Health Care Redesign for Responsive Behaviours—The Behavioural Supports Ontario Experience: Lessons Learned and Keys to Success
Publication: Canadian Journal of Community Mental Health
19 February 2015
Abstract
Our health care system is ill prepared for the growing number of older adults and their families/caregivers who live with responsive behaviours associated with cognitive impairment. Considering the burden of illness, quality of life issues, and escalating costs, system-wide redesign is warranted. The Behavioural Supports Ontario (BSO) project is a province-wide, regionally implemented, evidence-informed change strategy that utilizes quality improvement principles and knowledge translation best practices as critical enablers. This paper describes the project and key lessons learned in the implementation of this initiative that can be applied to other jurisdictions wishing to enable large-scale system redesign and sustainable system change.
Résumé
Notre système de santé est mal préparé pour faire face au nombre grandissant de personnes âgées ayant des comportements réactifs liés à des déficits cognitifs et dont s'occupent leurs proches ou des personnes soignantes. Étant donné le fardeau lié à la maladie, les questions de qualité de vie que cela soulève et l'escalade des coûts que cela implique, une révision du système est nécessaire. À cet égard, le projet Behavioural Supports Ontario, qui couvre l'ensemble de la province et est mis en oeuvre dans les diverses régions selon leurs besoins, offre une stratégie qui s'appuie sur des données probantes et sur des principes d'amélioration de la qualité et les meilleures pratiques de transmission des connaissances. Dans cet article, nous décrivons ce projet et les principales leçons que l'on peut tirer de sa mise en oeuvre, ce qui peut être utile à d'autres administrations qui souhaiteraient restructurer le système en profondeur en apportant des changements durables.
Formats available
You can view the full content in the following formats:
References
Alzheimer Society of Ontario. (2007). A profile of Ontario's home care clients with Alzheimer's disease or related dementia. Retrieved from http://www.nelhin.on.ca/uploadedFiles/Public_Community/Report_and_Publications/ALC/Profile%20of%20Home%20Care%20Clients-final.pdf
Anand K. S. and Verma R. A case of undue violent behavior associated with Alzheimer's disease American Journal of Alzheimer's Disease & Other Dementias 2012 27 10 -12
Barrett J. J., Haley W. E., Harrell L. E., and Powers R. E. Knowledge about Alzheimer disease among primary care physicians, psychologists, nurses, and social workers Alzheimer Disease and Associated Disorders 1997 11 99 -106
Behavioural Supports Ontario. (2012a). Capacity Building Roadmap. Retrieved from http://www.akeresourcecentre.org/files/BSOResources/Capacity%20Building%20Roadmap%20Updated%20191212.pdf
Behavioural Supports Ontario. (2012b). Behavioural Supports Ontario quarterly report Q1 2012/13. Period April 1, 2012–June 30, 2012. Retrieved from http://www.akeresourcecentre.org/files/BSOResources/BSO_Q1%20Report%20FINAL(B).pdf
Behavioural Supports Ontario. (2012c). Behavioural Supports Ontario quarterly report Q2 2012/13. Period July 1, 2012–September 30, 2012. Retrieved from http://www.akeresourcecentre.org/files/BSOResources/BSO_Q2%20Report%20FINAL%20(B).pdf
Behavioural Supports Ontario. (2012d). Behavioural Education and Training Supports Inventory (BETSI). Retrieved from http://www.akeresourcecentre.org/BETSI
Behavioural Supports Ontario. (2012e). Person and Practice-Based Learning (PerPLe). Retrieved from http://www.akeresourcecentre.org/files/PerPLe/PerPLeTool.pdf
Brodaty H. and Donkin M. Family caregivers of people with dementia Dialogues in Clinical Neuroscience 2009 11 217 -228
Callahan C. M., Boustani M. A., Unverzagt F. W., Austrom M. G., Damush T. M., Perkins A. J., and Hendrie H. C. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: A randomized controlled trial Journal of the American Medical Association 2006 295 2148 -2157
Third Canadian Consensus Conference on Diagnosis and Treatment of Dementia. (2007). 146 approved recommendations—Final, July, 2007. Retrieved from http://www.cccdtd.ca/pdfs/Final_Recommendations_CCCDTD_2007.pdf
Canadian Institute for Health Information. (2010). Supporting informal caregivers—The heart of home care. Retrieved from https://secure.cihi.ca/free_products/Caregiver_Distress_AIB_2010_EN.pdf
Cohen-Mansfield J. Theoretical frameworks for behavioral problems in dementia Alzheimer's Care Quarterly 2000 1 8 -21
Donabedian A. Evaluating the quality of medical care The Milbank Quarterly 2005 83 691 -729
Dudgeon, S. & Reed, P. (2013). Older Adults Behavioural Support System. Retrieved from http://www.akeresourcecentre.org/files/BSO/Older%20Adults%20Behavioural%20Support%20System.pdf
Ellen, M. (2010). A rapid literature review on behavioural support services. Distance Learning Group.
Feldman H. H., Jacova C., Robillard A., Garcia A., Chow T., Borrie B., and Chertkow H. Diagnosis and treatment of dementia: 2. Diagnosis Canadian Medical Association Journal 2008 178 825 -836
Fillit H. Commentary on “The Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, 2006.” Clinical guidelines are not enough: System-wide, population-based programs are needed to improve the care of patients with Alzheimer's disease and related dementias Alzheimer's & Dementia 2007 3 441 -443
Gaugler J. E., Kane R. L., Kane R. A., and Newcomer R. Early community-based service utilization and its effect on institutionalization in dementia caregiving Gerontologist 2005 45 177 -185
Gaugler J. E., Yu F., Krichbaum K., and Wyman J. F. Predictors of nursing home admission for persons with dementia Medical Care 2009 47 191 -198
Gauthier S., Cummings J., Ballard C., Brodaty H., Grossberg G., Robert P., and Lyketsos C. Management of behavioral problems in Alzheimer's disease International Psychogeriatrics 2010 22 346 -372
Hart, C. (2013). Doing a literature review: Releasing the social science research imagination. London, UK: Sage Publications.
Hay Group. (2012). Behavioural Supports Ontario. Hay Group interim report submitted to CRO. Retrieved from http://www.akeresourcecentre.org/files/Policy/BSO%20CRO_Memo_Mar%2031-12%20Interim%20Evaluation%20Report_24-May-12.pdf
Health Quality Ontario. (2012). Residents First: Advancing quality in Ontario's long-term care homes. Retrieved from http://www.residentsfirst.ca/documents/communicationsnewsletters/rfbrochureen.pdf
Hebert R., Durand P., and Tourigny A. Frail elderly patients: New model for integrated service delivery Canadian Family Physician 2003 49 992 -997
Hinton L., Franz C. E., Reddy G., Flores Y., Kravitz R. L., and Barker J. C. Practice constraints, behavioral problems and dementia care: Primary care physicians’ perspectives Journal of General Internal Medicine 2007 22 1487 -1492
Hogan D. B., Borrie M., Basran J. F. S., Chung A. M., Jarrett P. G., Morais J. A., and Woodmore-Goodwin S. Specialist physicians in geriatrics—Report of the Canadian Geriatrics Society Physician Resource Work Group Canadian Geriatrics Journal 2012 15 68 -79
Iliffe S. and Manthorpe J. The hazards of early recognition of dementia: A risk assessment Aging and Mental Health 2004 8 99 -105
Johri M., Beland F., and Bergman H. International experiments in integrated care for the elderly International Journal of Geriatric Psychiatry 2003 18 222 -235
Jolley D., Benbow S. M., and Grizzell M. Memory clinics Postgraduate Medical Journal 2006 82 199 -206
Kitson A., Harvey G., and McCormack B. Enabling the implementation of evidence based practice: A conceptual framework Quality in Health Care 1998 7 149 -158
Kunik M. E., Snow A. L., Davila J. A., Steele A. B., Balasubramanyam V., Doody R. S., and Morgan R. O. Causes of aggressive behavior in patients with dementia Journal of Clinical Psychiatry 2010 71 1145 -1152
Lee L., Hillier L. M., and Harvey D. Integrating community services into primary care: Improving the quality of dementia care Neurodegenerative Disease Management 2014 4 11 -21
Massoud F., Lysy P., and Bergman H. Care of dementia in Canada: A collaborative care approach with a central role for the primary care physician Journal of Nutrition Health and Aging 2010 14 105 -106
Mental Health Commission of Canada. (2009). Toward recovery and well-being: A framework for a mental health strategy for Canada. Retrieved from http://www.mentalhealthcommission.ca/English/document/241/toward-recovery-and-well-being
Mental Health Commission of Canada. (2011). Guidelines for comprehensive mental health services for older adults in Canada. Retrieved from http://www.cmhawpg.mb.ca/documents/seniors-guidelines.pdf
Morgan D. G., Crossley M., Kirk A., D'Arcy C., Stewart N., Biem J., and McBain L. Improving access to dementia care: Development and evaluation of a rural and remote memory clinic Aging and Mental Health 2009 13 17 -30
Office of the Chief Coroner of Ontario. (2005). Inquest touching the death of Ess-el-dine Ed-Roubi and Pedro Lopez: Jury recommendations, April 18, 2005. Retrieved from http://www.advocacycentreelderly.org/pubs/nursing/Jury_Recommendations_Restyled.pdf
Ontario Ministry of Health and Long-Term Care. (1999). Ontario's Strategy for Alzheimer Disease and Related Dementias—Preparing for our future. Retrieved from http://www.health.gov.on.ca/en/common/ministry/publications/reports/alz/alz_strat.pdf
Ontario Ministry of Health and Long-Term Care. (2007a). Building a better system: Caring for older individuals with aggressive behaviours in long-term care homes. Retrieved from http://www.southeastlhin.on.ca/uploadedFiles/Home_Page/Report_and_Publications/Building%20a%20Better%20System.pdf
Ontario Ministry of Health and Long-Term Care. (2007b). Ontario's Aging at Home strategy. Retrieved from http://www.health.gov.on.ca/en/public/programs/ltc/33_ontario_strategy.aspx
Ontario Ministry of Health and Long-Term Care. (2009). Every door is the right door: Towards a 10-year mental health and addictions strategy. Retrieved from http://www.health.gov.on.ca/en/public/programs/mentalhealth/advisorygroup/docs/rep_everydoor.pdf
Ontario Ministry of Health and Long-Term Care. (2010). Ontario's Excellent Care for All strategy. Retrieved from http://health.gov.on.ca/en/public/programs/ecfa/default.aspx/
Ontario Ministry of Health and Long-Term Care. (2012). Ontario's Action Plan for Health Care: Better patient care through better value from our health care dollars. Retrieved from http://health.gov.on.ca/en/ms/ecfa/healthy_change/docs/rep_healthychange.pdf
Patterson C. J., Gauthier S., Bergman H., Cohen C. A., Feightner J. W., Feldman H., and Hogan D. B. The recognition, assessment, and management of dementing disorders: Conclusions from the Canadian Consensus Conference on Dementia Canadian Medical Association Journal 1999 160 S1 -S15
Patton, M. Q. (2002). Qualitative evaluation and research. Thousand Oaks, CA: Sage.
Peacock S. C. and Forbes D. A. Interventions for caregivers of persons with dementia: A systematic review Canadian Journal of Nursing Research 2003 35 88 -107
Peacock S. C., Forbes D., Markle-Reid M., Hawranik P., Morgan D., Jansen L., and Henderson S. R. The positive aspects of the caregiving journey with dementia: Using a strengths-based perspective to reveal opportunities Journal of Applied Gerontology 2010 29 640 -659
Pratt R., Clare L., and Kirchner V. It's like a revolving door syndrome’: Professional perspectives on models of access to services for people with early-stage dementia Aging and Mental Health 2006 10 55 -62
Public Health Agency of Canada. (2013). Canada showing international leadership at G8 Dementia Summit. Retrieved from http://www.phac-aspc.gc.ca/media/nr-rp/2013/2013_1211-eng.php
Quality Improvement Innovation Partnership. (2009). Learning Collaborative One: An improvement journey for primary healthcare teams. Retrieved from http://www.hqontario.ca/portals/0/Documents/qi/qi-report-learningcollaborative1-0909-en.pdf
Rycroft-Malone J., Kitson A., Harvey G., McCormack B., Seers K., Titchen A., and Estabrooks C. Ingredients for change: Revisiting a conceptual framework Quality and Safety in Health Care 2002 22 174 -180
Sachs G. A., Shega J. W., and Cox-Hayley D. Barriers to excellent end-of-life care for patients with dementia Journal of General Internal Medicine 2004 19 1057 -1063
Schulz R. and Martire L. M. Family caregiving of persons with dementia: Prevalence, health effects, and support strategies American Journal of Geriatric Psychiatry 2004 12 240 -249
Seitz D., Puradnare N., and Conn D. Prevalence of psychiatric disorders among older adults in long-term care homes: A systematic review International Psychogeriatrics 2010 22 25 -39
Smetanin, P., Kobak, P., Briante, C., Stiff, D., Sherman, G., & Ahmad, S. (2009). Rising tide: The impact of dementia in Canada in 2008 to 2038. Toronto, ON: Risk Analytica.
South East LHIN. (2011). Local Health Integration Networks launch groundbreaking project: $40 million invested in health human resources to support seniors with complex mental health needs. News release retrieved from http://www.southeastlhin.on.ca/uploadedFiles/Home_Page/News_Rooms/290811-News%20Release-BSO%20Funding.pdf
Speziale J., Black E., Coatsworth-Puspoky R., Ross T., and O'Regan T. Moving forward: Evaluating a curriculum for managing responsive behaviors in a geriatric psychiatry inpatient population Gerontologist 2009 49 570 -576
Stolee P., Hillier L. M., Cook S., and Rockwood K. Cause, care, cure: Research priorities for Alzheimer's disease and related dementias Canadian Journal on Aging 2011 30 657 -667
Teel C. S. Rural practitioners’ experience in dementia diagnosis and treatment Aging and Mental Health 2004 8 422 -429
Tsasis P. Chronic disease management and the home-care alternative in Ontario, Canada Health Services Management Research 2009 22 136 -139
Valcour V. G., Masaki K. H., Curb D., and Blanchette P. L. The detection of dementia in the primary care setting Archives of Internal Medicine 2000 160 2964 -2968
Venohr I., Fine R., Saunders V., Tenney E., Vahan V., and Williams M. Improving dementia care through community linkages: A multi-site demonstration project Home Health Care Services Quarterly 2001 19 51 -63
Walker J. D., Morris K., and Frood J. Alternative level of care in Canada: A summary Healthcare Quarterly 2009 12 2009
Woods R. T., Moniz-Cook E., Iliffe S., Campion P., Vernooij-Dassen M., Zanetti O., and Franco M. Dementia: Issues in early recognition and intervention in primary care Journal of the Royal Society of Medicine 2003 96 320 -324
Information & Authors
Information
Published In
Canadian Journal of Community Mental Health
Volume 34 • Number 1 • April 2015
Pages: 45 - 63
History
Version of record online: 19 February 2015
Key Words
Mots-clés
Authors
Metrics & Citations
Metrics
Other Metrics
Citations
Cite As
GutmanisIris, SnyderMatt, HarveyDavid, HillierLoretta M., and LeClairJ. Kenneth. 2015. Health Care Redesign for Responsive Behaviours—The Behavioural Supports Ontario Experience: Lessons Learned and Keys to Success. Canadian Journal of Community Mental Health.
34(1): 45-63. https://doi.org/10.7870/cjcmh-2015-001
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
There are no citations for this item
View Options
View options
Get Access
Login options
Check if you access through your login credentials or your institution to get full access on this article.
Subscribe
Click on the button below to subscribe to Canadian Journal of Community Mental Health
