Promising Practice: Coordinated access to care from hospital emergency departments (CATCH-ED)

Promising Practices

By Rossana Coriandoli

In brief

The Coordinated Access to Care from Hospital Emergency Departments (CATCH-ED) pilot project was designed to reduce visits to the ED and improve access to care for people with mental health and addiction needs (MHA) who use EDs frequently.

The project is a partnership among six hospitals, three community mental health agencies, four community health centres, and one peer outreach service, sponsored by the Mental Health and Addictions Acute Care Alliance and supported by the Toronto Central Local Health Integration Network (LHIN).

EENet has developed a Promising Practice profiling the CATCH-ED project. It arose from the work of the Community of Interest for Racialized Populations and Mental Health and Addictions (COI). Promising Practices profile innovative practices and initiatives from around Ontario.
The COI supports knowledge exchange activities to improve provincial policy, planning and service delivery for racialized populations and mental health and addictions.

Currently, work is focused on mental health-related emergency department (ED) use by racialized populations.  In September 2012, the COI conducted a sector scan and follow-up interviews to identify promising practices in this issue area.  CATCH ED was one of several promising practices identified through this process. Additional promising practices are available on the COI website.
More Promising Practices are available on the CoI's webisite. For more information, contact ssubramanian [at] ontario [dot] cmha [dot] ca (Sheela Subramanian) (Canadian Mental Health Association, Ontario).

The CATCH-ED Pilot Project

The Coordinated Access to Care from Hospital Emergency Departments (CATCH-ED) pilot project was designed to reduce visits to the ED and improve access to care for people with mental health and addiction needs (MHA) who use EDs frequently.

The project is a partnership among six hospitals, three community mental health agencies, four community health centres, and one peer outreach service, sponsored by the Mental Health and Addictions Acute Care Alliance and supported by the Toronto Central Local Health Integration Network (LHIN).

CATCH-ED makes it easier for clients to access the services and supports they need by connecting them while they’re in the ED. The program gives them priority access to primary care, mental health and addictions counseling, peer support, and transitional case management (12-16 weeks of service) at six hospital sites.

People with poorly treated mental health problems are often frequent (and costly) users of hospital ED services. In January 2012, the Toronto Central LHIN Frequent Users Advisory Committee adopted and adapted a health service coordination model based on the original CATCH (Coordinated Access to Care for the Homeless) program that was developed at the Centre for Research on Inner City Health in Toronto. 

The original CATCH program, a variant of a Critical Time Intervention, provides transitional support to homeless people who have complex unmet health care needs to ensure they have access to health resources in the community.

The approach – Connecting clients to services in the ED

Coordinated Access to Care from Hospital Emergency Departments (CATCH-ED) is a partnership among six Toronto Central LHIN hospitals, three community mental health agencies and one peer outreach service, and four Community Health Centres. 

CATCH-ED transitional case managers do outreach in hospital EDs. When they identify a frequent user, they then build rapport with the patient and try to understand their immediate needs. The main role of the transitional case manager is to refer and connect the person to appropriate resources in the community, including to primary care and mental health and addictions counseling at participating community health centres and to peer support services through partner agencies.

Once the person is matched to appropriate resources, the transitional case manager works with the person to identify and understand the supports they need and what is driving their frequent use of the ED. The transitional case manager then helps the person connect to the additional supports they need.

For example, the program links clients to team-based primary care in community health centres and family health teams, trauma-informed group services, peer support services, and solution-focused therapy/support provided in non-ED settings. 

CATCH-ED works with people for approximately 12-16 weeks until they are well-connected to alternative supports. But re-entry into program is available and as simple as the person’s picking up the phone and calling his/her transitional case manager.  

Why CATCH-ED works – Intensive service and fast results

The CATCH-ED program is currently being evaluated to determine whether it has been implemented in accordance with the defined program model and works. The CATCH-ED program is hypothesized to work because people are connected to services and supports while they’re in the ED, so they don’t get lost in the system. Patients receive more intensive service up-front, because transitional case managers have smaller caseloads than in traditional case management and focus on the high-priority needs of a small number of people.

By supporting the patient’s transition to ongoing care while they’re in the ED and by partnering with community health centres, the program ensures that patients access primary care and ongoing MHA counselling, a previously identified gap.

Program evaluation - Challenges to multi-partner collaboration

The program is currently being evaluated as part of a randomized controlled trial with 166 participants. To date, 116 participants have been recruited. Half of the participants will receive CATCH-ED services and the other half usual care. The research questions are:

  • Is a brief, case-management intervention program (CATCH-ED) effective in reducing ED visits for frequent users of EDs? 
  • Is the intervention effective in improving health outcomes for frequent users of EDs, 12 months after program enrolment? 

An economic evaluation will also compare the cost-effectiveness of the CATCH-ED intervention with usual care. The study recruitment period ends October 31, 2013, at which time the CATCH-ED program will resume. The study results will be available in 2015.

An implementation evaluation was also conducted before the launch of the outcome evaluation and involved all partner stakeholders and ten clients. This evaluation showed that there were some issues with implementing the program model as designed, in part due to inherent challenges to multi-partner collaboration with decentralized leadership. 

This evaluation also led to the redesign of the program’s operational processes, including the introduction of a program manager to foster increased program cohesion, which is believed will be instrumental to the success of the program.

For more information about CATCH-ED contact 416-357-0606 (www.CATCH-ED.ca), Deborah Wise Harris, Research Coordinator, 416-864-6060 ext. 77359 (WiseHarrisD [at] smh [dot] ca); Adair Roberts, Project Director, 416-885-6213 (adair [dot] roberts [at] rogers [dot] com).