EVALUATION OF THE ONTARIO COMMON ASSESSMENT ... - CCIM

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OCAN Evaluation for Aboriginal Mental Health Programs 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 Sutherland & Maar - March 2010 Page 23
OCAN Evaluation for Aboriginal Mental Health Programs 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 Sutherland & Maar - March 2010 Page 24
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