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Five Reasons to Complete the Integration Survey by May 17 and Congratulations to our Winners!

Thank you to all those who completed our integration survey by the prize deadline of April 26, and congratulations to our prize winners:

CMHA Champlain East: Complementary registration for the upcoming AOHC Conference

Seniors Outreach Services-Maxville Manor: Free registration in the Capacity Builders volunteer management e-learning program

Community Care City of Kawartha Lakes: Free registration at the Inaugural Addictions & Mental Health Ontario Conference

Have you not yet completed the survey? With participation now around 40% we are extending the deadline to Friday, May 17. Here are five reasons why you should complete the survey!

1) You may have more integrations than you think! All of the following are forms of integration recognized by the LHINs:

Coordination/Cooperation, where two or more organizations informally agree to do their own independent activities in a coordinated way, without necessarily signing an agreement;

Joint Initiatives, limited time or longer-term partnerships where there is a more formalized joint agreement;

Behind the Scenes collaboration, which is not about direct service delivery to the patient/client − it includes co-location and sharing of financial, translation, IT, or other resources;

Clinical/Service Integration initiatives directly related to client care, including coordination of individual programs or care pathways, joint efforts to improve consistency, quality, or evidence-base of care, as well as “hub and spoke” service models where a program is delivered in multiple locations, shared clinics and shared clinical information systems;

Mergers∕Amalgamations, where two or more organizations combine.

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May 2013Inside This Issue

Five Reasons to Complete the Integration Survey and Congratulations to Winners…..Page 1

Gains and Growing Pains in the Multi-Service Sector…..Page 3

CHO Advocating for the HEIA in Health Links and Funding for Capacity Building…..Page 9

March 2013In this issue

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2) Show off these integrations to your clients, partners and funders! With survey results, CHO will create maps of integration for each LHIN and post them online.

3) Your organization can access integration resources! You will find a place in the survey to indicate your interest in resources such as learning events and facilitated meetings, which we could provide through our Trillium-funded Healthy Community Collaborations project.

4) You can help us show the LHINs and the MOHLTC the extent and effectiveness of community health sector integration. To support your organization’s ability to work in keeping with community health values, CHO needs to demonstrate to funders the impressive integration already achieved by community health organizations within the health system and with sectors crucial to addressing the social determinants of health.

5) You could win prizes! If you complete the survey by May 17, we will put you in a draw to win one of four $50 Chapters/Indigo gift cards, which you can use either online or in the store.

So please take a moment to fill in the survey now! It only takes about half an hour – longer if you have a lot of integration– but then there is more value in it for everyone! You can start, save, and then return to the survey.

Start the survey by clicking on the link below for the LHIN with which you have your Service Agreement or, if you are a provincial organization, the LHIN in which you are physically located. If in doubt, please check by postal code on the LHIN Map. If you have any trouble, please contact Janet and Robyn at jacreery@gmail.com and r.kalda@healthnexus.ca and we will fix it right away.

LHIN 1 - Erie St Clair: http://www.networkweaving.com/projects2/start.cfm?id=198LHIN 2 - South West: http://www.networkweaving.com/projects2/start.cfm?id=199LHIN 3 - Waterloo Wellington: http://www.networkweaving.com/projects2/start.cfm?id=200LHIN 4 - HNHB: http://www.networkweaving.com/projects2/start.cfm?id=197LHIN 5 - Central West: http://www.networkweaving.com/projects2/start.cfm?id=201LHIN 6 - Mississauga Halton: http://www.networkweaving.com/projects2/start.cfm?id=202LHIN 7 - Toronto Central: http://www.networkweaving.com/projects2/start.cfm?id=203LHIN 8 - Central: http://www.networkweaving.com/projects2/start.cfm?id=204LHIN 9 - Central East: http://www.networkweaving.com/projects2/start.cfm?id=205LHIN 10 - South East: http://www.networkweaving.com/projects2/start.cfm?id=206LHIN 11 - Champlain: http://www.networkweaving.com/projects2/start.cfm?id=207LHIN 12 - North Simcoe Muskoka: http://www.networkweaving.com/projects2/start.cfm?id=208LHIN 13 - North East: http://www.networkweaving.com/projects2/start.cfm?id=209LHIN 14 - North West: http://www.networkweaving.com/projects2/start.cfm?id=210

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March 2013In this issue

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Gains and Growing Pains in the Multi-Service Sector

Multi-service organizations have great potential to provide people-centred care, offering a variety of integrated services. With administrative and financial pressures also pushing more organizations to consider some form of integration, we decided to take a closer look at the successes and challenges of multi-service agencies. What did they lose or gain by integrating so many different services, often originally offered by independent organizations? Several agency leaders agreed to share their insights and cautionary tales with us.

Scarborough – getting community support services and primary care working harmoniously

Jeannie Joaquin, CEO of Scarborough Centre for Healthy Communities (SCHC), spoke to us in a brand new location at the busy intersection of Markham Road and Lawrence Avenue. One of 10 SCHC sites, it hosts most of the organization’s community support services, the core of the original organization. Founded as West Hill Community Services in 1977, it expanded to include one community health centre (CHC) in the early nineties and several satellites about a decade later. Ensuring that these services are harmoniously integrated with primary care has been an important goal of Jeanie’s work since she took the helm three years ago.

“The CSS felt gobbled up even though this was an expansion,” she says, pointing particularly to pay inequities. She worked hard at making pay scales equitable, breaking down silos and rebranding SCHC as a unified organization. Synergies are now evident. With intake standardized across services, staff identify needs outside their domain and pro-actively link to them. CSS clients who have no primary care, for example, are promptly linked to that service. The strength of the integrated organization allows SCHC to take the local lead in a number of areas, including caregiver wellness and transportation.

In the wider integration picture of her catchment area with exceptionally high proportions of immigrant and multicultural communities, Jeanie sees lots of gaps in the area of mental health and addictions as well as ethno-specific services. The Central East LHIN is focusing on a Community Integration Strategy, which does not include mental health or addictions, and while upcoming Health

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Jeanie Joaquin, CEO of Scarborough Centre for Healthy Communities, and Deborah Simon, CEO of Ontario Community Support Association

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Links discussions do include these sectors they exclude ethno-specific services because they cross Health Links’ boundaries.

Jeanie will keep us updated on progress through her role as our Healthy Community Collaborations Advisory Committee member for the Central East LHIN.

Davenport-Perth – no amalgamations, but lots of partners

Davenport-Perth Neighbourhood & Community Health Centre (DPNCHC) serves a denser area closer to downtown Toronto, but with a similarly diverse population: 88% of ethnic ancestry other than English or French, 33% visible minorities, 55% immigrants – with 22% not Canadian citizens, meaning many uninsured clients. Created in the mid-80s as a neighborhood centre, the organization’s addition of a CHC a few years later seems to have been relatively seamless but the organization’s offerings have been tossed by the funding tides – they lost their employment centre for newcomers, but have been able to maintain settlement services by finding new funding.

Executive Director, Kim Fraser, lists an impressive array of programs for each age group, addressing both immediate issues and social determinants of health. For youth they include arts and leadership, youth-friendly academic and employment skills development, and young women’s support groups; for adults, they range from Street Outreach and Crisis Intervention to Parent Relief/Respite Child Care, and include financial literacy skills and employment skills development; for seniors, arts and leadership programs as well as fitness, community dining and drop-ins.

There are no amalgamations involved or planned for this multi-service agency just “a LOT of partnerships,” says Fraser. One partnership that has already yielded particularly good results is with the Canadian Association for Mental Health (CAMH), which provides training and referrals for an innovative and successful dialectical behaviour therapy group offered for patients with a diagnosis of borderline personality disorder, and an exercise program aimed at alleviating depression. Fraser is now overseeing renovations to the old health centre to provide short and long term office space for non-profit organizations, and looks forward to some interesting co-location opportunities that may increase supports and services for the centre’s clients and the community.

Kawartha Lakes – Making the whole more than a sum of its parts

It’s a different world up in Kawartha Lakes, where Community Care City of Kawartha Lakes (CCCKL) serves a population of about 80,000 scattered over 3,000 kilometres of small towns and rural areas, including 250 lakes.

The area’s population is more homogenous than Toronto’s, with a high proportion of people of European descent. There is, however, a strong prevalence of low-income earners and seniors in this

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area, where agriculture is still an important part of the culture and the economy. “We serve many complex patients,” says Catherine Danbrook, CEO of CCCKL.

CCCKL has a long and successful history of collaboration. The organization originated more than a quarter century ago as a grassroots community support organization delivering Meals on Wheels to isolated seniors. In 2007-2008 they received funding to add a Community Health Centre. In 2011 the governing board of Hospice Kawartha Lakes, concerned with the ability of the organization to sustain itself, orchestrated a merger with CCCKL through a LHIN-facilitated process.

That latest integration was challenging, says Danbrook: “We spent a lot of time with volunteers to reassure them that programs and services would remain the same.” The Hospice kept their logo to ensure continuity and the CCCKL worked hard on communications to staff and donors, focusing on the added value of a new entity that was emerging as more than the sum of its original parts. They succeeded in keeping the vast majority of volunteers involved, and two members of the former Hospice board are now members of the CCCKL board.

CCCKL now offers a full range of community health and support services, including a Community Health Centre, adult day programs, in-home respite and supportive housing services, hospice and bereavement care, meal programs, specialized transportation (EMS diversion), and most recently a low-income dental clinic. Danbrook wishes that it were possible to more fully benefit from the synergies of the different services she now oversees, to offer a more comprehensive client experience. “Siloed funding structures are a challenge to integrated programming development,” she says.

CCCKL is now looking to the future. They have just received capital funding for a new CHC and plan to incorporate integrated health and community support services there to create a truly client-focused community hub. One issue they would particularly like to address is mental health and addictions, which Danbrook identifies as under-serviced in the area, and an integral part of CCCKL’s work.

South East Ottawa Community Health Centre – many services in tune with one another

The South East Ottawa Community Health Centre (SEOCHC) is planning to create a common database across their many services, which have a long history of harmonious collaboration. Growing out of a one-room community resource centre in the 1970s, the organization acquired funding for community support services in the late eighties and then for a CHC just shortly after. “They grew up together, so there was no divide,” says Martha Smith, Manager of Social Services.

Two part-time nurses who do geriatric home visits, funded by the Aging at Home program, are now strengthening the link between community support services and primary care. The SECHC is in fact providing one full-time nurse and one full-time Community Health Worker to five CHCs in Ottawa

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through the program, and would like to expand this Primary Care Outreach for Frail Seniors to all Champlain CHCs, including rural ones.

A wide variety of other services are also available. Housekeeping is offered for a fee with some subsidy available from the SEOCHC, and a representative of the City of Ottawa Home Support Program works onsite, providing these services free of charge to low-income clients. Health promotion, housing loss prevention (offered with city funding) and mental health counselling, including a walk-in, are also available. “You really cover a lot of the determinants of health here!” exclaimed Deborah Simon, Chief Executive Officer of the Ontario Community Support Association, on a recent visit to the centre.

Just last year the SEOCHC integrated with the Hunt Club Riverside Community Resource Centre, which was having trouble continuing to operate on its own. The Resource centre brings with it programs for youth, seniors, and new mothers as well as general community development dollars.

All counselling is offered in French or English, and staff can serve in 16 different languages, evidence of the increasing diversity of the Ottawa area.

Cross-disciplinary learning and collaboration is nurtured not only by staff meetings and discussions, but also by informal activities such as the yoga lessons and a long-standing choir that keeps the different professions in tune.

“Because Ottawa’s not such a big city, we have strong networks and strong working relationships,” says Leslie McDiarmid, the Executive Director of the SEOCHC, of her organization’s relationship with the wider health and social services system. She says there is a strong, long-established cross-sectoral network on senior’s issues, and one of the challenges is to make such established cross-sectoral networks work well with the developing Health Links covering smaller geographic areas. She also finds that, outside of the seniors’ population, her organization is least well connected with mental health services, especially for youth. She is working on partnerships to fill those gaps.

Uniting rural voices and services in the Champlain and SE LHINs

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From left to right: Deborah Simon, CEO of OCSA, Martha Smith, Manager of Social Services of SEOCHC, Cathie Racicot, Coordinator of Primary Care Outreach and Community and Home Support Services, Leslie McDiarmid, Executive Director

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In the countryside around Ottawa, health organizations have been teaming up to effectively serve and advocate for their clients. Lanark Health and Community Services (LHCS) is a prime example, integrating four health and social service agencies under one incorporated organization. Each has its own core funding agencies, mandates, programs, services, target populations and history: Lanark Community Programs, the North Lanark Community Health Centre, The Link Mental Health Support Project and the Whitewater Bromley Community Health Centre Satellite work in synergy under one administration, overseen by one governing Board.

Together the “parts” provide a wide range of primary health care, health promotion, community development, and peer support services in a very large, predominantly rural area in Lanark and Renfrew Counties. They address the major challenges of transportation and access by offering many services within each location and adopting a wide range of outreach strategies, including running group medical visits and group programs, offering programs and services in closer-to-home community halls, serving clients in their homes and building their capacity to use Tele-Health video conferencing, working with community volunteers to increase and diversify the programs they are able to offer, and partnering with local governments, other health and social service providers, schools, libraries, youth centres, service clubs, church groups and other civil society groups to coordinate appointment bookings so clients can make one trip rather than two or three.

According to Executive Director, John Jordan, the integration started when Lanark Community Programs (LCP) turned to the North Lanark Community Health Centre (NLCHC) as a sponsoring organization with a better “fit” than the Carleton Place Hospital, where they were originally embedded. This doubled the size of the North Lanark Community Health Centre (NLCHC) overnight. Soon afterwards, an organization serving young, at-risk parents and their families realized that it could benefit from governance and administrative assistance and decided to join in too. Then the Mental Health Support Project, a peer support initiative, faced challenging times and also turned to their trusted partner the NLCHC, which was already providing accounting and reporting services.

Adding to the complexity, during the same period the North Lanark CHC helped the Whitewater Bromley community in Renfrew County to access nurse practitioner services, and then in 2004, helped form the Whitewater Bromley Community Health Centre satellite. With all this rapid growth and change, “the first year was hell on wheels,” says John Jordan. “The parts struggled with loss of autonomy as they sought to conform to a common set of policies and procedures.”

Jordan nonetheless thinks all concerned believe they did the right thing. “They enjoy great autonomy as to what services they provide, and they don’t have to worry about financial and administrative things,” he adds, pointing to the risk of failure faced by similar small agencies due to administrative and governance burdens.

Jordan believes volunteer participation actually increased with the amalgamations, and staff comfort with them grew over time: “as staff across all parts got involved in committees of the board, their

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realization of advantages outweighed their doubts.”

While there was no financial assistance for the substantial costs of all these amalgamations, they did ultimately yield savings for everyone, says Jordan. He also thinks that the strong financial management and governance made possible by all this integration, and well documented through the accreditation process, enabled Lanark Health and Community Services to obtain building capital from Infrastructure Ontario and the Ministry of Community and Social Services.

The increased size and clout of the organization also helps them to advocate for much-needed services. LHCS contributed to bringing the lack of rural mental health services to the attention of the Champlain LHIN, and now receives funding from them for onsite Canadian Mental Health Association (CMHA) services. Jordan has helped bring the lack of rural community advisories to the LHIN’s attention, resulting in a Grenville and Lanark rural community advisory – an imperfect combination, he says, but better than nothing. He and his rural partners briefly obtained funding for an Aging at Home program but the LHIN has since refused to provide more funding, so Jordan continues to seek funding for senior services through partnerships with other organisations

Peter McKenna, Executive Director of the Rideau Community Health Services (RCHS), within the SE LHIN but just a few kilometers away, reports his organization experienced a similar increase in clout as it expanded and diversified. “Our size has made us a more equal partner with the LHINs and the hospitals,” he says. “We are better able to bring forward the values of community-centred care.”

Like the North Lanark CHC, RCHS also first expanded when a hospital-based organization, the Rideau Valley Diabetes Service (RVDS), was looking for a more suitable partner. However, they had the advantage of a gradual process, bidding for and earning the privilege to incorporate the RVDS. They continued this expansion several years later with the incorporation of the Smiths Falls Community Health Centre in 2006 and then South East Diabetes Regional Coordination Centre in 2010.

The mergers that created RCHS were smooth and successful, says McKenna, and the resulting growth and diversification offered advantages to both clients and staff.

“We’ve seen benefits for our clients: RVDS will walk across the hall and ask for primary care help with a client,” says McKenna. Staff also benefit, he says, from opportunities for promotion and professional development, and this makes the organization an attractive employer. “Right now we are large enough to attract people out of Ottawa, but we are still nimble, can make quick decisions, be

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responsive to client and staff needs. It’s a sweet spot,” he says of his organization’s current size, with about 70 employees and a budget of $7 million.

“We have a reputation for not trying to control everything, we have structured ourselves in such a way that people tend to come to us,” says McKenna. Indeed the structures in place seem to work smoothly, with a director from one of the internal organizations reporting each month to a strong board with a larger system view. “People see that working together is in the best interests of the clients and the community,” he says.

Continued leadership is clearly in the cards: RCHS recently became the regional telemedicine provider and is the suggested anchor agency for the proposed Rideau-Tay Health Links. These innovative Health Links would actually cross into the Champlain LHIN, incorporating organizations such as Jordan’s Lanark Health and Community Services. In January, the Lanark Alzheimer Society moved into the RCHS building, which opens up rooms for seniors dining clubs.

Plans for a LHIN-supported merger with Tri-County Addictions (TCA) were, however, recently abandoned. McKenna is mindful of the increasingly challenging health system context: he expresses concern that quick-changing standards, accountability, and targets make it impossible to undertake integration in the gradual way that has been effective in the past. He particularly worries about small organizations being forced into integration, and suggests they may be wisest to move ahead with integration on their own terms. “Now is the time to seek voluntary opportunities because in a couple of years it may not be voluntary.”

CHO Advocating for the Health Equity Impact Assessment in Health Links and Funding for Capacity Building

Community Health Ontario’s three associations are amplifying their voices through joint positions on common issues. In particular, two letters have gone to relevant Ministry of Health and Long-Term Care (MOHLTC) officials, one about the need to implement the Health Equity Impact Assessment (HEIA) tool in Health Links and another about the need for dedicated funding for capacity building in CHO’s three community health sectors.

The Health Links initiative aims to address the needs of people in Ontario who use health services the most. Meanwhile HEIA helps ensure specific populations – often the highest health system users with the greatest needs – are addressed in decision-making processes for planning, policy, programs and services, while building capacity about health equity and ensuring optimized health care investments. This makes it logical that MOHLTC would use its HEIA tool in planning and assessing Health Links. But they are not doing so, raising CHO concerns that it will be very difficult to ensure the initiatives are reaching those with the greatest needs and are effectively and sustainably addressing the root causes of their frequent health system use.

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CHO applauded the MOHLTC’s launch of the second version of the Health Equity Impact Assessment in 2012. Based on best practices from Australia, New Zealand, United Kingdom, Wales and the World Health Organization, the Ministry’s HEIA tool was made locally relevant by collaborative development with the Local Health Integration Networks and other Ontario-based health equity experts.

A simple means to consistently ensure those with the greatest needs are addressed via Health Links is to require the use of HEIA in their business plans and as part of their measurement metrics. Without applying a health equity lens, we will not know whom Health Links are reaching and whether or not we are effectively addressing and measuring the root causes of people’s frequent use. Just addressing and measuring the symptoms of the problems will keep people facing systemic barriers and poor determinants of health in the 5 percent of most frequent and most expensive health system users. With Health Links, the problem may move out of the hospital into the doctor’s office, but the problem will not be solved. Clearly, measuring health equity is as important as measuring dollars, making a significant impact on costs and sustainability. The HEIA tool would not be difficult to apply. It has existing Ministry support infrastructure to enable its effective use.

CHO’s second letter requested that 1.75 percent of the overall 4 percent health sector funding increase for 2013/2014 be dedicated to capacity building for the community health sector. Specifically, this money should be made available for community-governed primary health care organizations, mental health and addiction services and community support agencies to build capacity for enhanced quality, performance and accountability measures and improved information management systems.

The amounts requested would come to an estimated $6 million for community-governed primary care, $15 million for mental health and addiction services, and $11 million for community support services, leaving about $124 million for other LHIN and Ministry priority programs.

CHO is following the letters up with requests for meetings to move these opportunities forward.

Upcoming CHO Events

May 17, 2013: Champlain’s Health Link 2Debbie St. John De Wit, Advisory Committee member for Healthy Community Collaborations and Executive Director of the Seaway Valley Community Health Centre, will be hosting an information meeting on May 17th for participants in Champlain's Health Link 2 and allied health and social service organizations. HCC's Janet Creery will attend to gather insights for the rural integration whitepaper and provide information about Community Health Ontario's work.

May 31, 2013: Exploring an Elgin Health LinkCHO members and other representatives from community health and the broader continuum of care serving people in Elgin County will gather to build momentum toward a Health Link in Elgin.

June 5, 2013: Towards a Rural Health Strategy: Improving the quality of equitable, integrated, person-centred health services in rural Ontario

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Do you serve people living in rural, northern or remote Ontario? Join us at AOHC’s upcoming conference, “Working Better Together: Primary Health Care Conference 2013”, for a consultative Think Tank that engages participants in the development of CHO’s Rural Health Integration White Paper.

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About Community Health Ontario and Healthy Community Collaborations

CHO is a strategic partnership between the Association of Ontario Health Centres (AOHC), the Ontario Community Support Association (OCSA and the Ontario Federation of Community Mental Health and Addictions Programs/Addictions Ontario (OFCMHAP/AO). Together we represent the majority of not-for-profit home and community support, mental health and addictions and community-governed primary health care providers in Ontario. CHO envisions strong community-based services that address the social determinants of health as the key to a healthy society and are integrated and coordinated with the full continuum of care.

CHO thanks the Trillium Foundation for its funding to make the Healthy Community Collaborations project possible. The aim of this project is to support the community health sectors in their integration initiatives among themselves and with broader health and social systems, in keeping with community health values such as person-centred, community-driven services, bottom-up processes, inter-professional collaboration, strong relationships among sectors and across sectors, and overarching concern with the social determinants of health.

For more information, see communityhealthontario.org or contact:

Janet Creery Coordinator, Member Relations, jacreery@gmail.com Leah Stephenson Coordinator, Stakeholder Relations, leahstephenson@gmail.com David Kelly Chief Executive Officer, OFCMHAP/AO, dkelly@ofcmhap.on.ca Deborah Simon Chief Executive Officer, OCSA, deborah.simon@ocsa.on.ca Adrianna Tetley Executive Director, AOHC, adrianna@aohc.org

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