Imagine a clinical tool that gives mental health professionals the ability to offer every patient customized treatment options tailored to meet their own specific needs, abilities and circumstances.
Now imagine all of Alberta Health Services' mental health and addictions personnel in the Edmonton Zone having access to the same clinical decision support tool whenever they interact with one of their 45,000 clients, or recommend any of the Zone's 160 related treatment programs.
Sound too good to be true? Think again. In fact, it will soon be a reality. The tool is called LOCUS - or Level of Care Utilization System - and plans are well underway for a full rollout of LOCUS across the Edmonton Zone over the next six months.
More immediately, LOCUS is expected to be implemented at AHS's Addiction and Mental Health Access 24/7 - a new central information, assessment and navigational hub specifically designed to serve the region's addictions and mental health patients - when it opens its doors in January.
Access 24/7 will be located at Anderson Hall, just east of the Royal Alexandra Hospital's Emergency Department on 102 Street.
"LOCUS really piggybacks on our Access 24/7 initiative. The whole point of Access 24/7 is to direct our clients into programs offering the right level of care at the right time, and LOCUS is a big part of that," explains Mark Snaterse, AHS's Executive Director - Addiction and Mental Health, Edmonton Zone.
"If you look at all the AHS programs across the Edmonton Zone as well as programs delivered by our partner organizations you'll see that different programs offer varying intensities of treatment, ranging from daily psychotherapy groups to programs where clients may attend every week or two. It's all part of our philosophy of 'stepped care,' so people can access whatever level of intensity they need," he says.
Created by the American Association of Community Psychiatrists in 1996, LOCUS has been updated multiple times, with the latest version released in 2016.
Several healthcare organizations across Canada and the U.S. already use it, including Toronto's Centre for Addiction and Mental Health (CAMH), the Saskatchewan Health Authority and Vancouver Coastal Health. Several of these organizations report positive experiences with LOCUS.
The Ontario Shores Centre for Mental Health Sciences, in Whitby, Ont., reported that patient readmission rates in the 30-day period after discharge declined after it began using LOCUS. It also reported a sharp increase in the number of patients admitted to hospital from its waiting list.
"In Ontario they've also found that LOCUS has helped to increase the flow of patients out of hospital in a more timely manner," says Kimberly Poong, AHS Program Manager, Performance, Edmonton Zone. "And in Saskatchewan they've been able to compare data from region to region in terms of the needs of the local population base and reallocate services in the community more effectively, based on those findings."
Here's how LOCUS works. First, it evaluates each patient or client based on six dimensions. It then applies a rating scale - ranging from a low of one (minimal problem) to a high of five (extreme problem) - to score each individual on each dimension. The six dimensions include:
• Risk of Harm: A measure of suicide and homicide risk as well as impairment of perceptions, judgement or impulse control.
• Functional Status: A measure of the individual's ability to fulfill obligations at work, home and school; their ability to interact with others; and their eating, sleeping and hygiene habits.
• Co-Morbidities: An assessment of all medical, substance use or mental health disorders.
• Recovery Environment: The client's level of ongoing support / level of stress.
• Treatment and Recovery History: A review of the patient's past exposure to and use of treatment, and history of maintaining recovery.
• Engagement and Recovery Status: The patient's understanding of their illness and desire to engage in treatment and recovery.
The score assigned to each of these six dimensions is based on a combination of factors, including patient interviews, clinical judgement, records, third-party reports, history and observation.
"Following that process, there's a very complex algorithm that takes all of the individual dimension scores and outputs what we call a level of care recommendation," says Poong. "So it's quite complex."
"If a patient does really well after a brief series of treatments using cognitive behavioural therapy, we don't want to put them in some kind of intensive program. Nor would we want someone going into an 18-week, five-day-a-week intensive psychotherapy program if they would do well with a single session, solution-focused therapy," Snaterse explains.
"For group therapy alone we've identified about 168 different groups that are ongoing across all of our programs in the Zone. In addition there is individual counselling, assertive community treatment and outreach and a broad range of other services that reflect our 'stepped care' model."
LOCUS will allow for all of these programs to be divided by level of service intensity offered. To better match patient needs with services offered, programs will be organized using the following six categories:
• LEVEL ONE - These programs offer treatment to clients now living independently or with minimal support in the community who have achieved significant recovery from past episodes of illness.
• LEVEL TWO - These programs are geared to treatment for non-complex clients with mild to moderate symptoms who typically have one presenting issue and fairly supportive recovery environments.
• LEVEL THREE - For clients who need intensive support and treatment several times per week, but who are living independently or with minimal support in the community.
• LEVEL FOUR - For clients capable of living in the community -
either in supportive or independent settings - but whose treatment requires intensive management, possibly involving partial hospital programs.
• LEVEL FIVE - Care at this level is typically provided in non-hospital, free-standing residential facilities based in the community.
• LEVEL SIX - This is the most intensive level of care and is typically provided on an inpatient basis in a hospital setting.
"Our vision in introducing LOCUS to the Zone is to give people more treatment options to choose from. So those options might be delivered on different days of the week, at different times of day, and in different parts of the city, depending on what best meets the needs of each client," explains Snaterse.
At present, Snaterse and his colleagues at AHS are running training workshops and seminars on LOCUS in order to prepare mental health and addictions staff for the upcoming rollout.
"We all need to be talking the same language about the level of intensity of treatment that a patient may need. And we all have to be on the same page regarding the actual intensity of programming that each one of our services offers. In other words, we all have to be using the same triaging tool," he explains.
"After that, the next challenge is to make sure that all of the programs in the community that are receiving these patients are also speaking the same language. It's important that we're using it at all the points of entry where people may be coming into our system, but our first priority is going to be those who are impacted by the new Access 24/7 Centre."
Now imagine all of Alberta Health Services' mental health and addictions personnel in the Edmonton Zone having access to the same clinical decision support tool whenever they interact with one of their 45,000 clients, or recommend any of the Zone's 160 related treatment programs.
Sound too good to be true? Think again. In fact, it will soon be a reality. The tool is called LOCUS - or Level of Care Utilization System - and plans are well underway for a full rollout of LOCUS across the Edmonton Zone over the next six months.
More immediately, LOCUS is expected to be implemented at AHS's Addiction and Mental Health Access 24/7 - a new central information, assessment and navigational hub specifically designed to serve the region's addictions and mental health patients - when it opens its doors in January.
Access 24/7 will be located at Anderson Hall, just east of the Royal Alexandra Hospital's Emergency Department on 102 Street.
"LOCUS really piggybacks on our Access 24/7 initiative. The whole point of Access 24/7 is to direct our clients into programs offering the right level of care at the right time, and LOCUS is a big part of that," explains Mark Snaterse, AHS's Executive Director - Addiction and Mental Health, Edmonton Zone.
"If you look at all the AHS programs across the Edmonton Zone as well as programs delivered by our partner organizations you'll see that different programs offer varying intensities of treatment, ranging from daily psychotherapy groups to programs where clients may attend every week or two. It's all part of our philosophy of 'stepped care,' so people can access whatever level of intensity they need," he says.
Created by the American Association of Community Psychiatrists in 1996, LOCUS has been updated multiple times, with the latest version released in 2016.
Several healthcare organizations across Canada and the U.S. already use it, including Toronto's Centre for Addiction and Mental Health (CAMH), the Saskatchewan Health Authority and Vancouver Coastal Health. Several of these organizations report positive experiences with LOCUS.
The Ontario Shores Centre for Mental Health Sciences, in Whitby, Ont., reported that patient readmission rates in the 30-day period after discharge declined after it began using LOCUS. It also reported a sharp increase in the number of patients admitted to hospital from its waiting list.
"In Ontario they've also found that LOCUS has helped to increase the flow of patients out of hospital in a more timely manner," says Kimberly Poong, AHS Program Manager, Performance, Edmonton Zone. "And in Saskatchewan they've been able to compare data from region to region in terms of the needs of the local population base and reallocate services in the community more effectively, based on those findings."
Here's how LOCUS works. First, it evaluates each patient or client based on six dimensions. It then applies a rating scale - ranging from a low of one (minimal problem) to a high of five (extreme problem) - to score each individual on each dimension. The six dimensions include:
• Risk of Harm: A measure of suicide and homicide risk as well as impairment of perceptions, judgement or impulse control.
• Functional Status: A measure of the individual's ability to fulfill obligations at work, home and school; their ability to interact with others; and their eating, sleeping and hygiene habits.
• Co-Morbidities: An assessment of all medical, substance use or mental health disorders.
• Recovery Environment: The client's level of ongoing support / level of stress.
• Treatment and Recovery History: A review of the patient's past exposure to and use of treatment, and history of maintaining recovery.
• Engagement and Recovery Status: The patient's understanding of their illness and desire to engage in treatment and recovery.
The score assigned to each of these six dimensions is based on a combination of factors, including patient interviews, clinical judgement, records, third-party reports, history and observation.
"Following that process, there's a very complex algorithm that takes all of the individual dimension scores and outputs what we call a level of care recommendation," says Poong. "So it's quite complex."
"If a patient does really well after a brief series of treatments using cognitive behavioural therapy, we don't want to put them in some kind of intensive program. Nor would we want someone going into an 18-week, five-day-a-week intensive psychotherapy program if they would do well with a single session, solution-focused therapy," Snaterse explains.
"For group therapy alone we've identified about 168 different groups that are ongoing across all of our programs in the Zone. In addition there is individual counselling, assertive community treatment and outreach and a broad range of other services that reflect our 'stepped care' model."
LOCUS will allow for all of these programs to be divided by level of service intensity offered. To better match patient needs with services offered, programs will be organized using the following six categories:
• LEVEL ONE - These programs offer treatment to clients now living independently or with minimal support in the community who have achieved significant recovery from past episodes of illness.
• LEVEL TWO - These programs are geared to treatment for non-complex clients with mild to moderate symptoms who typically have one presenting issue and fairly supportive recovery environments.
• LEVEL THREE - For clients who need intensive support and treatment several times per week, but who are living independently or with minimal support in the community.
• LEVEL FOUR - For clients capable of living in the community -
either in supportive or independent settings - but whose treatment requires intensive management, possibly involving partial hospital programs.
• LEVEL FIVE - Care at this level is typically provided in non-hospital, free-standing residential facilities based in the community.
• LEVEL SIX - This is the most intensive level of care and is typically provided on an inpatient basis in a hospital setting.
"Our vision in introducing LOCUS to the Zone is to give people more treatment options to choose from. So those options might be delivered on different days of the week, at different times of day, and in different parts of the city, depending on what best meets the needs of each client," explains Snaterse.
At present, Snaterse and his colleagues at AHS are running training workshops and seminars on LOCUS in order to prepare mental health and addictions staff for the upcoming rollout.
"We all need to be talking the same language about the level of intensity of treatment that a patient may need. And we all have to be on the same page regarding the actual intensity of programming that each one of our services offers. In other words, we all have to be using the same triaging tool," he explains.
"After that, the next challenge is to make sure that all of the programs in the community that are receiving these patients are also speaking the same language. It's important that we're using it at all the points of entry where people may be coming into our system, but our first priority is going to be those who are impacted by the new Access 24/7 Centre."