Promising Practice: Using a recovery approach to completing the Ontario Common Assessment of Need (OCAN)

The Ontario Common Assessment of Need (OCAN) is the standardized assessment tool used in the community mental health sector since 2009. This tool supports conversations between service providers and their clients. It helps to better understand the client’s current situation, needs and strengths, and to develop a service plan that focuses on the person’s recovery.

In this issue of EENet’s Promising Practice, we look at the use of the recovery approach when conducting an OCAN assessment from the perspective of three service providers at the Canadian Mental Health Association, Peel Dufferin Branch:

  • Nicole Allin, Manager, Recovery West & Impact programs
  • Sweedian Robinson, Peer Support Worker
  • Brett McIsaac, Community Support Worker

This issue of Promising Practice was developed by the OCAN Community of Interest with support from EENet and Community Care Information Management (CCIM).

What are the key aspects of the recovery approach and strengths-based practice?

Nicole: The recovery model looks different for each client because it’s about being client centred. It’s based on the belief that the client has the potential to recover in a way that is meaningful to them. Having that core belief is about hope. It’s about recognizing the whole person and how the different aspects of their life interact with each other. It’s about focusing on people’s abilities to set their own priorities and make their own choices. 

Strengths-based practice overlaps with the recovery approach as it sees clients as having abilities and skills and is based on the belief that clients can do well when they’re able to identify and use those strengths. 

Tell us a bit about the training you do on the recovery model.

Nicole: We have a recovery assessment training, which is part of the required training for all staff. This training has two goals: 

  1. Ensure that all our staff have a good baseline understanding of the recovery model that we use at CMHA.
  2. Teach staff to implement the model when they are completing various assessments, including the OCAN. 

We know that if done poorly, assessments can be a dehumanizing experience for clients and can create barriers between the service provider and the client. In the training, we talk about how we can incorporate the recovery approach when applying assessment tools. A lot of the discussion focuses on how we share information and power when we’re completing assessments. Also, we make sure that when goals are prioritized as part of the assessment, we follow through on them so the client sees how it benefits their recovery journey. 

My favourite part of the training is that we have staff reflect on times when they were assessed themselves. For example, a physical with our family doctor. In the training, participants reflect on those experiences and make a list of what made them helpful or unhelpful, and we refer back to this list as we work with clients. The list helps to ground us and say, “If we were the client, how would we want to be approached?”

How do you approach OCAN assessments in a recovery-focused way?

Nicole: Because the OCAN has 24 domains, it provides a snapshot of the different aspects of a person’s life and experience. It doesn’t solely focus on symptoms related to a diagnostic criteria or one particular area of a person’s life. Instead, it looks at the interconnectedness of that experience.

Using the OCAN within a recovery approach means that we start conversations with discharge in mind. Discharge might not be the word we use with clients, but we explain that the tool can help us get a grasp on what is working well and what is not working well for them, to see how we can help them move forward. 

Because goal setting is part of the OCAN assessment, we talk about the client’s future from the start, and this aligns nicely with the recovery approach. The OCAN also helps provide consistency through the person’s recovery journey. OCAN has a six-month reassessment cycle that helps the client and worker see changes that happen from their initial OCAN to their reassessments. This process helps to move clients through levels of service intensity. 

Sweedian: We usually do the initial assessment within 30 days of meeting the client. I explain what the OCAN entails and that it’s literally the roadmap for what we’re going to be doing together. It helps to put goals in place and know what we’ll be doing over the next six months. 

The OCAN assessment is long and it can be a lot for clients. So I ask the questions at the client’s pace. I think what’s really important is not necessarily expecting all the answers at the first assessment and letting them know that they’re going to have another opportunity in six months to refocus on questions that we may not get to at first. 

In terms of the recovery approach to doing the OCAN, it’s about knowing that recovery is not a straight line. So I always remind clients that they have this goal they want to achieve and there may be a setback at some point but we’re here to support them to continue to move towards that goal. 

Brett: Reaching out to any support, especially mental health supports, can be a very scary thing. It can be a big leap you’re doing for yourself. I think that embedding that recovery language when using OCAN is super important. It’s not a “check the box” to me. It’s a great opportunity to start a conversation, to explore together areas of their life that might previously have been an issue and are now an achievement. 

Every six months, with the reassessment, we can highlight those successes no matter how big or small. But also, it’s a chance to open up that door and focus on areas of their life that are not going so well right now. 

In the OCAN process, it’s important to convey hope that they’re able to recover. I hope a client leaves the OCAN conversation saying, “Brett understood my issue. We’re solution focused now and have a plan to move forward.” 

Sweedian, as a peer support worker, how do you use your lived experience expertise when supporting a client to use the OCAN?

Sweedian: I ask clients if they know what a peer support worker is. And, usually, their answer is “no.” So I let them know that I am a person that has lived experience and has been through the mental health system. And when I say that, I see a change in their demeanor. You get a kind of surprised reception, because they’re not used to seeing people in a position like me doing this type of work. 

Usually, clients feel like they’re in a dominated position because they’re talking to a “professional.” I try to change that. When we’re doing the OCAN, I let them know that if they have questions around my lived experience, they can ask me. A lot of questions usually come up and I answer them. But I also refocus the discussion on them. 

When clients are completing the OCAN, they sometimes feel uncomfortable answering questions about certain things. So I try my best to help them. When I was going through my recovery, and I still am, I wish I had somebody like that. 

Can you share a specific example of how your recovery approach to using the OCAN has helped a client?

Nicole: A former client, Beth1, was upset after she completed the self-assessment. She said, “I did this assessment and marked everything as an unmet need. I thought I was doing OK and now I do this assessment and I see my life is a disaster!” 

Using a recovery approach, I suggested that we sort through the areas where Beth identified a need and start to identify one or two goals. I explained that the goals could be in one domain but they could have a ripple effect into other areas as well. I should add, as well, that it created this opportunity to talk directly about her strengths. We discussed the things Beth is doing well despite the needs she has in these areas.

This could have been a really negative experience if we just left it at, “OK, you have needs in all 24 domains, we can’t fix them all, so you’re just going to have to pick a couple.” Instead, we tied them together. When we did Beth’s OCAN reassessment, we looked at how the progress she made on these goals had an impact on different interconnected parts of her life. 

Sweedian: Janehad a diagnosis of borderline personality disorder. She had a friend who died by suicide, and she tried to die by suicide as well. She had no trust in healthcare professionals, she lost her job and everything literally fell apart. 

I met Jane at the hospital. She was distrustful of me as a worker. So I told her about my recovery, that I had actually been a patient in that hospital and I know how hard it can be. She was really receptive to that. 

When she came out of hospital, we went through the OCAN together. One of Jane’s goals was to find work, but she didn’t want to work with people because it was a trigger for her. IT-computer work was a skill she had.  We started looking for work-from-home positions and she found a job that she liked. 

Then, I wondered if we might take this further. I knew Jane didn’t like working with people but she did attend the Recovery West program, where she felt welcome because there were other people who had lived experience. This program had a computer lab and I thought that she might be able to work there to support clients who don’t know how to use computers. 

We had a meeting about this with the program manager and Jane said, “I don’t think I’m the person for it. You guys are just trying to be nice to me.” But the manager said, “No, we’re not. You have a skill and that’s why we want you.” Jane appreciated that.

She ended up doing so well at that job, which was amazing, because she didn’t want to work with people at all and here she was, working with people.

Eventually, I was going back to school so I had to transition her to another worker. Fast forward to me doing my job placement and going to get my COVID-19 vaccine the other day. I was waiting in line and there was a woman letting people in. She turned around and I saw that it was Jane! I was so shocked because she was working in such a public setting. Something that she never wanted to do before. I told my manager and we were so happy for Jane because we knew how far she’s come in her recovery.

Brett: I remember an individual, Susan3, who had been in the mental health and addiction system for a while but had never completed an OCAN assessment. 

When I introduced Susan to the OCAN tool, she was super into it. As we were going through it, she paused at the question, “Are you happy with the place you live in?” It was because she had never been asked that before. She’s someone who’s been within the housing system for a long time and had been displaced in many different residences. For Susan, “home” had always been in jeopardy and she had never felt very comfortable within where she lived. 

On the other hand, if you looked at her situation from the social services side, you could say that Susan had a roof over her head, therefore, that box should be checked as a met need. But emotionally, internally, how she felt was, “No, I’m not actually happy with my housing. Yes, I’m happy that I’m fairly safe and I have a warm place to sleep. But I’m not happy with it.” So she identified housing as an unmet need. 

In the end, Susan decided to stay in her current home. It was important for her that we worked on steps she could take to feel more comfort and ease with her living situation. 

Notes

  1. The client’s name was changed to preserve confidentiality.
  2. The client’s name was changed to preserve confidentiality.
  3. The client’s name was changed to preserve confidentiality.

Acknowledgements

This knowledge exchange activity is supported by Evidence Exchange Network (EENet), which is part of the Provincial System Support Program at the Centre for Addiction and Mental Health (CAMH). EENet has been made possible through a financial contribution from the Ministry of Health (MOH). The views expressed herein do not necessarily represent the views of either MOH or of CAMH.