Dégustation de savoir

This videoconference will take place on January 23, 2012 from 12:15 p.m. to 1:15 p.m. (In French only)

Véronique Wilson, M.Sc., occupational therapist and clinical coordinator at Maisonneuve-Rosemont Hospital, analyzed the implementation of hierarchized care in a Montréal-based CSSS. First, she compared the hierarchized care currently in place to stepped care models found in scientific literature. Then, the dynamic influence of contextual and organizational factors on the implementation of hierarchized care was examined using the Champagne model (2002).

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Over 60 people in 11 videoconferencing sites throughout Quebec attended this event, demonstrating that hierarchized mental health care implementation is a topic of interest.

Véronique Wilson, occupational therapist and clinical coordinator at Maisonneuve-Rosemont Hospital (HMR), described hierarchized care implementation as primary and secondary mental health care teams in three establishments experienced it in 2008-2009. Two managers, Rodrigue Côté, assistant director of child and adolescent mental health at the CSSS de la Vieille-Capitale and Dr. Daniel St-Laurent, chief of the mental health program at HMR, commented on the presentation. They drew on their own experiences to describe the organizational changes within their environment.

Practical ways were developed to facilitate the implementation of hierarchized care in the study areas (CSSS Lucille-Teasdale, Louis-H. Lafontaine Hospital and Maisonneuve-Rosemont Hospital). This included having a secondary care specialist supporting primary care teams in the CSSSs, applying a buddy system between primary and secondary care clinicians, implementing several activities between establishments, etc.

Clinical elements to develop in view of facilitating the implementation of hierarchized care include introducing objective evaluation criteria for patient needs, implementing an ongoing assessment of treatment response, information given to care providers regarding intervention strategies to implement at various stages of care, and the presence of a physicians research service for orphan patients.

Essential organizational factors that require improvement are: the development of certain missing services to promote a service continuum, the addition of human and financial resources necessary in primary care, and the standardization of reference criteria and mechanisms in secondary care.

Teams involved in hierarchized care would benefit from developing a culture of networking.

Hierarchized care implementation is a promising solution to address the inadequacy between populational needs and services offered.