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The Provincial Centre of Excellence for Child and Youth Mental Heath at CHEO



December 2006

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Promoting Positive Child and Youth Development
Integrating Child and Youth Welfare and Mental Health Systems - A New and Necessary Focus

Child welfare services seek to protect our most vulnerable young people from harm due to abuse and neglect. Mental health services for children and youth are designed to assist young people in reaching their full potential when faced with challenges to their emotional, psychological and behavioural health.Both service systems are designed to promote positive child and youth development. Significant gaps, barriers and tensions must be addressed in order to support environments that lead to positive outcomes.

Peter Dudding
Peter Dudding, Executive Director, Child Welfare League of Canada

Traditional organizational models are based on defining and limiting the scope of work in order to manage finite resources. Such organizational and professional behaviours are detrimental to the needs of young people and their families.

The report of the Senate Standing Committee on Social Affairs, Science and Technology on the mental health care system in Canada, Out of the Shadows At Last, places the primary emphasis in its national strategy on the need to shift from ‘provider driven’ to ‘consumer driven’ services. A more cohesive integration of children’s mental health services into child protection services would be a necessary element of this strategy.

There are many examples in the Senate report. For instance, a youth aged 18, who is also blind and exhibiting difficult behaviours, was admitted to a mental health care facility because child protection services was responsible for his care. Although the behaviour was not considered a mental illness, his care ultimately fell to mental health care services. Sadly, situations such as these can be found in every jurisdiction.

This example prompts important questions: how do we shift the mindset of those providing services to be open and inclusive? How do we ensure that information and expertise are shared while respecting privacy rights? How is responsibility for ensuring recovery and positive outcomes shared?

A successful model of integration, with one single point of access for clients, is the Chatham-Kent Children’s Services (CKCS). In this organization, there are no gaps between services; all workers, whether child protection, mental health or other, are on the same team collaborating from the outset. There are no competing factors, such as different organizational missions or values. There are similar agencies across Ontario, such as Services to Children & Adults of Prescott Russell (Eastern Ontario) and Timiskaming Child and Family Services (Northern Ontario). This type of approach to wraparound service needs to be adopted by more organizations. The challenge remains, however, to determine the best model for larger urban communities.

There are several highly practical recommendations contained in the Senate report to develop the integrated approach including: an emphasis on school and community-based services; greater use of case conferencing, tele-mental health and family therapy approaches; and the elimination of artificial age cut-offs between services.

The renewed energy and enthusiasm for re-thinking our services must be well-grounded on the principle of creating a true ‘consumer driven’ model with the full participation of young people and their families. Advancing concepts of joint problem solving, better multi-disciplinary training, funding formulas that reward positive client outcomes and resource sharing, and improved ethical information sharing are all necessary components.

The way forward is both exciting and challenging. We require clear vision, support for creativity and risk taking as well as purposeful leadership. The result can clearly benefit our most vulnerable young people.

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Share your enthusiasm about the innovative initiatives you think are working well in child and youth mental health.

From the outset, the Centre’s work has focused on building on existing areas of excellence in Ontario. We know of promising practices and approaches in many communities. You may be aware of many that we have not had the privilege to encounter. The Innovators’ Exchange is all about sharing new ways of doing things.

Nominate an organization, partnership or champion in Ontario – submit a brief description to us about what you think makes their initiative innovative. The Centre will follow up on your lead. We want your view on what we can learn from them as we work together to improve child and youth mental health in Ontario.

With your input we hope to make the Innovators’ Exchange a regular section in upcoming CHECKPOINT editions. As a nominee you do not win a prize but you will have the opportunity to share what is working well for you and for the good of children and youth in communities across Ontario. To get this Exchange launched, we have established some initial criteria to guide the nomination process.

As a starting point for the Innovators’ Exchange, the Centre proposes the following guidelines to help with your nomination. Consider nominating an organization, a partnership or a champion in your community whose work:

  1. Involves a unique or innovative approach. Give us a paragraph about what makes it so.
  2. Takes place in Ontario, relevant to child and youth mental health. The more stakeholders involved, the better.

The nominations should:

  1. Have at least two nominators whether they are individuals or organizations. We request however, that both nominations be from different organizations.
  2. Be submitted in writing to Cecily Wallace ( Please include contact information for those being nominated as well as those nominating them.

The Checkpoint editorial team will review submissions. We will prepare relevant articles for publication.

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Expertise Mobilization (Backfill) Awards

Finding the time to conduct research or to take part in educational activities on top of a busy clinical schedule is often challenging – a challenge that we have tried to address through the Centre’s Grants and Awards Program. Expertise Mobilization (Backfill) Awards are available to child and youth mental health clinicians and administrators with a research or educational interest. Up to $20,000 goes directly to the home-based agency/organization to backfill the clinicians’ time in order for him or her to take part in such activities. The maximum award term for these grants is one-year with the opportunity for renewal for up to one additional year. There is no fixed timeline for these awards. The next competition will come to a close on January 8, 2007.

Upcoming Opportunities and Deadlines:

Dare to Dream Program

Youth from across Ontario are being asked to join in on our efforts to raise awareness about mental health and mental illness and decrease the stigma that is often associated with it. Youth can apply for up to $1,000 as individuals or up to $5,000 as a group for an award that will help to make their innovative ideas come to life. Visit for more information on how you get involved as a mentor and more. The spring deadline for applications is March 30, 2007.

Professional Development Awards

This open invitation is not one to miss! Service providers are invited to submit applications to engage in continuing education for purposes of building capacity in the field of child and youth mental health in Ontario. If you are interested in an enhanced training, re-training or re-tooling opportunity to hone your skills and knowledge in a particular area, the Centre wants to support you. You can submit an application at any time.   

For more information about the Grants and Awards Program and the various opportunities available, please visit the Centre’s Web site at

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Study of research uptake delays likely to improve outcomes for children and youth

Susan Jack Research Grant recipient, Dr. Susan Jack of McMaster University is working with Peter Dudding of the Child Welfare League of Canada to study The Uptake and Utilization of Research Evidence by Child Welfare Policy Makers. Every five years extensive data is released nationally that is intended to increase awareness about child maltreatment and to provide information on the incidence of child maltreatment. With close to $120,000 from the Centre through the Research Grants Program, this project looks to minimize the time delay between the release of this information and its use by policy makers. Reducing that delay could also reduce suffering.

Traditionally, child welfare programs and policies have been developed based on stakeholder values and resource availability. As the evidence base for the field of child welfare develops, decision makers are encouraged to use research evidence to develop cost-effective programs and policies. Despite the availability of research evidence, a lag time exists between the creation and uptake of new knowledge by decision makers. This could be problematic in the fields of child welfare and mental health where these time lags may adversely affect client outcomes because current evidence is not being used to its fullest advantage.

The uptake of data from the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) and its national counterpart, the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) as part of the Public Health Agency of Canada's (PHAC) surveillance program on child maltreatment are the basis of the research evidence being assessed.

A research utilization survey will be administered to all 70 senior Ontario child welfare decision-makers. Results from the survey will provide information on decision-maker's awareness and utilization of OIS/CIS reports, the organizatonal and environmental influences on the use of research evidence in decision-making, and the extent to which CIS/OIS data influence child welfare policy.

Both qualitative and quantitative data will be collected from nine Children's Aid Societies (CAS) that deliver services to either urban, rural, or First Nations populations. A review of documents and key informant interviews will be conducted with directors responsible for child welfare and child protection policy at each agency to understand how the CIS/OIS data are used in their agency and to describe the influence and impact they have had on child and youth policy.

Key messages from this study will be identified and all reports for the funding agency and stakeholder groups will be prepared in a format that facilitates usage by decision-makers. Reports will be widely distributed in Ontario and beyond to national organizations.

By early summer 2008, the project outcomes are expected to include:

  • Development of a tool to assess research utilization by decision-makers in child welfare.
  • An individualized case study report for each agency that participated in the qualitative study.
  • A list of recommendations for disseminating CIS/OIS findings to key stakeholders and to influence the utilization of these data in the policy formation process.
  • Revised theoretical propositions from the case studies will contribute to the application of a model of research dissemination and utilization to the fields of child welfare and mental health.

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Introducing Dr. Howard Schachter, psychologist, research methodologist and expert in systematic reviews

Howard SchachterHoward Schachter joined the Centre earlier this year as a scientist, and is a key member of the team involved in conducting health services research, which includes systematic reviews. He plays a key role as a mentor to researchers at the Centre. Dr. Schachter presented at the recent Galvanizing Forum where he discussed one of the projects he is leading at the Centre, exploring what models have been used to integrate mental health services for children and youth. He invited participants to share any information they have about relevant models in Ontario. Among other projects, Dr. Schachter has conducted a systematic review of interventions geared to address stigma in Ontario schools. His findings will be shared once peer review publication is confirmed.

Before arriving at the Centre, he was co-founder and co-director of the University of Ottawa Evidence Based Practice Center, which specializes in systematic reviews of health care evidence on behalf of the US Federal Agency for Healthcare Research and Quality and its federal partners. He is also the former Director, Systematic Reviews, at the Chalmers Research Group, Children’s Hospital of Eastern Ontario Research Institute. He has extensive experience as a clinical research methodologist in completing both qualitative and quantitative types of evidence synthesis. He is an Assistant Professor in the Department of Pediatrics, Faculty of Medicine, University of Ottawa. Dr. Schachter did his graduate and postdoctoral clinical and research training in psychology.

Galvanizing Forum

The Centre hosted an inaugural Galvanizing Forum with over 100 participants in mid-October. Participants from the Centre’s advisory and reference committees as well as other leaders in the field came together to catalyze, strategize and build momentum around the concept of system integration for child and youth mental health in Ontario.

Over the span of an evening and a day, presentations, networking and working groups led to a jelling of ideas about system integration from representatives across the province. The Forum was launched with motivational speaker, Dennis Jackson, District Vice President of Scotiabank, Ottawa and West Quebec and United Way/Centraide Ottawa’s 2004 Campaign Chair. His family journey and community perspective personalized the experience of the mental health system and its inadequacies.

A key starting point for the full day of the Forum was a presentation by Bruce Swan, currently President and CEO of the Royal Ottawa Health Care Group. He shared his extensive experience in integration of health services and mental health services in British Columbia, Alberta and Manitoba. His starting point was the Canadian Council on Health Services Accreditation definition of integration: “Bringing together services, providers and organizations from across the continuum to work together jointly so that their services are complementary to one another, are coordinated with each other and are a seamless unified system for the client.” Mr. Swan further identified various models of integration as well as his perspective on the necessary elements to success based on lessons learned and past accomplishments in his career.

Galvanizing Forum participants shared their experience and ideas in working groups that focused on various integration-related questions. Specifically, they were asked to reflect on ideal outcomes of integration in the child and youth mental health system, and what integration would mean and could look like for the various stakeholders. Barriers to integration were discussed as well as the strategies to be considered for overcoming them. Participants were asked to identify what they, as individuals, could do to facilitate change. Very importantly for the Centre, the working groups were asked to reflect on how the Centre resources, expertise, influence and advisory and reference groups might be a positive force towards decreased fragmentation in child and youth mental health.

Many thanks go out to all who participated. We look forward to sharing the outcomes of the Forum with the advisory and reference groups and incorporating them into how we continue with our work, based on our vision:

“We believe that a fully integrated system meeting the mental health needs of children, youth and their families, in ways that are evidence-based, can be achieved."

At the recent Mood Disorders Canada Conference on Stigma, a mural was unveiled that presents a youth perspective on a world without stigma…

The ArtistsThe Centre has built a special partnership with the Ottawa School of Art. Together we have now produced two murals by youth for youth about mental health. The main goal of the projects is to use art to get young people talking to each other about mental health issues. As part of the projects, the students participate in information and discussion sessions and then work in groups to create the visuals and messages that reflect their visions of mental health.

This year students collaborated to create a mural that focused on breaking down the stigma of mental health. Under the guidance of Adam Davidson of the Ottawa School of Art, the artists included Claire Brascoupé, Alan Hay, Sébastien Lemire-Mulato, Angeliqua Pauzé.

In addition to their mural, the students wrote a poem reflecting what a world without stigma might look like:

A World Without Stigma Would Be…
A world of peace and equality where positive energy and happiness would be in abundance.
A world where acceptance and helping comes naturally.
A world where everyone is included, where differences are not boundaries.
A world of unity and the importance of being unique.


“The right to be heard" was the theme for National Child Day 2006 on November 20

The ‘right to be heard theme’ focuses on the child’s right to express views in various settings, such as the family, school, associations and politics, and to become an active participant in decision-making processes in these settings.

See the Public Health Agency of Canada Web site for more information:

The Centre is putting this theme into practice with a growing program of youth engagement. Future editions of CHECKPOINT will provide you with more information. Please visit the Dare to Dream Web site for more youth engagement opportunities.

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