Toronto%20Client%20Access%20to%20Integrated%20Services%20and%20Information%20(CAISI)%20Roundtable

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• Toronto Client Access to Integrated Services and
  Information (CAISI)Roundtable

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1.0 Chronic Homelessness

• Case Example 1
• 40 y.o. female, severe schizophrenia, no income,
  becomes combative in shelter 1, staff call
  police, taken to hospital A, treated, discharged
  with follow up, returns to shelter 2, combative,
  sent to hospital B, discharged with follow up,
  further decompensates, picked up by police, taken
  to hospital, admitted for 2 months, discharged
  with follow up, goes to shelter 1, becomes
  combative police called, taken to hospital A

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1.0 Chronic Homelessness

• Case Example 2
• 49 y.o. male, brain injured, receives welfare
  cheque, buys 6 bottles of wine with friends,
  blacks out, robbed, picked up by EMS taken to
  hospital A detoxed, discharged, next day has
  multiple seizures taken to hospital B treated,
  discharged to Family MD panhandles buys rubbing
  alcohol goes to shelter altercation gets
  barred, picked up by police, in station
  overnight, drinks mouthwash, blacks out, taken to
  hospital B, combative, put in restraints,
  detoxed, discharged, barred at next shelter, gets
  pneumonia goes to hospital B admitted,
  non-compliant, goes out drinking then leaves
  against medical advice

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1.0 Chronic Homelessness in Toronto

• Chronic Homelessness in Toronto
• 31,985 used shelter in 2002
• 3,070 used shelter gt 1 year (9.6)
• Shelter beds
• 5,300 shelter beds
• 58 used gt 1 year
• 26 used gt 3 years

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1.0 Chronic Homelessness

• A call for better Integration
• Golden Task Force on Homelessness
• Toronto Public Health
• Toronto District Health Council

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1.0 Chronic Homelessness

• City of Toronto - Supportive Communities
  Parternship Initiative
• Toronto Client Access to Integrated Services and
  Information (CAISI)
• 1) System for multi-agency integration of client
  care
• 2) multi-agency population care
• 3) Developed by front line agencies / workers

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2.0 CAISI Background

• CAISI Mandate
• Toronto Public Health, Golden Report, Toronto
  District Health Council recommendations for
  better multi-agency integration
• Proposal developed with front line staff in
  consultation with SSHAD
• Project funded by SSHAD SCPI Program
• Project approved by Toronto City Council

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2.0 CAISI Client Access to Integrated Services
and Information

• Vision
• End chronic homelessness among those with severe
  mental illness, addictions and disability
  through
• More integrated individual care
• Population care and advocacy
• (NB Homelessness not a medical problem)

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Components
• 1) More integrated individual care
• Early intake and appropriate referral
• Multi-agency case management
• Support movement from streets and shelters to
  housing

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Components
• 2) Population care and advocacy
• Real time needs assessment for homeless with
  mental illness, addictions disability
• Real time advocacy for supportive housing /
  resources
• TB control, Influenza pandemic planning /
  outbreak control

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Open Development
• 1) Open source IT development (free to all)
• 2) Front line agencies custom develop with
  project team
• 3) Rapid and frequent release of changes
• 4) Build on currently available systems
• 5) Privacy

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Open Development Systems Currently being
  integrated through CAISI
• OSCAR (electronic medical record)
• UHN PRO Integration (hospital system)
• EMS e-PCR
• SMIS (shelter system)

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Target Groups / Partner Agencies
• Shelters
• Drop-in centres
• Mobile Outreach teams
• Hospitals
• Primary care providers
• EMS / Public Health
• Advocacy groups / other

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Strategy / Operation Open Development
• Strategy
• Make work easier for front line agencies
• Provide better individual / population care

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Strategy / Operation Open Development
• Operation
• Identify partner agency
• Make custom changes to CAISI
• Implement next version of CAISI
• Inventory of services intake criteria
• Custom agency intake
• Integrate current systems

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Strategy / Operation Open Development
• Input from
• partner front line agencies
• Clients
• Advocacy groups

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2.0 CAISI Background

• CAISI Partner Agencies/Users
• Toronto Public Health
• Toronto EMS
• St. Michaels Hospital, University Health
  Network, other hospitals
• Partner shelters, drop-ins, mobile teams
• Community Mental Health Court

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2.0 CAISI Background

• CAISI Strategic Support
• Toronto Shelter, Support Housing Administration
  Division
• Ministry of Health and Long Term Care
• Chief e-Strategist, CIO Office
• Primary Care Model Delivery Unit
• Smart Systems for Health

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2.0 CAISI Background

• CAISI Components
• Stakeholder inter-relations
• Health triage tool
• Integration and discharge planning
• Action-based education
• Electronic health information forms
• Homeless health knowledge for population
  programming and,
• Ground work for sustainability.

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2.0 CAISI Background

• CAISI IT Functionality
• Health intake
• Referral
• Queuing
• Program admission and discharge
• Multi-agency case management
• Individual level reports
• Population level reports

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2.0 CAISI Background

• CAISI IT Infrastructure
• Expansion and modules built onto OSCAR system
  (electronic medical record)
• Open Source development (GPL License)
• Linkages with other information networks
• UHN PRO System
• EMS e-PCR
• SMIS

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3.0 CAISI Issues

• Privacy
• the right of an individual to control his or her
  personal information.
• City Of Toronto Privacy Impact Assessment Toolkit
  2005

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2.0 CAISI Background

• CAISI Privacy
• Build on experience of similar systems
• Will encompass HIC and non-HIC agencies
• Parallel Privacy Processes
• City legal privacy support
• Toronto CAP PIA

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3.0 CAISI Issues

• Privacy Vulnerable Clients
• Improve on existing mechanisms of client privacy
  and consent
• Role based access to information
• Mechanisms to check competence
• Multiple modes of messaging
• Clear decision making when consent cannot be
  obtained

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3.0 CAISI Issues

• Privacy
• PHIPA (Provincial Health Information)
• Build on UHN PRO experience
• Extend circle of care
• MFIPPA (Provincial Municipal Information)
• City Legal support
• City of Toronto Privacy Impact Assessment

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI - Sustainability
• governance
• Ongoing development
• Resourcing
• Hosting

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2.0 CAISI Client Access to Integrated Services
and Information

• CAISI Outcomes
• Short term
• Early identification and referral
• Assessment of all clients in partner agencies
• Number of homeless with disability / mental
  illness
• Medium term
• Agencies providing integrated care
• Increased client satisfaction
• Long term
• More effective use of social services
• End of homelessness among those with mental
  illness / addictions / disability

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