WoodGreen Community Services has completed
a quality improvement (QI) project, with coaching from the
E-QIP
team, to identify and address symptoms of depression among seniors in the
population they serve.
Health Quality Ontario had a chance to catch
up with Julia Chao, Project Lead, Rochelle McAlister, Clinical Project Lead,
and Rebecca Heersink, Business Intelligence Lead at WoodGreen to learn how they
used QI principles and tools to achieve their project’s goals.
Members of the WoodGreen team from left to
right: Rochelle McAlister, Rebecca Heersink, Erin Regala, Elizabeth Lee, Tazim
Lakhani, Brad Wright.
Why did
you focus on seniors and depression for your QI project?
The seniors who access our community
services often face many pressing issues like mental and physical illness,
cognitive impairment, addiction, and financial challenges. Oftentimes,
depression can be missed when other concerns takes precedence. However, when
depression is not addressed, the symptoms can affect clients’ motivation and
ability to take care of themselves. It can inadvertently make other issues
worse.
For many seniors in our community, we are the first
point of contact, which means we are in the best position to identify symptoms
of depression and encourage clients to access primary care to address their
symptoms. Seniors don’t often know they have symptoms of depression and can access
services, so it’s important for us to intervene.
Finally, Health Quality Ontario’s Major Depression Quality Standard informed our project’s goals. The
Quality Standard states that people suspected to have major depression have
timely access to a comprehensive assessment.
By identifying symptoms of depression within our senior population, we
would be able to facilitate timely access to a comprehensive assessment by a
primary care provider when appropriate.
What
was the aim of your project?
As with any QI project, we started by creating
our aim statement: The aim of this project was to identify clients within the Social
Work program with depression symptoms using the Patient Health Questionnaire (PHQ-9)
clinical assessment tool, and to achieve a 50% assessment completion rate and
develop a plan of care for those clients by August 31
st, 2018.
Excerpt
from WoodGreen’s
webinar
illustrating the benefits of the PHQ-9 tool.
How
do you implement the new PHQ-9 tool?
The PHQ-9 tool is a validated clinical tool
to screen for mild, moderate and severe depression. The tool helps to recognize
the presence and severity of symptoms in order to develop appropriate action
plans, which may include referral to primary care for diagnosis.
To implement this tool, we started with
small tests of change. The Social Work team used the tool over a few months
with various clients and via different modalities (i.e. in person or over the
phone, at WoodGreen or in the community, with pen and paper or a mobile-friendly
app). The approach was tailored to individual clients’ needs.
The mobile-friendly app was created by our
team using Office 365 software. The data is housed in Canada and meets privacy
requirements. It’s a great way of leveraging technology to support QI work.
What
has been the impact so far?
We achieved a 64% completion rate among senior
clients within the social work program with depression symptoms, which was
above our target of 50%.
The tool is opening up conversations
with seniors and normalizing mental health as a topic of discussion. Our Social
Work team has been able to develop care plans for clients who complete the
tool, which may include goal setting to address symptoms of depression. Care
plans are individualized and informed by the scores of the PHQ-9 tool.
Our clients now have access to multiple
avenues to get a proper diagnosis and address their symptoms of depression,
including:
- Referral to primary care: We encourage clients to
follow up with their physician when warranted to get a full assessment.
- Community-based psychotherapy at CAMH: We have
developed a partnership agreement with CAMH that allows integrated access to
community-based psychotherapy when warranted. Clients have access to 16
psychotherapy sessions, which is covered by OHIP.
- Walk-in counselling services at WoodGreen: This is a ‘just-in-time’
services with no wait list. Referrals are immediate.
Next
steps
We are exploring the development of exclusion
criteria to further standardize how to appropriately use the PHQ-9 tool. For
example, the tool may not be appropriate for clients with cognitive issues such
as dementia.
We have completed the roll-out of the tool
in the Social Work team and are hoping to spread the use of the tool in our
other Community Care Unit (CCU) teams. In the fall of 2018 we embarked on a
demonstration project with CAMH on identifying depression and anxiety for
access to structured psychotherapy services.
We have been able to leverage this project to start the spread the use
of the tool across other CCU teams.
Early in 2019, we are
hoping to finalize our implementation guidelines and share our work with other
community agencies via professional networks and conferences.