In Northern Ontario, the formidable forces of nature, geography, language, culture and isolation collide to form an ever-present hurdle for professionals struggling to provide quality mental health services to the region’s children and youth.
In this environment, collaboration and integration are not only highly valued approaches to child and youth mental health care; they are survival mechanisms.
“We realize we don’t have a lot of resources to spare,” says Patrick Lake, Executive Director of Timiskaming Child and Family Services. “People have set aside turf issues and all of those silos are coming down. We made a decision that it makes no sense at all for us to continue to plan independently.”
In Northeastern Ontario, child and youth mental health services are delivered through regional multi-service agencies, which house a myriad of professionals underneath one umbrella. Representatives from children’s mental health, youth justice, prevention, early intervention and child welfare regularly sit down together to streamline the service continuum and hash out budget arrangements.
“The way in which the Ministry has dealt with children’s services in the northeast, by establishing these multi-service agencies with clear boundaries, encourages co-operation,” says Lake.
Through the Integrated Services for Northern Children (ISNC) program, the ministries of Children and Youth Services, Health and Long-Term Care, Education and Northern Development and Mines came together to ensure children and youth across the vast northern region have access to a wide range of services. Service hubs are located in major centres of Northern Ontario, while a network of case managers provide critical and personal links to more far-flung communities.
Services providers from across the spectrum even work together to divvy up provincial funding for the region. This exercise forces all of the stakeholders to take a holistic view of the system and keep an eye on the ultimate goal – improved services for children and youth.
“This is not my responsibility or your responsibility,” says Lake. “It’s our responsibility – collectively.”
Though ISNC may have brought the players to the table initially, Lake believes it’s the shared sense of purpose that will keep them there long after the program is dismantled.
“The partners have decided that we’re going to continue to collaborate anyway,” he says. “There is a great deal of capacity that can be unleashed and unconventional partnerships can pay huge dividends.”
Most recently, three northeastern service agencies and four school boards embarked on an ambitious joint mission to identify the most pressing needs for northern children and youth and develop a plan to meet them. By planning a multi-sector, multi-region approach to the project, the group was able to maximize the effect of limited resources and leverage the expertise of a wide range of professionals. With the ISNC as a precedent, the co-operation came naturally.
“We already had a productive relationship,” says Corrie VanDyk, Director of Services at Child & Family Services of Timmins and District. “You have to respect the responsibility in your program, but you also have a responsibility to ensure collaboration is happening for the benefit of the children.”
According to VanDyk, cash-strapped organizations can’t afford to experiment but rather need to use what has been demonstrated to work. The biggest bang for the buck is a universal empirically validated school-based program that zeroes in on the specific risk factors for northern youth.
“One of the critical factors is we need the time to build capacity. If we don’t do that I think we expend a lot of energy and resources and don’t get the results we hoped for,” says VanDyk.
Following the blueprint of Communities that Care, a youth survey originally developed in the United States, the northern working group found substance abuse and antisocial behaviour were significant risk factors across all of the regions involved. For the first time, school boards and service providers are armed with a reliable profile of risk and protective factors for northern children. The survey results have helped guide and inform their choice for a universal school-based intervention.
“It enabled us to identify evidence-based programs for antisocial behaviour and substance abuse,” says VanDyk. “Whatever we looked at was going to be broad-based. We didn’t want to target a problem population, but we really wanted to build capacity.”
Starting in September 2007, the four school boards involved will pilot Lion’s Quest – a tested and adaptable program for social-emotional skill development, health, character education, service learning and drug use prevention – with a group of Grade 7 students.
Though collaboration can’t solve the practical problems of delivering services in the north, it can ease the burden of those enduring struggles and produce an exciting climate of care focused on innovation and getting results for children and youth.
“We are all well aware of the northern realities and there’s an understanding that all of us have to struggle with distance,” says Lake. “Barriers can be overcome if there’s a shared commitment to overcome them. You have a lot more opportunity to do stuff, to think outside of the box and to stretch yourself.”
Despite the progress being made and the remarkable ability of northern communities to adapt to harsh realities, significant problems remain. Mental health services for the region’s Aboriginal communities are scant, despite significant and growing needs. First Nations are in the early stages of developing the culturally appropriate capacity to care for children and youth in their own communities, but the gap remains wide and too many children are falling through. While mental health in Aboriginal communities is an inseparable part of the northern experience, it is also a unique concern that deserves an independent examination. The Centre will focus on Aboriginal issues in an upcoming CHECKPOINT later this year.
Do you have a topic to suggest for Focal Point? Send it to email@example.com.
A $20,000 grant from the Centre has allowed the Children’s Centre Thunder Bay to cover Dr. Schmidt’s clinical and administrative duties for one day each week while he pursues these exciting projects.
Mental health services exist in a climate of ever-increasing accountability with the shift moving more and more toward the use of evidence-based treatment models. The use of outcome measures plays a central role in evaluating the effectiveness of interventions and improving the quality of treatment services. Input from therapists and front-line clinicians is not only imperative in the current climate of accountability, but is essential in designing further research.
In a recent study, therapists reported a high level of satisfaction with the CAFAS. However, therapists in that study rated the instrument directly after training and before they had begun to routinely use it in their daily clinical work. There was therefore no measure of the degree to which this satisfaction was maintained in actual practice.
Dr. Schmidt is assessing the longer-term satisfaction and clinical use of treatment outcome measures. Approximately 30 therapists and supervisors from the Children’s Centre Thunder Bay have completed a questionnaire answering a range of questions about the type of clinical information and outcome measures they find helpful in treatment. Results from these questionnaires were complemented with coded information from each therapist’s clinical files regarding the actual use and integration of outcome measures into their clinical work. Roughly one-half of therapists also participated in a qualitative interview regarding their view and use of outcome measures in clinical practice.
The second research project involves a focused look at child therapists’ attitudes and practice toward between-session homework activities with their clients. Therapists often encourage clients to complete activities between sessions with the goal of enhancing therapy outcomes. While there is robust research evidence on the benefit of including homework in therapy with adult clients, a common treatment issue is the failure of therapists or clients to follow through with such activities. Importantly, there is virtually no empirical information examining how child therapists use homework in providing treatment.
A baseline knowledge of current practice and factors influencing how and when child therapists use and don’t use homework is essential. This is a first step toward the ultimate goal of increasing therapist skills in designing and assigning homework, which will improve the likelihood of the client completing between-session activities. Staff at the Children’s Centre have completed surveys and interviews for this portion of the project as well.
The data for both research projects have been collected and analyses are underway. It is expected that results will be available by the end of April 2007. This information will be used to understand how treatment outcome measures can be used to enhance treatment effectiveness as well as how to best measure and examine the role of common process treatment factors in future research. Similarly, these results will help identify how therapists can engage and help clients follow through with homework strategies and, subsequently, improve treatment outcomes.
According to Tom Walters, Executive Director of the Children’s Centre, “We are just delighted to be able to protect some of Fred Schmidt’s time to conduct research. Thanks to the Centre of Excellence it is a great opportunity that is having a powerful impact across our Centre. For an organization to grow and develop, at some point it needs to take a good look at itself, to learn from its best practices and improve on them. With Dr. Schmidt able to focus his time to it, we can do just that. His research is already bringing new ideas and perspectives to how we do our work. We are very appreciative to the Centre of Excellence for its leadership in providing us with this exciting option.”
Dr. Schmidt will use these findings to move to the next research stage this summer. As part of this award, he has been able to form partnerships between his own agency, Children’s Centre Thunder Bay, and the Thunder Bay Children’s Aid Society and Dilico (an Aboriginal treatment organization in Thunder Bay). The goal of this research partnership is to examine the impact of common process treatment factors in the delivery of an evidence-based treatment program with high-risk and child welfare families. As this work continues, Dr. Schmidt is interested in hearing from others who have similar research interests. He can be reached at firstname.lastname@example.org.
Online applications are now open for:
Visit our Web site for more information.
The Innovators’ Exchange is your opportunity to share your enthusiasm about the innovative initiatives you think are working well in child and youth mental health.
The Centre is pleased to join these groups in drawing attention to the dedicated work of Dr. Augimeri. She is a tireless champion for children and youth in her work with the Centre for Children Committing Offences (CCCO) at the Child Development Institute (CDI).
The CCCO focuses on children with serious aggressive and disruptive behaviours including those who have come into contact with the police. The CCCO’s research has been applied to develop model programs that prevent delinquency and criminal behaviour in children and youth. The research has also been used to identify children who may be at risk for aggressive behaviour.
In 2005, due in large part to Dr. Augimeri’s contributions, the CCCO was awarded the first-ever national award for outstanding research and evaluation in child welfare.
This community-based organization has extensive experience serving vulnerable children and their families. Over the past 30+ years it has developed an internationally recognized, comprehensive approach to working with children, families and their communities to prevent young children with aggressive and destructive behaviours from coming into conflict with the law.
The approach behind the research and evaluation activities at the CCCO encourages respect for diversity in ideas and is based on developing solutions to real-world problems. The research activities of the CCCO have had a positive impact on the welfare of children in Canada and elsewhere. At all levels this research has demonstrated positive program effects and has produced changes in service delivery that have benefited children and families. You can find out more about the CCCO at http://www.childdevelop.ca or email email@example.com.
The Centre is proud to have funded some of Dr. Augimeri’s work through our Grants and Awards program. In particular, she received a $50,000 Initiatives grant entitled "Toward the Establishment of a SNAP Community of Practice". SNAP™ is an evidence-based intervention from the CCCO.
Read the CHECKPOINT article on SNAP™ from our November 2005 edition…
We want your view on what we can learn from others as we work together to improve child and youth mental health in Ontario. Submit a brief description to us about what you think makes an initiative innovative. The Centre will follow up on your lead.
The following guidelines should help with your nomination. Consider nominating an organization, a partnership or a champion in your community whose work:
The nominations should:
The CHECKPOINT editorial team will review submissions and prepare relevant articles for publication.
The Centre’s Web site has valuable new content as well as a new look and feel. The new Evidence Syntheses Database contains a searchable collection of clinical practice guidelines and systematic reviews related to child and youth mental health. Doing More in Program Evaluation is a tool kit that provides an easy to use reference guide outlining the various steps in conducting program evaluation. Be an Agent of Change contains examples of how you can mobilize your knowledge and ideas. The Child and Youth Mental Health Service Directory now includes 250 organizations! As always, we welcome your feedback .
Check it out at www.excellenceforchildandyouth.ca
The Centre’s Consumer and Advocates Network (CAN) recently issued a request to the Minister of Children and Youth Services, Honourable Mary Anne Chambers, asking her to meet with representatives to discuss the implementation of the Ministry’s policy framework.
The Ontario Injury Prevention Conference entitled "Preserving Our People" will showcase leading edge intentional and unintentional injury prevention strategies that target the needs of people of all ages, living in different geographic, social and economic environments. Peter Levesque, one of the Centre's key advisors on knowledge exchange, will be presenting - June 3-5, Valhalla Inn, Thunder Bay.
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