Network Initiatives for 2009-2010
Earlier this year, the Advisory Committee of the Toronto ABI Network held an annual planning meeting to map out initiatives for 2009-2010. The session was informed through an environmental scan including consultation with stakeholders across the Network and a presentation by Warner Clarke, Senior Program Consultant, Community Services, Provincial Programs Branch, Health System Accountability and Performance Division, Ontario Ministry of Health and Long-Term Care.
A variety of issues pertaining to the funding, coordination and delivery of acquired brain injury (ABI) services across the continuum were discussed within the framework of current MOHLTC and LHIN priorities. Recognizing the need for the Network to support members and LHINs work towards the priority of reducing ALC, two over-arching objectives for the 2009-2010 year were identified:
- Maintain a continued focus on the acute to inpatient rehabilitation transfer and seek innovative solutions to support system enhancement and/or efficiencies
- Continue the Network’s review of community ABI services and make recommendations for maximizing use of resources and enhancing access to services, recognizing the impact that the state of community and post acute services have on access and patient flow right across the system.
These two priorities form the basis of the Network’s 2009/2010 Operating Plan. Task groups for these initiatives will be convened throughout the year to review progress and ensure alignment with activities given their shared common ground and objectives.
These initiatives are closely linked to other work in which the Network is participating to conduct a Systems Analysis of health and community services for ABI across the province. The ABI Systems Analysis - see story in the In Brief section - will describe and analyze the flow and scope of ABI services across the province to inform system planning and improvement.
In addition to the work outlined above, the Network will also engage members and others on initiatives focused on data analysis and reporting, advocacy and brain injury education about family intervention, neuropsychiatric support, homelessness and other topics.
Streamlining Follow-up Services
In order to limit duplication and to ensure the most effective use of our limited resources in providing follow-up to ABI patients post acute care; the Network facilitated a review of our current ABI follow-up services and worked with stakeholders to develop protocols for who will provide medical follow-up when a patient with ABI transitions from one level of care to another.
The following summarizes the agreement between acute care and rehab in relation to following ABI patients post acute care:
- If a patient from St. Michael’s Hospital is admitted to an ABI inpatient rehab program at Toronto Rehab, Bridgepoint Health or West Park Healthcare Centre, the Network will notify St. Michael's Hospital Head Injury Clinic to cancel their follow-up appointment.
- If a patient from acute care is discharged home to wait for rehab and subsequently declines an inpatient rehab bed offer, the Network will notify the respective acute care clinic to ensure a follow-up appointment is made where appropriate.
- If a patient is referred to either Toronto Rehab's or Bridgepoint’s Day Hospital, it will be the responsibility of the admitting program to notify the follow-up clinics of their intent to provide service to that patient.
Survey on the Use of Observers
In keeping with its current focus on issues related to capacity and access for ABI rehab, the Network is conducting a review of patients waiting for inpatient regular stream ABI rehab who can not be transferred due to use of an observer/sitter. The purpose of this review was to determine the potential benefits of a pilot project that would examine the inter-organizational financial and flow impacts of expedited transfers of these patients to rehab through time-limited financial support from acute care for the sitter/observer.
To achieve this, the Network has asked that the trauma and neurosurgery units at our member organizations track patient specific data related to the use of observers over a four week period. In addition, respondents were asked questions about their organizations current practices related to the use of observers/sitters.
A first phase of surveys have been received and reviewed, however, acute care is continuing to collect data to ensure that we have a sufficient sample to inform the next phases of the initiative.
The findings relating to current organizational practices and protocols for ordering, assessing, and weaning observers/sitters point to some potential opportunities for standardizing and enhancing practices. For example, only one of three organizations responding reported that they provide specific training to observers about the unique needs of ABI. Further none of the organizations have been able to secure a consistent roster of observers that would support the development of expertise.
It is anticipated that this work will be complete later this spring and the results will be reviewed with targeted stakeholders to determine next steps.
Provincial Initiative to Describe and Analyze Scope and Nature of ABI Services
The Ontario Neurotrauma Foundation (ONF) has called for a systems analysis of health and community services for acquired brain injury (ABI) in Ontario that focuses on what is happening within the system and the flow of services. A research team (see below) has been appointed to conduct the analysis.
The project will describe and analyze the:
- Scope and nature of ABI services across the continuum of service across the lifespan of individuals living with acquired brain injury.
- Flow of services across and between LHINs, specifically as it relates to:
- Services being provided including capacity and description of services that includes exclusion criteria
- Distribution of services
- Utilization of services, including access and waits for services
- Coordination of services including linkages, partnerships, relationships, associations
- Gaps in services
- Urban/rural differences
- Wait lists and time to access services.
- Partnerships, linkages, associations and relationships that exist for the delivery of ABI services.
- Opportunities where individuals could move to an alternate level of care if an ALC in the community existed and what that would look like.
Results of the study are intended to inform and enable ONF, planners, policy makers, advocacy groups and the ABI community, on a provincial level, to identify frameworks that might be helpful for Ontario to address ABI as a complex chronic disorder for adults, children and youth.
The analysis is being conducted beginning April 2009 with a targeted completion date of March 2010.
The project team includes: Dr. Susan Jaglal, Principal Investigator, Senior Scientist, Toronto Rehabilitation Institute, Associate Professor, Department of Physical Therapy, University of Toronto; Charissa Levy, Executive Director, Toronto ABI Network; Daria Parsons, Consultant with particular expertise and experience in data access and analysis; Rika Vander Laan, Consultant with particular expertise and experience in ABI systems; and Sarah Munce, Project Coordinator.
For further information please contact Sarah Munce, Project Coordinator, at sarah.munce@utoronto.ca.
ABI Rehab Definitions Initiative
The Toronto ABI Network, in collaboration, with the GTA Rehab Network has developed an ABI Rehab Definitions Framework. The framework articulates the essential components of ABI rehab drawing on evidence-based research to define the “gold standard” of rehab care. Where there was absence of literature, definitions were derived through consensus on current clinical practices. The completed ABI/Neuro Rehab Definitions Framework is available from the GTA Rehab Network's website.
The overall intent of the ABI Rehab Definitions Framework is to:
- Define and promote consistency in ABI rehab care across different care settings
- Increase clarity for patients, families and referrers through the use of consistent terminology
- Establish a standard of care to enable targeted discussions regarding system planning, resourcing of services and performance measurement in rehab to ensure the availability of quality rehabilitation interventions across settings.
Following the development of the GTA Rehab Network’s ABI Rehab Definitions Framework, a self-assessment survey tool was developed for each sector of the rehab continuum (i.e. acute care, inpatient and outpatient/ambulatory rehab, and community-based rehab).
The self-assessment tools provide a mechanism through which the Networks and individual organizations can:
- Identify opportunities for quality improvement initiatives
- Improve the delivery of ABI rehab services
- Advocate for resources to promote consistency and equitable access to ABI rehab services.
Self-Assessment Survey Approach:
The self-assessment survey tools and framework for ABI rehab were sent to all Network member acute care and rehab hospitals and GTA CCACs in winter 2008. These organizations were asked to evaluate the capacity of their ABI rehab programs to meet the definitions of the ABI Rehab Definitions Framework. These organizations used the rating scale below for services provided to ABI rehab patients within the past six months of the survey date.
Rating Scale:
| Fully met | >= 80% of time |
| Partially met | 40% - 79% of time |
| Not met | < 40% of time |
Designation of Key Criteria:
Members of the ABI Rehab Definitions Task Group subsequently identified a set of key criteria that ABI rehab programs would be expected to “fully meet” (i.e. at minimum, 80% of the time) in order to be consider a dedicated/specialized ABI rehab program. These key criteria typically represent 50% of the criteria for each type of program (e.g. inpatient rehab, outpatient/ambulatory etc.).
A total of 27 surveys were received from acute care, inpatient, outpatient and community-based rehab programs.
The overall findings of these surveys are as follows:
- One of the three programs that identified themselves as having a dedicated inpatient ABI rehab program fully met the surveyed key criteria 100% of the time; one program fully met 96% of the key criteria; and the third met 84% of the surveyed key criteria.
- None of the ‘Inpatient ABI Rehab on Mixed Unit’ programs fully met all criteria. Five of the six programs fully met 80% or more of all criteria; and one program met 43% of the criteria.
- For LTLD ABI rehab (or slow stream): Two of three programs met 81% of all criteria; and one met 53% of all criteria.
- Two of the nine outpatient/ambulatory rehab programs that responded met 100% of the criteria; five fully met between 70-85% of the criteria; and two met less than 60% of the criteria.
- For community ABI rehab programs: One program met 100% of criteria; and the other met 71% of the criteria.
Individual organizations will be receiving the results of their self-assessment surveys in the coming weeks allowing them to identify areas for improvement and compare their performance to that of their peers.
ABI and Homelessness Workshop
The Toronto ABI Network is working with COTA Health and the City of Toronto, Homelessness Partnership Initiatives, to host an education workshop aimed at increasing the level of awareness about brain injury among those that work with homeless individuals. This event was initiated in response to Dr. Stephen Hwang’s recently published research that indicates more than 50 % of people who are homeless have a brain injury, approximately 70% of whom attained the brain injury before becoming homeless.
The workshop will take place in the afternoon of June 2, 2009 at St. Michael’s Hospital. Dr. Hwang will open the afternoon with a review of his recent research in this area, laying the context for a practical, hands-on workshop for front line workers. The workshop, led by Dr. Carolyn Lemsky of Community Head Injury Resource Services and ABI case managers from COTA Health, will help those that work with homeless individuals better identify brain injury in their clients, understand its impact and enhance their ability to support this unique population.
The workshop is generously being funded by the City of Toronto, Homelessness Partnership Initiatives, and therefore can be offered free of charge to participants.
If you have any questions, please contact Judy Moir at the Toronto ABI Network office, 416-597-3057.
Data on Referrals Received
The Toronto ABI Network manages referrals for acquired brain injury services in the Greater Toronto Area. Referrals for inpatient service are triaged through the Network office to the first available bed that is appropriate to the individual's needs. The Network also facilitates the process of referring to community-based ABI providers. The following information reports only on patients/clients referred through the Network office and is not intended to reflect incidence data.
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In Brief
Employment opportunity at the Toronto ABI Network
The Toronto ABI Network is accepting applications for the position of Project Coordinator/ABI Referral Coordinator. This a one-year contract or secondment opportunity, starting in May 2009.
Responsibilities will include, but are not limited to, the following:
- managing a centralized referral system for inpatient and community based referrals for brain injury services across the GTA, including responding to referral inquiries and tracking of referral data.
- providing leadership, information and support to various committees of the Network that address clinical and systems-wide issues relating to brain injury services across the continuum. May involve literature reviews, design and analysis of surveys and inventories and facilitating stakeholder forums.
- participating in development of reports on trends and the utilization of the ABI and other rehabilitation programs which can be used for both policy and program planning and decision-making.
- participating in development of operating plan for the Network.
- a Masters degree in clinical discipline or health administration
- minimum 3 years clinical experience
- experienced and proven skills in report writing
- excellent organizational and communication skills
- the ability to work independently on multiple tasks and with teams
- computer skills in basics of Word and Power Point
- familiarity with ABI and/or other rehab services in Toronto.
Apply now > View complete job posting.
Brain Injury and Family Intervention
The Toronto ABI Network continues to work towards promoting best practices in family intervention. As one piece of this work, the Toronto ABI Network hosted a two-day workshop in February of 2009 to introduce the Brain Injury Family Intervention (BIFI) for families of adults affected by ABI and the newly-modified version designed specifically for adolescents ages 13 to 19 years (BIFI-A).
Caron Gan of Bloorview Kids Rehab, and Drs. Jeffrey Kreutzer and Taryn Stejskal of Virginia Commonwealth University, brought a phenomenal, comprehensive program to participants that focused on providing practical tools and a structured, manualized protocol for clinicians to use in their own practice.
An overview of family evaluation and intervention was provided to all participants on the first day, focusing on the impact of brain injuries on families, intervention techniques and theoretical frameworks, how to effectively manage difficult cases and situations, and objectively evaluating change and therapeutic benefits.
The next day, participants split into two groups to focus on intervention for adults with ABI and adolescents with ABI, respectively, where they were given the opportunity to focus on skill-building, drawing on family discussion, vignettes, role plays and interactive exercises.
The workshop was sold out and very well received. Participants expressed a desire to reconvene in approximately six months time to discuss how to proceed with the implementation of the model, raise any questions and problem solve around particularly challenging cases.
The planning group has reviewed the evaluations and is planning next steps, including the possibilities of hosting another session given apparent demand and/or supporting a follow-up session with the first group of participants.
Brain injury awareness concert
The Awareness Committee of the Brain Injury Society of Toronto is planning a lunchtime event on Thursday, June 18th in support of brain injury awareness month. The event will include bands, a survivor tent and artists' displays.
For details about this awareness event and to register your support, please visit the Brain Injury Society of Toronto's website at www.bist.ca.
Events Listing
The events listed here are provided for your information and are not necessarily being organized by the Toronto ABI Network. If you are interested in further details about any of the events below, please contact the appropriate individual identified in the event listing.
May 7-8, 2009
16th Annual Conference on Neurobehavioural Rehabilitation in Acquired Brain Injury:
Managing Transitions in ABI across the Lifespan
Location: Hamilton Convention Centre, Hamilton, Ontario
FOR FURTHER INFORMATION:
Contact Joyce Lambert, Hamilton Health Sciences
Phone: 905-521-2100 ext. 74213
Email: jlambert@hhsc.ca
Web: www.hamiltonhealthsciences.ca (and click on Clinics & Services/ABI Program)
May 7-9, 2009
International Vocational Outcomes in Traumatic Brain Injury Conference 2009
Location: The Empire Landmark Hotel & Convention Centre, Vancouver, BC
FOR FURTHER INFORMATION:
Contact Shelley Johnson
Phone: 604-875-1775
Email:sljproductions@telus.net
Web: www.tbicvancouver.com
May 11-12, 2009
Disability, Health & Wellness Conference:
Gaining Momentum for Change
Location: Victoria Inn, Winnipeg, Manitoba
FOR FURTHER INFORMATION:
Contact Mindie Copet, Planners Plus
Phone: 204-338-0154
Web: www.mfl.mb.ca/dhw-conf.shtml
May 12-13, 2009
Ontario Brain Injury Association, in conjunction with the Brain Injury Association of London & Region, presents:
Brain Basics
Brain Basics is a two-day training program designed for professionals, caregivers and family members working with people living with an acquired brain injury.
Location: Victory Branch Legion, London, Ontario
FOR FURTHER INFORMATION:
Contact Brain Injury Association of London & Region
Phone: 519-642-4539
Email: info@braininjurylondon.on.ca
Web: www.braininjurylondon.on.ca
May 14, 2009
NRIO presents the Breakfast Seminar series:
"Apathy: Why care?": Clinical issues related to motivational impairments post TBI
Guest speaker: Dr. Rob Van Reekum, MD, FRCPC
Location: NRIO, Etobicoke, Ontario
FOR FURTHER INFORMATION:
Contact: Christine Romanenchuk
Phone: 416-231-4358
May 23-28, 2009
10th Quadrennial Congress of The World Federation of Neuroscience Nursing:
Founded on Tradition - Focused on Tomorrow
Location: York University, Toronto, Ontario
FOR FURTHER INFORMATION:
Web: www.wfnn2009congress.ca
June 3-5, 2009
Ontario Brain Injury Association Training Program:
Advanced Rehabilitation for Persons with ABI - Level Two
Professors: Dr. Sherrie Bieman-Copland and Dr. Dawn Good
Location: Brock University, St. Catharines, Ontario
FOR FURTHER INFORMATION:
Contact: Ruth Wilcock or Debbie Spaulding
Phone: 1-800-263-5404 or 905-641-8877
Email: obia@obia.on.ca
Web: www.obia.on.ca
June 18, 2009
Brain Injury Awareness Month event:
Brain Injury Awareness Concert
Time: 12:00 pm - 2:00 pm
Location: Nathan Phillips Square, Toronto, Ontario
June 19, 2009
12th annual Brain Injury Association of London and Region conference:
"Moving Forward: Trends in Treatment"
Location: Four Points Sheraton, London, Ontario
Contact: Brain Injury Association of London & Region
Phone: 519-642-4539 / 1-888-642-4539
Email: info@braininjurylondon.on.ca
Web: www.braininjurylondon.on.ca
June 25, 2009
NRIO presents the Breakfast Seminar series:
"Two Heads are Better than One: A neurologist and an OT describe their comprehensive assessment"
Guest speakers: Dr. Jane Gillett, Medical Director, ABI Program, Hamilton Health Sciences; and Ann Fitzhenry Bedard, Occupational therapist in private practice
Location: NRIO, Etobicoke, Ontario
FOR FURTHER INFORMATION:
Contact: Christine Romanenchuk
Phone: 416-231-4358
This listing provides details of events taking place within several months of the newsletter’s release date. For a more comprehensive list of events of interest to the ABI community, please see the conference listing on our website.