Academic journal article Canadian Psychology

Assessing Capacity in the Complex Patient: RCAT's Unique Evaluation and Consultation Model

Academic journal article Canadian Psychology

Assessing Capacity in the Complex Patient: RCAT's Unique Evaluation and Consultation Model

Article excerpt

Abstract

This paper describes the development of a unique multidisciplinary patient capacity assessment team, the Regional Capacity Assessment Team (RCAT), which operates in the Calgary Health Region of Alberta. The goals of this paper are to provide a brief review of seminal models that influenced RCAT's development, discuss its ethical and theoretical underpinnings, and provide an overview of the RCAT approach to the completion of complex capacity assessments. The overview of the RCAT model will elucidate our multidisciplinary assessment algorithm, our consultation model, and describe our specialized assessment tools. This paper will be of interest to health care practitioners and administrators looking for a cost-effective, efficient, and clinically sound model for complex capacity assessments.

Capacity issues are challenging for everyone involved, due to the multiple legal, ethical, and medical factors involved. The Regional Capacity Assessment Team (RCAT) is currendy the only multidisciplinary team in Canada with the sole function of assessing and addressing capacity issues. It was created in 2005 to address the multiple complexities of capacity evaluations. RCAT serves the Calgary Health Region (CHR), which has a geographic area of 39,260 square kilometres and which serves a population of 1,143,368 (CHR, 2004). The CHR's main source of revenue (87%) is Alberta Health and Wellness (CHR, 2004). RCAT's assessment and consultation mandate includes the provision of services to all adults who have reached the age of majority, with no exclusionary criteria related to diagnosis. RCAT's patients have included adults with dementia, brain injury, psychiatric illness, addiction, and developmental disability. Frequently, there are co-morbid diagnoses, multiple medical conditions, and significant psychosocial stressors present. RCAT assessments are conducted across the CHR care spectrum, which includes acute care, community, and continuing care sites.

Capacity is a socio-legal construct frequently used in the health care domain in relation to decisions about a patient's medical and social care (Weisstub, 1990). Although definitions of capacity vary by jurisdiction, RCAT conceptualizes capacity as the ability to use cognitive processes to understand and identify options, to appreciate the consequences of different options, and to follow through (or direct a surrogate to follow dirough) with chosen options. This conceptualization of capacity, especially as it incorporates understanding and appreciation, reflects current practice and literature in the field (Grisso & Appelbaum, 1998; Office of the Public Guardian and Trustee & Ontario Ministry of the Attorney General, 2000; Weisstub, 1990; Yukon Department of Justice, 2004).

Current clinical practice also differentiates between "capacity" and "competency." The term "capacity" is used in relation to the clinical assessment and determination of a patient's decision-making abilities by health care professionals. By contrast, the term "competency" refers to the court's decision and ruling regarding the clinical determination of capacity (Brody, 2005; Checkland & Silberfeld, 1995; Lapid et al., 2003; Sturman, 2005; Sullivan, 2004; Wyszynski & Garfein, 2005).

Seminal Capacity Models in the Literature

At the inception of RCAT, and approximately four months prior to opening our clinic doors, an extensive review of existing capacity models representative of North America, Europe, Asia, and Australia was completed. For brevity, this paper will highlight five key Canadian models and approaches that particularly influenced the conceptualization and development of our team.

Baycrest Competency Clinic (Ontario)

The Competency Clinic for the elderly (now closed) at the Baycrest Centre in Toronto incorporated a multidisciplinary team, with a primary goal of developing and refining criteria of capacity (Silberfeld et al., 1988). …

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