Building Bridges for Inclusive Care in a diverse GTA Community
PEEL
The Peel Service Collaborative's intervention helps to build bridges between formal and informal mental health and addiction supports to better serve Peel's diverse youth.
What is the system challenge?
The Region of Peel (Brampton, Caledon and Mississauga) is the most ethnically and culturally diverse region in the GTA; however the Peel Service Collaborative observed that this diversity was not reflected in those using mainstream mental health and addictions services.
Specifically, the Peel Service Collaborative noticed that racialized youth (such as visible minorities) were not commonly using formal mental health and substance use services, despite having a need for these services. They also found that these youth were over-represented in hospital emergency departments, and the justice and child welfare systems.
Racialized youth identified in focus groups conducted by the collaborative felt that this was due to several factors. They shared their belief that mainstream services are not culturally appropriate and were not meeting their needs of inclusivity and client and family centeredness.
Because of these factors, many youth seek help from informal supports such as faith leaders when experiencing mental health or substance use issues; however, these supports indicated that they needed to build their skills and knowledge to better understand mental health issues and help youth seeking assistance.
What are we doing about it?
With help from the Provincial System Support Program at the Centre for Addiction and Mental Health, the Peel Service Collaborative designed an intervention consisting of two components. The intervention is designed to bridge the gap between formal and informal supports in Peel region and build a system that better serves the needs of the diverse population in the region:
1. Holistic Crisis Planning:
To address the challenges identified with mainstream services, the Service Collaborative implemented Holistic Crisis Planning (HCP) across the region. HCP aims to reduce unsafe situations for, and the likelihood of harm to, children and youth experiencing mental health and addiction issues, and their families.
It involves the use of a holistic, strength-based and person/family-centred approach to crisis and safety planning that meaningfully engages children, youth and their families in a personalized crisis planning process. HCP was originally developed by Kappy Madenwald of Madenwald Consulting, and was adapted to meet the unique needs of the Peel community.
The videos below demonstrate the approach in different settings:
More information on HCP, along with all related tools and resources can be found on the EENET Community of Interest Page (insert link)
EVIDENCE:
A growing body of evidence supports person and family-centred care in mental health and addictions treatment. The evidence reveals documented benefits at the individual, family and system level, including improved cost-effectiveness of services, earlier access to services, increased child and family satisfaction, amongst many others (MacKean, et al, 2012))
Using a client and family-centred approach to crisis planning is also recognized as an effective way to reduce harm and/or mitigate risk (Dept. of Veteran affairs, 2008, SAMHSA 2009, NICE 2011).
The HCP tools/approach was originally developed by Kappy Madenwald of Madenwald Consulting, LLC Columbus, Ohio for the Massachusetts Executive Office of Health and Human Services. Iterations of the approach have been implemented at a state level in Massachusetts, Maryland, Iowa North Carolina, Georgia and regionally, in Oregon, Pennsylvania and California. These content and materials were modified for the diverse Peel context by the Service Collaborative.
The approach and tools are rooted in the ten principles of wraparound care, which has been widely implemented and researched
Mental Health First Aid (MHFA) is an evidence-based program - learn more about the evidence and find MHFA resources.
2. Mental Health First Aid:
To build the capacity of informal supports such as faith leaders, the Service Collaborative used a train-the-trainer approach to implement and sustain Mental Health First Aid (MHFA) training in the community. MHFA is an internationally recognized, evidence-based program that helps participants recognize mental health issues and provides guidance on referring those in need to community mental health services. The program also helps to fight the stigma that often prevents many individuals and families from seeking help.
The Service Collaborative also supported relationship-building between faith leaders and service providers by holder a variety of networking and knowledge exchange events that brought the two groups together to discuss how to work better together to address the mental health needs of Peel’s diverse youth.
One such event included an dialogue/engagement breakfast for Peel faith leaders and local service providers - see video highlights
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The Peel Service Collaborative considered both primary and secondary data to identify their priority system gap. After building consensus across more than 60 agencies, the Service Collaborative decided to create a two-component approach designed to bridge the gap between formal and informal supports and better serve the needs of Peel’s racialized youth population. They specifically selected Mental Health First Aid (MHFA) and Holistic Crisis Planning (HCP).
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A two-day training event launched the implementation of HCP in Peel. After this initial training, implementing agencies formed a Service Collaborative Implementation Team (SCIT). Similarly, after a large training event, MHFA trainers also developed a SCIT. These teams took on the task of ensuring that implementation of HCP and MHFA would be tailored to the Peel context, including developing and adapting materials and tools that agencies would need to put new practices in place.
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The HCP SCIT decided to use a phased implementation approach, where clusters of agencies implemented HCP at different times. Throughout this process, HCP SCIT members engaged in continuous review and adaptation of the materials and approaches. As well, the HCP trainings continued along with train-the-trainer sessions to support the sustainability. The group also continuously identified and developed skills and knowledge building opportunities for agency champions.
MHFA training was rolled out across Peel to a diverse group of community leaders.
In conjunction with the formal intervention components of HCP and MHFA, several events were organized to support networking and knowledge sharing between faith leaders and service providers.
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Since April 2015, over 400 service providers in the Peel Region had received HCP training. These service providers are now using this approach to create HCP Safety Plans with children, youth and their families in a variety of settings, including schools, emergency departments, day hospitals, mental health and addiction agencies and other local community service agencies. A group of Holistic Crisis Planning champions continue to meet as a Community of Interest and intend to stay connected as a group to further the spread of HCP across the region.
A local coordinator was hired for a two-year term to support MHFA in Peel. After their first year in the position, more than 364 people from across 10 different faith communities had received MHFA training.
How do we know it works?
69% of participants (25 people) said they 'always' or 'often' reflect back on the session based on their personal worldview (as defined by race, gender, religion, etc.) in relation to their clients (n=36)
75% of participants (27 people) said clients 'always' or 'often' incorporate informal/natural supports into their plans (n=36)
81% or 34 staff indicated the HCP approach is having a positive or very positive impact on their interactions with clients and families (n=42)
Who is involved?
Next Steps
HCP Scaling up:
Based on initial success in the child and youth system, three adult-serving agencies have expressed intent to implement HCP across their services. One of these agencies represents a new sector for HCP implementation, which is housing. This agency is expected to begin implementing in one program this summer while building a champion base across the agency to spread the approach across services. The other agencies continue their involvement as the Holistic Crisis Continuum Community of Interest, where members are actively implementing the approach or have the intent to implement.
Mental Health First Aid (MHFA):
The Service Collaborative secured two-year funding from the Region of Peel’s Collaboration Fund for a Coordinator to support ongoing MHFA training. In addition, representatives from the agencies involved in HCP who have championed the approach within their agencies have come together as a Community of Interest to spread HCP through various knowledge exchange activities.
George Brown College- Holistic Crisis Planning Online:
George Brown College, CAMH PSSP, and Co-Design received funding from SSHRC (Social Sciences and Humanities Research Council) for 3 year project to create digital tools that support the process of crisis planning and management for youth aged 13 to 24 in Peel Region. The tools will be developed collaboratively by youth in Peel who have experienced crisis, their support networks (friends, family, and community), service providers, partner organizations, and students and faculty from the Interaction Design and Development program at George Brown College. The final product is expected to be completed in July 2018.
For more information, visit the project page here
Holistic Crisis Planning Resources
Resources to support Holistic Crisis Planning can be found on Evidence Exchange Network's website by clicking on the link below.