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MOMH-TO Meeting Nov. 5, 2015

 

logo for moving on mental health plan from the Province of Ontario

 

 

Overview: Peter welcomed participants and provided an overview of the day’s agenda. He noted that Collective Impact is about collective influence, not just results.

Lead Agency Update – Claire Fainer

Additional Funding for Youthdale

Paul Heung announced that Youthdale will be receiving an additional $300,000 this year and next year for waitlist management and aftercare funds from MCYS. With these new funds, Youthdale will be able to extend psychiatric consultation and psychological assessment to all services in Toronto, and offered agencies in the room the opportunity to work together in relation to this funding.

Discussion/Clarification – New Funding Investment – Claire Fainer

The proposal for the new MCYS investment is due December 17th. Funds must used in support of the identified core services through hiring of front-line staff. They are not to be directed to key processes or lead agency capacity. The ministry is very prescriptive about what the funds can be spent on: not for Lead Agency work, but for services. Although EMYS will submit the proposal funds will be dispersed directly to agencies.

Comments from the floor:

  • Resources should be held collectively
  • Need to be impartial
  • Could be an opportunity to staff walk-ins in a different way
  • Some families need navigation
  • Look at the biggest needs and gaps – maybe identify 2 or 3 areas
  • Determine which organizations are best placed to use the resources
  • How can we integrate the voices of children and families?

A short exercise at the table groups followed to quickly generate ideas to feed into a more in-depth afternoon discussion.

Summary of Feedback from table discussions:

  • PILOT—divide ‘regionally’
  • best idea—Multi-Agencies need to work TOGETHER; working together to create synergy
  • we’ve never been asked to come together in this way before—this is a real opportunity to put agency hats aside
  • there is also how to engage those who do not come for services such as immigrants/refugees/at risk neighbourhoods
  • constant evaluation of everything we do i.e. quality improvement thinking
  • “we can take a we can live with this approach”—infrastructure/costing/administration

Top Level Summary from Peter

  1. Personnel to help parents navigate the school system
  2. Embed staff and families in service program??
  3. Not build a new program but enhance existing services
  4. Embed services in the other organizations that are not centres
  5. Look at system coordination. Mechanisms to enable staff that work in schools and walk-ins together to improve system coordination and navigation.

Working Group Updates

Each working group gave an update on the status of their work and answered questions from the floor. Presentations are available from the Lead Agency.

Knowledge Café – table groups

Discussions occurred in table groups on options for the new funding investment.

COMMON THEMES

  • Meet People Where They Are

Mobile—Expand the System

  • Broaden range of services for intensive services (example – link with walk-ins – how to rethink it as a service and how to keep front-end. Meet people where they are at; in-home service and outreach; mobility of walk-ins; MSW going into homes to get kids going to school)
  • Staff going into home to provide brief but intensive services to prevent breakdown (System enabler – evaluate ongoing)
  • Expand house call programs where outreach workers go into homes as part of the continuum
  • Some programs exist but they generate high risk and therefor intensive training and high costs
  • Build in-home intensive services – invest in and evaluate intensive in-home
  • Expand/develop tele-mental health (more than tele-psychiatry, broader and inter-professional travelling intake {turns across city; similar to CAS}
  • Mobile response for crisis, 24/7 psychiatric support

Walk-In—Expand and/or Adapt

  • Mobile Walk in Clinics
  • Entire system could partner to offer rotating or mobile walk in clinics to centre that have spa
  • The team needs to ensure a receptionist/reception process that was consistent, and partner organizations make their counsellors available; could also partner with other sectors and offer walk ins at recreation centres, community health centres etc.
  • Build on walk-in service across the city
  • Increase the availability of walk-in system
  • Walk-in to be open 5 days/week instead of current 4 days (after hours), evening hours
  • Could use walk-in as intake mechanism/central access/increase capacity
  • Use walk-ins as hubs
  • Combination of more walk-ins in high need areas with a component of outreach for getting kids/families to Walk-ins
  • Adapt walk-in concept to develop new locations
  • Spread walk-ins geographically; i.e. should be in at least one of the outer suburbs
  • North York was mentioned as a high priority area
  • Attach longer term workers to walk-in so if higher need comes, they can be immediately assigned
  • Traveling MSWs attached to walk-in
  • Walk-in w/outreach component for those who wouldn’t go to a centre
  • Group of Walk-In staff immediately pick up family; Intensive streamlining i.e. schools Section 23
  • Walk-in—and ‘then what’ is the challenge; need a continuum and navigating back for longer term
  1. Improve or Expand ACCESS

Waitlists

  • Find methods to fill gaps – how to provide service when there are long waiting lists – improve on brief services
    • Wait list support e.g. drop-in groups for parents
    • Address the waitlist, including attaching more resources; convert part-time positions to full-time for waitlist
  • Increase long-term counselling to address the wait lists
  • Waitlists are critical which raises the question whether we should be dealing with bigger access issues for people who are already waiting
    • Is the “access” to address the waitlists to help decrease their acuity of need?—because they will end up backlogged again

Triage

  • Triaging people—access with assessment so in right line {triage involves agencies working together and talking}
  • Multiagency team can provide crises intervention and can work with family together
  • TRIAGE part—while people are actually waiting
  • More intake resources can do a match with proper service – add triage (go into home)
  • Agencies need some intake/assessment – could it be centralized and/or shortened?
  • Expand existing mechanisms e.g. CARS already does res. For 3 latency age agencies
  • Look at gaps/pressure points (don’t rely on one/few answers for all
  • Triage/Brief Service Expansion – Part-time or ‘living stipends

There is a need to more effectively triage the waitlists to determine the clients with the greatest need. Triage need not be strictly an administrative but could include brief service as well.

    • There are many Masters Social Work grads looking for work. Because this is an under funded sector, there are many that are doing unpaid internships just for the work experience.
    • Given the funding provides for 9.6 positions, would we be able to do something creative by hiring 18 MSWs to conduct triage, brief service and warm hand off to cases on waitlists with the greatest urgency. We could offer ‘paid internships’ ; This internship could be supplemented by a federal government grant that promotes the net new creation of positions – funding up to 70 % of the income. The money could be stretched to add this triage capacity. This is not only a way to add capacity now to triage and identify urgent cases – but also help build capacity in the future as the workforce ages and retires – these new workers will be trained and ready

‘Central Point of Access’ (CPA)/Pathways

  • CPA as a brief service and address system access – input to service system change
  • Improve access through building a fuller continuum using a health equity , diversity and sensitivity lens
  • Improve access generally in the system – Centralized Point of Access would work with Lead Agency to improve access across the system
  • Pathways to the right intensive service (respite, day treatment, residential, intensive in-home) –Service transitions – not a referral but a hand-off
  • Service pathways to 2nd most intensive service (e.g. Day Treatment)
  • Pathway to intensive services
  • Services for the early yearervice coordination and access codes – $ could be a system cost rather than an agency cost?
  • Announcement about centralized access (Who’s coming to the door?; Know where to send people to)
  • Create/expand teams of workers for transitioning youth to other pathway
    • More child and youth workers and in-home services to avert need for day Rx
  • Leverage existing capacity to increase service supports
  • Fund “Access” Centre/System   (* challenge as it is a question of access to “what”)

Additional Points:  

  1. System response versus agency level
  2. In the long run the Lead Agency should distribute funds
  3. Agency can fund more administration to free up service staff that can be government funded
  4. 2 working groups: access/front-end and intensive – let them build the business case
  5. Do not put all $ at one end of the spectrum – expand / enhance intensive supports
  6. Health equity lens that considers new arrives/trauma stories

Wrap-up and Next Steps – Peter O’Donnell

Brief Service was summarized:

  • Easy access/triage/immediate service

*walk in service

  • Use a health equity lens
  • Leverage existing capacity to increase services opportunities
  • Centralized access plus input to service system change

Group will have the opportunity to provide input before the proposal is finalized.

Upcoming meetings for this group will be held on December 9, January 27 and March 3.

Claire expressed her thanks to the group for their participation. It was a long and productive day. Lead Agency will follow up with information on how to access Youthdale’s consultation services. Ideas from today on how to use the new funding will be rolled up. The deadline for submission of the proposal is December 17.

She thanked the working group chairs for their leadership and noted that the shared leadership concept in Collective Impact is really being demonstrated in the working groups. She reiterated that the information which has been kept confidential regarding the new funding will be shared as soon as the ministry makes the public announcement.