EVALUATION OF THE ONTARIO COMMON ASSESSMENT ... - CCIM

More documents

Recommendations

Info

OCAN Evaluation for Aboriginal Mental Health Programs 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 Sutherland & Maar - March 2010 Page 25
OCAN Evaluation for Aboriginal Mental Health Programs 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. Sutherland & Maar - March 2010 Page 26
Page 1 and 2: EVALUATION OF THE ONTARIO COMMON AS
Page 3 and 4: OCAN Evaluation for Aboriginal Ment
Page 25: OCAN Evaluation for Aboriginal Ment
Page 53 and 54: Sutherland & Maar - March 2010 Page
Page 55 and 56: Sutherland & Maar - March 2010 Page

EVALUATION OF THE ONTARIO COMMON ASSESSMENT ... - CCIM

Create successful ePaper yourself

Delete template?

Save as template?