflective of the Aboriginal patient journey and which would assist in determining how, when 

and with whom the tool would be administered 

Refinements to the tool’s overall design to render it less of an intrusive, linear succession of questions 

to one more in keeping with a wholistic (not holistic) medicine wheel approach 

Reorientation from an “assessment tool” focused on needs and unmet needs to a more strengths 

based “personal wellness inventory” 

Improvements in specific domains such as transportation, sexual expression, housing, money and 

telephone to better reflect Aboriginal cultural, geographic and community realities. 

5. Automation 


Implement a centralized Aboriginal coordinator to assist participating Aboriginal mental 

health programs, agencies and organizations with support, managing the technological 

implementation, quality control, ongoing training, liaison and coaching as part of the 

OCAN support centre functions. 

Rationale: 

While Aboriginal communities aspire to the same level of automation in their management of client and 

community health information, many face additional technological hurdles including, chiefly, ICT infrastructure, 



connectivity and human resources capacity. For this reason, we advocate for a centralized coordinator to 

assist participating Aboriginal mental health programs, agencies and organizations with support, managing 

the technological implementation, quality control, ongoing training, liaison and coaching as part of the OCAN 

support centre functions. 

Important context outside of OCAN – System Impediments 

It is important to acknowledge that system impediments exist that create barriers to the OCAN 

implementation. These cannot be resolved by local OCAN teams or even Community Care Information 

Management (CCIM) Program or the Community Mental Health Common Assessment Project (CMH CAP). 

However an awareness of these issues and a long term commitment to collaborate with other sectors on 

solutions are necessary. 

At the First Nation community mental health services level there are no protocols for information sharing 

between federal and provincially funded programs. Furthermore, the ability to share information with 

external partners (e.g. treatment centres, hospitals and other provincially funded Aboriginal mental health 

and addictions program) is currently not possible. Given these limitations and as participation in OCAN is 

voluntary; urgently needed service needs often prevail and OCAN becomes a secondary chore. 

6. Impact on clinical and administrative processes 


Coordinate with other (federally and/or provincially funded) departments/sectors 

implicated in mental health service delivery to facilitate the integration of OCAN in 

Aboriginal Mental health services and its use as a case management tool that can be 

utilized by any worker at the community level (regardless of their funding source). 

Rationale: 

In most First Nations settings and Aboriginal communities the mental health needs are numerous and complex. 

Largely due to the legacy of residential schools combined with inequities in the determinants of health, mental 

health issues are generally higher in Aboriginal communities compared with mainstream communities. This 

situation is exacerbated by the fact that access to mental health resources are exceedingly limited in many 

Aboriginal communities, due to geographic, cultural, socio economic and federal/provincial cross-jurisdictional 

challenges. 

Without exception, program participants expressed the view that diverting scarce time and staff resources, in 

particular those of specialized mental health service providers to complete the OCAN will reduce clinical 

services and thus limit critical and scarce mental health service delivery. Given the need for these services, 



providers are very reluctant to trade clinical services for the completion of OCAN – in particular because of 

the current lack of data sharing limits the benefits of OCAN. 

It was noted that perhaps a dedicated intake worker or case manager would be the optimum level of staff to 

complete the OCAN but that such staff resources, for the most part, do not exist within Aboriginal communities. 

However it is managed and administered, it should be noted that resources are necessary to ensure that direct 

service delivery is not compromised to implement the OCAN. The Aboriginal mental health system in its current 

form can simply not sustain a reduction of clinical services. 

7. Policy implications 


Continue to dialogue with other mental health system partners to develop a coordinated 

strategy around mental health information gathering and sharing that would facilitate 

broader rollout of the OCAN as an assessment tool for Aboriginal and non-Aboriginal 

community mental health programs. 

Develop a process to facilitate broader roll out and information sharing capacity of the 

common assessment tool, including (but not limited to) 

►treatment centres 

►hospitals 

►other provincially funded Aboriginal health/ mental health programs 

►federally funded First Nations community health/mental health services programs 

►federally funded First Nations community social services programs 

Rationale: 

One of the biggest impediments related to OCAN noted by programs participating in this pilot is that, at 

present, there seems to be no system wide sharing of information or integration in the mental healthcare 

system that would allow for the realization of the full benefits of OCAN. 

Participants feel that OCAN takes up significant amounts of already very scarce mental health human 

resources, without realizing the potential benefit of information sharing with key partner organizations in the 

Aboriginal mental health system. In particular, the following challenges were cited repeatedly: 

Lack of inter-jurisdictional coordinated planning, or vision for electronic medical records and 

information sharing agreements between federal and provincial programs operating on First 

Nations. 



No avenue for information sharing amongst and between federal and provincial Aboriginal 

programs and external agencies, providers and referral partners. 

No clear mandate or authority to ensure consistent implementation of OCAN. At present this is still 

a voluntary participation and few service providers on or off reserve have bought into it. 

While program participants were very supportive of the notion of streamlining and aligning administrative 

intake processes so that clients only “tell their story once” they note that, in practice, the system and mental 

health care delivery environment is not at this stage as yet. 



APPENDIX A: FOCUS GROUP AND INTERVIEW QUESTIONS FOR 

PROVIDERS/STAFF 

[Service context] 

“Please tell me about the mental health services in your area…” 

1. What kind of mental health services exist? (Probes: what services are provided on reserve? Are there 

linkages to off reserve services? Who funds these services? What is your client profile in terms of 

demographics/presenting concerns/mental health issues?) 

2. Was the OCAN implemented by all workers and as planned? (Probes: who does/does not use the 

tool? Are there specific service providers that feel the tool does/does not work for them? why/why 

not?) For what kind of clients (presenting concerns) does the tool work well? Where does it not work 

well? 

3. Were there any cross jurisdictional issues that affected implementation? (Probes: what about federal 

programs?) 

4. Is integration/lack of integration of federal and provincial services affecting the implementation of 

OCAN? 

5. Were there any other issues that affected implementation? (Probes: Is training and issue? How about 

time?) 

[Provider Perspectives] 

“Okay, I would like to now ask you more about your overall experience with the OCAN tool as a provider” 

1. How was the OCAN project introduced to you? (Probes: What do you understand are the reasons for 

trying this new assessment process?) 

2. What were your expectations? (Probes: what were your reasons for trying this new assessment 

process? Why did you elect to participate in the pilot?) 

3. What has been working well about the Common Assessment process in your program? 

4. What has not been working well? (Probes: are there language or cultural barriers? There specific 

sections/domains that are difficult – “please just list them now and we will spend some more time 

asking you about the details later in our interview)”?) 

5. How do you feel about the OCAN domains on aspirations and spirituality? (Probes: what is the clients’ 

reaction? Has it been useful? Why/why not? 

6. Is the information that the common assessment tool gathers useful? (Probes: What do you see as the 

benefits of the common assessment process? What do you see as the drawbacks?) 



7. What impact is the common assessment having on your clinical practice? (Probes: how could the impact 

be improved?) 

8. What impact is the common assessment having on your program’s/agency’s approach? (Probes: how 

could the impact be improved?) 

“Now we’d like to talk to you about the OCAN as an automated process for information gathering and we’d 

like to learn about your thoughts related to that” 

1. This project is part of the overall provincial initiative that is moving towards the electronic health 

record. Were you ready for this? (Probes: Was your work environment ready? Are your clients 

ready? Do you think there are privacy concerns related to electronic records? What about concerns 

about government monitoring of First Nations people? Was OCAP a concern?) 

2. Does an electronic assessment process fit with your view and experience of mental health care? 

(Probe: does an electronic assessment process fit with your type of program? How about with your 

client group? Why or why not?) 

3. What supports did you offer to consumers? (Probes: What supports did you offer to client which are 

above and beyond what your training suggested? Why was that necessary? 

4. What supports are essential? (Probes: Was translation required? How did this work?) 

5. What is/is not working in the automated process? 

[Future Implementation of the OCAN] 

“now we’d like to ask some questions that will help us to better understand possible future implementation 

issues related to the OCAN in Aboriginal Mental Health services” 

1. How did you introduce OCAN to your clients? (Probes: How has it worked out? Has your approach 

changed? Why/why not?) 

2. Which domains were particularly useful? 

3. Which domains - if any - were problematic? (Probes: Did you feel the domains were culturally 

inappropriate? How did you feel about the lack of strengths based domains? Are there domains that 

you would like to see added?) 

4. Reflecting on your experience with the OCAN training and supports, what would you recommend as 

essential for future implementation with other Aboriginal programs? 

5. Based on your experience in the pilot, where and how would it be most useful to implement OCAN? 

6. How do you think standardization of assessment in Ontario will affect mental health care in Aboriginal 

communities and programs? 



APPENDIX B: SURVEY TOOL FOR PROVIDERS/STAFF 


Sutherland & Maar - March 2010 Page 52 

OCAN Evaluation for Aboriginal Mental Health Programs






APPENDIX C: INTERVIEW QUESTIONS FOR CONSUMERS 

[Client Perspectives] 

“First I’d like to ask you about your experience with the assessment tool and how it worked for you” 

7. How was the assessment project introduced to you? (Probes: Did you need more information? Were all 

your questions answered by your worker? What do you understand are the reasons for trying this 

new assessment process? Did you fill it out by yourself? Did you someone help you? Once you were 

finished, did your worker go over it with you?) 

8. When the mental health worker gave you the set of questions to fill in, what were you told? (Probes: 

Were you comfortable trying this process? Did you have any concerns?) 

9. What was helpful about the instructions you received? (Probes: What supports were offered to you to 

assist in completing the questions? How long did it take you to complete the questionnaire? What 

types of supports were helpful (Friend? Relative? Translator? Peer worker? Staff member? Your 

worker?) 

10. Did you complete the self assessment questionnaire on paper or on the computer? (Probes: Why? Do 

you have any ideas about how to encourage people to fill in this questionnaire on the computer?) 

11. If you have had previous experiences with mental health programs, how did this assessment process 

compare with what you went through in the past? (Probes: Is this the first time you have been asked 

for your views about needs you have when seeking mental health services? Were there aspects that 

were better? Worse?) 

12. Was the questionnaire easy to use? Did you understand the questions (ie language) and instructions? 

What about the rating scheme? What would improve the questionnaire? 

13. Did the questions make sense to you? Where there any that you found difficult? (Did you understand 

why there were private or intimate questions? Did you fell comfortable answering them? Where there 

any that you really liked? What did you think about being asked about your hopes and reams? 

What about the questions on spirituality? 

14. Did the questionnaire help you think about and identify needs that you had not thought of before? 

Do you feel that the questionnaire will strengthen your relationship with your worker? Do you feel it 

helps your worker understand you and your needs better? 

15. Did the tool help you to tell the worker about the care and supports you want? Do you feel the 

questionnaire gives you a better say in your service plan and goals? 

16. What did you think about the fact that you filled in a set of questions and also had the worker go 

over these same questions in more detail? (Probes: Is this how the process worked for you and your 

worker? Or did you do the assessment differently? Was it useful?) 



17. Do you think the care you have received has improved as a result of the new assessment process?) 

[Future Implementation of the OCAN] 

“now we’d like to ask some questions that will help us to better understand what can help to improve the 

assessment with OCAN in Aboriginal Mental Health services” 

18. Reflecting on your experience, what supports would you recommend are important for others to 

complete this self assessment? 

19. Which areas of the OCAN were particularly useful? 

20. Which areas - if any - were problematic? If so how can they be changed? (Probes: Did you feel the 

domains appropriate for your situation? Are there domains that you would like to see added?) 

21. Did you have any concerns about storing your information as an electronic record? (Probes: did your 

worker address these concerns? What concerns if any do you still have?) 

22. Do you think that it is important for people with mental health needs to be able to access the same 

kind of assessment no matter where they live in the province, on or off reserve? What about cultural 

background? 



APPENDIX D: LETTERS OF INFORMATION AND CONSENT FOR 

PARTICIPANTS 

Letter of Information 

Evaluation of the implementation of the Ontario Common Assessment of Need (OCAN) tool and processes in 

Aboriginal mental health programs 

Investigators: 

Mariette Sutherland, B.Eng. 

Whitefish River First Nation 

General Delivery 

Phone: 705-285-1411 

Email: m_sutherland_7@sympatico.ca 

Marion Maar, Ph.D. 

Northern Ontario School of Medicine 

Laurentian University 

935 Ramsey Lake Road 

Sudbury, ON, P3E 2C6 

Tel 705-662-7233 

Fax 705-675-4858 

Email: marion.maar@normed.ca 

Evaluation Study Sponsor: Ministry of Health Community Mental Health – Common Assessment Project (CMH-CAP) 

Purpose of the Study 

The main purpose of this study is to evaluate the implementation of the Ontario Common Assessment of Need (OCAN) tool 

and processes in Aboriginal mental health programs in the Ontario North East Local Health Integration Network (NE LHIN). 

Specifically we will be working on the following objectives: 

‣ Analyzing the degree of fit of the OCAN tool for completing assessments by staff and consumers within Aboriginal 

mental health programs, using a variety of data collection methods. 

‣ Determining what best practices were used during the process of completing OCAN. 

‣ Collecting and using existing and proven or best practice tools. We will work with the project to propose, discuss and 

advise on the merits of validated tools for addressing quality, access, acceptability and cost. 

‣ Evaluating what cultural supports need to be in place for both staff and consumers in completing the tool and 

incorporating OCAN processes in Aboriginal mental health programs. 

‣ Examining barriers and challenges for using OCAN in Aboriginal programs that did not elect to participate in the NE 

LHIN pilot. 



Procedures involved in the Evaluation 

We request to conduct an interview with you and we may ask for your feedback on a survey. We will ask you about your 

experience with the OCAN tool and its impact on programs and program constraints. We will ask for your consent to audiorecord 

this interview. 

Potential Harms, Risks or Discomforts: 

It is not likely that there will be any harms or discomforts associated with participation. There may be a chance that others who 

know you well may be able to attribute your quotes to you. For this reason we ask that you only share comments, information 

or perspectives that you would feel comfortably sharing widely. You do not need to answer questions that make you 

uncomfortable or that you do not want to answer. 

Potential Benefits 

The evaluation is intended to examine the implementation of the OCAN tool in Aboriginal mental health programs and identify 

ways to improve this for others using the assessment with Aboriginal clients. 

Payment or Reimbursement: 

There will be no payment for your participation 

Confidentiality: 

Anything that you say or do in the study will not be attributed to you personally. Anything that we find out about you that could 

identify you will not be published or disclosed to anyone else, unless we receive your permission. Your privacy will be 

respected. 

The information you share will be summarized along with information obtained from other participants. Only the researchers 

will have access to the audio recorded interview. The recording will not be shared with the sponsor of this study. All measures 

of privacy, confidentiality and security will be respected. This includes keeping the information secured in a locked filing 

cabinet for a period of at least seven years. 

b) Legally Required Disclosure: 



Information obtained will be kept confidential to the full extent of the law and we will treat all information provided to us as 

subject to researcher-participant privilege. 

Participation: 

Your participation in this study is voluntary. It is your choice to be part of the evaluation or not. If you decide to participate, 

you can decide to stop at any time, even after signing the consent form or part-way through the study. If you decide to stop 

participating, there will be no consequences to you. If you do not want to answer some of the questions you do not have to, 

but can still participate in the project in the future. Your decision whether or not to participate will not affect your own or your 

organization’s relationship with the evaluation’s sponsor. 

Information About the Study Results: 

You can contact Stephanie Carter after March 31, 2010 for information on the evaluation results. 

Stephanie Carter, Project Leader 

Community Care Information Management (CCIM) Program 

444 Yonge Street - Toronto , ON - M5B 2H4 - Box # 2 

Phone: 416.212.7584 

Fax: 416.314.1585 

Email: Stephanie.Carter@ontario.ca 

Information about Participating as a Study Subject: 

If you have concerns or questions about your rights as a participant or about the way the study is conducted, you may contact 

Stephanie Carter at the address above. 



CONSENT FORM 

I have read the information presented in the information letter about an evaluation being conducted by Mariette 

Sutherland and Marion Maar on behalf of the Ministry of Health and Longterm Care (CMH-CAP). 

I have had the opportunity to ask questions about my involvement in this evaluation, and to receive any additional 

details I wanted to know about the evaluation. I understand that I may withdraw from the evaluation at any time, if I 

choose to do so. I have been given a copy of this form. 

I understand that I am participating in an interview/focus group to discuss my experience with the Ontario Common 

Assessment of Need (OCAN) tool and processes in Aboriginal mental health programs. 

I consent to the recording of this session. 

Date: 

__________________________________ 

______________________________________ 

Signature of Participant 

Name of Participant 



APPENDIX E: SURVEY RESULTS 

OCAN tool evaluation 

Question 1.1 

Your gender 

Answer Options 

Response 

Percent 

Response 

Count 

Male 16.7% 3 

Female 83.3% 15 

answered question 18 

skipped question 1 

Question 1.2 

Your age group 


Response 

Percent 

Response 

Count 

15-24 11.1% 2 

25-34 11.1% 2 

35-44 22.2% 4 

45-54 50.0% 9 

55-64 5.6% 1 

65+ 0.0% 0 

prefer not to answer 0.0% 0 



Question 1.3 



Your highest level of education 


Response 

Percent 

Response 

Count 

grade school 0.0% 0 

some high school 0.0% 0 

graduated high school 0.0% 0 

some college 11.8% 2 

graduated college 23.5% 4 

some university 5.9% 1 

graduated university 35.3% 6 

some postgraduate level education 5.9% 1 

Master's 5.9% 1 

PhD 5.9% 1 

Do not wish to answer 5.9% 1 



Question 1.6 

How many years have you worked in the mental health field? 


Response 

Percent 

Response 

Count 

0-2 16.7% 3 

2-5 27.8% 5 

6-10 27.8% 5 

11-14 0.0% 0 

15-19 11.1% 2 

20+ 16.7% 3 





Question 1.7 

How many years have you worked in the mental health field working with Aboriginal 

clients specifically? 


Response 

Percent 

Response 

Count 

0-2 22.2% 4 

2-5 16.7% 3 

6-10 27.8% 5 

11-14 11.1% 2 

15-19 11.1% 2 

20+ 11.1% 2 



Question 2.1 

Prior to the implementation of OCAN at your site, which instruments/inventories did 

you use? 


Response Count 

15 



Number 

1 

Response Text 

mental health assessments, crisis assessments, program developed 

forms 

2 paper 

3 none 

4 mental health assessment created by our program 

5 all 



6 CDS forms 

7 have not used 

8 electronic, report writing to funder/ spread sheet 

9 rxy- EWR 

10 n/a 

11 other assessment - hard copy 

12 brief symptom inventory 

13 mcmi-III becks 

14 ongoing inventories weaved in over the course of visits 

15 Asking clients' concerns 

Question 2.4 

Are you using the tool... (please check all that apply) 


Response 

Percent 

Response 

Count 

In the office 92.3% 12 

When meeting clients out of the office 46.2% 6 



Question 2.3 

If you are not using OCAN outside of the office, why not? 


Response 

Count 

11 





Number 

Response Text 

1 Haven't needed to, I see clients in office 

2 techno. problems 

3 technology, no interest, access 

4 

no wish to take paperwork out of the 

office 

5 the clients are not interested 

6 i can, but don’t 

7 i am just a student 

8 do not use 

9 student 

10 no clients interested in it 

11 clients are seen in the office for confidentiality 

Question 2.4 

How do you normally use OCAN? 


Response 

Percent 

Response 

Count 

I use the staff assessment only 0.0% 0 

I use the consumer self assessment only 9.1% 1 

I use both the staff assessment and the consumer 

self assessment 

90.9% 10 



Question 2.5 

How do you use the staff assessment? 


Response 

Percent 

Response 

Count 

I record the client's responses on paper and later 

transfer them to the automated tool 

72.7% 8 



I enter the information into the automated tool while I 

am meeting with the client 

I record the client's responses on paper and other 

staff transfer them to the automated tool 

I have the automated tool visible during the interview, 

but enter later 

0.0% 0 

27.3% 3 

0.0% 0 

Other (please specify) 7 



Number 

Other (please specify) 


2 or client could have if comfortable, input themselves, set up for them 

3 i transfer the information into the automated tool 

4 do not use 

5 n/a 

6 not used 

7 

I record the client's response on paper and later transfer them to the 

questionnaire 

Question 2.6 

What is your typical experience with the consumer self assessment? 


Response 

Percent 

Response 

Count 

the client fills out the consumer self assessment with 

minimal assistance 

the client fills out the consumer self assessment with 

assistance 

the client completes the consumer self assessment with 

strong encouragement 

clients do not wish to complete the consumer self 

assessment 

0.0% 0 

55.6% 5 

44.4% 4 

11.1% 1 






Number 


1 worker helps complete self assessment with client 

2 With translation 


4 do not use 

5 n/a 

6 not used 

7 

Client will ask the worker to write for him, worker writes the answer to 

questionnaire 

Question 3.1 

How satisfied are you with the following 


very 

satisfied 

satisfied 

neither 

satisfied nor 

dissatisfied 

dissatisfied 

very 

dissatisfied 

not applicable - 

I did not 

receive/know 

about this 

Response 

Count 

Training to use 

OCAN 

Reflective 

Practice Guide 

Assessment 

Skills Workshop 

Getting 

answers to 

questions form 

the Agency 

Change Team 

Follow up 

support from 

Project Support 

Team 

One page 

Common 

1 9 4 1 0 2 17 

0 8 3 1 0 2 14 

0 6 5 1 0 4 16 

1 6 4 1 0 4 16 

1 8 3 0 0 4 16 

0 7 3 0 0 4 14 



Assessment 

Template 



Question 3.2 

Are there any other supports you can think of that would make it easier to use the 

OCAN? 


Response 

Percent 

Response 

Count 

Yes 20.0% 3 

No 80.0% 12 

If yes, please explain 3 



Number 

If yes, please explain 

1 refresher training 

2 Lisa, our trainer from NSTC 

3 shadowing with someone who does OCAN assessments regularly 

Question 3.3 

Please tell us how much you agree with the following statements 


strongly 

agree 

agree 

neither agree 

nor disagree 

disagree 

strongly 

disagree 

Response 

Count 

The client version of the 

questionnaire needs to be completed 

before my assessment gets 

underway 

0 9 4 4 0 17 



The OCAN is too long 3 7 4 3 1 18 

The OCAN can work well for 

Aboriginal Mental Health Services 

The OCAN has lead to a more 

detailed care plan 

The OCAN is helping to identify the 

clients' goals for the care plan 

The 23 domains provide useful 

information 

Using the OCAN has improved 

communication with clients 

Overall completion of the OCAN is 

too demanding 

The OCAN works well within the 

cultural context of Aboriginal clients 

My agency should continue to use 

the OCAN 

1 3 4 7 0 15 

2 6 7 3 0 18 

1 7 8 2 0 18 

2 10 5 1 0 18 

1 4 10 3 0 18 

0 11 5 1 0 17 

1 0 7 8 1 17 

1 4 8 4 0 17 



Question 3.4 

What do you see as the strengths of the OCAN? 


Response 

Percent 

Response 

Count 

The OCAN helps to gather information about the 

client that is useful for care planning 

Working with both the client's and the clinical 

version of OCAN improves the assessment process 

The OCAN allows an exploration of the client's 

aspirations 

58.8% 10 

29.4% 5 

47.1% 8 

None of the above 17.6% 3 






Number 


1 identify needs and gaps of services needed. 

2 culturally inappropriate 

3 

work in a small community where clients are familiar with services and 

worker 

Question 3.5 

What do you see as the weakness of OCAN? 


Response 

Percent 

Response 

Count 

Takes too much time 73.7% 14 

Having to complete a client as well as a clinical component 31.6% 6 

Takes time to enter the data in the agency's automated 

tool 

Some of the domains are not a good fit with Aboriginal 

clients 

26.3% 5 

73.7% 14 

Some of the domains are too personal 21.1% 4 




Number 

1 


need to identify and address issues related to mental health ie. grief , trauma, 

coping 

2 too much time but not enough info 

Question 3.6 

Based on your experience with OCAN, would you recommend OCAN to other Aboriginal mental 



health services? 


Response 

Percent 

Response 

Count 

Yes 57.1% 8 

No 42.9% 6 

Please explain 9 



Number 

Please explain 


2 not to sure, need to use it first 

3 

same assessment tool, all mental health agencies using standardized, common tool in 

Ontario 

4 needs to be revised 

5 don’t know enough about it to recommend it 

6 not psychological servers 

7 unknown 

8 to identify and concretize the needs that should be prioritized 

9 -with reservation and explanation of areas of concern 

Question 3.7 

How is the OCAN best implemented in Aboriginal health services environments? 

Answer Options Response Percent Response Count 

Computerized version 33.3% 5 

Paper-based followed by entry into computerized version 60.0% 9 

Paper-based version 6.7% 1 

Please explain your answer 9 





Number 

1 

Please explain your answer 

ideally computerized ,however could pose problem without access, offline work and sync to 

the system would be beneficial. OR Receptionist to do some of the entering is required. 

2 not implemented 

3 this would be ideal, but we need to make sure that is will be safe 

4 both, using your judgment, decide what best fits consumer 

5 it would be suited to have hard copies as well letting the client have privacy to complete 

6 shorter version 

7 for youth 

8 provide heard copy to review when internet not available 

9 computer access is limited in some communities 

Question 3.7 

Do you have any other comments? 


Response Count 

10 



Number 

Response Text 


2 no 

3 as discussed 

4 n/a 

5 thanks for coming 

6 none 



7 

standardized assessment is a useful aspiration for communication between mental health 

services providers but some items in this tool are not capturing helpful information. we need 

a long term research strategy to amend and validate an improved version of this tool that will 

tap into aboriginal health needs 

8 have aboriginal model of OCAN based on a medicine wheel 

in summary, some resources will be necessary 

I look forward to the solutions to clients' needs so that we can fully seve and be a part in the 

clients recovery 

9 

Good luck!! More power to you!! 

- little attention to native culture given to overall survey in terms of language, norms, etc 

10 

- intrusive to new clients

EVALUATION OF THE ONTARIO COMMON ASSESSMENT ... - CCIM

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