Transcript Slide 1

Systems Improvement
through Service
Collaboratives
(SISC)
Brian Rush, PhD
(on behalf of the Performance Measurement &
Implementation Research Team)
Centre for Addiction &
Mental Health
Ontario, Canada
Outline
• Background and Context
• Ontario
• CAMH
• Systems Improvement through Service Collaboratives (SISC)
Initiative
• Implementation Framework
• Background
• Adaptation of the National Implementation Research Network
(NIRN) Active Implementation Framework to SISC
• Balancing between Science & Pragmatism
• Implementation research dilemmas
2
Ontario, you say?
Source: http://www.fmcsa.dot.gov/intlprograms/canada/index.htm
3
Ontario, you say?
What Ontario is…
What Ontario isn’t…
4
Ontario: Population density
5
What is CAMH?
The Centre for Addiction and Mental Health (CAMH) is Canada's largest
mental health and addiction teaching hospital, as well as one of the
world's leading research centres in the area of addiction and mental
health.
CAMH combines clinical care, research, education, policy development and
health promotion to help transform the lives of people affected by mental
health and addiction issues.
CAMH has been recognized internationally as a Pan American Health
Organization and World Health Organization Collaborating.
6
Background:
Open Minds, Healthy Minds
• CAMH has been asked by the province
of Ontario to lead several key provincial
activities which are now underway as
part of Open Minds, Healthy Minds:
Ontario’s Comprehensive Mental
Health and Addictions Strategy.
• The Strategy begins with a three-yearplan that focuses on children and youth.
7
Ontario’s Comprehensive Mental Health and Addictions Strategy
OVERVIEW OF THE THREE YEAR PLAN
Starting with Child and Youth Mental Health
INDICATORS
THEMES
Our Vision: An Ontario in which children and youth mental health is recognized as a key determinant of
overall health and well-being, and where children and youth reach their full potential.
Provide fast access to high quality
service
Identify and intervene in kids’ mental
health needs early
Kids and families will know where to go to get what
they need and services will be available to respond
in a timely way.
Professionals in community-based child and youth
mental health agencies and teachers will learn how to
identify and respond to the mental health needs of kids.
• Reduced child and youth suicides/suicide
attempts
• Educational progress (EQAO)
• More professionals trained to identify kids’
mental health needs
• Fewer school suspensions and/or
expulsions
• Higher parent satisfaction in services
received
Improve public access to
service information
INITIATIVES
• Higher graduation rates
Pilot Family Support
Navigator model
Y1 pilot
Funding to increase supply
of child and youth mental
health professionals
Increase Youth Mental
Health Court Workers
Reduce wait times for service,
revise service contracting,
standards, and reporting
Outcomes, indicators and
development of scorecard
Implement Working
Together for Kids’ Mental
Health
Amend education curriculum
to cover mental health
promotion and address
stigma
Close critical service gaps for vulnerable
kids, kids in key transitions, and those in
remote communities
Kids will receive the type of specialized service they need
and it will be culturally appropriate
• Decrease in severity of mental health
issues through treatment
• Decrease in inpatient admission rates
for child and youth mental health
Implement standardized
tools for outcomes and
needs assessment
Develop K-12 resource
guide for educators
• Fewer hospital (ER) admissions and
readmissions for child and youth
mental health
• Reduced Wait Times
Enhance and expand
Telepsychiatry model and
services
Hire new Aboriginal workers
Implement Aboriginal Mental
Health Worker Training Program
Provide support at key
transition points
Improve service
coordination for high needs
kids, youth and families
Implement school mental
health ASSIST program and
mental health literacy
provincially
Provide designated mental
health workers in schools
Expand inpatient/outpatient
services for child and youth
eating disorders
Hire Nurse Practitioners for
eating disorders program
Implement Mental Health
Leaders in selected School
Boards
Provide nurses in schools to
support mental health services
Create 18 service
collaboratives
Strategy Evaluation
8
“Create 18 Service Collaboratives”
Systems Improvement through Service
Collaboratives (SISC) is one initiative
encompassed within the Comprehensive
Strategy. 18 Service Collaboratives
established across Ontario will focus on
addressing system gaps related to mental
health and addictions services.
SISC’s Goal
To support local
systems to improve
coordination of
and enhance
access to mental
health and
addiction services.
9
Which Ministries are involved?
The Centre for Addiction and Mental Health (CAMH) is
working with six provincial ministries to ensure the Service
Collaboratives’ success. They are:
•
•
•
•
•
•
Ministry of Health and Long-Term Care;
Ministry of Children and Youth Services;
Ministry of Education;
Ministry of Training, College and Universities;
Ministry of the Attorney General, and;
Ministry of Community Safety and Correctional
Services.
10
Advisory and Accountability
Structures
Provincial Government Oversight Committee
Systems
Improvement
through
Service
Collaboratives
(SISC)
Project
Sponsor:
CAMH
Advice, Communication and Approvals
Accountability
Communication
Advice and
Communication
Ministry of Health and Long-Term Care
Provincial
Collaborative
Advisory
Group
Service User Expert Panel
Scientific Expert Panel
Other Expert Panels
Communication
Related Services and Stakeholders
11
Minimum Specifications
• Focus on improving transitions
• Multi-sector partnerships
• Use of Implementation Science & Quality Improvement
tools
• Focus on Equity
• Evaluation
12
What is a Service Collaborative?
A group of local service providers
who work together to improve
access to and coordination of
mental health and/or addiction
services.
• Membership in Collaboratives
reflects the cross section of sectors
that provide service to children and
youth with complex needs.
• 14 Service Collaboratives are
geographically based, and 4 focus on
transitions between the health and
justice systems.
Statement of Purpose
Service Collaboratives will bring together
service providers and other stakeholders
from various sectors that interact with
people who have mental health and/or
addictions problems, in particular children
and youth agencies, justice programs,
health providers, and education
organizations. By working together to
identify and implement system level
changes, the Collaboratives will improve
individuals’ ability to access services, their
service experience, and their health
outcomes.
(Government of Ontario, 2011)
13
Key Transition Points
Hospital
Community
Services
Child
Services
Adult
Services
Health
Justice System
E.g. Clients transitioning from inpatient
to community based services.
E.g. Youth transitioning to adult services.
E.g. An individual with mental health and/or
addiction issues moving between health
and justice services.
14
Who is participating?
Service
Users
Children &
youth
services
Educational
institutions
Family
health
care
centres
Community-led
Service
Collaborative
Culturespecific
services
Mental
health and
addictions
Justice
Programs
Hospital
services
Community
services
15
Service Collaborative Rollout
The Strategy’s First 3 Years – Children & Youth
2011-2012
4 demonstration sites
have been established
(Cluster 1).
2012-2013
8 Service Collaboratives
(6 geographic and
2 justice + health)
2013-2014
6 Service Collaboratives (4
geographic and 2 justice +
health)
(Cluster 3).
(Cluster 2).
16
Service Collaborative Locations (to
date)
Cluster 1 2011/2012
Cluster 2 2012/2013
Thunder Bay
Ottawa
Simcoe/Muskoka
Waterloo/Wellington
London
Champlain (J)
Kingston, Frontenac,
Lennox & Addington
Durham
Toronto (J)
Peel
Hamilton
17
Implementation Framework
Implementation
•
A specified set of purposeful activities at the practice, program, and system level
designed to put into place a program or intervention of known dimensions with
fidelity.
•
A “make it happen” process, as opposed to diffusion or dissemination, which can
be more passive in nature (Greenhalgh, Robert, Macfarlane, Bate, and
Kyriakidou, 2004).
Implementation Science
•
The study of the methods to implement research findings (i.e. evidence-based
research) into routine practice to ultimately improve client outcomes;
18
Adaptation of the National Implementation
Research Network (NIRN) Active
Implementation Framework to SISC
1. Implementation Stages – SC sites phased in by 3 clusters
- Exploration
- Installation
- Initial Implementation
- Full Implementation
2. Implementation Teams - Central and regional resources
3. Implementation Cycles - QI tools (i.e. PDSA and practice-policy communication
loop)
4. Implementation Drivers –
- a) Leadership;
- b) Competency;
- c) Organization (e.g. program evaluation / decision support data systems).
19
Implementation Science in a
Community Development Context
Science
Where we land depends
on the issue, stakeholder
perspective and perceived
costs and benefits
Pragmatism
20
Balancing between Science &
Pragmatism
• Developmental evaluation (Patton, 2011)
has been applied from the beginning of the
SISC initiative and aligned with the
implementation stages.
– Seeks to balance the gold standards of
evaluation practice, policymaking and
implementation science with the realities of
community development
21
SISC Evaluation Plan
Performance
Measures
Provincial
Level
• Health equity
• Key transitions
• Partnership/collaboration
• Implementation progress
• Intervention outcomes
Internal
Interim
Assessments
• Strengths, Weaknesses, Opportunities, Threats (SWOT)
Case Studies
of Selected
Service
Collaboratives
Performance
Measures –
Local level
• Semi-annual
• In-depth analysis to understand the factors associated with the
implementation of the Service Collaboratives and their impact.
• 4 sites
22
Local Evaluation
• Logic model / Evaluation Framework / Contribution Analysis
– Linking activities, processes and outcomes
• Evaluation Plans with Key Principles
– Distinction between process and outcome objectives
– Stakeholder-based
– Consistent with developmental evaluation
• Local indicators developed after decision on interventions
23
Evaluation Challenges I
• Meeting provincial expectations while supporting community
development process
- Intervention + context = outcome
- NOT a linear process
• Developmental Evaluation
- Evaluation is part of the development of SISC, not above or
outside of it
• Time constraints
- Timeline for SISC program development, including for PMIR (e.g.
hiring Regional Evaluation Coordinators)
- Timeline for intervention and short to medium term outcomes –
what is measurable and when?
24
Evaluation Challenges II
• Holding space for Implementation Science
- Tremendous opportunity but needs time and resources
• ‘Levels of evidence’ – Implementation Science for EBPs
compared to reality of lack of evidence
• Moving timelines
– Challenges with fidelity to stages with moving timelines
(community reality)
• Data sharing
- Sharing of client info, confidentiality, legal issues…etc
25
Balancing between Science & Pragmatism
Science
Not an easy balancing act
but it’s exciting and we
don’t think we’re alone!
Pragmatism
26
ServiceCollaboratives.ca
About SISC
- The Strategy
- FAQ
- Who we are
- Implementation
Framework
News &
Resources
- Project Updates
- Upcoming Events
- Resources
- Newsletters
Service
Collaborative
Communities
- Map of active
Service
Collaboratives
- A page for each
Collaborative
27
For more information about the Systems Improvement
through Service Collaboratives (SISC) initiative, contact:
Brian Rush
Director, Performance Measurement and
Implementation Research Team
Provincial System Support Program (PSSP) CAMH
[email protected]
Fiona Thomas
Research Coordinator, Performance Measurement
and Implementation Research Team
Provincial System Support Program (PSSP)
CAMH
[email protected]
28
Appendix: Cluster 1 Gaps &
Interventions
System Gap
Intervention
London
Continuity of care for children
and youth with complex needs
during transitions between
services and/or sectors.
The intervention is informed by:
•The Transitional Discharge Model
•The Emergency Department Clinical
Pathways for Children and Youth
Thunder
Bay
Community linkages that
increase access to care and
supports for Dennis Franklin
Cromarty (DFC) High School
students, and a service delivery
plan that coordinates access of
services for youth at DFC.
The Fostering School, Family, and
Community Involvement: Effective
Strategies for Creating Safer Schools and
Communities model (Adelman and Taylor,
2002) to bring together the family,
community, and school to improve the
student’s chance of success.
29
Appendix: Cluster 1 Gaps &
Interventions
System Gap
Intervention
Ottawa
Access to services for
transition aged youth (1424) that are coordinated,
youth-centred, timely,
consistent, effective and
evidence-based, least
intrusive, innovative and
community driven.
The implementation of a formalized care plan
including critical components:
1.Formalized Care Plan
2.Interagency and Cross‐sectoral Collaboration
3.Meaningful Priority Population Involvement
4.Meaningful Child and Youth Involvement
5.Meaningful Family and Supporter Involvement
Simcoe/
Muskoka
Youth with mental health
and/or addiction concerns
transitioning between youth
services (e.g., community
services, justice and
education) and Emergency
Department and Hospital
mental health services.
The Transition to Independence Process (TIP)
model to:
•Engage youth in their own future planning
process;
•Provide youth with services and supports that are
developmentally appropriate, non‐stigmatizing,
culturally competent, and appealing;
•Involve youth, their families, and other informal
key players.
30