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Family Support Provider Model in Ontario: A Parent, Agency, Government Collaborative Process
Children’s Mental Health Research and Policy Conference – Tampa 2011
Sarah Cannon, Executive Director, Parents for Children’s Mental Health Jennifer de Munnik, Research Assistant, Kinark Child and Family Services Dr. Sandra Cunning, Director, Research and Evaluation, Kinark Child and Family Services
Project funded by: Ministry for Children and Youth Services, Ontario, Canada
Thanks to
• Sarah Cannon, Executive Director, Parents for Children’s Mental Health
• Cathy Dandy, Director, Parent and Youth Engagement, Kinark Child and Family Services
• Zaynab Ebrahim, B.A., M.S.W. (Cand.), Research Assistant, Kinark Child and Family Services
• Jonathan Golden, Ph.D., C. Psyc., Clinical Director, Community Mental Health, Kinark Child and Family Services
• Sylvia Naumovski, President, Parents for Children’s Mental Health
• Bev Richards, Parent Advisor
Overview
• The Partners • A Phased Approach • Phase 1 (Completed)
• Evidence • Model
• Phase 2 (Planned) • Implementation • Evaluation • Deliverables
Parents for Children’s Mental Health
• Parents for Children’s Mental Health (PCMH) • Provincial, non-profit, parent-led organization
• Mission: • To provide a voice for families that face the challenges
of child and youth mental illness. • To provide support, education and empowerment by
linking networks of families, communities, agencies and government.
• To promote family-centered principles of care. • Vision:
• A future in which children and youth with mental illness enjoy a high quality of life in welcoming and supportive communities
Parents for Children’s Mental Health
• 1989 - Children’s Mental Health Ontario (CMHO) recognizes the importance of the parent role and the need for a provincial parent association
• Task Force Developed
• 1991 - Task Force reports Parent association absolutely necessary
• 1993 - Planning Committee hosts discussions to answer the following: ~ Should this type of association be developed and why? ~ What is the purpose? ~ What are the individual needs of the families ?
Parents for Children’s Mental Health Results: Need:
To advocate on behalf of families and agencies To impact on Provincial Legislation To share have an and pool information
Purpose: To educate and inform members, the public, government and
agencies To help change the system To support families
Family Specific Needs: Support/Friendship A place to be involved A place to access current, relevant information and resources to
assist with unique challenges
Kinark Child and Family Services
Services Mental Health Autism Youth Justice Other programs; e.g.
- Child Care Centres - Kinark Outdoor Centre - Supervised Access Centres
Staffing 16 Member Board of Directors 850 full and part-time employees (575 FTE) 300 volunteers 3 Unions (CUPE, OPSEU, CWA)
Kinark Child and Family Services
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4 5
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Lake Ontario
Georgian Bay
Legend: 1 – Haliburton/Minden 2 – Peterborough 3 – Northumberland 4 – Durham 5 – York 6 – Simcoe 7 – Central West
Ministry of Children and Youth Services
Ministry of Children and Youth Services (MCYS) • Created to:
• Help families find the services to give kids the best start in life • Improve access to services needed at all stages of development • Help youth become productive adults.
• Vision: • An Ontario where children and youth have the best opportunity to
succeed and reach their full potential.
• Mission: • Working with other ministries and community partners to develop
and implement policies, programs and a service system to achieve the vision
Ministry of Children and Youth Services
MCYS Provides: • Early identification and intervention services • Licensed child care • Ontario Child Benefit • Intensive Behavioural Intervention, respite, residential and
rehabilitative supports • Child and youth mental health supports; • Opportunities and supports (e.g., summer job programs, outreach) for
youth in high needs communities • Protection services for children • Community and custodial programs for youth aged 12 to 18 in, or at
risk of, conflict with the law
Ministry of Children and Youth Services
Partnership
• 2008 - Original idea discussed with MCYS • 2009 - Proposal presented to Minister • 2010 - MCYS contracts with Kinark and PCMH to
identify model(s) that will: • Help families navigate children’s services • Align with key priorities of both Provincial and Federal
Governments and other initiatives
• 2011 - Initial Report
Project Phases
Phase 1 - Planning and Model Development
• Phase 2 – Initial Rollout/Implementation
• Phase 3 – Full Implementation
The Approach
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6 Effective intervention practices
+ Effective implementation practices
=
GOOD OUTCOMES FOR CHILDREN AND FAMILIES
The Approach
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National Implementation Research Network Model (Model)
Implementation occurs in stages: Exploration Installation Initial Implementation Full Implementation Innovation Sustainability Intervention 100%
Outcomes 0%
Implementation Outcomes
Fixsen, Naoom, Blase, Friedman, & Wallace (2005)
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INTEGRATED & COMPENSATORY
CONSULTATION & COACHING
STAFF PERFORMANCE EVALUATION
FACILITATIVE ADMINISTRATIVE
SUPPORTS
RECRUITMENT AND SELECTION
PRESERVICE TRAINING
SYSTEMS INTERVENTIONS
DECISION SUPPORT DATA SYSTEMS
The Approach
Phase 1: Evidence • Comprehensive review academic and grey literature • History:
• Significant increase in the advocacy/family support last 30 years
• Evidence: • Less research attention than other types of programs • Evidence regarding:
• Filling gaps in service delivery, • Family engagement • Advocacy and systems change work
• Emerging data: • Increased levels of satisfaction • Improved mental health • Cross-sectoral impacts (e.g., improved academic performance,
school attendance, and system co-ordination)
Phase 1: Evidence
Topic: Model(s) of family support provision Data Base: PsycINFO Parameters: Social Sciences Earliest to 2011
Key words Search Parameter Number of Hits Saved results Date retrieved
Family support, children's mental health Anywhere 51 2 08/03/2010 Family support, mental health Anywhere 764 NO 08/03/2010 Family support, children's mental health, models Anywhere 399 5 10/18/2010 Family support, school, models Anywhere 470 NO 08/03/2010 Family support, children's mental health, models Keywords 2 NO 08/04/2010 Parent advocate Anywhere 221 0 08/09/2010 Parent navigator Anywhere 0 N/A 08/05/2010 Family peer-‐to-‐peer support Anywhere 2 1 08/09/2010 Parent-‐to-‐parent Anywhere 517 1 08/09/2010 Parent support, model, children's mental health Anywhere 50 2 08/09/2010 Parent advocate, systems of care Anywhere 9 1 08/10/2010 Canada, families, mental health access Anywhere 7 0 08/19/10 Canadian families, mental health Anywhere 207 0 08/19/10 Canadian children, mental health needs Anywhere 11 1 08/19/10 Peer mentoring, children's mental health, models Anywhere 10 1 09/15/10 Children's mental health, systems in Canada Anywhere 2 0 10/11/2010 family, peer-‐to-‐peer support programs Anywhere 8 0 10/11/2010
Phase 1: Evidence Model Name Service
Co-‐ordinator
Training CerLf Fidelity Checks
Supervision Qual. Data
Pre-‐post Data
Control Data
Parent to Parent (Parent Training) X ? ? ? ? ? One County (Broward) X ? ? ? ? ? ? ? Parent Connectors Program X ? ? ? Arkansas Family Support Providers X ? X X X X Family/Whanau Advisors ? ? ? ? X X X Parent Connector Project ? ? ? ? ? X X X Parent Mentoring Program of Sask ? ? ? ? ? X X X Woodgreen Community Services
? ? ? ? X X X
Buddy Program (How to Guide) ? ? ? ? X X X
Phase 1: Evidence Model Name Service
Co-‐ordinator Training CerLf. Fidelity
Checks Supervision Qual.
Data Pre-‐post Data
Control Data
Parent Partners X X ? X Tapestry (Parent Partners)
? X X
Targeted Parents Assistance Plan (Keys)
X ? ? ? X
AssociaVon for CMH (Parent Partners)
X ? ? ?
Family Support Network X ? X X ? ? ? ? Advocacy Services for Kids & WRAPS
X ? ? ? ? ? ? ?
Phase 1: Evidence Online Focus Group • Similar to a face-to-face focus group:
• Ideal when the topic is well-scoped but deeper understanding needed
• The online venue: • Offers a lower cost • Works well for issues and topics which may be more private/
personal
• Reaches beyond geographical borders/limitations
• Participants discuss and respond to questions and each other
• Takes place in a live chat or bulletin board style over a few days or up to many weeks
Phase 1: Evidence Method • Recruitment:
• Initial e-mail invitation to members from PCMH • Interested parents/caregivers contacted PCMH • Parents/caregivers referred to researchers • Screening and consent completed • n = 12
• Discussion guide: • Online group - 3 days:
• Day 1 :Introduction and feedback on mental health services • Day 2: Feedback on family support provision and the development of FSP
program. • Day 3: ‘The perfect program’
• User Agreement/Rules: • No identifying situations or information shared • Respect of other participants honoured • Violations of guidelines participants would be removed
Phase 1: Evidence
Denotes a conversation
Denotes ability to see but not communicate
Parent/Caregiver Forum
Service Provider Forum
Family Support Provision Group Members Forum
Moderators
Phase 1: Evidence
Phase 1: Evidence
Results What about a Family Support Provider?
• Offers lived experience to families • Brings a different perspective than an agency worker • Provides moral support • Helps parents/families to access community resources • Role as a navigator between and within systems
Note: Concern about the FSP own mental health “I have learned that no professional can really guide me
as well as I need. It is only through other parents, and my own research and advocacy that I have been able
to get so far”
Phase 1: Model Principles Underlying Family Support Provision (Olin et. al., 2010) • Family support:
• is individualized and tailored • facilitates linkages • is respectful and responsive • builds skill through training, modeling and mentorship • increases informed decision-making • allows for meaningful engagement • focuses on needs and solutions and successes • is outcome and goal oriented • broadens and expands the possibilities for involvement • promotes advocacy and empowerment
Phase 1: The Model
Rationale: • A “Made in Ontario” model of support that will
• Consist of a composite of various models addressing Ontario’s needs
• Informed by available evidence • Reflect policies • Provide evidence for value of the model through comparison
group study
Purpose: • To enhance service provision, decrease stigma, and improve
accountability through a family-centered approach that focuses on meeting the need of both clients and families
Phase 1: The Model
Family Support Provision Co-ordinator
Service Expert who • Provides consultation to the
CSS & Service Providers • Responsible for fidelity to
service Frontline Supervisors
Provides clinical and service support to the Direct Service
Practitioners
Family Support Provider
Legend: Supervisory = Advisory =
PCMH Responsible
for Family Support
Provision Service
Director, Program Services
Responsible for Family Support Provision Project
Project Manager Project Oversight
Direct Service
Practitioner
Program Directors Regional service delivery
Phase 1: Model
• Process Flow (handout)
Phase 1: Model
Family Support Provider Role: • Assists families in identifying and prioritizing needs • Assists in locating/accessing community programs and resources • Provides information for obtaining appropriate services • Provides emotional support during course of service • Serves as liaison to build collaborative relationships between services,
other service providers and families • Assists families in developing strategies to communicate effectively
with services and service providers (e.g., mental health, education, health, YJ, child welfare)
• Supports families in navigating various systems and services • Provides support and information to other service providers
Phase 1: Model
Role of FSP Co-ordinator: • Supports intake and matching of families to Family Support Providers • Co-ordinates Family Support Providers • Works to establish family participation in processes and systems • Facilitates training and on-going education • Provides peer supervision and consultation to FSP • Monitors fidelity of processes and model • Assists in involving family members in policy, procedure and process
development • Assists in quality assurance processes • Ensures best practice in family-to –family support
Phase 1: The Model
Children’s Mental Health • Community CMH Partner (e.g., Chimo) • Frontline CMH Service Practitioner • Director, Parent & Youth Engagement (Kinark) • Director, Program Services (Kinark)
Child Welfare • Regional Family Service Worker representative
Education • Teacher or Guidance Counselor • Regional School Board Senior Staff (e.g., Lead Support Services) representative
Health • Regional LHIN representative
Families • Service Co-ordinator (PCMH) • Executive Director(PCMH) • Community Parent – regional representative
Family Support Provision Project
Steering Committee Research
• Director, Research & Evaluation (Kinark)
Phase 2: Initial Implementation
Goals: 1. Build evidence for the cross-sectoral “Made in Ontario:
Family Support Model” and; 2. Develop the Knowledge to expand and implement the
model across the Province
Initial implementation: 4 Kinark Program areas to ensure: • Cultural diversity/representation • An ability to control extraneous factors • Streamlined data systems and processes • Reduced barriers related to sharing of information
Phase 2: Implementation
Staffing: • Family Support Co-Ordinator • Family Support Provider/Kinark area program = 4 FSPs • Project Management provided by both Kinark and PCMH Senior Staff
Service: • 20 families x 4 Kinark Area Programs = 80 families (FSP) • 20 families x 4 Kinark Area Programs = 80 families (comparison) • Families recruited from the DirectResponse Program – Kinark • Randomly selected
Phase 2: Implementation
Family Support Provider Training/Education: • Michigan model (FSP workers)
• Phases of FSP Training 1. 3-day in-class training 2. 6-week field placement/practicum 3. 2-day practicum review 4. 9 months of coaching and consultation
• Agency Staff Education
Phase 2: Implementation
Evaluation: • Client (child/youth) • Caregiver • Service Providers • Family Support Providers • Service • Agency • Community
Phase 2: Implementation Objectives Rationale Intervention
& Population Activities &
Outputs Client: • Improved functioning
Caregiver: • Increased efficacy • Decreased isolation
Staff: • High alliance with families
Intervention: • High fidelity to practice
Service: • Improved policies and procedures
Community: • Increase service integration
Theory: • Theory/ background of selected EBPs
Services Reviewed: • Review of other services or agencies using particular EBP
Principles: • Evidence-based • Client-focused • Competency based • Evidence informed • Minimally sufficient • Collaborative • Inter-disciplinary • Clinically supervised
Intervention: • The nature of the intervention (e.g., individual, group, parent education etc.)
Population: • The specific population for the intervention • Reflects the specific client clinical need
Activities: • All the specific activities involved in delivery of the intervention (e.g., 16 week group session)
Outputs: • All deliverables of the intervention (e.g., number of group sessions, attendance, posters, phone calls, number of interviews, manuals etc.)
Phase 2: Deliverables/Timelines
Deliverables: • Comprehensive comparison effectiveness study • Evidence regarding case loads and costs for delivery of FSP • Process map outlining the pathways for system navigation • System for evaluating future models
Timeline: • Planning and Pre-service Training (6 months) • Implementation of the Model (12 months) • Reporting /Mobilizing the Evidence(6 months)
Discussion
• What have you noticed that has worked well for parents/caregivers in the access and use of mental health services?
Discussion
• What common barriers/challenges have you noticed parents/caregivers experiencing within the mental health system?
Discussion
• What supports do you think would help families get into and through children’s mental health services?
Discussion
• If you could create the perfect family support role for parents, what would it look like? What would they provide for families?
Discussion
Contact Info
Sandra Cunning, Ph.D., Director, Research & Evaluation
Kinark Child and Family Services, 500 Hood Rd., Suite 200 Markham, ON L3R 9Z3
Phone: 905-474-9595 ext. 497 Fax: 905-474-1448 [email protected]
