Service Co-ordination Guidelines

Training Project

Final Report

Feb. 27, 2012

C. Grady

Project Description

The project included the design, development, and delivery of training related to the implementation of Service Co-ordination Guidelines in Leeds-Grenville, having been approved by the lead community planning table, Every Kid in Our Communities (EKIOC), and spear-headed by the Service Integration Working Group (SI Working Group). In addition, development of a mentoring component was identified as important for sustainability beyond the initial training.

Project Goals

to help service providers understand how this will affect the way they work with colleagues and/or deliver service

to establish an effective training and mentoring plan for transitioning to new philosophy of service and help to sustain efforts

Were goals met?

Approximately 80 service providers were introduced to the training modules and spent time in discussion with their colleagues as to how this would affect the way they work together. With this group, plus those in support at the management level at the EKIOC lead table, and distribution of the training tool to member agencies shortly, it is expected that the first goal has been achieved.

The second goal was partially met with the inclusion of reference to factors to include in mentoring model development in the 3rd module (Business Processes), as well as discussion and establishing next steps on Feb. 13th. Further accomplishment of this goal will take place as the SI Working Group and EKIOC proceed with these next steps and continue communication with this trained group of service providers.

Training tool

Articulate software was used to develop modules as it is user friendly and compatible with Microsoft PowerPoint, allowing most (if not all) service agencies access to the finished tool. It was determined that three modules would provide the most effective, and comprehensive training related to Service Co-ordination, and was sub-divided into three topics; Service Co-ordination Guidelines, Family-Centered Practice, and Business Processes. Each module takes approximately 20-30 minutes to review.

Modules are going to be made available via weblink on EKIOC site. Correspondence to accompany the live links will include steps on ‘how to use’ the modules and will be distributed by end of March, 2012 to partner service agencies of EKIOC.

Training Day

One day of training (Feb 13, 2012) was held for approximately 80 participants from various sectors which included an introduction to the modules, related activities, and contribution to module development.

Discussions by table are included in Appendix A with the training day evaluation as Appendix B.

Highlights of the discussion include;

Capacity to implement

Most felt able to implement Service Co-ordination Guidelines, but generally seeking more clarity regarding next steps (the how-to).

Thoughts varied on the capacity of agencies to implement the Guidelines, primarily due to the different mandates, some which many be more amenable to the Guidelines and thus better suited to take the lead. Hours of service for most agencies was identified as potential barrier to implementation in terms of meeting with families after hours. Also cited was the lack of knowledge about what other agencies provided in terms of services.

Common language

Although four key terms were identified for participants, there seems to be no clear agreement (or even disagreement) on whether the definitions provided will suffice. However, a few things to note from the discussions include; perhaps ‘family-centered’ should be changed to ‘client-centered’ which would be more inclusive, and, ‘mentoring model’ definition should be made clearer. On this note, the module definition for ‘mentoring model’ has been adjusted, however, no change has been made to ‘family-centered’ at this time. Also, no other changes have been made to definitions taken directly from the Guidelines so as not to alter their intent.

Establishing a common language was agreeable to all in attendance as being of primary importance, however, this may require slow movement toward using a limited number of common terms. If changes are made to language, repetition will be critical in both the communication to families and in the modules.

Challenges and Opportunities associated with Family-Centered Practice

The key challenges and opportunities identified here have been added to the slide in Module 2, Family-Centered Practice, relevant to implementation in Leeds-Grenville:

Challenges

  • Knowing who the service partners are
  • Working with involuntary families
  • Finding time to make meetings work (after hours, coordinating providers)
  • Geography and travel associated with large region
  • Childcare and transportation needs of clients/families to attend meetings

Opportunities

  • Promotes common messaging to parents
  • Gaining understanding of other agency roles
  • Reduces duplication for families and agencies
  • Increases transparency with goal development
  • Increases permanency in planning

Stakeholder Assessment

A brief assessment of both the participants and another person from their own agency who was NOT in attendance at the training indicates that further communication within agencies related to Service Co-ordination is needed. Maintaining communication with those in attendance at the training may be helpful in disseminating the information related to Guidelines implementation.

Mentoring Model Development

Feedback from participants indicated that next steps in developing a framework for mentoring between agencies was critical to success of Guideline implementation with lots of good suggestions made (Appendix A).

Of particular note is;

  • Continued involvement of the SI Working Group and/or EKIOC seen as important, primarily as taking a leadership (champion) role.
  • Communication focus is very important, both to families and between agencies, utilizing new technology and joint efforts. This may indicate need for policy development within agencies that do not currently utilize effective methods of communication as required by families.
  • Sharing of good news stories also identified as being critical to sustained efforts, offering examples of how Service Co-ordination is working in Leeds-Grenville

Recommendations

  1. Pilot testing the modules with a small group of agencies to ensure tool relevance and accuracy should be considered prior to full distribution. Evaluation of the modules (6 months, 1 year) will inform the SI Working Group of usage, sustained relevance and identify necessary modifications to be made by EKIOC technical support person.
  1. The mentoring process should begin right away, starting with 3-4 champions from the SI Working Group or EKIOC in order to retain the momentum of the training session. It will be necessary to highlight steps and ensure availability of mentors/champions to support other agencies in implementation.
  1. If the province, or another region, is interested in duplication of modules, use this opportunity to celebrate in Leeds-Grenville as being ‘ahead of the pack’ and being able to add to the knowledge in field.
  1. Some resources should be identified (staff, time, $$) to the development of common communication tools to get agencies on-board and start with common messaging to families/clients, increasing impetus to use guidelines. Agencies seem to be looking for this (as opposed to having to invent by themselves) and this provides a good opportunity to continue the collaborative spirit from the training day.
  1. Some resources should also be devoted to mentoring start-up and continuation of training as the momentum from the training day could easily be lost if supports to agencies not made apparent.
  1. If changes are made to the Guidelines (either re-wording, or insertion of common language terms), ensure that this is reflected throughout the modules to encourage repetition.

APPENDIX A

Service Co-ordination Guidelines Training – Feb. 13, 2012

Discussion Notes

1.1 Capacity for Implementation

As someone working in a child and youth serving agency in Leeds-Grenville do you feel able to use the Service Co-ordination Guidelines right now? If not, what might help you to do this?

  • Yes, able to use
  • Child care – communication front line –management requires hours and time
  • Youth justice – already formal coordination legislation – family – subject – guidelines
  • NFP – Girls – need more steps (e.g. consents)
  • Employment – process – deal with individual families not always involved management and high authority needs to be involved
  • Yes, can use now. It is hard work. Clarify organization role for this
  • Yes. Accreditation influences. Role of managers. Yes, often done now by case conferences, more defined. Ensures follow through
  • Would be ready to use but not necessarily appropriate for service co-ordinator. Could refer if aware and also realizing that they could take more responsibility in terms of ensuring child hooked up to resources
  • CMH do this already. Challenge figuring out who the service co-ordinator is. CAS does this already
  • Benefit – meeting before there is a crisis plus clarify plan
  • Client engagement – clients are voluntary – family may not agree with suggested referral/resource (eg: CAS involvement, healthcare)

Looking now at the capacity of your agency, do you feel that implementing the Service Co-ordination Guidelines can be done right now? If not, what might help?

  • Flexible time is key
  • ‘tweaking’ what is happening
  • Transportation/childcare obstacles
  • How to communicate with all staff
  • ODSP/OW will possibly pay if clients
  • Who can/contact
  • Use of resources
  • Who isn’t involved?
  • Sometimes just need resources
  • Forms-duplication
  • Implementation: issues – difficulty arises with issues that fall outside of agency mandate – resources needed, links, short-term mandates, ‘child service ‘focus, not family focused
  • What would help? Discussion around blended/broadening funding, information about broader family supports, educate families to benefits of service co-ordination – sharing of necessary info, empowering families
  • Agency mandates (eg. Adult mental health) need to be involved,
  • legislation dictates some groups community approval boards funding required budgets limited
  • agency knowledge for whole organization
  • front-line workers ministry supports needed
  • What might help? Organizational policies, expectations from employer
  • Clarify consent issues
  • Job duties in a unionized setting
  • Who is part of coordination – OEYC, FCS, silos – common language
  • When to implement this service co-ordinator, time added +++
  • Lack of family understanding of who is doing what?
  • Families need to be part yes – slow, complex, barriers, not easy access, transportation , $$, phones
  • Hours of work – not able to do meetings after work
  • # of people (part-time staff)
  • Medical model – expert advice, patient care, no time for patient centered, community aspect part time staff do have philosophy of family centered
  • Some agencies do have capacity to do out of normal hours meetings- time is flexed
  • What might help? Funding, perform secondary role (not take lead)
  • With many agencies comes competing priorities and keep patient/family priority at forefront
  • Difficulty engaging parents who are involuntary clients
  • Link between inclusive childcare, PSL, IDP and daycares works well
  • Family may not want F ACS (or others?) present (not voluntary)
  • ARCC – trauma-based and clients often want confidence maintained
  • Client may not feel comfortable in large group meeting
  • Rapport building takes time. Service Co-ordinator should be someone with good rapport that can advocate. {Perhaps more detail re: criteria for choosing co-ordinator
  • Parents not available in daytime
  • Next step – integrated intake to avoid re-telling story. ARCC/Tricas/Mental Health try to share intake reports. IDP and Inclusive childcare share also (opportunities to build on)
  • We all navigate system already and find ‘the right door’
  • Consent complex to meet all needs Big opportunity but big challenge
  • Child care – don’t always know child is involved with agencies, don’t get a lot of information, not well received from parents when they suggest other services
  • OEYC – can recommend a service but don’t know if they contacted them. Don’t keep files so not always aware who is involved with whom
  • Issue – sharing information, families may decline to give permission to share info. DSLG seeing children 1st identified at school and families reluctant to sign consents.
  • Next step – common consent, some families still sceptical of that
  • Communication to families – need to educate families on benefits to service coordination/sharing info
  • Hard for agencies to keep up to date on who’s doing what. Need a time for agencies to share what they do
  • Issue – hard to find a time that everyone can attend. Solution- use Doodle surveys, still very time consuming
  • This is what wraparound did here years ago
  • Needs funding attached. LHIN funding adult wrap around in Portland area.
  • Need this in Policies and procedures in all agencies
  • Need child care for parents (and transportation ) to attend
  • Different for different people. Some people have to speak for others. Involvement
  • Comfort level for family. How to do it without being intimidating for families.
  • Agency awareness. Opportunities during natural transitions
  • Understanding each others’ philosophy
  • How do we engage key service providers (eg: schools)
  • Education and training of staff still needed. Staff will move forward more they understand the model
  • Resource issues – varying capacity
  • Addressing challenges (eg: how to deal with family not in agreement with service providers an issue)

1.2Service Co-ordination : Common language

Developing a common vocabulary is necessary for the community to have a shared understanding of key terms in order that communications between agencies is optimized and confusion doesn’t present a barrier to integration. Some key terms are presented here along with the definition in the modules. Does this fit? Other terms missing?

  • Mentoring – seems vague, more detail related to process (steps)
  • Others? Strengths-based
  • “family” centered language excludes some services. “client-centered” philosophy also applies. Is there a way to be more inclusive? “client-driven/focused”?
  • Definitions are straight-forward. Not at a level for all families to understand – need to be sensitive to families and gear our communication to the family’s strengths
  • Provide some examples – a new front-line staff might need examples of service co-ordination
  • Family-centered- include importance of listening to parents and garnering their input
  • Family-centered – how do you deal with it when it’s non-negotiable and facilitate parents participation by providing supports for families. Doesn’t preclude child protection
  • Families – culture of professionalism and shared problem solving rather than ‘defending’ perspectives
  • For agencies like DSLG – working with adults – they are ‘client-centred’ since it sometimes differs from family goals
  • Combine family and client?- after age of consent or when child is able to give an opinion
  • All of the definition would apply to youth – not just family – sometimes have different goals
  • Service Co-ordinator – wordy, eliminate 1st sentence, take out intervention, it’s a process, use organization instead of co-ordination
  • Need to put family or client, can’t use service co-ordinator in the def’n
  • A process.....
  • Keep integrated, seamless, not consumer friendly language
  • Need a pamphlet for families describing Service Co-ordination – to be explained to them by service provider
  • respect – instead ‘remember’ parents include respect and acknowledge – include identifying goals
  • change name of Integrated Service Plan to reflect Family Driven nature
  • Service Co-ordination (intervention) use process instead maybe too wordy for some parents - more plain language “what we do to make sure everyone is on the same page”
  • Use opportunity vs intervention
  • Best possible plan to meet your family goals
  • We are going to assume effective and efficient
  • Mentoring Model – something missing/include learning process
  • Other terms – being specific, may end up being more “meeting specific”
  • Situational assessment language
  • Barrier – child care was mentioned – not just parent attendance (re: childcare, transportations, etc.) but for child care staff to participate (supply to cover) and other agencies willing to have flexible hours (after 4p.m. etc.)

2.1 Family-Centered Practice – Challenges and Opportunities

What might be some challenges within your agency, or sector, that you can foresee in adopting family-centered practice? What might be some opportunities if this approach is fully adopted in your agency, sector?

Challenges:

  • Initiating support – time to reinforce positive when situation is volatile
  • Not always there for positive
  • Time because of caseloads
  • On the road – no office time
  • Timing of follow up
  • How to find out who partners are
  • Traditional thinking “we know better’ – culture shift – will take time
  • Maintaining dignity and respect for families but some may not have knowledge
  • Involuntary – families who aren’t informed of developmental levels and don’t realize child isn’t at level he should be at
  • More time consuming to involve family- longer meetings, documentation, shared consent, getting everyone together
  • Defining ‘family’ (eg neighbour, church, extended) flexibility with limits
  • Capacity of the family
  • Power struggles (eg. Professionals us>)
  • Resources, strength to determine and empower
  • Trust, service history
  • Service provider turnover
  • Enlisting all key services
  • When opportunities do not match identified needs
  • How to education, when is this NOT family-centered
  • Using flex hours/overtime to make meetings
  • Hours it requires to provide meetings
  • Taxing on a service we are providing
  • Geography and travel
  • Keeping current role and additional duties
  • Dynamics/scope of family and extended family involvement
  • Finding efficient ways to complete forms and record services
  • Having goals the family chooses that are not “professionals” choice due to developmental stages
  • Deal with the client, not whole family (e.g. unemployment)
  • Expertise of agency staff
  • Hours of operation – available time to meet with working parents
  • Families not always accepting so if they do not recognize a problem
  • Philosophies of agencies – offers a specific service (e.g child care)
  • Confidentiality
  • Getting all service providers together (eg: scheduling)
  • Easy to overload families in our efforts to empower them – we expect a lot already of our overburdened families
  • Families sometimes can’t do it all – pick service
  • Finding balance between supporting families and empowering them – don’t want families to become dependent upon agencies
  • Need for education for parents and service providers on what agencies are doing what
  • F&CS mandating supervision order includes voluntary services “we” recognizes clients are not invested
  • If mandate of service is client-centered (eg: ARCC/Youth Justice)
  • Daycare – parents deny issues (no readiness), parents at work/busy
  • Staff work hours
  • School involvement (lack of)
  • Staff skill/knowledge and mindset (lack of)
  • Compliance with legislation may get in the way (eg: OW compliance requirements).
  • Power imbalance implicit (CAS) – non-voluntary clients
  • Consent – family may not agree to involve a partner that service providers feel must be a partnership – neither the family nor the agencies can dictate the terms. TRUST is important – communication
  • Fully adopting – cost, time factors. Child care for meetings, transportation, etc. to help families participate fully. Family friendly hours for staff not necessarily best for family centered care
  • Interaction with child welfare
  • Maintaining relationship with the parents when there are concerns related to child welfare
  • Hours of work – M-F/9-5
  • We don’t do crisis work
  • Family-centered – how do we get family to understand benefits of engaging in service
  • Understanding child welfare as support
  • Employee support for parents
  • Measuring success
  • Referral process/waitlists
  • Shared use of space/liability
  • Parents want something different than what we offer

Opportunities