Pandemic Return to Service Considerations and Risk Matrix May 10, 2020

PREAMBLE CONSIDERATIONS

This document is intended to offer health care service providers in the mental health and addictions sector helpful, but non-prescriptive guidance pertaining to pandemic risk determination and related considerations and responses. The framework is purposely nimble and adaptable for use and should be personalized accordingly. In that vein, it invites decision-makers to consider the WHAT but not necessarily the HOW of risk assessment and response in a pandemic context.

PRINCIPLE CONSIDERATIONS

1. The health and well-being of our staff teams and the individuals we serve are our utmost priority. It is understood that the interests of these two groups can sometimes be perceived to be as competing (e.g., access to service versus mitigating the risk of an internal outbreak).

2. In the context of a pandemic response, we accept the responsibility to do all we can to mitigate the risk of community spread.

3. Our decision-making and related actions for the direction forward should be evidence-informed, based on available best practices, and aligned with governmental guidance.

STRUCTURE / HOW TO USE DOCUMENT

Service Area Criteria influence the level of risk determination.

Parameters will vary by organization/program and should be adjusted as needed.

Levels of Risk are best viewed as a continuum as opposed to distinct categories. Overlap between risk levels are to be expected, and organizations may have different risk thresholds. As well, identical circumstances can result in different risk determinations by organizations as specific LIKELIHOOD and IMPACT can vary.

Personalize sections to your organizational environment, such as:

a. Inserting links to relevant legislative orders and/or legislation (i.e. Federal, Provincial, Ottawa Public Health)

b. Inserting links to sector-specific guidance documents (e.g., residential, outpatient, community-based mental health, home visits, hospital etc.)

c. Inserting links to relevant standards of practice/professional obligations (e.g., professional colleges)

d. Insert links to agency-specific policies and procedures (e.g., PPE, HR, etc.)

Scenario Planning is an important way to use these documents and walk through risks and assumptions in this very dynamic pandemic situation. Different scenarios and organization specific assumptions can be developed and considered within these tools to help organizations prepare for moving between service levels.

Tools Section: The following bullets describe three tools built for your consideration. Examples of the tools with context are within this document, and separate versions are provided as working documents for your organization to adapt, as needed.

Decision Tree below provides questions for you to consider as you move through different levels of service provision on the accompanying matrix. Government guidelines, healthcare provider colleges, and your own organizations risk management considerations are all important in determining next steps.

Levels of Service Matrix provides specific criteria and parameters per service level to help determine the new normal and three associated restricted levels of service. This is another tool to customize for your own circumstances. The decision tree and matrix can work together for each service level, as different parts of the organization move through the matrix. ie. Different services will most likely be at different levels on the matrix, depending on the circumstances.

Risk Management Framework provides a method for an organization to review and score likelihood and impact of risks, which can give focus to risk mitigation efforts. The first section is a detailed review of the type of risk, mitigation and overall residual risk. The second graphic is a scorecard or heat map to provide a view of the collective risks.

L evels of Restriction – CoVid-19 pandemic planning

N.B. - Under all closure conditions individuals with symptoms or close contact with anyone known to be infected with

Instructions This decision matrix was created in response to the Covid 19 epidemic and the need for a

successive range of measures and restrictions designed to provide optimum safety for staff and clients. Three levels of restriction (consistent with the Province of Ontario ‘Reopening framework’) are proposed. Level 1 is the most restrictive and level 3 is the least restrictive set of expectations beyond ‘new normal’ conditions.

The agency can use this format to determine criteria to be considered in decision making, identify critical categories of responses that can be adjusted, and create specific guidelines to be implemented at various levels of restrictions. Each service type (work unit, service architecture, modality) would be expected to have its own unique set of criteria, benchmarks, protocols.

Criteria would be identified and would be considered in determining how the inherent risks and current guidelines on which decisions would be made. While agencies can identify their own unique set of criteria these would likely include government policies, professional standards, local conditions, etc. Critical changes in benchmark criteria that would lead to lessening restrictions can be identified by the agency/service in advance.

Response categories are defined as the various aspects of the work and workplace that can be adapted to meet the adaptations called for by the level of restrictions and should be considered for planning purposes.

Agencies would complete the body of the table with more detailed guidelines outlining how specific protocols and measures would be established appropriate to each level of restrictions. These can be prepared in advance and confirmed as implemented. Information contained in the body of this matrix is for example only and should be amended as needed by each organization and applicable to each service area. Furthermore, the decision tree document can assist in deciding when to move between different service levels.

Levels level 1 level 2 level 3 Normal Access Heavy limits Moderate limits Light limits Ongoing limits

Criteria

Prevalence of CoVid-19 Unknown/ growing Growing known Stable, known Stable, known, lowGov’t orders Comply Comply Comply System load Full Near full Low LowTreatment/ Vaccine Not available Not available Limited

availabilityAvailable

Testing Unavailable when needed

Available on site, or accessible in community

Available on site

Widely available

Levels level 1 level 2 level 3 Normal Access Organizational rules and obligations

comply Comply Comply Comply

Professional standards comply Comply Comply Comply Service area #1: Office operationsConsiderations Building access – staff Only pre-approved Limited entry,

drop-in max=5Max = 10 with screening at door;checked in

Unlimited entry with sign-in. Self-screening for symptoms

Unlimited entry,Self-screening for symptoms

Building access – clients none Physical distancing 2m. By invitation only

Screening at door

Unlimited entry

Stair/elevator access

Elevator to basement only; stairs closed

Elevator to basement open; to 2nd and 3rd by fob.One way stairs.

Elevator to basement and second open, 3rd by fob

Elevator to basement and second open, 3rd by fob

Concierge On site – deliveries On-site deliveries and distribution;check staff in/out (end-of-day walk around)

On-site, deliveries and distribution; check people in

Not needed

Work from home Everyone, except essential/occasional on siteHome office support

All, limited scheduled access, home office support in place

Occasional work at home; no special home office supports

As required;no special home office supports

Kitchens Kitchens closed Limited access, 1 at a time

Limit 4 at a time

Unrestricted access

Meeting rooms Single occupancy, wiped down after use

Single assigned occupancy, wiped down after use

Half max capacity

Full capacity

Paper distribution Limited paper exchange

Safety protocols in place (gloves when indicated, distancing, no-touch practices)

Safety protocols in place (distancing, low-touch practices)

Increased automated systems

Coffee stations Closed Only Coffee Open access

Levels level 1 level 2 level 3 Normal Accesshandwashing available, one

person at a time

Movement in office One way only hallways

Any direction Any direction

PPE Supply Management As needed and available

Anticipated allotment for all staff as available

Required allotment for all staff as available

Regular supply available

Disinfection/cleaning weekly cleaning Extra 2 x weekly cleaning, daily hi-touch disinfection

Regular cleaning, daily hi-touch disinfection

Regular cleaning, daily hi-touch disinfection

Work Stations Not used Limited availability – every third, rotated daily. Disinfectant spray at hand.

Every second desk open, rotated daily.Disinfectant spray at hand.Splatter shields to be considered.

No restrictions, Disinfectant spray available

Cloth masks on site Worn when moving around office

Worn by clients and staff in office

Worn during close contact in office

Not needed

Mail Collected periodically – opened scanned and emailed; personal mail addressed to individual staff set aside for pickup

Collected, set aside for pickup

Collected, set aside for pickup

Collected, set aside for pickup

Education Virtual/ Online Virtual/ Online Smaller groups - ½ room capacities

Open, continue screening, don’t attend if you are sick etc.

Gym Closed Closed Limit 4 at a time, self-screening, don’t use if sick

Open, self-screening, don’t use if sick

Service area #2: Community Client Services

Levels level 1 level 2 level 3 Normal AccessConsiderations Driving clients None permitted None permitted Emergency

only, PPE and or shields

As indicated

In home visits None permitted Permitted with PPE and qualified

Permitted with PPE and qualified

In community visits Only with distancing

Only with distancing

Only with distancing

PPE Practices Full PPE for close contact (< 2m) for all

Full PPE for close contact (< 2m) for presumptive cases

Follow Ottawa Public Health Guidelines

Follow Ottawa Public Health Guidelines

Individual client sessions None on site, Remote only

Limited on-site, distanced

Limited on-site, distanced

On site

Group counselling None on site; virtual only – staff remote

None on site; virtual only

?? Open access with no close contact

Nursing access Off-site, pre-approved, full PPE. Only for injections and if client at risk of harm or illness if not seen.

As needed, pre-approved. Limited contact with full PPE on site. Off-site if presumptive case.

PPE as needed PPE as needed

Service area #3: Blank – Copy and Create Own Service Area Considerations

Considerations Driving clients

In home visits

In community visitsPPE PracticesIndividual client sessionsGroup counsellingNursing access

Service Areas to be completed – In home visits, in community visits, housing, etc. May 6, 2020© Canadian Mental Health Association – Ottawa Branch

Risk Assessment Framework Example

Risk Assessment Scorecard / Heat map –for Monitoring

Enclosures:

1. Decision Tree: Visio and PDF formats

2. Service Levels Document: Excel and Word Versions

3. Risk Assessment Framework: 8.5 x 11 and 11 x 17 Versions

4. Web Links Word Document

5. A Measured Approach to Planning for Surgeries and Procedures during the COVID-19 Pandemic

6. A Framework for Reopening our Province