The development of national standards governing staff's delivery of services to clients has been a longstanding priority within Veterans Affairs Canada. This issue has been discussed since the mid 1980s and has again been identified as a requirement by numerous working groups including the 1991 VIP Process Evaluation, the 1993 Chiefs, Client Services Conference at Mill River, the 1995 Risk Contact System Validation Report, and the 1995 Audit & Evaluation Review of the Veterans Independence Program. The Health Services Directorate, in its original mandate in 1993, was tasked with "ensuring" that VAC clients continue to receive quality client service and appropriate care within the community or institution. At that time, service activities were identified as occurring at both the client and program levels. At the health care level, services included a wide range of case management activities, including assessment, consultation and referral, care/case planning, coordination of services, follow-up and reassessment. At the program level, e.g. VIP, service referred to the advisory services (e.g. Health Care Teams, medical advice on entitlement and clinical need) provided to Departmental policy and decision makers to ensure that programs functioned effectively. To date there have been a number of major Departmental initiatives (Pension Reform, CCSA, VIP Review, Role of the Health Professional Review) which have resulted in collaborative and complementary efforts to achieve better outcomes for our clients.

Numerous internal and external reports confirm that our clients are becoming increasingly frail and require augmented interventions on the part of VAC. The recent Review of Veterans' Care Needs Survey provides us with specific indicators which reflect the type of interventions on which VAC can focus in the short and medium term. This data, coupled with our observations of the medical and psycho-social complexities of the Regular Force clients and a corresponding diminution of provincial service in some regions, confirm that VAC's participation in delivering select primary health care services to clients is, in fact, warranted. With this consideration and in view of the full implementation of CCSA, it is an opportune time for Health Services to implement the service standards now. The standards and outcomes presented for review by the members of the Branch Executive Committee are based on the "Standards and Outcomes" document previously ratified by the Client-Centred Service Initiative Models and Standards Committee in June 1996.

The development of standards, which includes the main components of the Client- Centred Service Delivery Model, is a critical step in the successful implementation of the new service philosophy. The client outcomes, standards, and definitions are designed to provide staff with a uniform framework both to ensure that our clients receive consistent, effective and appropriate service, and to serve as a benchmark against which organizational performance can be measured.

The service standards which are presented here have been developed to serve as a model for evaluating organizational performance in the area of client service delivery.

These standards are designed for national use and will ensure consistency in the delivery of quality services in order to achieve quality outcomes for our clients. They have been designed to allow for flexibility to adapt to changing internal and external environments.

The standards are presented in a pyramidal format based on the major components or service activities of the Client-Centred Service Delivery Model.

The "Client Outcomes" represent the tangible results to be realized by the client receiving VAC service delivery (e.g. case management).

Each "Service Activity" has respective "Outcomes" which represent the expected results related to that activity.

Each "Service Activity" also has "Standards" which support the realization of the "Outcomes". These "Service Activities" will be conducted according to proscribed procedures which are identified in practice manuals such as the Client Assessment and Care Planning Guide (CACPG).

Veterans Affairs is a client-centred organization whose services promote the following outcomes for its clients:

• Clients receive the highest recognition and value as "special" Canadians.

• Clients remain in their homes and /or communities as long as possible.

• Clients retain or enhance their independence in day-to-day living.

• Clients maintain or enhance involvement in meaningful and productive daily activities.

• Clients maintain or enhance personal and social contacts.

• Clients are informed partners in the making of decisions affecting their lives.

Reception Services promotes the following outcomes for individuals contacting the department:

• Individuals (clients and non-clients) receive basic Departmental and external agency information.

• Individuals (clients and non-clients) are directed to the appropriate staff.

Reception Services Standards

• Telephone and walk-in clients and non-clients are received by a VAC representative (a "live"person).

• Individuals (clients and non-clients) are provided with basic Departmental and external agency information (e.g. names/contacts, addresses, phone numbers).

• Individuals (clients and non-clients) are directed to the most appropriate staff member.

Screening Services

• Screening Services promote the following outcomes for clients:

• Early identification of problems, changes and/or issues.

• Access to VAC services and programs.

• Access to external services and resources.

Screening Standards

• Prior to commencing the screening process, the VAC representative will first address the client's reason for contact.

• Clients are offered the opportunity for screening with every telephone and face to face contact with the Department;

• Clients are screened when they contact the Department, and when the Department contacts the client as per periodic review requirements of the VIP, Pensions, Special Awards, and WVA.

• A standardized screening process is used to collect data.

• Screening is performed immediately or upon access to the first available staff representative.

• Urgent referrals from screening will result in contact with the client and/or representative within twenty-four hours.

• Routine referrals from screening will result in contact with the client and/or representative within five working days.

• Data collected from the screening process is documented and becomes part of the client's confidential VAC record.

Assessment Services

Assessment Services promote the following outcomes for clients:

• Identification of the client's strengths, deficits and resulting needs

• Development of an individualized care plan.

• Access to VAC services and programs.

• Access to external services and resources.

Assessment Standards

Clients are offered assessment services when:

• a problem or change in status has been identified in screening.

• requested by the client, or other internal or external individuals.

• complying with program or benefit requirements (i.e. Long Term Care, Veterans Independence Program, Pensions, AA, WVA).

• developing a care plan.

Also:

• Assessment services are performed by designated individuals (e.g. Area Counsellors, District Office Nurses and Doctors, Occupational Therapists, Physiotherapists, Respiratory Therapists and external assessors).

• Assessment is conducted during a face-to-face interaction with the client (gathering of information contributing to the assessment may be done over the phone for the purposes of putting interim services in place)

• A standardized assessment process is used to collect assessment data.

• Planned assessments (low priority) will be completed within four weeks. High priority assessments (e.g. early discharge from hospital, need for chronic home care) will be completed within three days.

• Data pertaining to, and resulting from the screening service is documented and becomes part of the client's confidential VAC record.

Care Planning

Care planning promotes the following outcomes for clients:

• Identification of the client's immediate short-term and ongoing needs, and a plan for resolution.

• The client/family are provided with an opportunity to participate in the development of an individualized care plan.

• The client is provided with access to appropriate internal/external resources (e.g. members of the multi-disciplinary team).

• The client/family are provided with regular review and monitoring of the individualized care plan.

Care Planning Standards

In developing the care plan, the case manager:

• collaborates with the client to specify and prioritize problems to be solved.

• engages the client in efforts to resolve these problems

• engages the clients/family in selecting appropriate goals and actions and in identifying target dates.

• consults and collaborates with members of the multi-disciplinary team to identify and meet client needs.

• ensures the appropriate utilization of community, family and Departmental resources.

• determines, with the client/family, the extent to which objectives have been met.

• conducts follow-up/monitoring to evaluate the efficacy of the care plan itself and to measure the client's response to the services and programs being delivered.

• maintains current recording of all client contacts and the outcomes of the interventions.

Case Management Quality Assurance - Quality Improvement »»