Canadian Mental Health Association Integration

 Integration Plan Canadian Mental Health Association (Central East LHIN North East Cluster) An integration facilitated by the Central East Local Health Integration Network January 13, 2012 Table of Contents 1 Executive Summary ................................................................................................................................ 1 2. Preparing for the Integration ................................................................................................................. 3 2.1 Introduction .................................................................................................................................. 3 2.2 Background ................................................................................................................................... 3 2.3 Description of Mental Health Services ......................................................................................... 4 2.4 Description of the Canadian Mental Health Association .............................................................. 4 2.5 Principles Guiding Integration ...................................................................................................... 5 2.6 Canadian Mental Health Association Integration Planning Team ................................................ 5 2.7 Facilitated and Negotiated Integration Process ........................................................................... 6 3 Current State of Community Mental Health Services ............................................................................ 9 3.1 Canadian Mental Health Association ‐ Kawartha Lakes ............................................................... 9 3.1.1 Organization History ............................................................................................................. 9 3.1.2 Accreditation ....................................................................................................................... 10 3.1.3 Organizational Structure ..................................................................................................... 10 3.1.4 Role of Volunteers ............................................................................................................... 11 3.2 Canadian Mental Health Association ‐ Peterborough ................................................................ 11 3.2.1 Organizational History ........................................................................................................ 11 3.2.2 Accreditation ....................................................................................................................... 13 3.2.3 Organizational Structure (high‐level) .................................................................................. 14 3.2.4 Role of Volunteers ............................................................................................................... 15 3.3 Key Operational Information ...................................................................................................... 16 3.4 Access to CMHA Services in the Central East LHIN North East Cluster ...................................... 19 3.5 Summary Description of Client Services ..................................................................................... 20 3.5.1 Intake Services .................................................................................................................... 20 3.5.2 Crisis Services ...................................................................................................................... 20 3.5.3 Rapid Response Services ..................................................................................................... 21 3.5.4 Non‐Rapid Response Services ............................................................................................. 22 3.6 CMHA Services by Funding Source and Geographic Region ....................................................... 28 3.6.1 Services Funded by the Central East LHIN by MOHLTC Program Funding and Geographic Region . 28 3.6.2 Services Funded Directly by Other Ministries/Governments and Geographic Region ....... 30 3.7 Integration Planning Team Observations of CMHA Operations ................................................. 31 3.7.1 General: ............................................................................................................................... 31 3.7.2 Back Office: ......................................................................................................................... 31 3.7.3 Front‐Line Direct Client Services: ........................................................................................ 31 3.7.4 Organizational Leadership and Governance: ...................................................................... 31 3.8 Community and Stakeholder Engagement Process.................................................................... 32 3.8.1 Opportunity Themes Identified .......................................................................................... 32 3.8.2 Barriers to Integrating Services ........................................................................................... 33 3.8.3 Most Important, Expanded and New Services .................................................................... 33 3.9 Request for Participation from Four Counties Addictions Services Team .................................. 34 4. Opportunities for Integration ............................................................................................................... 35 4.1 Back‐Office Analysis Work Team ................................................................................................ 36 4.2. Front‐Line Direct Client Services Analysis Work Team ............................................................... 37 4.3. Organizational Leadership and Governance............................................................................... 37 4.4. Options Considered .................................................................................................................... 38 4.5. Options Analysis ......................................................................................................................... 38 4.6. Key Decision Factors ................................................................................................................... 42 4.7. Preferred Option ......................................................................................................................... 42 5. Integrated Service Delivery Model ....................................................................................................... 43 5.1 Key Attributes of a Voluntary Merged/Amalgamated Organization .......................................... 43 5.2 Proposed Implementation Timeline ........................................................................................... 46 5.3 Risk Analysis – New Organization ............................................................................................... 46 5.4 Risk Matrix and Interpretation ................................................................................................... 48 5.5 Risk Response Strategies ............................................................................................................ 48 5.6 Risk Threshold ............................................................................................................................. 49 5.7 Feedback on DRAFT Integrated Service Delivery Model ............................................................ 49 5.7.1 Summary of Survey Responses ........................................................................................... 50 5.7.2 Key Feedback Themes ......................................................................................................... 50 5.7.3 Incorporating Feedback into the System Design ................................................................ 52 5.8 Alignment with Provincial Mental Health Reports/Panels ......................................................... 52 5.9 Alignment with Triple Aim .......................................................................................................... 54 5.10 Alignment with Central East LHIN Strategic Aims ...................................................................... 55 5.11 Central East LHIN Clinical Services Plan ...................................................................................... 55 5.12 Annualized Operating Budget ..................................................................................................... 57 5.13 Performance Commitments ....................................................................................................... 57 6. Transition .............................................................................................................................................. 58 6.1. Drivers and Strategies ................................................................................................................. 58 6.1.1. Accessibility of Services to Clients ...................................................................................... 58 6.1.2. Identify and Implement Early Cost Saving Opportunities ................................................... 58 6.1.3. Minimize Transition Costs ................................................................................................... 58 6.1.4. Privacy and Confidentiality ................................................................................................. 58 6.2. Transition Schedule .................................................................................................................... 58 6.3. Transition Costs .......................................................................................................................... 60 6.3.1. Phase 1: Back‐Office Transition .......................................................................................... 60 6.3.2. Phase 2, 3 & 4: Front‐Line, New Organization and Wind‐Down Transition ........................ 60 6.3.3. Human Resources Planning and Labour Adjustment Costs ................................................ 60 6.4. Value of the Central East LHIN’s Financial Support for the Transition ....................................... 60 6.5. Transition Implementation ......................................................................................................... 61 6.5.1. Implementation Team ........................................................................................................ 61 6.5.2. Oversight and Reporting ..................................................................................................... 61 Appendix: .................................................................................................................................................... 62 1 Executive Summary This Integration Plan provides the information necessary for the Boards of Directors of the Central East Local Health Integration Network (Central East LHIN), Canadian Mental Health Association – Kawartha Lakes (CMHA‐
KL) and Canadian Mental Health Association – Peterborough (CMHA‐P) to make an informed decision on the integration of mental health services currently provided by both organizations. The integration identified in this plan represents a voluntary amalgamation of CMHA‐KL and CMHA‐P into a new organization and the voluntary wind‐down of the current CMHA‐KL and CMHA‐P organizations. To accomplish this integration the following four phases of activity have been identified: •
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Phase 1: Back‐Office consolidation by April 1, 2012. Phase 2: Front‐Line Services integration by September 2012. Phase 3: Establish of New Amalgamated Organization and assumption of services, assets and liabilities by April 1, 2013. Phase 4: Wind‐up of existing CMHA‐KL and CMHA‐P organizations by August 2013. To develop this Integration Plan a set of principles were agreed upon by the parties to guide the integration process. The most important of these principles placed the client needs at the forefront of the process. A Planning Team was established to develop and implement an Integration Plan. The team set about the task by undertaking information sharing and due diligence to understand what comprises mental health services, the “current state” and the scope of these services. The team also engaged stakeholders and the community on two separate occasions to obtain input and feedback. With this understanding the team identified opportunities for integration, undertook more in‐depth analysis, and evaluated various options. The analysis clearly indicated that the creation of a new organization through the voluntary amalgamation of CMHA‐KL and CMHA‐P met the majority of the pre‐established decision factors including identifying an estimated $253k annually once transition is completed for reinvestment in front‐line direct client services. To implement Phase 1 – Back‐Office consolidation by April 1, 2012, there will be some transition costs incurred by CMHA‐KL and CMHA‐P. These costs have been estimated at $55.0k in 2011/12 and the Central East LHIN has committed to make these funds available to support these transition activities. The Central East LHIN has also committed to support the organizations in meeting any labour adjustment cost liabilities that may result from the integration process by advancing funds and developing a repayment strategy. This integration of CMHA organizations is the first step of several that will be required along the road to full integration of mental health and addictions services in the North East Cluster. To ensure the commitment toward a broader vision and that the process of integration will continue: •
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The Boards of CMHA‐KL and CMHA‐P and the new organizational entity will explore further integration opportunities within the broader health system, and in particular with other mental health and addiction health service providers. CMHA‐KL and CMHA‐P will consider opportunities for system efficiencies with other organizations as they undertake detailed transition planning for front‐line direct client services. 1 •
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A full range of governance structures and affiliations will be explored to support broader system integration. Future integration processes will follow the same principled and detailed process of the present facilitated integration to determine how to better serve the needs of mental health and addictions clients in the North East Cluster of the Central East LHIN. The integrated mental health service is expected to operate on an annualized basis within the current Central East LHIN funding envelope as set out in the current Multi‐Service Accountability Agreements. There is considerable work required to integrate these mental health services. The Integration Plan identifies many of these activities, estimates some of the costs. Further details on transition activities will be determined through more detailed transition planning activities once this Integration plan has been approved. The Integration Planning Team would like to extend its appreciation to the CMHA‐KL and CMHA‐P staff members that participated on the Analysis Work Teams. Also the Planning team would like to thank all CMHA clients and their family members, CMHA staff, volunteers and Board members, community partners and community members for their support and feedback throughout this integration planning process – the input has factored into the current integration and has helped determine the next steps in the broader vision for mental health and additions integration across the North East Cluster. 2 2.
Preparing for the Integration 2.1 Introduction This Integration Plan provides the information necessary for the Boards of Directors of the Central East Local Health Integration Network (Central East LHIN), Canadian Mental Health Association – Kawartha Lakes (CMHA‐
KL) and Canadian Mental Health Association – Peterborough (CMHA‐P) to make an informed decision on the integration of mental health services currently provided by both CMHA organizations. The integration identified in this Plan represents a voluntary amalgamation of CMHA‐KL and CMHA‐P into a new organization. 2.2 Background CMHA‐KL and CMHA‐P have joined with the Central East LHIN in discussions to explore integration opportunities. The impetus for the discussions stems from the March 23, 2011 Central East LHIN Board of Directors meeting where the Board asked to receive a report back on the alignment and integration possibilities between CMHA‐
KL and CMHA‐P. During the integration of consumer survivor services in Kawartha Lakes between Survivors Psychiatric Advocacy Centre (SPAN) and CMHA‐P, the Central East LHIN observed there were opportunities for closer cultural and operational alignment between the two CMHA branches in the Central East LHIN’s North East Cluster (comprising Haliburton, City of Kawartha Lakes, Peterborough City and County and Northumberland County). The Central East LHIN has brought CMHA‐KL and CMHA‐P together in a facilitated integration process to develop a stronger integrated community based mental health services delivery model for the North East Cluster. It is the LHIN’s mandate to promote integration opportunities that enhance both the client experience and achieve greater value for money (e.g., efficiency). It is the position of the Central East LHIN that additional integration of mental health services across its North East Cluster will improve ease of access and navigation to community services for mental health clients and will leverage existing local governance, management, back office support, front‐line service delivery, volunteerism and fund raising currently provided by CMHA‐KL and CMHA‐P. The objective of this integration is to integrate CMHA services in the North East Cluster to: •
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Strengthen community based mental health services, Achieve a higher level of service delivery in existing programs and create the ability to introduce new programs, Reach out to clients in underserviced areas, Provide more efficient use of existing resources, Create a seamless delivery model that improves access to care, Establish more accountability to match funding with needs of local communities and clients, and Build stronger partnerships with other cluster‐based providers including educators, primary care providers and local law enforcement organizations. 3 2.3 Description of Mental Health Services For purposes of this integration initiative, mental health is defined as “a state of well‐being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community"1. Mental health services in Ontario are considered to include the following functions: • • • • • • • • • • • • • Identification/Early Intervention Treatment Crisis Supports Consultation Coordination Residential Support and/or Housing Case Management/Coordination Social Support Vocational Support Self‐Help/Peer Support Family Support and Advocacy Health Promotion/Public Education Court Support/Diversion/Release from Custody 2.4 Description of the Canadian Mental Health Association The Canadian Mental Health Association (CMHA) was founded in 1918 and is one of the oldest voluntary organizations in Canada. Each year CMHA provides direct service to more than 100,000 Canadians through the combined efforts of more than 10,000 volunteers and staff across Canada in 135 branches. As a nation‐wide, voluntary organization, the CMHA promotes the mental health of all and supports the resilience and recovery of people experiencing mental illness. The CMHA accomplishes this mission through advocacy, education, research and service. CMHA’s vision is “Mentally Healthy People in a Healthy Society.” CMHA focuses on combating mental health problems and emotional disorders using tools such as research and information services, sponsored research projects, workshops, seminars, pamphlets, newsletters and resource centres. The CMHA’s programs assist with employment, housing, early intervention for youth, peer support, recreation services for people with mental illness, stress reduction workshops and public education campaigns for the community. In addition, the CMHA acts as a social advocate to encourage public action and commitment to strengthening community based mental health services and legislation and policies affecting services. All CMHA’s mental health projects are based on principles of empowerment, peer and family support, participation in decision‐making, citizenship, and inclusion in community life. CMHA Ontario was founded in 1952 and is a non‐profit, charitable organization committed to improving the lives of people with mental illness and their families, and to the promotion of mental health for all Ontarians. CMHA Ontario achieves its mission through public education, applied research and policy analysis, and advocating for healthy public policy and an effective and efficient health system. Ontario's 32 local CMHA 1
World Health Organization 4 branches provide direct services and supports to communities across the province. CMHA‐KL Branch and CMHA‐P Branch provide services to the Central East LHIN North East region. Both CMHA organizations fulfill their mission by: •
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Providing a range of responsive programs; Educating the wider community regarding mental health issues; Developing and operating community‐based mental health programs; Working closely with other related services in the community; Participating in the development of other suitable programs in the community. Additional details on these services are provided in Section 3. 2.5 Principles Guiding Integration For the purpose of facilitating an integration of CMHA services in the North East region, the Central East LHIN sought consensus with CMHA‐KL and CMHA‐P on a set of foundational principles to guide the integration process, dialogue and outcomes. These principles were agreed upon by the parties and served as the basis for establishing integrated mental health services. All parties recognized at the onset of this process that specific details, strategies and tactics supporting integration would evolve throughout the process, and that the principles are foundational guides subject to revision only with the support of all parties. The principles agreed to are identified under service delivery, process and end‐state categories. The foremost principle focuses on the client and how best to meet their needs. The full set of principles agreed to by the parties is included in Appendix B. 2.6 Canadian Mental Health Association Integration Planning Team The Central East LHIN, CMHA‐KL and CMHA‐P approved and signed‐off on a set of principles to guide information sharing and integration planning activities. The Central East LHIN’s preferred approach to the integration is through facilitation and negotiation. The Central East LHIN committed resources and expertise to work with the parties to collectively develop and successfully implement the integration of consumer support services according to the approved principles. The Central East LHIN, CMHA‐KL and CMHA‐P agreed to establish a Canadian Mental Health Association (Central East LHIN NE Cluster) Integration Planning Team (Planning Team) to develop and implement an Integration Plan in accordance with the approved principles. A Terms of Reference was developed and approved by the Planning Team on May 3, 2011 (see Appendix C). The scope of the Planning Team is referenced in the following chart: 5 “IN” Scope “OUT” of Scope • All mental health and related services currently provided by CMHA‐KL and CMHA‐P in the North East Cluster and funded by the Central East LHIN • Governance, management and operations of CMHA‐KL and CMHA‐P • Risks and liabilities of CMHA‐KL, CMHA‐P, and the Central East LHIN • Communications and community engagement • Financial commitment of all 3rd parties • Development of an Integration Plan with associated transition costs and ongoing operating budgets • Implementation of the approved Integration Plan • Services and programs not funded by the Central East LHIN • Approval of the Integration Plan • Mental health services currently provided by other mental health agencies • Other community based mental health and support services 2.7 Facilitated and Negotiated Integration Process Under the provisions of the Local Health Services Integration Act, 2006 (LHSIA), the LHIN, the Minister of Health and Long‐Term Care and health service providers can integrate in several ways. 1. 2. 3. 4. 5. Coordinate services and interactions between different persons and entities Partner with another person or entity in providing services or in operating Transfer, merge or amalgamate services, operations, persons or entities Start or cease providing services Cease to operate or to dissolve or wind up the operations of a person or entity2 In order to execute integrations, the LHSIA provides several tools for the LHIN, the Minister and health services providers to integrate. Integration Type Description LHIN Funding LHSIA S.19 The LHIN uses its funding authority to promote integration of services with/between HSPs. Facilitated and Negotiated Integration LHSIA S.25 The LHIN and/or HSPs explore appropriate integration strategies and the LHIN facilitates or negotiates integration with the HSPs. Required Integration LHSIA S.26 The LHIN orders HSPs to integrate services. Voluntary Integration LHSIA S.24 & 27 A HSP at their own initiative plans to integrate services funded by the LHIN. Minister’s Order LHSIA S.28 The Minister orders a HSP to integrate i.e. cease to operate, dissolve, wind‐
up its operations, amalgamate or transfer operations. 2
It is important to note that the LHIN does not have the authority to integrate by “Ceasing to operate or to dissolve or wind up the operations of a person or entity” (#5). This authority is reserved for the Minister of Health and Long‐Term Care and/or the voluntarily by the persons/entities involved. 6 Through a LHIN facilitated process the appropriate resources and expertise available through the Central East LHIN support CMHA‐KL and CMHA‐P in developing an Integration Plan. The Central East LHIN provided CMHA‐
KL and CMHA‐P with a Facilitated and Negotiated Integration Process and Requirements Guide outlining the key process steps, best practices and documentation requirements associated with obtaining Central East LHIN approval of a facilitated and negotiated integration. In line with the approved Principles and Terms of Reference the Planning Team engaged in a series of meetings and discussions to develop a “facilitated and negotiated” integration of mental health services in the Central East LHIN North East Cluster. The process of developing this Integration Plan proceeded along the following Critical Path: Activities and Milestone Δ Target Date Δ Joint CMHA/LHIN Meeting April 7, 2011 Initial Planning Team Meeting April 11, 2011 CMHA‐KL Board Presentation April 13, 2011 CMHA‐P Board Presentation April 20, 2011 Δ Approve Principles (Commitment to a facilitated/negotiated integration) May 3, 2011 Δ Approve Planning Team Terms of Reference May 3, 2011 Conduct Information Sharing and Due Diligence May 3 – mid‐June, 2011 Update to AGM ‐ CMHA‐P/CMHA‐KL; Update to Central East LHIN Board June 22/23/29, 2011 Community & Stakeholder Engagement #1 (Input on opportunities) July 19, 2011 Review Community & Stakeholder Engagement #1 Findings July 21, 2011 Identify Integration Opportunities July 21, 2011 Δ Status Report to Central East LHIN Board, CMHA‐KL and CMHA‐P July 27, 2011 Agreement on Opportunities and Scope August 10, 2011 Determine Opportunities Analysis Approach August 10, 2011 Finalize Analysis Work Teams Terms of Reference/ Membership (Back‐Office/Front‐Line) August 19 – 27, 2011 Complete Opportunities Analysis (Back‐Office) October 14, 2011 Status Report to CMHA‐P, CMHA‐KL and Central East LHIN Board October 19 ‐27, 2011 Complete Opportunities Analysis (Front‐Line) November 22, 2011 Status Report to Central East LHIN Board November 23, 2011 Joint CMHA Board Review Meeting November 29, 2011 Complete Opportunities Analysis (Leadership/Governance) December 2, 2011 Develop Draft Integrated Service Delivery Model December 7, 2011 Δ Agreement on Draft Integrated Service Delivery Model December 9, 2011 Joint CMHA Board Meeting Status Update/Share Draft Integrated Service Delivery Model December 15, 2011 Status Report to Central East LHIN Board December 21, 2011 7 Activities and Milestone Δ Target Date Community & Stakeholder Engagement #2 Dec 16 ‐ Jan 6, 2012 Prepare Integration Plan (Incorporating Community & Stakeholder Feedback) January 11, 2012 Sponsors and CMHA Boards Review/Comment on Draft Integration Plan January 13, 2012 Finalize Integration Plan (including Communications and Community Engagement Plan) January 16, 2012 Δ Review/Decision on Integration Plan – CMHA‐ P Board of Directors January 18, 2012 Δ Review/Decision on Integration Plan – CMHA‐KL Board of Directors January 19, 2012 Δ Review/Decision on Integration Plan ‐ Central East LHIN Board of Directors January 25, 2012 Community & Stakeholder Engagement #3 (Inform about the approved Integration) Early February 2012 Commence Implementation of Integration Plan Early February 2012 Phase 1: Transition February ‐ March 2012 Δ Phase 1: Complete April 1, 2012 Phase 2, 3, 4 Transition Planning April 2012 – March 2013 Δ Phase 3: Assumption of Services, Assets & Liabilities by New Organization April 1, 2013 Δ Phase 4: Wind‐Up of CMHA‐KL and CMHA‐P August 2013 8 3 Current State of Community Mental Health Services 3.1 Canadian Mental Health Association ­ Kawartha Lakes 3.1.1 Organization History The first meeting in the birth of the Victoria County Branch, now referred to as the Kawartha Lakes Branch of the Canadian Mental Health Association was held on February 10, 1987 at Ross Memorial Hospital. A Steering Committee was formed from this foundation of concerned citizens gathering to discuss the mental health needs of the residents of Victoria County. The Committee identified the following needs of the community: early recognition of symptoms and appropriate treatment; post‐hospital community living facilities to support and rehabilitate consumers both socially and financially; family and client support groups; and accessibility of services. The Steering Committee was granted Branch status and in February 1989 the Victoria County Branch of the Canadian Mental Health Association was born. The operation of Harrison House began with a proposal drafted in March 1987 for a level one high‐support housing program. The program received its initial funding on February 19, 1988 and a Housing Co‐ordinator and an Administrative Assistant was hired. In March 1989, the Ministry of Housing granted the program funding for an eight bed high‐support home. On October 23, 1989, the Victoria County Branch began operating Harrison House. The house was named in memory of Kay Harrison whose vision of a residence for those individuals with psychiatric illnesses was realized. Harrison House began as a high‐support home with the ability to provide twenty‐four hour service to eight full‐time residents coping with serious mental illness. Harrison House operated conceptually under the group‐home model of service delivery, where staff provided support and assistance on a twenty‐four hour basis to the residents of the house. Prior to the restructuring and expansion of service delivery, residents of Harrison House were the primary recipients of supportive mental health services offered by the branch. Generally, residents of Harrison House initially require more intensive support in order to live in the community. Along with coping with a serious mental illness, a large portion of the residents have been involved long‐term with a psychiatric hospital. The efforts of the Board of Directors and Branch staff during the early stages of the agency’s development were focused on housing; education and public relations; organizational; fundraising; and advocating. As the Branch began to grow and the community of Victoria County began to expand, the agency began to reflect on its own mandate, values, and program evaluation. In an attempt to continue to meet the mental health needs of our changing community, the Victoria County Branch entered into a series of internal and external consultations in 1996‐1997, and began formalizing proposals and receiving approval for the inception of the Community Support Program. In adopting the model of Community Support Service Delivery, the Victoria County Branch was able to provide supportive services not only restricted to the residents of Harrison House, but also to those individuals coping with psychiatric illnesses in the community. The objectives of the Community Support Program included providing and/or assisting area residents who have ongoing, persistent, and/or significant mental health issues to access services needed in their chosen community within Victoria County. The Community Support Program provides the following services and activities: outreach and promotion of mental health, psychosocial assessment, individualized support, supportive housing, family and significant other liaison, advocacy, staff education, training and supervision, as well as ongoing program planning, development and evaluation. The evolution and development of the 9 Community Support Program continues to be an ongoing flexible and dynamic process. The services offered by the Program, and the need for services from consumer groups and the community continues to expand and increase. 3.1.2 Accreditation CMHA‐KL has achieved accreditation with Accreditation Canada3. In its evaluation Accreditation Canada awarded CMHA‐KL with high marks in the accreditation process, passing 98% of relevant standards. Several conditions were issued and by April 2011 the conditions had been met by CMHA‐KL. In May 2011 the decision awarded by Accreditation Canada was changed to “Accreditation”. 3.1.3
Organizational Structure CMHA-KL
Board of Directors
Executive
Director
Neighbourhood Housing
in Lindsay
Manager
Financial and
Organizational Services
Kawartha Lakes &
Haliburton Mental Health
Services Inc
Manager
Community Mental
Health Programs
Team Leader
Mental Health Outreach
and Family Services
Office Administrator
Administrative
Assistant
Bookkeeper
IT Support
E-Health
Office Maintenance
Human Resources
Joint Health & Safety
Committee
Accreditation
Seniors Support Network
Employment Support
Youth Mental Health
CSP Community Outreach
Program
Psycho Educational
Support Groups
Intake/Brief Services
Public Education
Early Psychosis
Intervention, Family
Support
Psycho Educational
Support Groups
Team Leader
Housing and Case
Management
Harrison House
Market Square
Apartments
Homelessness
Initiative
Voluntary Finance
Planning and
Management
Case Management
Psycho Educational
Support Groups
Team Leader
Justice Services and
Case Management
Court Support/
Diversion
Release From Custody
Human Services &
Justice Coordinating
Committee
Case Management
Social Recreation
Psycho Educational
Support Groups
The Board of Directors are volunteers and their role is to govern the agency, establish long‐term and short‐
term goals, objectives and priorities in meeting the needs of the community and be accountable for funds expended in the delivery of services. 3
Accreditation Canada (formerly Canadian Council on Health Services Accreditation) a not‐for‐profit, independent organization that provides health organizations with an external peer review to assess the quality of their services based on standards of excellence. Accreditation Canada is accredited by the International Society for Quality in Health Care and has been fostering quality in health services across Canada and internationally since 1958. 10 The Executive Director’s role is to oversee strategic planning, overall administration and day‐to‐day direction, management, control and coordination for the operation and relevance of mental health programs and services. 3.1.4 Role of Volunteers CMHA‐KL has volunteers who assume governance and leadership responsibilities and volunteers who provide front line assistance. Governance and Leadership Volunteers are involved with the Board of Directors. There are currently 12 volunteers serving on the Board of Directors. There are an additional 29 Front Line Assistance Volunteers involved in various activities such as social recreation, food bank, administrative support (including attending phone/reception etc.) fundraising (dinner/dance, auction, bingo, Lindsay exhibition parking, food court). For each fundraising initiative there is a specific designated volunteer pool. 3.2 Canadian Mental Health Association ­ Peterborough 3.2.1 Organizational History CMHA‐P was established in 1951. Between 1951 and 1979 the organization provided advocacy for the mentally ill and community mental health education. Funding was provided by a United Way grant and services were provided by 1 paid staff and supported by volunteers. Since 1979 the organization has provided supportive housing and by 1986 had an 18 member Board of Directors, 4 part time staff, 6 programs, a budget of $82,965 and worked out of two rooms at St. Andrew’s United Church. On February 22, 1988, the CMHA‐P was incorporated by the Ministry of Consumer and Commercial Relations. By 1989, the budget increased to over $500,000, partly as a result of funding received for Level I house from both the Ministry of Housing and the Ministry of Health, and staff comprised 10 full‐time and 7 part‐time employees. In 1991 the agency was divided into 5 departments: Administration, Property Systems, Supportive Housing, Residential Services and Community Self‐Help, with corresponding committee members on the Board. Dual diagnosed and multiple diagnosed clients were included in the range of services. Total budget was approximately $850,000. In 1992 staff moved to 349A George Street North to accommodate 23 full‐time, 18 part time staff and a growing number of clients. 1993 marked the beginning of the transformation of mental health services across Ontario. A 18‐month divestment plan commenced in July 1993 to assist consumer/survivors in operating a drop‐in centre. The Carver Model of Governance was also adopted by the Board. In 1994, CMHA–P created a “Getting the Word Out” package to assist in educating government officials and the community about the importance of mental health. A new policy and procedures manual was developed and the client base for dually diagnosed individuals expanded as a result through D’Arcy Place closure in Cobourg. CMHA‐P housed 52 individuals and couples requiring various levels of support to remain living in the community as well owned and managed 11 housing properties consisting of a total of 36 units. 11 In January 1996, CMHA‐P was successful in securing $82,000.00 for two non‐clinical Case Managers for Peterborough County. This enhancement came from the Ministry of Health Community Investment Fund. The submission was a joint proposal with the Peterborough Civic Hospital Mental Health Services (now known as Peterborough Regional Health Centre). In 1997‐1998 some of the challenges CMHA‐P faced included the introduction of Bill 142: Ontario Works Legislation/Ontario Disability Support Plan, Bill 111: Mental Health Act legislative changes, the Ministry of Municipal Affairs and Housing devolution of housing to municipalities, and the restructuring of the Haliburton, Kawartha & Pine Ridge District Health Council to include Durham County. Between 1997 and 2002 many new programs and partnerships were established. 2000–2001 marked the 50th anniversary of the CMHA‐Peterborough Branch and the organization secured a new office location at 466 George Street North, Peterborough. A partnership was initiated with Human Resources Development Canada to continue the work with consumer/survivors of serious mental illness to utilize their skills to assist other consumer/survivors in employment readiness, computer skills and life skills development. The Peer Training Resource Centre developed the Making it Work! employment and vocational training program. In 2001 there was a major expansion of housing and supports to homeless people along with case management supports to individuals on Community Treatment Orders. The Ministry of Health and Long Term Care expanded funding to accommodate 40 housing units and support to the literal homeless and those at imminent risk of becoming homeless. Between 2001 and 2003 CMHA‐P continued to establish new programs and partnerships and engage with other community service providers to share and develop relationships to better serve individuals with significant mental health issues living in the community. During 2003‐2004 CMHA‐P developed a Service Delivery System that incorporated the organization’s Operating Principles, the principles of Recovery and Psychosocial Rehabilitation, best practices in mental health care, the need for a continuum of mental health services, and efficient and effective use of resources. The Service Delivery System was put into operation in January 2004. A Continuous Quality Improvement Committee was established, the purpose being to continuously examine and improve systems and processes resulting in providing clients with more responsive, effective and efficient services. Board and staff reviewed and rewrote various personnel policies and procedures of the Branch. Fifty‐eight policies and procedures were adopted. By 2005 CMHA‐Peterborough had received $957,650 to develop a four county Early Psychosis Intervention Program, Crisis Management Services for the four counties followed by the development of a HKPR Human Service & Justice Coordinating Committee. In February of 2005 the branch received a further increase of $504,000 to expand Community Mental Health Services which lead to implementing a four‐county support program along with forensic intensive case management supports. Further crisis funding also allowed the expansion of crisis services thereby providing a crisis outreach component. 12 In March 2006, the Ministry of Health provided funding to expand case management positions in Peterborough County and increase psychiatry supports as well as develop peer support services and 6 crisis stabilization beds. Funding was received for a total of 64 housing units (12 service enhancement and 52 supportive housing units) which were shared with the Northumberland Region in a unique partnership with Northumberland Hills Hospital and Campbellford Memorial Hospital. On November 22, 2006, CMHA‐P hosted the Canadian Council on Health Services Accreditation (CCHSA) where a decision was unanimously supported to prepare and be measured by national mental health standards with the evaluation set for March 2008. On June 1, 2007 Crazy Cooks Catering now known as Catering Plus (formerly operated by the Ontario Council of Alternative Business (OCAB) from Toronto), officially became a part of CMHA‐Peterborough. In February 2008, CMHA‐Peterborough was the successful recipient of $216,000 to deliver programs to individuals living in poverty including homelessness outreach, trusteeship services, and primary health care services. In March 2009 the branch joined the Ontario Telemedicine Network as a member. The OTN service enabled CMHA‐Peterborough to access more than 700 sites within Ontario as well as the opportunity to participate in one of the world’s largest collaborative community of telemedicine‐enabled organizations, allowing participants in clinical, educational and healthcare administrative events. From April to September 2009 Accreditation continued to be the main focus of the branch and as of November 2010, CMHA‐Peterborough received full Accreditation. As of April 1, 2011 the integration process initiated by the Central East LHIN’s for Survivors Psychiatric Advocacy Network (SPAN) to amalgamate with CMHA‐Peterborough Branch was concluded and finalized. The Consumer survivor initiative operating in Kawartha Lakes is now known as Kawartha Lakes Reach for Recovery. CMHA‐P provides a wide range of community mental health services across the four counties. Its annual operating budget exceeds $8 million and the workforce has grown to 90 full‐time and 68 part‐time positions. 3.2.2 Accreditation As of November 2010 CMHA‐P is an accredited organization through Accreditation Canada4 with a 3 year award without conditions (2011‐2014). As part of the accreditation CMHA‐P has been recognized as a leader in peer support. 4
Accreditation Canada (formerly Canadian Council on Health Services Accreditation) a not‐for‐profit, independent organization that provides health organizations with an external peer review to assess the quality of their services based on standards of excellence. Accreditation Canada is accredited by the International Society for Quality in Health Care and has been fostering quality in health services across Canada and internationally since 1958. 13 3.2.3
Organizational Structure (high­level) Board of Directors
CMHA - Peterborough
Executive Director
Accreditation
Coordinator
Director of
Human Resources,
Finance & Housing
Director of
Programs & Services
Case Management &
Mental Health
Human
Resources
HKPR
Early Psychosis
Case Management &
Dual Diagnosis
Information Systems &
Technology
REACH Centre
REACH @ Charlotte
Court Diversion
Court Support
Supportive
Housing
Consumer Survivor
Services
Kawartha Lakes
Homelessness
Partnership
Strategy
Housing
Maintenance
“Making it Work”
Trustee
Coffee PLUS
Catering PLUS
Health Promotion/
Public Education
Volunteer Development
Consumer Survivor Initiatives Program
Director of
Programs & Services
Finance
4 Counties Crisis:
Safe Beds
Administration
& Reception
The Board of Directors are volunteers and their role is to govern the affairs of the agency in accordance with the mission statement, vision/values and principles, plan, establish priorities, review, monitor and evaluate the overall delivery of services, ensure proper administration of resources. The Executive Director’s role is to provide leadership for the overall operation of the agency ensuring policies and directions of the agency are implemented in accordance with the mission statement. 14 The role of Program Directors is to manage the programs and services offered by the agency, recruit, manage, evaluate and support volunteers and assigned staff, actively develop community partnerships to enhance the life of clients, collaborate with other community groups to enhance goals and strategies. The role of the Director of Human Resources, Finance and Housing is to manage the overall financial, administrative, human resources and information technology operations and housing of the agency. 3.2.4 Role of Volunteers Volunteers are utilized from time to time in governance and front‐line services. Currently there are 140 active volunteers and of these 12 serve on the Board of Directors. CMHA‐P endeavours to accommodate volunteer requests to assist usually in line with individual career development goals or special interest opportunities. As with all new staff, volunteers are systematically oriented to the agency and the program area in which they will participate. Volunteer opportunities include: •
•
•
•
•
•
Kids on the Block Sound Recreation Volunteer Reception Volunteer Crisis Cupboard Volunteer Volunteer Coffee Counter Attendant Gardening Volunteer CMHA–P also provides numerous student placements each year (10 students in 2010). Students are from Master’s, Bachelor’s and Diploma programs from College and University institutions. Disciplines include nursing, social work, social services, administrative, criminology, public relations, accounting, etc., placements. 15 3.3 Key Operational Information The following table highlights key operational information of CMHA‐P and CMHA‐KL – (June 2011). Activity/Criteria
Financial: ‐ 2011/12 Central East LHIN Funding ‐ Ministry of Health – Paymaster (To)/From Other Agencies ‐ Ministry of Health – Housing (Rent Geared to Income & Operations) ‐ Ministry of Health – Housing Capital Reserve ‐ Ministry of Health – Rent Supplement ‐ Ministry of Community and Social Services ‐ Ministry of Training, Colleges and Universities ‐ Payment for Services from Other Service Providers (e.g. Back Office) ‐ City of Peterborough (Vocational Employment) ‐ City of Kawartha Lakes (Homelessness Strategy) ‐ United Way ‐ Other Grants (e.g. Trillium, MCSS Supplements, etc.) ‐ Rental Income for Housing Units ‐ Donations and Fundraising ‐ Sales ‐ Cleaning Services ‐ Training Services ‐ Miscellaneous (e.g. Interest) Total ‐ Projected Surplus/Pressure CMHA‐P $6,472,658 (1,050,458) $378,854 $16,329 $401,337 $1,003,125 $166,805 $50,000 $209,469 $32,241 $107,516 $120,000 $86,147 $30,450 $10,673 $30,947 $8,066,093 0 $25,000
$5,000
$2,111,852
0 80% 70%
1,957 43,693 1,755
16,590 Central East LHIN Funding (%) Total 2011/12 CSS In‐Home/Community Services Funded by the Central East
LHIN (M‐SAA Form 3a): ‐ Individuals Served (Unique Individuals) ‐ Visits Services (Visits) ‐ Case Management Mental Health ‐ MH Clubhouses ‐ Early Psychosis Intervention ‐ Forensic Case Management ‐ Court Diversion ‐ Crisis Intervention – Mental Health ‐ Residential MH – Support Within Housing ‐ Residential MH – Crisis Short Term Support Beds ‐ HKPR Family Caregiver Network Total Board of Directors Year Agency Established Year Incorporated: Charitable Not for profit CMHA‐KL
2011/12 7,400 3,962 4,962 1,440 1,540 11,904 5,316 7,169 _____ 43,693 14 positions 12 active members 2 vacancies 1951 1988 $1,474,792
$111,757
$82,792
$1,719
$160,263
$43,000
$65,242
$25,000
$67,287
$50,000
2011/12
7,065
85
900
8,050
490
16,590 12 positions
12 active members 0 vacancies 1989 1990 16 Activity/Criteria
Current Staff Positions (FTEs) ‐ Admin and Support ‐ Trustee Support ‐ Case Management Mental Health ‐ MH Clubhouses ‐ Early Psychosis Intervention ‐ Forensic Case Management ‐ Court Diversion/Release From Custody/Bail Support ‐ Crisis Intervention – Mental Health ‐ Residential MH – Support Within Housing ‐ Residential MH – Crisis Short Term Support Beds ‐ Consumer Survivor – Alternative Businesses ‐ Vocational Services ‐ Consumer Survivor Initiatives ‐ Family ‐ Adult Supports Daily Drop In – Social/Recreation ‐ Case Management Dual Diagnosis ‐ Crisis Response Network ‐ Homelessness Partnering Strategy ‐ Health Promotion ‐ Marketed Services ‐ Volunteer Coordination Total CMHA‐P Staff
FTE 13
8.93 2
1.60 12
11.00 6
5.61 13
4.95 1
1.00 1
1.00 32
22.27 12
10.96 14
7.72 15
3.82 6
2.0 2
1.60 16
9.74 1
1.00 2
2.00 2
1.80 7
3.68 1
0.40 158 101.08 CMHA‐KL
Staff
FTEs
*6
5.00
1
.80
*6
4.47
*1
.60
5
5.00
7
7.00
*1
.33
1
1.00
____
25 ____
24.20 * Indicates some individual staff assigned to more than one service Current Full Time Employees Current Part Time / Relief Employees FTEs 2010/11 Volunteers (including Board members) 90 68 101.08 24
1 24.2 140 active 41 active % 2.39 11.89 7.56 53.58 24.58 100.00 31.5 26.8 7.6 10.7 23.4 7.7 3.2 1.1 CMHA‐P CMHA‐KL Total Number of Clients Served by Location 2010/11 Actual (Total of Unique and Non‐Unique Individuals) Number Location
Number 93 22 Haliburton
464 2,242 Kawartha Lakes 295 12 Northumberland 2,090 56 Peterborough 959 67 Other 3,901 2,405 Total Population Served (M‐SAA Schedule A)
Anyone over 16 with a mental health diagnosis. Mood Disorder
Schizophrenia Personality Disorder Anxiety Disorder Other Serious Mental Illness Concurrent Disorder Dual Diagnosis Community Treatment Order Unknown %
.91
93.22
.50
2.33
2.79
100.00 48.0
0
5.0
23.0
22.0
20.0
0
0
1.0 17 CMHA‐P CMHA‐KL Geography Served (M‐SAA Schedule A)
‐ Case Management ‐ Mental Health: City and County of ‐ Case Management – Mental Health: City of Kawartha Peterborough Lakes; ‐ Supports Within Housing: City and County of ‐ Release from Custody Program: includes Four County Peterborough area including Peterborough, Haliburton, ‐ PC – MH Diversion and Court Support: Lead agency for Northumberland, Durham, Region of Brock; Release Four Counties (HKPR); CMHA services are provided from Custody program provides services across the primarily in City and County of Peterborough province ‐ PC – MH Forensic: City and County of Peterborough ‐ Mental Health Clubhouse: Lead agency for Four ‐ Supports within Housing: City of Kawartha Lakes Counties (HKPR); CMHA services are provided to City ‐ Mental Health Diversion and Court Support: City of and County of Peterborough, City of Kawartha Lakes, Kawartha Lakes, Haliburton, Region of Brock, Durham Haliburton County and Northumberland County ‐ Family Initiatives: City of Kawartha Lakes, Haliburton, ‐ Consumer /Survivor Initiatives ‐ Alternative Peterborough Businesses: City and County of Peterborough ‐ Early Intervention – Family Supports: City of ‐ MH Early Intervention: Lead agency for Four Counties Kawartha Lakes (HKPR); CMHA services are provided primarily to City and County of Peterborough with the Family Support and Education program provided to the HKPR area ‐ Crisis Intervention and Short Term Crisis Support Beds: Crisis phone line services accessible to all 705, 905, and 416 area codes, majority of callers from the (HKPR) Four County areas. Other services of the program – Mobile response, Short Term Case Management and Crisis Safe Beds provided to clients from the HKPR‐Four County areas Offices ‐ Number and Locations
Owned by Corporation Owned by Corporation
466 George Street N., Peterborough (Head Office) 51 Adelaide Street North, Lindsay (Harrison House) 648 George Street, Peterborough 174‐176 Rubidge Street, Peterborough 767 Water Street, Peterborough 568 Charlotte Street, Peterborough 267 Park Street, Peterborough 548 Barker Avenue, Peterborough 311 Stewart Street, Peterborough 564 Sherbrooke Street, Peterborough 60 McDonnel Street, Peterborough 674 Reid Street, Peterborough 604 Stewart Street, Peterborough Owned by Canadian Mental Health Association – Non Profit Housing Corp. of Peterborough 24 Paddock Wood, Peterborough ‐ (Oct. 2006) Rental Property Rental Property 3 Kent Street West, Lindsay (Lease – 5 year) 2 Kent Street West, Lindsay (Head Office – Lease under 180 Charlotte Street, Peterborough (Lease – 1 year) negotiation) 18 3.4 Access to CMHA Services in the Central East LHIN North East Cluster CMHA North East Cluster
Access to Community Mental Health Services
KEY to Service
Provider
Client direct
contact or referral
from other
source
CMHAPeterborough
CMHA
Intake
CMHA-Kawartha
Lakes
Assessment of Need
&Triage
Four
County Crisis
Crisis Service
Stabilization and
Redirection
Rapid
Response
Services
Non-Rapid
Response
Services
Court Services
Brief Services
Release From
Custody
Senior Support
Assessment of Need
& Triage
Referral to
Other
Organization or
CMHA Service
Telephone Crisis
Intervention
Mobile Crisis
Intervention
Case Management
Client needs
coordinated
across programs
Community
Treatment Orders
Crisis
Services
Client needs
coordinated
across programs
Short-Term Case
Management
Homelessness
Housing
Specialized Network
of Care
Early Psychosis
Intervention
Family Services
Crisis/Safe Beds
Justice Services
Intake
Assessment of
Need & Triage
conducted by
program
Peer Support
Dual Diagnosis
Health Promotion &
Education
Vocational Services
Trustee Services
Intake
Assessment of
Need & Triage
conducted by
program
Psychoeducational
Support Groups
Client contacts
CMHA program
directly
19 3.5 Summary Description of Client Services 3.5.1
Intake Services CMHA ‐ Peterborough CMHA ‐ Kawartha Lakes Intake The central point of entry and contact for prospective clients. Intake services respond to phone calls and walk‐
ins. The service ensures eligible access to CMHA‐P services and links/refers to external programs when required. Prospective clients may also enter directly through the individual programs. Intake
The central point of entry and contact for prospective clients. Intake services respond to phone calls and walk‐
ins. The service ensures eligible access to CMHA‐KL services and links/refers to external programs when required. Prospective clients may also enter directly through the individual programs. 3.5.2
Crisis Services CMHA ‐ Peterborough CMHA ‐ Kawartha Lakes Crisis Service First response to clients in crisis (suicide, emotional first‐aid, etc.) who call‐in or drop‐in to CMHA‐P directly during normal business hours (rather than contacting Four County Crisis). Clients are stabilized before being transferred/redirected to Four County Crisis, CMHA‐P Case Manager or to external partner (hospital, police, etc.) Crisis Service
First response to clients in crisis (suicide, emotional first‐aid, etc.) who call‐in or drop‐in to CMHA‐KL directly during normal business hours (rather than contacting Four County Crisis). Clients are stabilized before being transferred/redirected to Four County Crisis, CMHA‐KL Case Manager or to external partner (hospital, police, etc.) Four County Crisis Telephone Crisis Intervention: A non‐medical service providing assistance to individuals experiencing mental health problems with 24 hour telephone support and referral to appropriate services. Mobile Crisis Intervention/Short‐Term case Management: Assessment may lead to outreach through a mobile team or short term case management services available within the program. Specialized Network of Care: Provides short‐term intensive case management services to people with a dual diagnosis (intellectual disability/mental illness) and intellectually challenged individuals. Services include: community outreach, assessment/referral, crisis prevention and intervention, life and social skills development linking, coordinating and advocating services with other organizations. Crisis/Safe Beds: Six crisis/safe beds are also available for individuals meeting criteria for a 3 – 10 day stay to assist them gain stability and make linkages to appropriate services. Specialized services are available for those individuals in crisis with concurrent disorders or those with an intellectual delay experiencing a crisis. 20 3.5.3
Rapid Response Services CMHA ‐ Peterborough Court Services CMHA–P is the lead agency for a four county Court Support Service. This service assists those individuals experiencing a mental illness, dual diagnosis or concurrent disorder who have been charged or could be charged with a minor criminal offense, who are in the Peterborough court system. It provides these individuals with supports and referrals from within the court to direct them away from the criminal justice system. Intensive Case Management: Provides support services to people with mental illness who are also in conflict with the law for up to 1 year. The program provides appropriate linkages with other mental health services as well as criminal justice, corrections, and social services, in order to improve service coordination and support. Assistance is provided with access and maintenance of psychiatric services, systemic advocacy and coordination, and supporting people to manage crises. CMHA ‐ Kawartha Lakes Court Services
Court Diversion: Provides assistance for individuals with mental illness or symptoms of mental illness that are in conflict with the law. A diversion plan is facilitated as a suitable alternative within the criminal justice system. CMHA‐KL works collaboratively with community partners including Court Officials, Police, Crown Attorney, Legal Counsel, Mental Health Agencies, Social Services and other community agencies to provide linkages for treatment and support where required, in order to minimize the possibility of further involvement in court and ensure appropriate mental health supports and follow‐up as needed. Participants may qualify if they have been diagnosed or suspected to have a mental health concern, are 16 years of age or older, have been charged with an offense, agree to voluntarily participate in our program and have approval from the Crown Attorney. Court Support: This program allows staff to provide advocacy, support and case management for clients not accepted for diversion in the criminal justice system, by working collaboratively with them and their community partners. Intensive Case Management: Provides support services to people with mental illness who are also in conflict with the law for up to 1 year. The program provides appropriate linkages with other mental health services as well as criminal justice, corrections, and social services, in order to improve service coordination and support. Assistance is provided with access and maintenance of psychiatric services, systemic advocacy and coordination, and supporting people to manage crises. Release From Custody
The Release from Custody program assists individuals living in Ontario with mental illness in the transition from incarceration to the community. This is done cooperatively with the other CMHA‐KL programs and other agencies in the community. Direct services include, but are not limited to: psychosocial assessment, treatment planning, intensive case management, outreach, advocacy, community education, program development, training, and consultation. Intensive Case Management services are provided throughout Kawartha Lakes, Haliburton, Northumberland, and Peterborough and provide case management services including linkage, referrals, and follow up care throughout Ontario. CMHA‐KL acts as the paymaster for Release from Custody services in Durham Region. 21 CMHA ‐ Peterborough Homelessness A collaboration between CMHA‐P, Peterborough Social Planning Council, the Peterborough County‐City Health Unit and VON Peterborough office to provide prevention services to homeless individuals in both the city and the county. The program includes community outreach, trustee services, as well as medical services for the homeless to find and maintain housing, employment and vocational opportunities. Early Psychosis Intervention CMHA–P is the lead agency for a four county rapid response treatment program (Lynx) for individuals in early stages of a psychotic illness. The Lynx program also provides family supports and community education. 3.5.4
CMHA ‐ Kawartha Lakes Senior Support
The Senior Support Network is a specialized Mental Health Case Management program geared to the needs of seniors. The program offers a rapid response service where seniors living in the community with a mental illness who are identified as being in crisis will be provided an assessment within 72 working hours of notification to the program. Seniors enrolled in the program on an on‐going basis receive intensive case management services from staff members who have been trained in seniors mental health. Homelessness
The program addresses the needs of people with serious mental illness who are homeless and/or at risk of becoming homeless by offering Intensive Case Management services, sometimes in combination with rent supports, in order to maintain their home in the community. Clients admitted to this program typically present with heightened mental health presentations including longer duration of symptoms, increased frequency of relapse, long‐term chronic symptoms, and transient housing patterns as well as co‐morbid symptoms. Direct services provided by this program include, but are not limited to: Intensive Case Management, rent supplements, psychosocial assessment, brief counselling, outreach, advocacy, community education, program development, training, and consultation. Early Psychosis Intervention
Funds received from CMHA‐P to provide information and intensive support to family members of individuals who are enrolled in the Early Psychosis Intervention program. Another goal of the program is to enhance the knowledge and skills of professionals in the community (teachers, nurses, social workers, personal support workers, clergy, etc.) regarding mental illness including enhancing skills in identification and appropriate intervention. Non­Rapid Response Services CMHA ‐ Peterborough Brief Services Brief services provide intensive, short‐term case management and/or brief counselling services for individuals with mental health issues. The brief services format allows a response to concerns in a timelier manner and to meet the needs of more people in the community. CMHA ‐ Kawartha Lakes Brief Services
Brief Services provide intensive, short‐term case management and/or brief counselling services for individuals with mental health issues. The brief services format allows a response to concerns in a timelier manner and to meet the needs of more people in the community. Counsellors in the program use clinically‐
based solution‐focused counselling and techniques from reality therapy, narrative therapy, CBT, and Dialectical Behaviour Therapy (DBT) to address an individual’s unique mental health needs. 22 CMHA ‐ Peterborough Case Management Case Management provides intensive case management services to support individuals with a serious and persistent mental illness, concurrent disorder or forensic population to be able to live in the community. Community Treatment Order CMHA‐P provides a Community Treatment Order (CTO) program. A CTO is an order to provide a person who suffers from a serious mental disorder with a comprehensive plan of community‐based treatment or care and supervision that is less restrictive than being detained in a psychiatric facility. The program assists individual’s follow‐up in the community as an alternative to hospitalization. The CTO plan identifies what the person and their supports (e.g. family, friends and health care professionals) must do to help them stay out of the hospital and includes intensive case management support. CTO’s are intended for those who have a serious mental illness and a history of repeated hospitalizations where a doctor has examined the individual and believes the person requires continuing treatment and care or supervision while residing in the community. Housing The CMHA‐P owns and manages 13 properties consisting of a total of 35 Rent Geared to Income units dedicated to the seriously mentally ill and dual diagnosed population. CMHA‐P also administers 104 Rent Supplement units with 24 in Northumberland along with 10 strong Community Rent Supplement units with the City of Peterborough. An additional 8 Rent Supplement units have recently been allocated for the addiction population. CMHA‐P will provide the property management and FourCAST will provide the case management supports. CMHA ‐ Kawartha Lakes Case Management
Case Management provides intensive case management services to support individuals with a serious and persistent mental illness, concurrent disorder or forensic population to be able to live in the community. Aspects of the service include community outreach, assessment/referral, crisis prevention and intervention, life and social skills development, stress management, education/coping strategies, symptom and medication management, leisure skills, linkage and advocating and coordinating services with other agencies, health care workers and with resources in the community. i.e. Ontario Works and Ontario Disability Support Program Outreach to Remote Communities: Provides counselling from trained therapists to individuals with mental illness who live in remote communities and do not have access to counselling services. The program is community based, allowing access to counselling services. Housing
Harrison House: A transitional, eight‐bed, co‐ed psychosocial rehabilitative housing program for individuals with serious mental health concerns. Rental agreements are time limited and geared toward the goal of returning to independent living. Individuals residing at Harrison House are provided case management support through CMHA‐KL. Supports are flexible and depend on the needs of the individual. Residents have the opportunity to participate in social recreation and psycho‐educational programming provided in the home, as well; residents participate collaboratively in activities of daily living and household duties. The residents as a whole, are responsible (under 23 CMHA ‐ Peterborough Family Services The Lynx program, a four county rapid response treatment program (Lynx) for individuals in early stages of a psychotic illness, also provides family supports and community education. CMHA ‐ Kawartha Lakes staff supervision) for the financial matters of the house.
Market Square Apartments: Provide safe, decent, permanent and affordable housing to people who have suffered with a mental health concern, but who are capable of living independently in the community. The apartment complex includes 6 one bedroom apartments. Hamilton Street Apartments: Provide safe, decent, permanent and affordable housing to people who have suffered with a mental health concern, but who are capable of living independently in the community. The apartment complex includes 18 one bedroom apartments. Mental Health Services Program: Provides Rent Supplements as well as financial assistance through rent supplements to individuals in the Kawartha Lakes region ages 18 and over. Individuals enrolled in this program work with a Case Manager to complete a thorough psycho‐social assessment and create a Service Plan with individualized goals geared to help the individual meet his or her personal goals. Individuals are linked with community resources based upon their identified needs. CMHA‐KL manages 50 rental units with 37 landlords and 3 seniors units with the Fenelon Area Independent Living Association. Family Services
The Lynx program, a four county rapid response treatment program (Lynx) for individuals in early stages of a psychotic illness, also provides family supports and community education. CMHA‐KL provides supports to family members of individuals enrolled in the Early Psychosis Intervention program. Services provided by the program include a full psychosocial assessment completed with the family and the development of family service planning goals. On an on‐going basis, the Family Support Worker provides the family education and information regarding mental illness. A family support group is also offered on a monthly basis. The Family Support program provides support, education, and advocacy in order to improve the lives of families and caregivers of people with serious mental illness. The goal of the program is to educate families, paid caregivers, and the general public about mental illness, stigma, and care for caregivers. Direct services provided by the program include, but are not limited to: outreach, advocacy, community education, support, and consultation. While family members and caregivers are provided with one on one counselling support and education as needed and requested, a major focus of the program is the Journeying Together curriculum (see Psycho educational Support Groups). 24 CMHA ‐ Peterborough Justice Services Short term intensive case management services to individuals with a mental illness, dual diagnosis or concurrent disorder who have been involved in the criminal justice system for minor offences. Access to this program is through the court support program. CMHA ‐ Kawartha Lakes Justice Services
Short term intensive case management services to individuals with a mental illness, dual diagnosis or concurrent disorder who have been involved in the criminal justice system for minor offences. Access to this program is through the court support program. CMHA‐KL manages a bail bond program providing short term case management services to individuals with a mental illness who are involved in the court and are released on bail to provide them with the necessary supports and linkage to needed services. Peer Support Peer Support
The Family Initiatives program links family members of The REACH Centre in Peterborough provides informal individuals who have serious mental illness to other style support through peer counselling and social recreational activities Monday to Friday 8:30am‐4:30pm. families who have similar experiences for peer support. A resource room is staffed by qualified consumer /survivors who assist those with mental illness develop The Social Recreation program (also called “Friends in computer literacy and other life skills training. Rural and Motion”) offers a wide range of social, recreational and vocational opportunities for individuals with mental local outreach services are provided through Peer Outreach workers. The facility offers a Saturday Activity illness. The focus is on providing recreation leisure Group Experience (SAGE). The REACH Centre vision is a opportunities to improve social skills, quality of life and enjoyment. Participation in the program activities place where consumers of mental health services receive support from those who understand best: their assists members to develop and build their self‐
peers. A place where quality of life is improved and vital confidence, learn a variety of life skills, increase socialization activities, strengthen informal support supports are created and where consumers direct services in a place they call their own. REACH is an contacts, foster peer support and belong to a acronym for Recovery, Empowerment, Advocacy, supportive community setting. Community, and Hope. REACH@ Charlotte is a Day Program in Peterborough providing a supportive learning environment, offering social recreational activities and life skills building for adults who live with a Dual Diagnosis. The facility is also open on Saturdays and in the evenings for social recreation activities. Catering PLUS and Coffee PLUS (People Learning Useful Skills) are two business operated by REACH providing employment opportunities in a community business setting to consumer survivors. Kawartha Lakes REACH for Recovery (KLR4R) located in downtown Lindsay is part of CMHA–P’s consumer initiative and has a life skills and peer support focus. Groups, individual support, outings, referrals and a computer lab are some of the resources available. In addition, rural outreach and social recreation programs highlight this community–based program. The Centre is open Monday to Friday 9:00am–5:00pm and currently Saturday from 11:00am–3:00pm. Dual Diagnosis Dual Diagnosis
Intensive case management services for individuals Intensive case management services for individuals living with both a mental health issue and an living with both a mental health issue and an intellectual disability. intellectual disability. Services include a 24 hour high support group home, supportive independent living (SIL) and day program supports and services. 25 CMHA ‐ Peterborough Health Promotion and Education Presentation/Workshops/Seminars: Speakers are available to interested groups requesting information on mental wellness and mental illness. Suicide Intervention Training: The Living Works model of suicide prevention uses trained facilitators to address attitudes, skills and knowledge required by professionals and caregivers to enable them to recognize and utilize a model to prevent a life being taken. Interlink Choir: An intergenerational program connecting seniors and grade six children through music and letters. Information and Referral: A service to assist individuals in accessing information on mental health or mental illnesses. An on‐site library houses books and videos specific to mental illness. Community resources available to meet the needs of those inquiring are provided. Support Groups: CMHA refers to groups offering self help support to individuals dealing with a variety of issues. Support with space and resource development is also provided. Kids on The Block: A troupe of life size puppets available to young (elementary school) audiences relaying mental health and mental wellness messages. Open Your Mind: A program available to high schools offering information on mental illnesses and the stigma and myths associated with the illness. Vocational Services The “Making it Work” program offers a positive supportive environment to assist individuals to identify, develop, and achieve their employment and educational goals. Food Services – Coffee PLUS and Catering PLUS provide employment opportunities to enable individuals to learn and use real life skills. Trustee Services A flexible financial management program offered to individuals who lack money management skills to achieve short‐term financial stability and long‐term security. CMHA ‐ Kawartha Lakes Health Promotion and Education Lectures: CMHA‐KL lectures help local businesses, organizations with their productivity issues by addressing mental health, mental illness and work‐life conflicts within their work environment. Lectures range from full‐day sessions, to quick/informative lunch and learn presentations. Workshops: Offers a number of different workshops for the community addressing a wide range of issues related to mental health including Applied Suicide Intervention Skills and Training (A.S.I.S.T.): a two‐day interactive training program that emphasizes suicide first aid. Non –Violent Crisis Intervention: A physically intensive two‐day training program these teaches non‐harmful interventions – using verbal and physical techniques. Other: CMHA‐KL staff is active in the Kawartha Lakes Community, attending community fairs, and spreading information regarding mental health and mental illness in a variety of ways. Trustee Services
A voluntary financial planning program with a range of services to allow individuals to work on goals related to financial planning and financial stability. Individuals can attend budgeting classes, receive budgeting support, choose to sign on with a Trustee who will co‐manage their funds with them while working together to help them learn to manage their finances successfully. Individuals can also receive assistance in reducing and eliminating debt. Psycho Educational Support Groups Dialectical Behaviour Therapy: Taking control of life through practicing mindfulness techniques, learning emotional regulation skills, practicing distress tolerance and setting and achieving personal goals. Assertiveness Training: The differences between 26 CMHA ‐ Peterborough CMHA ‐ Kawartha Lakes aggressive, passive and assertive personalities. Practise conflict management and other assertive skills. Depression Support Group: Identify the types of depression, common symptoms, coping skills and information on anti‐depressant medication. Health and Empowering Relationships: Definition and maintenance of healthy boundaries, clear communication and recognition of boundary violations. Grief Support: General group session for anyone dealing with the death of a loved one. Anxiety Management: Defining, dealing with anxieties and phobias, as well as understanding the causes and remedies for worry and panic. Includes learning relaxation techniques. Suicide Bereavement: Points to Recovery: Addresses the myths of mental illness, medication, taking charge, signs of change, strengths, organizing help and coping strategies. Living a Healthy Life with Chronic Conditions: Learning how to feel better, do more activities, make changes to diet and exercise, strategies to manage medications and communicate with the doctor. Journeying Together: Family members and caregivers share their experiences with each other in discussions around understanding stigma, overcoming stress, navigating the mental health system, developing a crisis plan and community resources. 27 3.6 CMHA Services by Funding Source and Geographic Region 75 5 09 76 72 5 10 76 12 72 5 10 76 40 72 5 10 76 41 72 5 10 76 51 72 5 10 76 55 72 5 10 76 56 72 5 10 76 81 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Durham Region Brock County Case Management – Mental Health
Brief Services Case Management Dual Diagnosis Concurrent Disorders Brief Services Case Management Dual Diagnosis (also includes Barrie/ Simcoe and York) Concurrent Disorders Community Treatment Orders Mental Health Counselling and Treatment
Counselling and Treatment Counselling Mental Health Vocational/Employment
Vocational Rehabilitation Mental Health Clubhouses
REACH Centre (includes Social Recreation) Kawartha Lakes REACH for Recovery Mental Health Early Intervention
Early Psychosis Intervention (Lynx Program – Family) Early Psychosis Intervention (Lynx Program) – Paymaster Early Psychosis Intervention Case Management Early Psychosis Intervention Education Mental Health Forensic Release from Custody ‐ (Paymaster to Durham Mental Health Services) Case Management Mental Health Diversion and Court Support
Court Diversion Court Support Bail Support Court Diversion Court Support (paymaster to CMHA‐KL for Court Support) Mental Health Social Rehabilitation/Recreation
Social Recreation Northumberland County KL KL KL KL P P P P P KL P KL P P KL P P P KL P KL KL KL P P KL (Source 2011‐14 MSAA) Peterborough Program/Service City of Kawartha Lakes MOHLTC Program Code Haliburton County Services Funded by the Central East LHIN by MOHLTC Program Funding and Geographic Region CMHA Branch 3.6.1
X X X X X X 28 72 5 15 76 72 5 40 76 30 72 5 40 76 60 72 5 50 10 72 5 51 76 12 72 5 51 76 20 P KL KL KL P P P P P P P P P P P P P KL KL P P KL Crisis Intervention – Mental Health
Four County Crisis (Regional program managed by CMHA‐P) Residential Mental Health – Support Within Housing
2 Hamilton Street, Lindsay (owned by Kawartha Lakes & Haliburton Mental Health Services Inc.) Harrison House, Lindsay Market Square Apartments, Bobcaygeon 648 George Street, Peterborough 174‐176 Rubidge Street, Peterborough 767 Water Street, Peterborough 568 Charlotte Street, Peterborough 267 Park Street, Peterborough 548 Barker Avenue, Peterborough 311 Stewart Street, Peterborough 564 Sherbrooke Street, Peterborough 60 McDonnel Street, Peterborough 674 Reid Street, Peterborough 604 Stewart Street, Peterborough 24 Paddock Wood, Peterborough (Owned by Canadian Mental Health Association – Non Profit Housing Corp. of Peterborough) Residential Mental Health – Short‐Term Crisis Support Beds
Four County Crisis (Regional program managed by CMHA‐P – beds located in Peterborough) Health Promotion/Education and Development – General
Public Education Psych Educational Support Groups Consumer Survivor Initiatives – Alternative Businesses
Coffee Plus Catering Plus Consumer Survivor Initiatives – Family Initiatives
Family Caregiver Network X X X X X X X X X X X X X X X X X X X X X X X X X X X X Durham Region Brock County Northumberland County Peterborough (Source 2011‐14 MSAA) City of Kawartha Lakes Program/Service Haliburton County CMHA Branch MOHLTC Program Code X X X X X 29 Ministry of Health & Long‐
term Care Ministry of Community & Social Services Ministry of Training, Colleges & Universities City of Peterborough City of Kawartha Lakes United Way Other Grants Other Fundraising KL KL KL P P P P P P P P P P P Rent Geared to Income ‐ Rent Supplements
Homelessness Units Capital Reserves Rent Geared to Income ‐ Rent Supplements Homelessness Units Addictions Supportive Housing Capital Reserves Specialized Network of Care – services to clients with Dual Diagnosis Case Management – Dual Diagnosis Day Program – REACH@Charlotte, 180 Charlotte Street, Peterborough Supported Independent Living, Group Home Vocational Program (Day Program)
Making it Work Job Development, Job Readiness/Coaching X X X X
X X X X X X X X X X X X X X X X KL Homelessness Initiative X KL P P P KL P KL KL X X X X X X X X
X Durham Region X
P Planning for Success ‐ Vocational Employment
Voluntary Trusteeship Health Promotion Homelessness Partnering Strategy Trustee Program Trillium: Economic Development
Ministry of Health Promotion & Sport: Healthy Communities Health Promotion Voluntary Trusteeship (purchase service agreement with Tri‐
County Community Support Services) Brock County Northumberland County Peterborough Program/Service City of Kawartha Lakes Funding Source Haliburton County Services Funded Directly by Other Ministries/Governments and Geographic Region CMHA Branch 3.6.2
30 3.7 Integration Planning Team Observations of CMHA Operations 3.7.1
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General: Both agencies staff are non‐unionized. CMHA‐P workforce has job‐specific job descriptions. CMHA‐KL workforce has generic job descriptions (case managers). Both agencies are not‐for‐profit corporations and registered charities. Both agencies are accredited with Accreditation Canada. Majority of funding provided through the Central East LHIN (CMHA‐KL – 70%; CMHA‐P – 80%). Both agencies receive United Way funding and are subject to United Way restrictions on their own fundraising activities. Both agencies appear to have different philosophies and organizational cultures toward service delivery and operations that reflect their local catchment areas. Back Office: Both agencies use the same financial (GP Dynamics) and human resource (QHR) systems. Both agencies use CMHA Ontario/National as their pension provider (Sun Life). Both agencies have different group benefits plans and providers (CMHA‐KL ‐ Great‐West Life; CMHA‐P ‐ Green Shield Canada). Both agencies have in‐house payroll systems through CCIM HRIS. CMHA‐KL provides financial services for two other agencies in exchange for payment and services in kind. Both agencies have plans in development for relocating their existing offices – either independently or combined with other service providers. Front­Line Direct Client Services: Both agencies use the same client information management system (EPS) and have partnered in selecting CRMS as the new client management information system compatible with OCAN (CMHA‐P is the host). Different approaches to client intake process. Different approaches to administration of the housing program. Different approaches to administration of the trustee program. Different philosophy concerning assignment of staff/case management. Early Psychosis Intervention (EPI) program is a four county program (CMHA‐P as lead agency and paymaster). Four County Crisis program is a four county program (managed by CMHA‐P). Release from Custody is a provincial program managed in the four counties by CMHA‐KL. Consumer Survivor Initiative is a four county program (managed by CMHA‐P). Organizational Leadership and Governance: Both agencies oversight provided by a volunteer Boards of Directors. Both agencies managed by an Executive Director. 31 •
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Roles and responsibilities of the Boards and Executive Directors reflect the requirements of the catchment area they serve. Both agencies have a wide‐range of management committees supporting planning and operations. 3.8 Community and Stakeholder Engagement Process Following the sharing of information on CMHA‐KL and CMHA‐P services and operations the Planning Team undertook a process during early to mid‐July 2011 to ask local residents, mental health clients, their families and caregivers, CMHA staff and volunteers and other health service providers to provide their input to support development of a new service delivery model for community‐based mental health services in the North East Cluster. Input was obtained through focus groups for 1) clients their family members and care givers and for 2) CMHA staff, volunteers and board members. Other stakeholders were asked to provide their input by completing a survey. The input request focused on the following questions: •
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the services most important to them, where new services or expanded services are required, potential opportunities for integrating services, potential barriers/roadblocks to integrating services. The following table summarizes the type of input received during the engagement process. Input Type 2 Focus Groups ‐ Clients, Family Members and Caregivers
3 Focus Groups ‐ Staff, Volunteers and Board Members On‐line Surveys E‐mailed Surveys E‐mailed Comments Hospital Meetings Total
Responses/Participants
63 participants
71 participants
37 responses 5 responses 2 responses 5 responses 183 participants/responses
3.8.1 Opportunity Themes Identified The following key themes were identified in the input from the community/stakeholder engagement process that support the identification of reinvestment potential to expand existing programs and/or create new programs/services: •
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Shared training for CMHA staff and coordinated internship programs. Common job descriptions for staff. Coordinated accreditation process and standards. Standardized/common/shared intake philosophy and process – common selection criteria. Standardized care across all geographic areas. Common/shared best practices and standards and coordinated service plans. Standardized and coordinated social recreation programs. Coordinated volunteer services i.e. recruitment, training and retention. Streamlined service delivery, improved efficiencies, reduction in duplication. Consistent, standardized, shared systems, databases and reporting processes. Enhanced performance measurement and consistency in measures and outcomes. 32 •
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Standardized policies, processes and procedures. Shared planning, risk management, quality assurance and priority setting. Shared/coordinated community education, awareness and promotion. Coordinated community fundraising – create a foundation to manage fundraising and awareness programs. Consistency to support client relocation between geographic areas. More integration of services with other community partner agencies and police. Improved equity in resource allocation between CMHAs. Creation of a single leadership and governance structure – standardized administrative functions. 3.8.2 Barriers to Integrating Services The following are the identified themes in the barriers that may potentially stand in the way of achieving the above referenced integration opportunities. •
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Different criteria for client support and access to services. Different philosophies, processes, standards, policies and systems. Communications challenges between CMHAs and other community mental health partners. Lack of ongoing funding and inequity of funding between Kawartha Lakes and Peterborough. Different definitions of programs and services. Size of the geographic area ‐ large distances across the four counties – travel time for staff and clients. Demographic and socioeconomic differences create natural geographic barriers between Kawartha Lakes and Peterborough. Perceived resistance to change – at staff and governance levels. Inability to adapt to a regional perspective. Different organizational cultures between CMHAs. Fear of loss of community identity and service loss/disruption. Fear of potential staff job loss. Volunteer process is complicated and restrictive – difficult for clients to become volunteers. Silos among health service providers. Lack of coordination and planning among agencies. 3.8.3 Most Important, Expanded and New Services All input from the community/stakeholder engagement process indicated quite clearly that all services provided by CMHA‐KL and CMHA‐P are considered important. In the event efficiencies can be achieved from integration the following represent the highest priority (in no particular order) for expanded and/or new programs and services for stakeholders: •
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Expanded crisis response services – crisis beds in Lindsay. Expanded access to rural outreach. Sustainable homelessness partnership strategies. Expanded affordable/subsidized housing in all areas (including rural). Expanded services for those with concurrent disorders. Creating awareness and advertising/promoting access to services. 33 •
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Services for families. Expanded trustee program. Community and social recreation programs. Transportation services. Employment programs. Re‐integration and transitional services. Services for seniors. 3.9 Request for Participation from Four Counties Addictions Services Team On July 12, 2011 the Central East LHIN received a letter, from the Chair of Four Counties Addiction Services Team (FourCast), expressing “interest in becoming active participants in the current process of developing a new service delivery model for community‐based mental health services in the North East Cluster”. On July 21, 2011 the Planning Team received a presentation from FourCast with additional context and rationale for the request. The Planning Team unanimously decided not to include FourCast in the CMHA integration at the time ‐ but resolved to be mindful of opportunities for FourCast (and addictions issues in general) throughout the process. The decision not to include FourCast was based on the recognition that the CMHA facilitated integration is covering new and complex territory requiring significant attention to project planning and change management and there was a desire to capture the progress made at the time without delaying the process by several months. Once the initial process of community based mental health service integration has been completed, the Central East LHIN indicated it would be examining integration opportunities with other mental health and addictions services. 34 4.
Opportunities for Integration During the information sharing and due diligence process, and in consideration of the input received through the community and stakeholder engagement process, the Planning Team identified the following integration opportunities, with increasing levels of scope, to generate operating flexibility to supporting the expansion and/or creation of new programs and services for clients of CMHA‐KL and CMHA‐P. Category Back‐Office Front‐Line Direct Client Services Scope Opportunity Description Status Quo 0 OCAN – partner in selection and operation of Client Management 1 System Replacement As above + partner in combining Financial, Human Resource and 2 Payroll systems, operations and support – normalize staff responsibilities and job descriptions As above + partner in combining policies, procedures, standards, 3 best practices and related systems, accreditation, safety and quality assurance, staff training functions, procurement As above + coordinate preparation of financial and performance 4 reporting processes As above + create a single back‐office/administration function 5 supporting both organizations – one organization to be primary provider of services 0 Status Quo (some 4 county‐wide programs i.e. EPI, 4 County Crisis) Combine Sessional Fees – partner in recruitment and services of a 1 part‐time psychiatrist (possibly expand resources from other providers) As above + coordinate all social recreation programs, rural 2 outreach, support groups, mental health education and awareness, and volunteer coordination As above + coordinate/standardize client access, intake process, 3 criteria, assessment of need (OCAN) and service allocation As above + coordinate/standardize program delivery (trustee 4 program, housing services and support, etc.) As above + merge all front‐line service operations and 5 management As above + normalize staff positions, duties and responsibilities 6 35 Category Organizational Leadership and Governance Scope Opportunity Description 0 Status Quo 1 Coordinate strategic and operational planning and plans Adopt compatible organizational philosophy applicable to both 2 organizations 3 As above + create single Chief Executive Officer 4 As above + create/coordinate single senior leadership team 5 As above + create/coordinate single management team Create separate legal entity responsible for “cluster‐wide” strategic planning, strategic relationships, performance 6 management, financial management, back‐office, etc. – jointly managed by both CMHA P & KL staff and Boards of Directors Full merger/amalgamation of CMHA‐KL and CMHA‐P – create a 7 new agency to deliver services “cluster‐wide” (name, board, philosophy, etc.) serving 4 counties. 8 Create a Foundation responsible for fundraising for both CMHAs The Planning Team agreed to move forward initially with further analysis of Back‐Office and Front‐Line Direct Client Services. Analysis of Organizational Leadership and Governance was deferred until the recommendations were available for the other categories as the “functions” may provide direction for the “form” of leadership and governance. The Planning Team agreed to establish two work teams to undertake the analysis and development of recommendation for Back‐office and Front‐Line Direct Client Services opportunities. Each work team was comprised of CMHA‐KL and CMHA‐P staff (maximum of 2 staff each per team) plus an impartial facilitator designated by the Central East LHIN and agreed to by the Planning Team. The Planning Team also agreed that the scope of the analysis, objectives, deliverables and timelines were to be set out in a Terms of Reference for each work team. The level of the analysis required would be high‐level (due to limited time for the analysis) but sufficient for the teams to make informed recommendations to the Planning Team, CMHA Boards and Central East LHIN Board. The Planning Team recognized that further detailed analysis and planning may need to be undertaken as part of the transition to integrated services approved in the Integration Plan. The Planning Team agreed that the work of the work teams would need to be completed by late‐October/early‐November 2011. The Terms of Reference for the Back‐Office and Front‐Line Direct Client Services work teams are available as part of each teams Business Case in Appendix D and E. 4.1 Back­Office Analysis Work Team A Back‐Office Analysis Work Team was established with membership from both CMHA organizations to explore the opportunities identified by the Planning Team and assess the integration potential. The work of the team occurred from mid‐September to mid‐October 2011. The details of the team’s analysis and recommendations are contained in the Business Case in Appendix D. 36 Using a consensus approach to its work, the Back‐Office Analysis Work Team recommended to the Planning Team •
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Amalgamation of all back‐office functions. The greatest benefit in terms of reinvestment potential, conservatively estimated at $253.0K annually, to front‐line direct client services will be realized with a single service provider organization serving the community mental health needs in the Central East LHIN North East Cluster. This represents both potential real cost savings and reallocation of staff effort from back‐office functions (e.g., committee work) to front‐line services. Given the similarities in the back‐office functions and that both CMHA‐KL and CMHA‐P use the same core systems, the amalgamation of back‐office functions could potentially be implemented for the start of the 2012/2013 fiscal year on April 1, 2012. 4.2. Front­Line Direct Client Services Analysis Work Team A Front‐Line Direct Client Services Analysis Work Team was also established with membership from both CMHA organizations to explore the opportunities identified by the Planning Team and assess the integration potential. The work of the team occurred from early October to early November 2011. The details of the team’s analysis and recommendations are contained in the Business Case in Appendix E. The Front‐Line Analysis Work Team indicated there is already a significant degree of coordination and partnership between many programs that produce benefits to client services. The team identified two primary options for further integration for consideration by the Planning Team. •
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Partnership ‐ assumes both CMHA organizations continue to exist and they partner in the delivery of front‐line service; this may include sharing a common set of policies, procedures, and processes (where appropriate), a formal Memorandum of Understanding (MOU) outlining roles and responsibilities, joint participation in funding opportunities, joint decision‐making in service planning and delivery, and access to a shared client database. Amalgamation – assumes there is a single CMHA organization providing community based mental health services in the Central East LHIN North East Cluster; this would include maintaining existing services based out of offices in both Kawartha Lakes and Peterborough. The Front‐Line Direct Client Services Analysis Work team did not identify any efficiencies in their report associated with either the partnership or amalgamation options. 4.3. Organizational Leadership and Governance Given the recommendations of the Analysis Work Teams the Planning Team was charged with developing recommendations for the “form” of the organizational model(s) to deliver front‐line direct client services and back‐office functions. •
Under a “partnership” model the leadership and governance elements are unlikely to change from the status quo. Both CMHA‐KL and CMHA‐P would continue to exist as separate legal entities, with separate management, separate senior executive leadership and separate Boards of Directors. Changes will be primarily in the form of formal arrangements (MOUs) to deliver services that will be 37 •
implemented through a shared management structure – management working together to determine best practices and deliver service locally. Under “amalgamation” there would be a single new CMHA organization created from the existing CMHA‐KL and CMHA‐P. Such an organization would have a single management structure, a single senior executive leader and a single Board of Directors. The new organization would adopt a single set of policies and procedures and best practices to reflect the needs of the clients and communities served. In addition to addressing the options provided by the Analysis Work Teams the Planning Team considered a range of other options for organizational leadership and governance models. 4.4. Options Considered 1. Status Quo – no change to the existing funding/service delivery structures. 2. Back‐Office and Front‐Line Partnership –both CMHA organizations continue to exist and they partner in the delivery of back‐office functions and front‐line service. For the back‐office this means functions are delivered by one organization on behalf of both organizations. For the front‐line this may include sharing a common set of policies, procedures, and processes (where appropriate), a formal Memorandum of Understanding (MOU) outlining roles and responsibilities, joint participation in funding opportunities, joint decision‐making in service planning and delivery, and access to a shared client database. 3. Strategic Alliance – a separate legal entity created with a separate Board ‐ responsibility for strategic planning, strategic relationships, back‐office functions, etc. – jointly managed by both CMHA P and CMHA‐KL staff and Boards of Directors. CMHA‐KL and CMHA‐P continue to exist with responsibility primarily for front‐line service delivery and input into overall strategic direction. 4. All LHIN Funded Services Transferred to a single existing CMHA – an existing CMHA becomes the entity responsible for delivery of all LHIN funded services and related back‐office functions in the CMHA‐KL and CMHA‐P catchment area. The other non‐LHIN funded CMHA may continue to operate independently providing non‐LHIN funded services. 5. Create a New CMHA Organization through the Voluntary Merger/ Amalgamation of CMHA‐KL and CMHA‐P – one service provider serving the CMHA‐KL and CMHA‐P catchment area with a new name and governance structure recognizing the broader geographic responsibility. 4.5. Options Analysis Option 1. Status Quo Pros
Cons • No one‐time transition costs • No disruption in client services or back‐office functions • Client services remain localized in communities • Local autonomy remains • Some services are already delivered on a four‐
county basis • Perpetuates fragmented community mental health services sector in Northeast region of the Central East LHIN • Gaps in current services will remain • Missed opportunity to enhance client services by capitalizing on potential back‐
office reinvestment conservatively estimated at $253K annually • Limits future expansion of community 38 Option Pros
Cons mental health services ‐ most new LHIN funding will only be available to “integrated” or 4 county‐wide services • Continued proportionately high administration costs. • Does not support findings of stakeholder and community engagement process • Demonstrates CMHA organizations are unable to develop integrated solutions 2. Back‐Office and Front‐Line Partnership • No disruption in client services • Builds on positive partnership experiences already in place between both organizations Back‐Office policies, processes and procedures standardized • Addresses stakeholder themes for standardization and consistency (some functions/services only) • Some reinvestment potential from back‐office operations estimated at $58K annually • Some staff coverage/back‐up benefits for back‐
office functions • CMHA‐KL and CMHA‐P corporate entities remain intact • Positioned to take on additional back‐office functions from other community service providers • Perpetuates fragmented community mental health services sector • Missed opportunity to enhance client services by capitalizing on potential back‐
office reinvestment conservatively estimated at $253K annually • One‐time transition costs – estimated at $62K for back‐office – none identified for front‐line (but anticipated) • Continued operational costs to support multiple Boards of Directors • Strategic planning and relationships continue to be managed independently • Does not fully address findings of stakeholder/community engagement process – many inconsistencies and gaps in services will remain • Complexity added to front‐line management and decision making processes – creates complicated service delivery landscape • Loss of autonomy in some key service areas • Creates governance challenges for both organizations • Not applicable to all front‐line services (based on front‐line report) 3. Strategic Alliance • No disruption in client services • Some improvement in strength of community mental health services sector • Community mental health services strategically aligned in KL and P catchment areas • Back‐office operations managed jointly across region • Single entity accountable for service delivery with the Central East LHIN • Limited or no reinvestment potential for front‐line services realized (back‐office reinvestment offset by additional processes, governance and multiple reporting) • Support required for three separate Boards of Directors • No additional funding available to support additional costs • Adds management and administrative complexity (MOUs, oversight, etc.) • Creates governance complexity ‐ challenges between the new corporate 39 Option Pros
Cons entity and the existing CMHAs –
recruitment/additional duty of board members • Added responsibility for senior leadership without compensation (no additional funding) • Substantial one‐time transition costs anticipated • Operational and cultural differences may inhibit implementation of joint strategies and results 4. All LHIN Funded Services Transferred to a Single CMHA • No disruption in client services • Realization of full potential of back‐office reinvestment to front‐line direct client services conservatively estimated at $253K annually • Consistent approach to working with clients and other hospital and community stakeholders • One service delivery entity accountable for all Central East LHIN funded programs in CMHA‐
KL and CMHA‐P catchment area • Builds on existing Four‐County model of service delivery • Improved relationships with hospital and other community partners • Consistent/standardized policies, procedures and policies applied to all front‐line services • Fully supports the themes identified in the stakeholder/community engagement process for LHIN funded services • Operational and financial support available from the Central East LHIN to support the transition • Non‐LHIN funded CMHA may continue to operate to deliver non‐LHIN funded services • Community mental health sector strengthened and positioned to engage in further integrations and service enhancements with hospital sector and other community health service providers (FOURCAST) • LHIN funded CMHA expected to adjust its by‐
laws and governance structure to reflect an expanded geographical mandate • LHIN funded CMHA not required to assume operational or financial liabilities of other CMHA • Only one service accountability agreement to be negotiated with the Central East LHIN • Expected high‐level of support from other funding bodies (MCCS, MAH, etc.) • Viewed as a “loss” in confidence for non‐
LHIN funded CMHA • One‐time transition costs will be incurred • Non‐funded CMHA will not receive transitional support from the Central East LHIN as they adjust to their new smaller mandate. • Non‐funded CMHA will be responsible for their own staffing and associated labour adjustment liabilities • There will be challenges disentangling LHIN and non‐LHIN funded services and staffing 40 Option Pros
Cons • Integration decision streamlined – can be achieved quickly through MSAA or LHSIA 5. Create a New CMHA Organization through the Voluntary Merger/ Amalgamation of CMHA‐KL and CMHA‐P • No disruption in client services • Realization of full potential of back‐office reinvestment to front‐line direct client services conservatively estimated at $253K annually • Several opportunities for efficiencies including reduced duplication of some services (social recreation, crisis services), enhanced use of consumer survivor services, potential economies of scale from consolidation of services/programs in Kawartha Lakes (KLR4R and existing CMHA‐office), etc. • Consistent approach to working with clients and other hospital and community stakeholders • Consistent/standardized policies, procedures and policies applied to all front‐line services • One service delivery entity for all Central East LHIN funded programs in CMHA‐KL and CMHA‐
P catchment area • New CMHA organization assumes all operational/financial assets and liabilities of CMHA‐KL and CMHA‐P • Only one service accountability agreement to be negotiated with the Central East LHIN • New governance structure to reflect an expanded geographical mandate • Fully supports the themes identified in the stakeholder/community engagement process • Further potential for front‐line efficiencies and service expansion/enhancement • Operational and financial support available from the Central East LHIN to support the transition • Community mental health sector strengthened and positioned to engage in further integrations and service enhancements with hospital sector and other community health service providers (FourCast) • Opportunity for a “WIN, WIN, WIN” for all parties – coming together to integrate to strengthen and expand services. • Expected high‐level of support from other funding bodies • CMHA‐KL and CMHA‐P to dissolve corporate entity once all legal obligations have been met • May be viewed as a “loss” in confidence by existing CMHA Boards even though the amalgamation will proceed voluntarily • Perceived loss of local community autonomy • One‐time Transition costs will be incurred • CMHA‐KL and CMHA‐P may choose not to voluntary dissolve corporate entities and continue to operate 41 4.6. Key Decision Factors The following key decision factors were created to evaluate integration options: •
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Adherence to guiding principles (client focus, do no harm, etc.) Opportunity for reinvestment to support expanded or new client services across the Central East LHIN North East Cluster Takes into account the key themes from the stakeholder and community engagement process Strengthens unique community based mental health services in the Central East LHIN North East Cluster Contributes to broader system integration among other providers Annual operating costs to remain within current CMHA‐KL and CMHA‐P funding envelope One‐time transition costs should not inhibit a longer‐term integration opportunity to reinvest in client services Integration should result in maintained or improved quality and adherence to best practices with minimal or no impact on service delivery 4.7. Preferred Option Given the pros and cons of all options, Option 5: Create a New CMHA Organization through the Voluntary Merger/ Amalgamation of CMHA‐KL and CMHA‐P, is preferred as it meets most of the key decision factors. The Planning Team also determined that the creation of a new organization through amalgamation would lead to more efficient delivery of front‐line services and identified the following examples that could be achieved: •
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Directing more Kawartha Lakes clients to Consumer Survivor Initiatives/peer support services (Kawartha Lakes Reach for Recovery ‐ KLR4R) freeing up Kawartha Lakes case managers for more intensive clients. Reduce duplication of social recreation services between Kawartha Lakes social recreation and KLR4R. Reduce duplication of crisis services within Kawartha Lakes. Reduction of front‐line staff on committees and other administrative work (Accreditation, policies, health and safety). Potential co‐location of Lindsay office with KLR4R. Evaluate case manager roles, caseloads, services, etc. Engage enhanced services of Acute Community Care Treatment Team or hospitals for most severe clients. Possible hub and spoke model running from a central location with satellites in key communities. Those would be augmented by outreach capacities, i.e. vans, outreach workers etc. Additional efficiencies and opportunities to enhance front‐line services are expected to be identified during the detailed transition planning (refer to Section 6 ‐ Transition). 42 5. Integrated Service Delivery Model Based on the preferred option the Planning Team developed a DRAFT Integrated Service Delivery Model for review by the CMHA‐KL and CMHA‐P Boards of Directors at a joint Board to Board meeting on December 15, 2011. At this meeting the options analysis leading to the preferred option was discussed in detail. The meeting concluded with unanimous support to proceed to obtaining stakeholder and community feedback on the Draft model described below. 5.1 Key Attributes of a Voluntary Merged/Amalgamated Organization CMHAPeterborough
CMHAKawartha
Lakes
CMHA/New
Organization
43 Access to Community Mental Health Services Remains Unchanged in the New Organization – “Every Door is the Right Door” Governance •
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Existing CMHA‐KL and CMHA‐P branches voluntarily merge/amalgamate to create a “New not‐for‐
profit charitable organization”. CMHA‐KL and CMHA‐P assets and liabilities become the responsibility of the new organization. A new Board of Directors ‐ representative of Kawartha Lakes and Peterborough communities. CMHA‐KL and CMHA‐P may dissolve once all outstanding obligations have been satisfied. Leadership and Management •
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A single executive director and management leadership team advocating for community clients. A new vision, mission and values statement and a new strategic and operational plan. A single set of operational policies/procedures that meet best practices and unique client/community needs. Accreditation from Accreditation Canada. Operations (Front‐Line and Back‐Office) •
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Community based services continue to be delivered through offices in Kawartha Lakes and Peterborough. No disruption in services to clients – “every door is the right door”. Increased outreach to rural clients and underserviced areas. 44 •
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Clients free to move within North East Cluster and benefit from flexible service options. Every effort made to minimize impact on staff and client relationships. All funding organizations and partners continue relationship with new organization. Central East LHIN funding continues to support services. Estimated $253,000 available on an annual basis for reinvestment in front‐line direct client service enhancements. Stronger cluster‐based organization – positioned to support additional service integration. Development of a Human Resources strategy for staff transition activities and Central East LHIN funding support for one‐time transition costs. Local fundraising continues to be directed to donor’s community of choice. Single back‐office to support all Finance, IT and HR needs of the amalgamated organization. Current State Organizations
Future State New Organization
CMHA-KL
Board of Directors
Executive
Director
Community Mental
Health Programs
Finance &
Organizational
Services
CMHA/New
Organization
Board of Directors
Justice Services &
Case Management
Executive
Director
Outreach &
Family Services
Housing &
Case Management
Community Based Mental Health Front-Line Services
- Four County Wide e.g.
Crisis/Safe Beds
Justice Services
Consumer Survivor Initiatives
Case Management
Housing & Supports
Etc.
Back-Office
Corporate Services
CMHA-P
Kawartha Lakes
Board of Directors
Northumberland
(Future)
Executive
Director
Four County Programs
& Services
Case Management
Programs & Services
REACH Centre
Case Mgmt. Dual
Diagnosis
Early Psychosis
Intervention
Case Mgmt. Mental
Health
Four County Crisis
Health Promotion/
Education
Peterborough
Haliburton
(Future)
Human Resources,
Finance & Housing
Safe beds
45 5.2 Proposed Implementation Timeline Key Activity/Milestone
Detailed Transition Planning ‐ Back‐Office Function
CMHA‐KL and CMHA‐P Back‐Office Functions Consolidated
Detailed Transition Planning ‐ Front‐Line Direct Client Services Detailed Transition Planning – Leadership and Governance
New Organization Launched New Organization Board Recruited and in Place
New Organization Vision, Mission, Values and Strategic Planning
Amalgamation Occurs ‐ New Organization Accountable for Service Delivery
Voluntary Wind‐Down/Dissolution of CMHA‐KL and CMHA‐P
Target Date
Feb. – Mar., 2012
Apr. 1, 2012
Apr. – Sep., 2012
Apr. – Sep., 2012
Sep. 2012 Oct. 2012 Oct. – Mar., 2013
Apr. 1, 2013
Jul. 2013 5.3 Risk Analysis – New Organization The Front‐Line Direct Client Services and Back‐Office Functions Analysis Work Teams and the Boards of Directors of CMHA‐KL and CMHA‐P identified risks associated with creating a new organization through a voluntary amalgamation/merger. These risks, an initial assessment of the risks and proposed mitigation strategies are identified below. Risk ID Risks Likelihood of Occurrence Impact of Occurrence Mitigation Strategy (Low/Moderate/High) (Low/Moderate/High)
1 • Eligibility criteria for case management vary between the two CMHAs – eligibility would need to be standardized which will impact service delivery – either more individuals eligible for service, thus creating a waitlist or a more restrictive eligibility criteria, thus decreasing access to service 2 • Perceived negative impact on service delivery by local health service provider partners (e.g. hospitals) 3 • Considerable disruption to current staff composition (e.g. CMHA‐P has case managers and housing support workers and CMHA‐KL has all case managers) ‐ will negatively impact client service 4 • Potential loss of community resources 5 • Loss of established relationships with local community partners (e.g. City of Kawartha Lakes, Housing Corporations) 6 • Loss of local voice in decision‐making and advocacy 7 • Complexity in decision‐making (e.g. risk from small community perspective that in the event that more housing dollars are awarded, the funds may go to the larger community) L M • Provide flexibility in eligibility criteria to respond to the needs of both communities – over time (longer‐term) work to standardize criteria • Every effort made to have same front‐line staff continue to serve clients L L • Maintain existing local service delivery standards L L • Provide wage parity/equalization to case managers and back‐office staff L M L M L M L M • Provide assurances that local services will continue and be enhanced • Provide assurances that local services will continue under the new organization and that services are expected to be enhanced • Local management will continue to exist in both communities • Governance structure to reflect all communities • Engagement of all stakeholders, partners and advisory bodies • Continued local on‐site management will ensure local perspective in decision making 46 Risk ID Risks Likelihood of Occurrence Impact of Occurrence Mitigation Strategy (Low/Moderate/High) (Low/Moderate/High)
8 • Potential loss of investment in local community (e.g., property management) or process delays in attaining maintenance services 9 • Change in philosophy may have a negative impact on client (e.g., landlord and client disputes) 10 • Risk of standardization may jeopardize client services because of philosophical differences/current practices which are reflective of local housing resources (e.g., City waitlists) and client needs 11 • Perceived loss of local responsiveness to landlord issues 12 • Potential for labour adjustment costs (severance, retraining, etc.) to transition staff L L • Ensure services are provided locally wherever possible L L • Ensure existing local service delivery models are retained wherever possible L L • Ensure existing local service delivery models are retained wherever possible L L H H 13 • Potential loss of existing partnering arrangements ( KLHMHS and Neighbourhood Housing) 14 • Potential decline in staff satisfaction due to change to organizational culture M L M H 15 • Potential cultural conflict M H 16 • Process delays may impact payroll run L H 17 • Potential loss of volunteer base (i.e. Client Safety Committee) M L 18 • Uncertainty of how Accreditation Canada manage this process L L 19 • Timing of an amalgamation is crucial ‐ process may be rushed and key transition factors missed 20 • Potential loss of continuity of year‐over‐
year reporting 21 • Potential loss of community donation, possible confusion by donors L H • Ensure existing local service delivery models are retained wherever possible • Determine funding source for ongoing wage parity/equalization. • Central East LHIN to work with CMHA organizations to find funding solutions to one‐
time transition costs • Continue to offer back‐office services to these agencies to the same standard and cost of the existing services provided by CMHA‐KL • Implement a process to create a new unified Vision, Mission and Values for the new organization to support the creation of a new organizational culture • Create a new strategic plan for the organization • Ensure appropriate change management best practices are incorporated into the transition process – provide ongoing opportunities for building organizational culture in the new organization • Communicate with all staff to make them aware of the payroll process and key payroll timelines/deliverables • Communicate with volunteers, advise them of important role they play in their community, advise that services will remain in the community, they are needed and a vital part of the team in improving services and welcome to the new organization • Advise Accreditation Canada of the proposed change and seek their guidance on how to proceed to maintain accreditation. By adopting the policies and processes of one CMHA will likely mitigate any issues with accreditation • Provide enough time and resources for comprehensive transition planning process L M L M • Ensure financial statements incorporate reconciliations between fiscal years • Reinforce that donations can be directed to local community – legal requirement to do so. Reinforce the need for ongoing community 47 Risk ID Risks Likelihood of Occurrence Impact of Occurrence Mitigation Strategy (Low/Moderate/High) (Low/Moderate/High)
22 • Reinvestment potential for enhanced front‐line services may not be realized L L •
•
23 • Transition costs may be understated L L •
•
financial support. Communicate how services are expected to be improved/strengthened for clients Ensure estimates are conservative Confirm estimates in detailed transition planning process Ensure estimates are conservative Confirm estimates in detailed transition planning process 5.4 Risk Matrix and Interpretation There are several high‐priority risks identified (12, 14, 15, 16, 19) requiring detailed management planning and/or specific assigned responsibility to senior management. Likelihood Risk Ranking High Low 16, 19 Specific management responsibility Moderate High 14, 15 12 Detailed management planning and attention required To be managed by senior management with a detailed plan. Specific management responsibility Detailed management planning and attention required Impact Moderate 1,4,5,6,7 Manage using specific procedures Low 2,3,8,9,10,11,18, 19,22,23 Manage by routine procedures Specific management responsibility 13,17,20,21 Manage using specific procedures Legend Lowest Priority Moderate Priority Highest Priority 5.5 Risk Response Strategies 12 The Planning Team will work with the CMHA organizations and the LHIN to determine the cost of any wage parity/equalization required, determine options for funding any shortfall in funding and explore all funding sources to address any shortfall. 14 & 15 A new organizational culture will develop for the new organization through a comprehensive process to establish a new unified Vision, Mission and Value set to support the creation of a new culture. This will be followed by a comprehensive strategic and operational planning process that addresses the needs of the clients and communities served. 16 A new payroll process will be developed and communicated to staff to make them aware of the key timelines and deliverables to ensure there are no delays in payments to staff. 48 19 A transition planning team will be established with the appropriate resources to plan the transition of services to the new organization. Approximately 15 months will be provided before the new organization assumes accountability for the amalgamated/merged services. All remaining lower‐level risks are expected to be addressed by the Integration Planning Team and/or the new organization’s Transition Management Team through communication strategies, general community and stakeholder engagement processes and through close monitoring of the new organizations operations. 5.6 Risk Threshold The Planning Team, for purposes of this Integration Plan, considered the following risks unacceptable: •
•
•
•
•
•
Activities/actions that are counter to the expectations set out in the guiding Principles (Appendix B). Lost opportunity to reinvest an estimated $253k annually to front‐line services within 2 years of integration. Future administrative and operational efficiencies not reinvested into front‐line direct client services. Lack of adequate transition, human resources and change management planning activities. Lack of support for CMHA‐KL and CMHA‐P transition activities. Central East LHIN funds used for services other than those set out in the Multi‐Sector Service Accountability Agreement (M‐SAA) and/or approved for transition activities. Risks that are acceptable include: •
•
Challenges related to change management. Agencies currently receiving Back‐Office services from the existing CMHA branches declining to continue receiving services from the new organization. 5.7 Feedback on DRAFT Integrated Service Delivery Model On December 16, 2011 the Central East LHIN issued a news release announcing the development of a DRAFT Integrated Service Delivery Model and asking for input on the proposed new way of providing community‐
based mental health services for the North East Cluster. The news release provided a hyperlink to the Central East LHIN website (Resource Documents/Integration/Integration Initiatives page) where background documents outlining the model were available along with web‐enabled and hard‐copy versions of the input survey. 49 5.7.1
Summary of Survey Responses Input Type
Responses/Participants
2 Focus Groups ‐ Clients, Volunteers, Family Members, Caregivers, 30 participants • CMHA‐KL ‐ January 3, 2012 36 participants • CMHA‐P – January 5, 2012 3 Focus Groups ‐ Staff, Volunteers and Board Members 16 participants • CMHA‐KL – January 4, 2012 23 participants • CMHA‐P – 2 sessions on January 5, 2012 On‐line surveys 2 responses • CMHA Board Members 1 response • CMHA Clients 25 responses • CMHA Staff 5 responses • Health Service/Community Support Service Provider (NE Cluster) 1 response • Health Service/Community Support Service Provider (all Central East LHIN) 3 responses • Health Service/Community Support Service Provider (outside Central East LHIN) 1 response • Local Community Resident Not Currently Receiving CMHA Services Mailed Surveys 1 response • Health Service/Community Support Service Provider (all Central East LHIN) 1 response • Health Service/Community Support Service Provider (NE Cluster) Faxed Surveys 5 responses* • CMHA Client 1 response • CMHA Staff 1 response** • CMHA Board Member 2 responses** • Health Service/Community Support Service Provider (NE Cluster) 1 response* • Local Community Resident Not Currently Receiving CMHA Services Letter Submitted from Health Service Provider 1 response
Total 154 participants/responses
* Survey response indicated a member of both groups ** Survey response indicated a member of both groups 5.7.2 Key Feedback Themes Given the timeframe of the community and stakeholder engagement process (December 16 to January 6) the number of responses/participants involved in providing feedback is considered by the Planning Team to represent a good response. The majority of responses/participants were from CMHA clients, CMHA staff and CMHA Board members ‐ clients provided over 53% of the feedback and staff provided 42% of the feedback. Some of the key themes identified in the feedback are reflected below: Benefits of a voluntary merger/amalgamation • Improved efficiency – streamlined services i.e. OTN in Kawartha Lakes • Continuity in service provision across/between communities i.e. housing • Flexibility for front‐line workers, pooling of resources and building on strengths/expertise • One service provider • Better positioned for future funding • Creates platform/starting point for further system integration opportunities with hospitals and other community service providers i.e. addictions Disadvantages of a voluntary merger/amalgamation • Spread out of resources may result in service reductions • Concern about job loss i.e. back‐office and front‐line staff 50 •
•
•
•
Integration will be complex May lose uniqueness of local programs/services, community partnerships Is not inclusive of other community mental health/addictions/hospital services May be inclined to stop with CMHA integration Additional comments on the attributes of the proposed amalgamated organization included the following themes: Governance • Opportunity for clients to have a voice – through Board or advisory groups • Membership should encompass all 4 counties, include various skills and backgrounds • Single strategic plan – one reporting structure – inclusiveness in strategic planning • Create new organization before commencing with transition • Transparency Leadership and Management • Single management and leadership, requires exceptional management • Local management with autonomy • Open competition for leadership roles/positions • More opportunities for consumers to participate Operations • Satellite locations across 4 counties • No reduction in services • Standardized processes i.e. intake • Adopt best practices/learning from each organization – improve quality Feedback on the top priorities to be considered during implementation include: • Focus on clients • Stick to timelines • Develop change management and human resources plans • Communications and involvement throughout process i.e. staff, clients and other stakeholders • More investment in community services • Ensure efficient and effective service delivery Notwithstanding that there are many comments indicating there is insufficient detail or about the measure of change that can be expected the Planning Team’s overall assessment of the feedback from all sources indicates a generally favourable response to statements that the DRAFT Service Delivery Model will: •
•
•
•
•
Better meet the needs of mental health clients and families in the community. Will deliver more sustainable, integrated services Ensure consistent standards and high quality services. Maintain and build local capacity for volunteer support, fundraising and other community partnerships/supports. Improve access to community based mental health services for all clients in the Central East LHIN North East Cluster – Haliburton County, Peterborough City and County, City of Kawartha Lakes, Northumberland County. 51 5.7.3 Incorporating Feedback into the System Design The key message from ` the feedback received is that the integration of community based mental health services as defined in the DRAFT Integrated Service Delivery Model should proceed. There is also a clear message that integration should not be limited to both CMHA organizations and should be expanded to encompass a broader vision for a system of mental health and addictions services across the North East Cluster in acute care and community settings. There is recognition by all parties that the voluntary amalgamation of CMHA‐KL and CMHA‐P into a new organization should be the first step in an ongoing process toward the broader vision to fully integrate the entire system of mental health and addictions services consistent with the policy direction established by the Province, the Central East LHIN’s strategic directions and what is considered best practice. However, the need for an all‐encompassing system design has to be tempered with the practical realities of what can be achieved within a reasonable period of time, scarce current funding resources, a process that has a track record of demonstrating positive results, impact of significant change on the system and clients, the ability and appropriate resources to organize, muster and lead other mental health and addictions service providers in establishing and acting upon a common vision. To this end the Planning Team sees the creation of a new organization to provide community based mental health service (as defined in the Integrated Service Delivery Model) as the first step of several that will be required along the road to full integration of a system of mental health and addictions services in the North East Cluster. To ensure the commitment toward a broader vision and that the process of system redesign will continue: •
•
•
•
The Boards of CMHA‐KL and CMHA‐P and the new organizational entity will explore further integration opportunities within the broader health system, and in particular with other mental health and addiction health service providers. CMHA‐KL and CMHA‐P will consider opportunities for system efficiencies with other organizations as they undertake detailed transition planning for front‐line direct client services. A full range of governance structures and affiliations will be explored to support broader system integration. Future integration processes will follow the same principled and detailed process of the present facilitated integration to determine how to better serve the needs of mental health and addictions clients in the North East Cluster of the Central East LHIN. 5.8 Alignment with Provincial Mental Health Reports/Panels The Community Mental Health and Addictions System has long been criticized for its fragmentation and lack of consistency in terms of access and service. In 1983 the Heseltine Report5, supported the notion of a continuum of service delivery. Over the years, subsequent reports have provided the same recommendation in more detail. These have included the Graham Report6 (1988), Putting People First7 (1993), 2000 and Beyond: 5
Hesletine, G.F., Towards a Blueprint for Change: A Mental Health Policy and Program Perspective: Discussion Paper. Toronto. Ontario Ministry of Health, 1983 6
Graham, Robert. Building Community Support for People: A Plan for Mental Health in Ontario. Toronto. Ontario Community Mental Health Committee, 1988 52 Strengthening Ontario’s Mental Health System8 (1998), the report of the Health Services Restructuring Commission9 (2000), Making it Happen10 (1999), and the reports of the Mental Health Implementation Task Forces11 (2002/03). The report of the Central East Mental Health Implementation Task Force12 recommended an integrated model of teams that would provide consistent access and service across the Central East area. This was based on the work of many people from various perspectives, and is contained in a lengthy report that continues to be available. In 2009, the report Every Door is the Right Door13 was produced as a discussion paper as the foundation for the Minister’s Ten Year Strategy to reform the Mental Health and Addictions System in Ontario. This strategy was the culmination of a great deal of work that had been completed by a series of sub‐ groups with cross‐sectoral membership. These working groups reported to the Minister’s Select Panel on specific issues related to mental health and addictions reform. For the first time, the people who were engaged in the sub groups came from diverse backgrounds and sectors which included education, justice, health and social services among others. There were statements throughout the Strategy that spoke to the need for “services that are Integrated and coordinated”, (Executive Summary, pg 10), that makes better use of existing skills and resources and held the goal of “transforming the system” as being fundamental to change. The Minister’s strategy spoke to the importance of having an integrated, seamless system, where “Every Door is the Right Door”. The report indicates that people and organizations across Ontario support the proposed strategy – particularly the focus on supportive environments, resilience, early intervention and integrated services. 7
Putting People First: the Reform of the Mental Health Services in Ontario. Toronto. Ministry of Health, 1993 8
Newman, Dan. 2000 and Beyond: Strengthening Ontario’s Mental Health System: A Report on the Consultative Review of mental Health reform in the Province of Ontario, 1998 9
Looking Back, Looking Forward. The Health Services Restructuring Commission (1996‐2000): A Legacy Report. March 2000. Looking Back, Looking Forward. Seven Points for Action. Ontario Health Services Restructuring Commission. March 2000 10
Making It Happen: Framework for the Delivery of Mental Health Services and Supports. 1999. Making It Happen: Implementation Plan for Mental Health Reform. Ministry of Health and Long‐Term Care. 1999 11
In accordance with the Ministry of Health and Long‐Term Care mental health policy “Making it Happen” nine regional mental health implementation task forces were established by the Minister of Health and Long‐Term Care to develop recommendations for regional and local improvements to mental health services across the province. The task forces were designed to serve as mechanisms through which recommendations would be developed for the Ministry with respect to Provincial Psychiatric Hospital Restructuring, community reinvestments and the implementation of mental health reforms. The task forces completed their mandates in December 2002 and January 2003. 12
Seizing the Opportunity. Central East (Whitby) Mental Health Implementation Task Force. December 2002 13
Every Door is the Right Door: Towards a 10‐Year Mental health and Addictions Strategy: A Discussion Paper. Ministry of Health and Long‐Term Care, 2009 53 At the same time, a Select Committee on Mental Health and Addictions was formed with membership from all of Ontario Members of Provincial Parliament. Their final report14 was released in August of 2010. The Report began with the following statement: “One of the main problems in Ontario’s mental health and addictions system is that there is, in fact, no coherent system. “ (page 3) One of the key recommendations of the report was an “integrated system” of services that would be consolidated into one “umbrella organization” (page 14). Clearly the need for an integrated and accessible system has been recognized by each report dedicated to the revision and reformatting of Ontario’s Mental Health and Addictions System dating back to the early 1980’s. Accessibility and seamlessness has been a key recommendation of every report that has been published. In his draft report on the review of Ontario Government spending, Don Drummond is signalling better integration and expansion of community and chronic care or mental health services will gain efficiencies that would save substantial costs and/or allow funds to be reinvested in services.15 Prescribing a better investment of health dollars, Don Drummond reinforced what many health professionals have already been advocating, “For the amount of money spent, the system should surely be delivering better results. It needs to shift from an acute‐care model to a chronic care model. It needs to broaden in purview from health care to health more generally, which brings in prevention and socio‐economic factors. It needs be centered on the patient, with all parts of the system coordinated around patient care. It needs to find mechanisms to ensure more equal access to non‐primary care…..the system must not only grow less rapidly in cost, but must deliver greater value‐for‐money.”16 The model proposed for the delivery of community based mental health services in the Central East LHIN’s North East Cluster is reflective of these recommendations and will form the foundation for further integration of the mental health and addictions system throughout the Central East LHIN. 5.9 Alignment with Triple Aim The integration of community based mental health services provided by CMHA‐KL and CMHA‐P and its partners supports the “Triple Aim” approach to healthcare improvement adopted within the Central East LHIN: •
Enhancements in population health will be achieved by continuing and stabilizing community services for mental health clients and positioning for future community based mental health service enhancements. 14
Final Report: Navigating the Journey to Wellness: The Comprehensive Mental health and Addictions Plan for Ontarians. Select Committee on Mental Health and Addictions. August 2010 15
Cohn, Martin Regg. Brace for a budget firestorm across Ontario. Toronto Star. January 5, 2012 16
Drummond, Don. “Therapy or Surgery? A Prescription for Canada’s Health System”; CD Howe Institute Benefactor Lecture; Sponsored by Briar Foster; Toronto, November 17, 2011 54 •
•
Patient experience will be enhanced by continuing to deliver the service around the needs of the client) and delivering high quality services. Clients will have easier access to services across the North East Cluster from a single organization. Value for money is achieved by reducing overhead costs and reinvesting these to enhance and expand front‐line direct client services and programs. 5.10 Alignment with Central East LHIN Strategic Aims Sustainable and enhanced community based mental health services are vital link in the continuum of care. These community based mental health services also support the achievement of the Central East LHIN’s Strategic Aims in the following ways: Save 1,000,000 Hours of Time Patients Spend in Central East LHIN Emergency Departments by 2013 •
•
•
•
•
•
Crisis services directly avoid visits to the Emergency Department (ED) for mental health crisis situations caused by loneliness or lack of social supports. Informal peer support services provide crisis prevention techniques that help to avoid visits to the ED. Specific skills training in the form of Wellness Recovery Action Planning (WRAP), only provided by consumer survivor or peer support services, offer a “Crisis Prevention Toolkit” which teaches each person to recognize their own individual crisis signals and avoid a crisis ‐ this also provides a crisis plan that also assists in avoiding ED Visits. Consumer survivor services offer a safe place to go and offer meals and other factors that prevent crisis by supporting basic needs such as food, friendship and other skills that prevent the life situations that often lead to mental health crisis. Research has shown that Crisis services, peer support and consumer survivor supports are instrumental in preventing ED visits and reducing the length of time spent in the ED. Strengthening the community based mental health support system, including housing and supports within housing, is expected to result in reduced ED visits and length of hospital stays for mental health patients. Reduce the Impact of Vascular Disease in the Central East LHIN by 10% by 2013. • Healthy living programs offered through peer support and consumer survivor supports teaches lifestyle tactics that help to avoid poor nutrition and health, i.e.: daily walks, healthy eating on a budget, group meal preparation, etc. • Self management and mutual support programs teach skills that assist in preventing medication side effect problems, increase compliance with prescribed health regiments and teach people to advocate with their health care providers on their own behalf. 5.11 Central East LHIN Clinical Services Plan The Central East LHIN launched the Clinical Services Plan (CSP) project to examine the feasibility of horizontal integration of health services, specifically for hospital services. The CSP project was intended to be a starting point for health services integration and a key step towards the goal of creating “One Acute Care Network”. 55 The vision is that this single acute care network will assume a collective leadership responsibility and accountability in adopting a health system‐wide approach to meet the needs of its communities. The CSP project recognized and acknowledged the need to work with the community support services and long‐term sector as the Central East LHIN progressively works towards overall service integration. The initial scope of the CSP was focused on physician integration and hospital based services in the following clinical areas: •
Cardiac Services •
Maternal‐Child‐Youth Services •
Mental Health and Addiction Services •
Thoracic Surgery •
Vascular Surgery This initial focus on hospital based services was not intended to minimize the importance of other community based service providers and the long‐term care sector, but was based on the need to manage the scope of this initial planning project to a manageable size, with the intent of applying learning gained from the CSP project to future integration planning initiatives. The future service model recommended for Mental Health and Addiction Services in the CSP states: 1. Clusters will revolve around the hospitals providing Mental Health inpatient services, with capabilities to admit patients to Schedule 1 beds in three regions: North East, Durham and Scarborough clusters. 2. Whitby Mental Health Corporation (WMHC ‐now Ontario Shores Centre for Mental Health Sciences) will continue to provide the specialized tertiary services and support to the entire LHIN. 3. Clusters will provide 24/7 access to clinical expertise to support all hospitals, which will be facilitated through a centralized bed registry. 4. MHA leadership structure will partner with a LHIN‐wide Maternal‐Child Youth leadership structure, which is responsible for planning for inpatient services for paediatric mental health cases, developed in consultation with WMHC. 5. Each cluster will also pursue the integration of hospital services with outpatient and community services. Benefits to be realized: •
•
•
•
•
Improved overall care quality, access and system sustainability. Enhanced integration between facilities within clusters, as well as between clusters. Standardized approach and effective communication to enable equitable access for all patients. Enhanced capacity and efficiency in managing appropriate inpatient admission stay. Strategic decision‐making to minimize service duplication and effectively plan for program expansion. The voluntary amalgamation of CMHA‐KL and CMHA‐P strengthens community based mental health services in the North East Cluster to be better positioned to address recommendation 5 above – pursue the integration of hospital services with outpatient and community services. A stronger community based mental health sector also creates the opportunity for further integration opportunities among other community mental health and addictions service providers in the North East Cluster. 56 5.12 Annualized Operating Budget Commencing in 2012/13 fiscal year the annualized operating budget for both CMHAs is expected to remain at the same level as 2011/12 funding, subject only to any known adjustments and new or returned one‐time funding. All funding partners will be encouraged and be expected to continue to meet their funding commitments for services provided. At a minimum the Central East LHIN funding commitment will remain constant at the same levels of funding provided individually to CMHA‐KL and CMHA‐P. Commencing in 2013/14 fiscal year the annualized operating budget for the “new organization” is expected to remain constant, subject only to any known adjustments and new or returned once‐time funding. At a minimum the Central East LHIN funding commitment will remain constant at the same levels of funding provided individually to CMHA‐KL and CMHA‐P. 5.13 Performance Commitments Performance commitments for 2012/13 will remain constant at current 2011/12 levels as set out in the current Multi‐Sector Service Accountability Agreements for CMHA‐KL and CMHA‐P. Beginning in 2013/14 following the voluntary amalgamation, total performance commitments are expected to increase consistent with investments in front‐line services. These performance commitments will be developed as part of the front‐line transition planning process. 57 6. Transition 6.1. Drivers and Strategies In addition to the Principles established to guide the integration of consumer survivor services, the following drivers and related strategies have been specifically identified as influencing the successful transition toward the creation of a new organization. 6.1.1. Accessibility of Services to Clients Consistent with the Client Centred principle, the transition process must recognize the needs of clients and continue to provide services with minimal or no service disruptions. The community and clients must be aware of how to access services when needed and know that qualified staff are available to provide services. Special communications products and information sharing tactics will be created to support community and client awareness of the changes in consumer survivor services. 6.1.2. Identify and Implement Early Cost Saving Opportunities Opportunities to reduce costs of operations, that are consistent with the creation of a new amalgamated organization, will be identified and actions will be taken to implement them (with support of each organization) prior to the formal voluntary amalgamation of the CMHA organizations. 6.1.3. Minimize Transition Costs It is inevitable that there will be costs incurred to transition to a new organization. Given the relatively small amount of discretionary financial resources available to CMHA‐KL, CMHA‐P and the Central East LHIN it will be important to implement transition activities in a way that is timely and minimizes one‐time and unusual transition costs. However, it is recognized that one‐time transition costs may be incurred to secure longer‐
term efficiencies and reinvestment to front‐line services. 6.1.4. Privacy and Confidentiality The protection and privacy of personal client, volunteer and donor information is a legal requirement and of paramount importance to all parties. Legal advice will be sought and incorporated into the plan to manage the transfer of this information to the new organization so that clients can continue to access appropriate information and services. 6.2. Transition Schedule Following approval by the Board of Directors of CMHA‐KL, CMHA‐P and the Central East LHIN the Integration Plan and the transition of services to the “new organization” can be implemented. The transition is expected to occur in four distinct phases of activity: •
•
•
•
Phase 1: Back‐Office consolidation ‐ services to be administered through CMHA‐P systems. Phase 2: Front‐Line Services integration. Phase 3: Establish New Organization and assumption of services, assets and liabilities. Phase 4: Wind‐up of existing CMHA‐KL and CMHA‐P organizations. The following are some of the key activities and milestones to be undertaken as part of the transition activities. 58 Resp. Δ Δ Δ CMHAs CMHAs CMHAs CMHAs CMHAs CMHAs CMHAs CMHAs Central East LHIN CMHAs CMHAs & Central East LHIN Δ CMHAs CMHAs CMHAs CMHAs CMHAs CMHAs Δ CMHAs CMHAs CMHAs CMHAs CMHAs & Central East LHIN Δ CMHAs CMHAs CMHAs Transition Activities and Milestones Δ Approve Integration Plan – CMHA‐P Board
Approve Integration Plan – CMHA‐KL Board
Status/Target Date Jan 18, 2012 Jan 19, 2012 Jan 25, 2012 Feb, 2012 Feb – Mar, 2012 Feb – Mar, 2012 Feb – Mar, 2012 Feb – Mar, 2012 Feb – Mar, 2012 Feb – Mar, 2012 Feb – Mar, 2012 Approve Integration Plan ‐ Central East LHIN Board PHASE 1: Detailed Transition Planning for Back‐Office Functions Transfer Engage Stakeholders and Community Partners Create Transition Team – Establish Terms of Reference Review Back‐Office Services for Transfer Review Back‐Office Policies and Processes Assess Systems Capabilities Refine Transition Cost Estimates Prepare Transition Plan (incl. HR Plan) Approve Transition Plan Approve Transition Costs Feb – Mar, 2012 Implement Systems/Process Changes Feb – Mar, 2012 Adjust MSAA Accountabilities, Funding, etc. Feb – Mar, 2012 Back‐Office Services Transfer PHASE 2: Detailed Transition Planning for Front‐Line Services Create Transition Team – Establish Terms of Reference Prepare Transition Plan (incl. HR Plan) Assess Transition Costs Approve Transition Plan PHASE 3: Establish New Organization Commence Governance Planning Establish Transition Board Create Legal Entity – Launch New Organization Recruit and Appoint Board Members Recruit/Appoint Executive Director Vision, Mission and Values Process Strategic Planning Process April 1, 2012 Apr – Aug, 2012 Apr – Aug, 2012 Apr – Aug, 2012 Sep, 2012 Apr – Aug, 2012 Sep, 2012 Oct, 2012 Oct, 2012 Oct, 2012 Oct 2012 – Mar, 2013
Oct 2012 – Mar, 2013
Establish New MSAA with Central East LHIN Amalgamation of Services into New Organization PHASE 4: Wind‐up Existing CMHA‐KL and CMHA‐P Organizations Complete prior year final reports to Central East LHIN (CAT, WERS, etc.) Complete audited financial statements and tax returns Wind‐up CMHA‐KL and CMHA‐P corporate entities (revoke Letters Patent) Mar, 2013 Apr 1, 2013 June 2013 June 2013 July 2013 Further details on transition activities will be identified by the transition teams that will be created once the Integration Plan is approved. 59 6.3. Transition Costs 6.3.1. Phase 1: Back­Office Transition The following table identifies for planning purposes the estimate of one‐time transition costs to transfer the back‐office functions for April 1, 2012. This estimate of costs will be updated and communicated to the Central East LHIN throughout the transition process. Cost Category Staff Costs (overtime, short‐term contracts)
Hardware/Software Supplies/Miscellaneous
Total Estimate 2011/12 Estimated Transition Costs $000 $45.0 $ 5.0 $ 5.0 $55.0 6.3.2. Phase 2, 3 & 4: Front­Line, New Organization and Wind­Down Transition Transition costs associated with these phases of the transition will be identified by the transition teams established to plan and manage the transition planning process. 6.3.3. Human Resources Planning and Labour Adjustment Costs CMHA transition planning activities will include the development of a Human Resources Plan that will consider the full impact of the integration on all staff and each employer’s obligations under law to mitigate job loss and provide appropriate compensation in the event of job change and/or loss. Approval of this Integration Plan may trigger termination provisions of current employment contracts. Any liability created by these contracts is the responsibility of the respective organizations to manage. However, the Central East LHIN will work with the organizations to manage these liabilities so that it will not impact on the delivery of client care. 6.4. Value of the Central East LHIN’s Financial Support for the Transition The following points identify the benefits for the CENTRAL EAST LHIN by providing support to CMHA‐KL and CMHA‐P through the transition: •
•
•
•
Back‐office efficiencies reinvested in front‐line services – more front‐line workers (e.g. case managers) providing direct services to clients. The degree of financial, operational and administrative risk for the Central East LHIN is significantly diminished through the strengthening of the community based mental health services in the North East Cluster. Starts a process of implementing a broader vision for mental health and addictions service in the North East Cluster. Central East LHIN financial support demonstrates that the Central East LHIN will be there to underpin accountability, secure client record privacy, strengthen overall service sustainability and support the initiative to integrate services. 60 •
The Central East LHIN’s commitment to provide financial support in this instance for one‐time start‐up costs ensures current services provided by CMHA‐KL and CMHA‐P are not financially disadvantaged or penalized as a result of their decision to integrate services. 6.5. Transition Implementation 6.5.1. Implementation Team Transition planning towards implementation of all phases of the integration will commence immediately following approval of the Integration Plan by the Central East LHIN Board of Directors. The Boards of CMHA‐KL and CMHA‐P will appoint an Executive Director to lead and manage the transition planning and implementation activities until the new amalgamated organization Board is in place. The Executive Director will be accountable to the Boards of CMHA‐KL, CMHA‐P, the Central East LHIN and the new organization during the transition process. The appointed Executive Director will be the primary spokespersons for CMHA‐KL and CMHA‐P on all matters related to the transition of services. The Central East LHIN will lead the development of a shared Stakeholder Communications and Community Engagement Plan and the Central East LHIN Communications Lead will be the LHIN’s primary spokesperson. Transition teams for each phase of planning and implementation will be established with the appropriate Terms of Reference and deliverables. The teams will comprise CMHA‐KL and CMHA‐P staff as required to complete the established objectives/deliverables. The Board of the new organization will determine the appropriate recruitment process for the senior leadership of the new organization. 6.5.2. Oversight and Reporting The CMHA Executive Director leading the transition will report regularly to the CMHA‐KL and CMHA‐P Boards of Directors and to the Central East LHIN on the progress and any issues and emerging risks that may occur throughout the transition process. 61 Appendix: A.
B.
C.
D.
E.
Glossary of Terms and Acronyms Principles Document Integration Planning Team Terms of Reference Back‐Office Analysis Work Team Final Report Front‐Line Direct Client Services Analysis Work Team Final Report 62 Appendix A: Glossary of Terms and Acronyms ACTT Acute Community Care Treatment Team ADL Activities of Daily Living CD Concurrent Disorder CENTRAL EAST LHIN Central East Local Health Integration Network CM Case Management CPP Canada Pension Plan CAMH Centre for Addiction and Mental Health CMHA Canadian Mental Health Association CMHA‐KL Canadian Mental Health Association – Kawartha Lakes Branch CMHA‐P Canadian Mental Health Association – Peterborough Branch CSI Consumer/Survivor Initiative C/S Consumer/Survivor CSS Community Support Services CTO Community Treatment Order DART Drug and Alcohol Registry of Treatment EYI Early Youth Intervention EPI Early Psychosis Intervention FTE Full Time Equivalent MHCC Mental Health Commission of Canada Sched 1 Schedule 1 Facility, (can take involuntary patients) OCAB Ontario Council of Alternative Businesses ODSP Ontario Disability Support Plan, (used to be Family Benefits Plan) OPDI Ontario Peer Development Initiative OS Ontario Shores OW Ontario Works (used to be General Welfare Assistance) PPAO Psychiatric Patient Advocate Office VOC Rehab Vocational Rehabilitation Appendix B: Principles Document CONFIDENTIAL
Principles Supporting Integration Discussions and Actions: Between Canadian Mental Health Association – Kawartha Lakes Branch and Canadian Mental Health Association – Peterborough Branch Facilitated by the Central East Local Health Integration Network Purpose The purpose of this document is to establish a set of foundational principles, to be agreed to by the parties, to guide Canadian Mental Health Association – Kawartha Lakes Branch (CMHA‐KL), Canadian Mental Health Association – Peterborough Branch (CMHA‐P) and the Central East Local Health Integration Network (CE LHIN) through discussions and actions related to the integration of mental health services in the CE LHIN North East Cluster (comprising Haliburton, Kawartha, Peterborough and Northumberland Counties). All parties recognize at the onset of the process that specific details, strategies and tactics supporting integration will evolve throughout the process and that the principles are foundational guides subject to revision only with the support of all parties. CE LHIN Role The CE LHIN has offered to facilitate the integration process and lead the development of an Integration Plan for approval by all parties. It is the LHIN’s mandate to promote integration opportunities that enhance both the client experience and achieve greater value for money (e.g., efficiency). It is the position of the CE LHIN that an integrated “range of mental health services” in the CE LHIN North East Cluster will not only improve ease of access and navigation to community services for mental health clients, but will leverage governance, management, front‐line service delivery, back office support, volunteerism and fund raising operations. Definition of Mental Health Services For purposes of this integration initiative, mental health is defined as “a state of well‐being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community"1. Mental health services in Ontario are considered to include the following functions: • Identification/Early Intervention • Treatment • Crisis Supports 1
World Health Organization Page | 1 CONFIDENTIAL
• • • • • • • • •
•
Consultation Coordination Residential Support and/or Housing Case Management/Coordination Social Support Vocational Support Self‐Help/Peer Support Family Support and Advocacy Health Promotion/Public Education Court Support/Diversion/Release from Custody Service Delivery Principles Consumer Centred ‐ The integration process will be guided and motivated by a continuous focus on how to best meet the community health needs of mental health clients. Efforts will be made by all parties to minimize service disruptions during any integration transition that may occur as a result of this process. Quality Services –CMHA‐KL, CMHA‐P and the CE LHIN will design sustainable integrated services that provide consistent standards and high quality to mental health clients. Regional Access – Integrated services must be accessible to all mental health clients in the CE LHIN North East Cluster. Leveraging the Local – The CE LHIN believes that community mental health services are best supported by an understanding of the communities being served and by local management that can maximize the use of local volunteers, fundraising opportunities and other community supports. Process Principles Do No Harm ‐ The CE LHIN will work with all parties to ensure that any integration opportunity does not result in new risks or pressures (legal, financial, operational, reputational) to any party to the integration. The CE LHIN will also be responsive in working with CMHA‐KL and CMHA‐P in supporting the resolution of both foreseen and unforeseen risks that may arise following the implementation of any integration. Transparency or “No surprises” ‐ The CE LHIN and all parties will provide full disclosure of information required to support the integration process, notwithstanding personal information that is protected by law. Respectful – All parties will conduct the integration process in a manner that does no harm to the reputation of the board, management, staff or volunteers of CMHA‐KL, CMHA‐P, and the CE LHIN. Employee Commitment and Skills – The current employees of CMHA‐KL and CMHA‐P are recognized as having a high‐level of commitment supporting mental health clients and have been instrumental in meeting the needs of their clients. Page | 2 CONFIDENTIAL
Communication – During the integration process the CE LHIN, CMHA‐KL and CMHA‐P will agree to a shared communication strategy and messages as coordinated by the CE LHIN. Timing – CMHA‐KL and CMHA‐P will engage in meaningful discussions on opportunities for integration in a timely manner. The CE LHIN would like to see a progress report on alignment and integration possibilities presented to the CE LHIN Board no later than its July 2011 meeting. Legislative Ascendance – The principles and process as laid out in this document are guides agreed to by the parties. In no way can these principles limit the authority of the LHINs, health service providers and the MOHLTC as set out in legislation, namely the Local Health System Integration Act (LHSIA). Community Engagement – The CE LHIN encourages CMHA‐KL and CMHA‐P to engage mental health stakeholders and consider their input in decision‐making processes respecting mental health services in the North East Cluster. Confidentiality – The parties agree to keep the content of discussions confidential until such time as there is agreement to share information as set out in a shared communications and community engagement plan. The Planning Team can discuss matters related to the integration initiative confidentially with their respective sponsors and/or Board of Directors. End State Principles CE LHIN Funding – The CE LHIN anticipates that all the funding currently directed to CMHA‐
KL and CMHA‐P will continue to be provided. Integration – Any proposed integration will rationalize and maximize existing back office supports. Where appropriate administrative overhead and infrastructure should be reduced and savings redirected to front‐line service delivery. Continuum of Care – CMHA‐KL and CMHA‐P will work with the CE LHIN and other health service providers – notably the specialized hospitals, community hospitals, primary health care system, and addictions agencies – in any redesign of community mental health services to ensure they are fully integrated into the mental health continuum of care. Flexibility & Innovation – Within the combined financial resources, and considering the existing service and operational infrastructure, CMHA‐KL and CMHA‐P may redesign services to meet the needs of mental health clients. There is no assumption that existing delivery practices must be maintained, however, all parties agree at a minimum to maintain current service delivery targets and service levels and minimize service disruption for current mental health clients. Governance – The Board of Directors of CMHA‐KL and CMHA‐P will be reminded of their fiduciary responsibilities to their organizations and clients and to their obligations to support the integration of the health system as set out in the legislation (LHSIA) and the M‐
SAA agreements. Clear lines of governance will be established for any integrated services. Page | 3 CONFIDENTIAL
Accountability – M‐SAA agreements with the CE LHIN will be revised to address any integrated services and related performance expectations. CMHA‐KL and CMHA‐P agree to live within the means made available by the CE LHIN, other government sources of funds and/or local fundraising. Transfer – The terms of the transfer of any assets and liabilities is dependent upon the nature of the integration i.e. merger/amalgamation of entities, transfer of services, coordination of services, etc. Any transfer does not automatically include existing staff or board members. Every effort will be made to ensure continuity of any volunteer pools and local fundraising donations. To this end, all parties will work together to secure continuity of funding support from third parties to the integration service provider(s). Integration Process Under the LHSIA the LHIN, the Minister of Health and Long‐Term Care and health service providers can integrate in several ways. 1. Coordinate services and interactions between different persons and entities 2. Partner with another person or entity in providing services or in operating 3. Transfer, merge or amalgamate services, operations, persons or entities 4. Start or cease providing services 5. Cease to operate or to dissolve or wind up the operations of a person or entity It is important to note that the LHIN does not have the authority to integrate by “Ceasing to operate or to dissolve or wind up the operations of a person or entity” (#5). This authority is reserved for the Minister of Health and Long‐Term Care and/or voluntarily by the persons/entities involved. In other words, aside from the Ministry, only CMHA‐KL and CMHA‐P can decide to dissolve their own corporate entity. In order to facilitate or execute integrations, the LHSIA provides several tools for the LHIN, the Minister and Health Services Providers to integrate. Integration Type Description LHIN Funding LHSIA S.19 The LHIN uses its funding authority to promote integration of services with/between HSPs. Facilitated and Negotiated Integration LHSIA S.25 The LHIN and/or HSPs explore appropriate integration strategies and the LHIN facilitates or negotiates integration with the HSPs. Required Integration LHSIA S.26 The LHIN orders HSPs to integrate services. Voluntary Integration LHSIA S.24 & 27 A HSP at their own initiative plans to integrate services funded by the LHIN. Page | 4 CONFIDENTIAL
Minister’s Order LHSIA S.28 The Minister orders a HSP to integrate i.e. cease to operate, dissolve, wind‐up its operations, amalgamate or transfer operations. It is expected through a LHIN facilitated process the appropriate resources and expertise available through the LHIN can support CMHA‐KL and CMHA‐P in developing an Integration Plan. To support these integration discussions and actions the CE LHIN has provided CMHA‐KL and CMHA‐P with a Facilitated and Negotiated Integration Process and Requirements Guide which outlines the key process steps, best practices and documentation requirements associated with obtaining CE LHIN approval of a facilitated and negotiated integration. Page | 5 Appendix C: Integration Planning Team Terms of Reference Cen
ntral East
Loc
cal Health In
ntegration Network
N
Canadian Mental Health Association (CE
LHIN North East Clusterr)) Integration
Planning Team
erencce
Terms of Reffe
e
Author:
Barry Hyde
Status:
nal
Fin
Version Numb
ber:
Version Da
ate:
3
April 11, 20
011
Table of Contents
1. BACKGROUND/CONTEXT..........................................................................................................................................3 1.1. 1.2. 1.3. Purpose.......................................................................................................................................................................................................................4 Scope...........................................................................................................................................................................................................................4 Authority.......................................................................................................................................................................................................................4 2. ROLES & RESPONSIBILITIES OF THE PLANNING TEAM ...........................................................................5 2.1. 2.2. Role of the Planning Team...................................................................................................................................................................................5 Responsibilities of the Planning Team ..............................................................................................................................................................5 3. MEMBERSHIP & ROLES OF INDIVIDUAL PLANNING TEAM MEMBERS ............................................5 3.1. 3.2. 3.3. 3.4. 3.5. Membership ..............................................................................................................................................................................................................5 Reporting Relationships.........................................................................................................................................................................................6 Linkages & Partnerships........................................................................................................................................................................................6 Duration of Service...................................................................................................................................................................................................6 Individual Roles of Planning Team Members ................................................................................................................................................6 4. LOGISTICS AND PROCESSES..................................................................................................................................7 4.1. 4.2. 4.3. 4.4. 4.5. 4.6. 4.7. 4.8. Role of Chair ..............................................................................................................................................................................................................7 Frequency of Meetings ..........................................................................................................................................................................................7 Decision-Making Process.....................................................................................................................................................................................7 Quorum Requirements..........................................................................................................................................................................................7 Proxies to Meetings.................................................................................................................................................................................................8 Meeting Agenda Items...........................................................................................................................................................................................8 Minutes & Meeting Papers...................................................................................................................................................................................8 Issue Resolution.......................................................................................................................................................................................................8 5. ACCEPTANCE & SIGN-OFF........................................................................................................................................9 Canadian Mental Health Association (CE LHIN North East Cluster) Integration Planning Team
Page 2 of 9
1. Background/Context
The Canadian Mental Health Association – Kawartha Lakes Branch (CMHA-KL) and Canadian
Mental Health Association – Peterborough Branch (CMHA-P) have joined with the Central East
Local Health Integration Network (CE LHIN) in discussions to explore integration opportunities.
The impetus for the discussions stems from the March 23, 2011 CE LHIN Board of Directors
meeting where the Board asked to receive a report back on the alignment and integration
possibilities between CMHA-KL and CMHA-P. During the integration of consumer survivor
services in Kawartha Lakes between Survivors Psychiatric Advocacy Centre (SPAN) and CMHAP, the CE LHIN observed there were opportunities for closer cultural and operational alignment
between the two CMHA branches in the CE LHIN’s North East Cluster (comprising Haliburton,
Kawartha, Peterborough and Northumberland Counties). The CE LHIN has brought CMHA-KL
and CMHA-P together in a facilitated integration process to develop a stronger integrated
community mental health services delivery model for the North East Cluster.
For purposes of this integration initiative, mental health is defined as “a state of well-being in
which the individual realizes his or her own abilities, can cope with the normal stresses of life, can
work productively and fruitfully, and is able to make a contribution to his or her community"1.
Mental health services in Ontario are considered to include the following functions:
•
•
•
•
•
•
•
•
•
•
•
•
•
Identification/Early Intervention
Treatment
Crisis Supports
Consultation
Coordination
Residential Support and/or Housing
Case Management/Coordination
Social Support
Vocational Support
Self-Help/Peer Support
Family Support and Advocacy
Health Promotion/Public Education
Court Support/Diversion/Release from Custody
It is the LHIN’s mandate to promote integration opportunities that enhance both the client
experience and achieve greater value for money (e.g., efficiency). It is the position of the CE
LHIN that additional integration of mental health services across its North East Cluster will
improve ease of access and navigation to community services for mental health clients and will
leverage existing local governance, management, back office support, front-line service delivery,
volunteerism and fund raising currently provided by CMHA-KL and CMHA-P.
On April 11, 2011 the Central East LHIN, CMHA-KL and CMHA-P agreed to a set of principles to
guide integration discussions and integration planning activities. These Principles are in the
process of being approved by the parties. The CE LHIN’s preferred approach to the integration is
through facilitation and negotiation. The Central East LHIN will provide resources and will work
with the parties to collectively develop and implement integration opportunities according to the
approved principles. The Central East LHIN, CMHA-KL and CMHA-P have agreed to establish a
Canadian Mental Health Association (CE LHIN North East Cluster) Integration Planning Team to
share information, explore integration opportunities and design new integrated mental health
services.
1
World Health Organization Canadian Mental Health Association (CE LHIN North East Cluster) Integration Planning Team
Page 3 of 9
1.1. Purpose
The purpose of the Canadian Mental Health Association (CE LHIN North East Cluster) Integration
Planning Team (Planning Team) is to develop and implement an Integration Plan in accordance
with the approved principles. The Integration Plan will include: 1) a description of the services to be
provided; 2) details on how the services will be delivered; 3) details on the activities to transition the
services; 4) actions/measures to address any outstanding liabilities and risks; and 5) an
accompanying shared Communications and Community Engagement Plan.
1.2. Scope
The Planning Team is concerned with the planning and implementation of activities to support a
facilitated integration of mental health services currently provided by CMHA-KL and CMHA-P in the
CE LHIN’s North East Cluster.
“IN” Scope
•
All mental health and related services
currently provided by CMHA-KL and
CMHA-P in the North East Cluster and
funded by the CE LHIN
•
Governance, management and
operations of CMHA-KL and CMHA-P
•
Risks and liabilities of CMHA-KL,
CMHA-P, and the CE LHIN
•
Communications and community
engagement
•
Financial commitment of all 3rd parties
•
Development of an Integration Plan with
associated transition costs and ongoing
operating budgets
•
Implementation of the approved
Integration Plan
“OUT” of Scope
•
Services and programs not funded by the
CE LHIN
•
Approval of the Integration Plan
•
Mental health services currently provided
by other mental health agencies
•
Other community mental health and
support services
1.3. Authority
The Planning Team authority does not extend beyond the individual authorities of its members and
their respective decisions and sphere of influence.
The Planning Team does:
•
Have the authority to share information about their organizations services, governance,
management and operations.
•
Have the authority to recommend on behalf of their organizations plans and actions
associated with the integration of services.
•
Establish working groups as required to explore specific issues related to integration (i.e.
legal issues related to corporate wind-up, separation of employees, etc.).
Canadian Mental Health Association (CE LHIN North East Cluster) Integration Planning Team
Page 4 of 9
•
Not have the authority to approve the Integration Plan as this is reserved for the Boards of
Directors of each organization.
2. Roles & Responsibilities of the Planning Team
2.1. Role of the Planning Team
The work of the Planning Team will focus on identifying solutions for the design of integrated
mental health services, identification of activities to transition integrated services, identify any
potential barriers to service delivery, identification of strategies to mitigate risks and liabilities and
identification of communications and community engagement strategies to inform stakeholders
about integration opportunities. In this role the Project Team will:
•
Support the facilitated and negotiated approach to integration.
•
Identify options for an integrated consumer survivor service.
•
Identify barriers to service.
•
Identify associated risks and mitigation strategies.
•
Liaise with other organization representatives to clarify information, test planning
assumptions and receive feedback on proposed actions/measures.
•
Ensure integrated services are aligned with the approved principles.
•
Write the Integration Plan.
•
Prepare and write a Communication and Community Engagement Plan.
•
Recommend the Integration Plan to the Boards of Directors of the Central East LHIN,
CMHA-KL and CMHA-P.
•
Manage the implementation of approved integration initiatives.
2.2. Responsibilities of the Planning Team
The main function of the Planning Team is to take responsibility for the development of the
Communications and Community Engagement Plan and Integration Plan, including the
presentation of the Integration Plan to the respective Board of Directors for review and approval.
Following approval of the Integration Plan the Planning Team will be responsible for managing the
implementation of approved integration activities.
3. Membership & Roles of Individual Planning Team Members
3.1. Membership
The Planning Team will be co-chaired by Naresh James and Mark Graham.
The Planning Team membership will be composed of senior representatives from the following
organizations/stakeholder groups:
Name
•
Naresh James
Organization/Stakeholder Group
•
Executive Director, CMHA-KL
Canadian Mental Health Association (CE LHIN North East Cluster) Integration Planning Team
Page 5 of 9
Name
Organization/Stakeholder Group
•
Mark Graham
•
Executive Director, CMHA-P
•
Jeanne Thomas
•
Team Lead System Design, CE LHIN
•
Jai Mills
•
Integration Consultant, CE LHIN
•
Katie Cronin-Wood
•
Communications Lead, CE LHIN
•
Indra Narula
•
Integration Consultant, CE LHIN
•
Barry Hyde
•
Facilitator - Lead, CE LHIN Project Management
Office
3.2. Reporting Relationships
The Planning Team will seek sponsorship from the Central East LHIN Senior Management Team
through James Meloche Senior Director, System Design and Integration and the Boards of
Directors of CMHA-KL and CMHA-P.
A status update and key messages will be prepared for the sponsors by the Planning Team
following each meeting and/or significant event.
3.3. Linkages & Partnerships
The Planning Team may seek input from a wider group of subject matter experts in the design of
integrated mental health services. These subject matter experts may include other mental health
service providers, other mental health and addictions service agencies and networks, Central East
CCAC, hospitals, etc.
3.4. Duration of Service
The members and Co-Chairs of the Planning Team will serve until the completion of the Integration
Plan. The Planning Team anticipates it will continue, following approval of Integration Plan, to
oversee and monitor integration activities.
New members of the Planning Team may be added from time-to-time to address a perspective
and set of skills of benefit to the Integration that may have been overlooked in the identification of
the original Planning Team membership.
3.5. Individual Roles of Planning Team Members
Name
•
Naresh James
Individual Role
•
•
Co-Chair the Planning Team.
Educate the team on the governance, management and
operations of CMHA-KL. Identify opportunities and
contribute to the design of integrated mental health services
in the North East Cluster.
Canadian Mental Health Association (CE LHIN North East Cluster) Integration Planning Team
Page 6 of 9
Name
Individual Role
•
Mark Graham
•
•
Co-Chair the Planning Team.
Educate the team on the governance, management and
operations of CMHA-KL. Identify opportunities and
contribute to the design of integrated mental health services
in the North East Cluster.
•
Jeanne Thomas
•
Provide advice and guidance on system design matters
related to the integration of mental health services and to
address risks.
•
Jai Mills
•
Provide advice and guidance on health policy matters
related to the integration of mental health services and to
address risks.
•
Katie Cronin-Wood
•
Lead the development of the Communication and
Community Engagement Plan and coordinate the messages
to stakeholders.
•
Indra Narula
•
Provide advice and guidance on integration risks.
•
Barry Hyde
•
Facilitate the work of the Planning Team. Ensure due
diligence is completed and provide project support to the
team.
4. Logistics and Processes
4.1. Role of Chair
The Planning Team Co-Chairs, in conjunction with the Facilitator, will determine the time, date and
location of the meetings, approve the meeting Agenda and conduct the meeting.
4.2. Frequency of Meetings
Planning Team meetings will be held as required throughout the planning process to ensure timely
preparation of an Integration Plan.
Teleconference, video conference and/or webinar meetings are an acceptable alternative to inperson meetings.
4.3. Decision-Making Process
Planning Team decisions will be reached by consensus and reflected in the minutes.
4.4. Quorum Requirements
To constitute a formal meeting, the Co-Chairs, the Facilitator and one representative each from
CMHA-KL, CMHA-P and CE LHIN must be present. Decisions or actions taken in the absence of a
quorum are not binding on the team.
Canadian Mental Health Association (CE LHIN North East Cluster) Integration Planning Team
Page 7 of 9
4.5. Proxies to Meetings
Proxies or substitutions for Planning Team members are accepted with advance notice. However,
due to the sensitive nature of the activities of the Planning Team it is not recommended to regularly
have proxies or substitutions.
The Co-Chair, in conjunction with the team members, will determine attendance by invited guests
on a meeting-by-meeting basis
4.6. Meeting Agenda Items
Meeting Agendas and related materials will be prepared and distributed in advance of Planning
Team meetings.
4.7. Minutes & Meeting Papers
Meeting Minutes and Meeting Papers preparation and distribution will be the responsibility of the
facilitator. Minutes will be prepared and distributed by e-mail following each meeting.
4.8. Issue Resolution
All issues raised before the Planning Team will be provided on an Issue Sheet that includes a
description, impact assessment and proposed issue resolution. Issues that cannot be resolved by
the Planning Team will be escalated to the respective Sponsors for resolution.
Canadian Mental Health Association (CE LHIN North East Cluster) Integration Planning Team
Page 8 of 9
Appendix D: Back­Office Analysis Work Team Business Case Back-Office Analysis Work Team Business Case
Canadian Mental Health Association (CE
LHIN North East Cluster) Integration
Planning
Back-Office Analysis Work Team
Business Case
October 14, 2011
CONFIDENTIAL
Back-Office Analysis Work Team Business Case
Table of Contents Executive Summary ...................................................................................................................... 3 A. Background ........................................................................................................................... 4 B. Need, Problem or Opportunity Statement ............................................................................. 7 C. Description of Back-Office Functions .................................................................................... 7 D. Stakeholder Analysis ............................................................................................................. 8 E. Analysis of Integration Opportunities ..................................................................................... 9 F. Decision Factors .................................................................................................................. 11 G. Summary Comparison of Opportunities .............................................................................. 11 H. Recommendation and Rationale ......................................................................................... 12 a) Constraints .......................................................................................................................... 13 b) Assumptions ........................................................................................................................ 13 I. Transition Requirements ..................................................................................................... 13 J. Acceptance and Sign-Off ..................................................................................................... 15 Appendix A: Back-Office Analysis Work Team Terms of Reference ....................................... 16 Appendix B: Back-Office Analysis Work Team Terms of Reference ....................................... 27 Appendix C: Back-Office Functions Stakeholder Analysis ...................................................... 34 Appendix D: Analysis of Back-Office Integration Opportunities .............................................. 39 2
Back-Office Analysis Work Team Business Case
Executive Summary This business case identifies integration opportunities related to the back-office functions
provided by Canadian Mental Health Association – Kawartha Lakes Branch and Canadian
Mental Health Association – Peterborough Branch. It also identifies reinvestment potential to
expand or develop new front-line direct client services for the North East Cluster mental health
clients and the one-time transition costs required to integrate back-office functions.
The impetus for this business case stems from the work of the CMHA Integration Planning
Team and their initial identification of potential integration opportunities related to back-office
functions. A Back-Office Analysis Work Team was established with membership from both
CMHA organizations to explore these opportunities and assess the integration potential. The
work of the team occurred from mid-September to mid-October 2011. The details of the team’s
analysis are contained in worksheets in Appendix B, C and D and summarized in the body of
the document.
The team, using a consensus approach to its work, is recommending the full amalgamation of
all back-office functions. The greatest benefit in terms of reinvestment potential,
conservatively estimated at $253K annually, to front-line direct client services will be realized
with a single service provider organization serving the community mental health needs in the CE
LHIN North East Cluster. This represents both potential real cost savings and reallocation of
staff effort from back-office functions (e.g., committee work) to front-line services.
Given the similarities in the back-office functions and that both CMHA-KL and CMHA-P use the
same core systems, the amalgamation of back-office functions could potentially be
implemented for the start of the 2012/2013 fiscal year on April 1, 2012.
Ideally any decision to move to integrate CMHA services will consider the opportunities across
the full spectrum of back-office functions, front-line direct client services, leadership and
governance. Proper oversight, project management and change management practices will
need to be established in the context of the overall integration proposal.
The current senior management and staff at CMHA-KL and CMHA-P have the necessary skills
to successfully manage the amalgamation of back-office functions. Their skills and expertise
may need to be supplemented by temporary resources to ensure systems, policies, processes
and procedures are standardized and there is historical continuity and understanding related to
financial, human resources and performance reporting. A conservative estimate of transition
costs associated with an amalgamation of back-office functions are in the order of $102K.
Amalgamation will strengthen the overall delivery of back-office functions and provide greater
organizational flexibility. A single back-office operation will also establish a stronger platform for
CMHA community mental health services upon which to engage community partners and
agencies in further integration discussions.
3
Back-Office Analysis Work Team Business Case
A. Background The Canadian Mental Health Association – Kawartha Lakes Branch (CMHA-KL) and Canadian
Mental Health Association – Peterborough Branch (CMHA-P) have joined with the Central East
Local Health Integration Network (CE LHIN) in discussions to explore integration opportunities.
The impetus for the discussions stems from the March 23, 2011 CE LHIN Board of Directors
meeting where the Board asked to receive a report back on the alignment and integration
possibilities between CMHA-KL and CMHA-P. The CE LHIN has brought CMHA-KL and CMHAP together in a facilitated integration process to develop a stronger integrated community mental
health services delivery model for the North East Cluster.
Under the provisions of the Local Health Services Integration Act, 2006 (LHSIA), the LHIN, the
Minister of Health and Long-Term Care and health service providers can integrate in several
ways.
1.
2.
3.
4.
5.
Coordinate services and interactions between different persons and entities.
Partner with another person or entity in providing services or in operating.
Transfer, merge or amalgamate services, operations, persons or entities.
Start or cease providing services.
Cease to operate or to dissolve or wind up the operations of a person or entity.
For purposes of this integration initiative, mental health is defined as “a state of well-being in
which the individual realizes his or her own abilities, can cope with the normal stresses of life,
can work productively and fruitfully, and is able to make a contribution to his or her community".
Mental health services in Ontario are considered to include the following functions:
•
•
•
•
•
•
•
•
•
•
•
•
•
Identification/Early Intervention
Treatment
Crisis Supports
Consultation
Coordination
Residential Support and/or Housing
Case Management/Coordination
Social Support
Vocational Support
Self-Help/Peer Support
Family Support and Advocacy
Health Promotion/Public Education
Court Support/Diversion/Release from Custody
It is the LHIN’s mandate to promote integration opportunities that enhance both the client
experience and achieve greater value for money (e.g., efficiency). It is the position of the CE
LHIN that additional integration of mental health services across its North East Cluster will
improve ease of access and navigation to community services for mental health clients and will
leverage existing local governance, management, back office support, front-line service
delivery, volunteerism and fund raising currently provided by CMHA-KL and CMHA-P.
On April 11, 2011CMHA-KL, CMHA-P and the CE LHIN agreed to a set of principles to guide
integration discussions and integration planning activities. An Integration Planning Team
4
Back-Office Analysis Work Team Business Case
(Planning Team) was established in mid-April with representatives from CMHA-KL, CMHA-P
and the CE LHIN. The work of the Planning Team through August 2011 was focused on
understanding the current services provided by both CMHA’s, conducting due diligence and
engaging the community and key stakeholders, through focus groups, an on-line survey and inperson meetings, to solicit their input on community mental health opportunities.
The Planning Team created several documents describing key operational information, the
services currently being delivered and in which communities, to support identification of gaps
and opportunities. These documents were used to provide context and to support the
community and stakeholder engagement process. These documents and additional background
information are available on the CE LHIN website as follows:
http://www.centraleastlhin.on.ca/Page.aspx?id=19612
The following key themes were identified in the input from the community and stakeholder
engagement process that support the identification of reinvestment potential to expand existing
programs and/or create new programs/services:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Shared training for CMHA staff and coordinated internship programs.
Common job descriptions for staff.
Coordinated accreditation process and standards.
Standardized/common/shared intake philosophy and process – common selection
criteria.
Standardized care across all geographic areas.
Common/shared best practices and standards and coordinated service plans.
Standardized and coordinated social recreation programs.
Coordinated volunteer services i.e. recruitment, training and retention.
Streamlined service delivery, improved efficiencies, reduction in duplication.
Consistent, standardized, shared systems, databases and reporting processes.
Enhanced performance measurement and consistency in measures and outcomes.
Standardized policies, processes and procedures.
Shared planning, risk management, quality assurance and priority setting.
Shared/coordinated community education, awareness and promotion.
Coordinated community fundraising – create a foundation to manage fundraising and
awareness programs.
Consistency to support client relocation between geographic areas.
More integration of services with other community partner agencies and police.
Improved equity in resource allocation between CMHAs.
Creation of a single leadership and governance structure – standardized
administrative functions.
Based on the Planning Team’s understanding of CMHA services during the information sharing
and due diligence process, and in consideration of the input received through the community
and stakeholder engagement process, the Planning Team identified a number of integration
opportunities. These opportunities identified increasing levels of scope, to generate increasing
levels of operating flexibility to support the expansion and/or creation of new programs and
services for clients of CMHA-KL and CMHA-P. These integration opportunities address:
•
•
•
Back-office Functions
Front-Line Direct Client Services
Organizational Leadership and Governance
5
Back-Office Analysis Work Team Business Case
The Planning Team agreed to move forward initially with further analysis of Back-Office and
Front-Line Direct Client Services. Analysis of Organizational Leadership and Governance was
deferred until the recommendations were available for the other categories as the “functions”
may provide direction for the “form” of operational leadership and governance.
The Planning Team agreed to establish two work teams to undertake an analysis and
development of recommendations for Back-Office and Front-Line Direct Client Services
opportunities. Each work team would be comprised of CMHA-KL and CMHA-P staff (maximum
of 2 staff each per team) plus an impartial facilitator designated by the CE LHIN and agreed to
by the Planning Team. The Planning Team also agreed that the scope of the analysis,
objectives, deliverables and timelines were to be set out in a Terms of Reference for each work
team. The level of the analysis required would need to be high-level (due to limited time for the
analysis) but sufficient for the teams to make informed recommendations to the Planning Team,
CMHA Boards and CE LHIN Board. The Planning Team recognized that further detailed
analysis and planning may need to be undertaken as part of the transition to integrate services
approved in the Integration Plan.
The Planning Team’s identified Back-Office integration opportunities are as follows:
Category
Scope
0
1
Back-Office
2
3
4
Opportunity Description
Status Quo
As above + partner in combining Financial, Human Resource and Payroll
systems, operations and support – normalize staff responsibilities and job
descriptions
As above + partner in combining policies, procedures, standards, best
practices and related systems, accreditation, safety and quality
assurance, staff training functions, procurement
As above + coordinate preparation of financial and performance reporting
processes
As above + create a single back-office/administration function supporting
both organizations – one organization to be primary provider of services
The Back-Office Analysis Work Team was formed with the following membership:
Name
Organization/Stakeholder Group
Barry Hyde
Analysis Team Lead
Carolyn Jones
Manager, Financial and Organizational Services, CMHA-KL
Kim Smith
Staff Member, CMHA-KL
Linda Saunders
Director of Human Resources, Finance & Housing, CMHA-P
Colleen De La Haye
Staff Member, CMHA-P
The Terms of Reference for the Back-Office Analysis work team is available in Appendix A. The
Back-Office Team commenced its work on September 7, 2011. Meetings of the team were held
at the offices of CMHA-KL and CMHA-P through October 14, 2011 to complete this business
case.
6
Back-Office Analysis Work Team Business Case
B. Need, Problem or Opportunity Statement To identify integration opportunities related to the back-office functions (finance, human
resources, payroll, procurement, etc.) provided by CMHA-KL and CMHA-P, to identify
reinvestment potential to expand or develop new front-line direct client services for North East
Cluster mental health clients, and to identify one-time transition costs required to integrate backoffice functions.
C. Description of Back­Office Functions Back-office functions can be defined as the behind the scenes service that support an
organization’s ability to serve its clients. In the context of CMHA-KL and CMHA-P these
functions are administrative, transactional and/or strategic in nature.
Within CMHA-KL and CMHA-P the back-office functions reviewed are as follows:
•
•
•
•
•
•
•
•
•
•
•
•
•
Finance
Human Resources
Payroll and Benefits
Client Management
Information Technology Services
Procurement
Health and Safety
Accreditation/Quality Improvement
Legal
External Reporting
Fundraising
Board and Management Support
Property Management
These functions, estimated full-time equivalents and operating costs (salaries & benefits and
unique items) are defined in Appendix B. In almost every function, with very few exceptions, the
definition of the function is identical between CMHA-KL and CMHA-P. In almost every case
each function is reported to be delivered using similar processes. However, there may be some
operational policy, procedural and internal control differences between the organizations. This is
not unexpected as both CMHA-KL and CMHA-P use the same information systems to manage
the financial, human resources, payroll and external reporting functions.
•
•
Great Plains – GP Dynamics (Community Care Information Management sponsored
project)
Quadrant - QHR (Community Care Information Management sponsored project)
These systems, support from vendors and the expertise of the staff that manage the systems
are the main strengths of each function supported by these systems.
Other strengths associated with back-office functions can be characterized by the
expertise/qualifications of staff, their ability to wear many hats, and their commitment to serving
their clients and community.
7
Back-Office Analysis Work Team Business Case
Weaknesses associated with back-office functions are characterized as a lack of staff to
complete work, the scope of work required exceeds job descriptions, short delivery timelines,
lack of funding to support implementation and management of new regulatory changes, different
and changing nature of requirements of funding agencies, reliance upon the goodwill of staff to
volunteer their time to meet operational requirements.
There is a significant difference between the size of the back-office functions between CMHAKL and CMHA-P. This is not unexpected due to the physical size of the organizations and the
need for every organization to provide back-office functions. Within CMHA-KL these costs
include support for two not-for-profit agencies. The following table provides a comparison of the
FTEs and operating costs dedicated by each CMHA to these back-office functions.
CMHA-KL
Total
Back-Office
Organization
FTEs
Operating Costs
(salaries & benefits, unique
items)
%
Back-Office
CMHA-P
Total
Organization
%
5.0
24.2
20.7%
10.4
101.1
10.3%
$355.7K
$2,111.9K
16.8%
$772.8K
$8,066.1K
9.6%
Only selected other direct operating costs were included in the analysis – these are generally
unique costs specifically related to a back-office function e.g., audit costs, accreditation
membership and survey costs, CMHA-Ontario membership costs, strategic planning costs.
Other costs were not identified because they were not currently known (costs to manage new
CCIM sponsored systems), were very small (e.g., office supplies, etc.), could not reliably be
apportioned between the various functions or the costs related to overhead that might be
expected to continue even after an integrated service delivery model has been recommended
(e.g., rent, utilities, insurance, etc.).
Both CMHA organizations have a variety of funding partners and provide specific services to
meet the objectives of the funding agencies. The CE LHIN provides approximately 80% of all
funding for CMHA-P operations and 70% for CMHA-KL operations. Therefore, the funding of
back-office functions is a hybrid of all funding providers.
D. Stakeholder Analysis A stakeholder can be defined as a group or individual:
•
•
•
•
Critical to the achievement of the organization’s core businesses and key strategies.
Affected by the achievements of the core businesses and key strategies.
With special knowledge or is part of networks related to the organization’s core
businesses and key strategies.
That may be facing similar issues as the proposed initiative.
An analysis of stakeholders was conducted to determine their interests/needs related to each
back-office function provided by CMHA-KL and CMHA-P and to identify mitigation strategies to
ensure their interest/needs continue to be met. The key to ensuring stakeholders interest/needs
continue to be met is to ensure that functions continue uninterrupted, legal and regulatory
requirements are met on time and payments are accurate and made on a timely basis for
services rendered. The details of this stakeholder analysis are contained in Appendix C.
8
Back-Office Analysis Work Team Business Case
The following stakeholder map identifies an assessment of each stakeholder’s perceived level
of support for the integration initiative and their ability to impact the initiative.
Level of Support for Initiative
High
• Funding Agencies
Impact on Initiative
High
• Clients/tenants
Neutral
Low
Moderate
Low
• Staff
• Management
• Boards of Directors
• Landlords
• Accreditation Agency
• Donors
• Vendors
• Banks/Financial Institutions
• Source deduction/regulatory
agencies
• Colleges/Universities
• Legal service providers
While there are many stakeholders, the key ones that are able to have a high/moderate impact
on the integration of back-office functions are the funding agencies (e.g., CE LHIN, Ministry of
Housing, etc.) and all staff and Board members of each agency. Staff and Board members are
identified as moderate in their level of support given the perceived potential for disruption to
their jobs and a perceived negative impact on their organization culture and community.
E. Analysis of Integration Opportunities With a common understanding of each back-office function, the themes identified in the
stakeholder engagement process and knowledge of the key stakeholders, the team analysed
the integration potential for each function. In most cases the integration options for each
function were to:
•
•
Partner in the delivery of functions – assumes both CMHA organizations continue to
exist and they partner in the delivery of back-office functions – this may include a
single organization providing the service on behalf of the other organization or
sharing a common set of policies, procedures and processes.
Transfer, merge or amalgamate functions – assumes there is only a single
organization providing community mental health services/back-office functions in the
CE LHIN North East Cluster.
The options and the associated pros, cons and risks for each back-office function are identified
in Appendix D. The following table summarizes the integration fit, reinvestment potential and
estimated transition costs for each option.
9
Back-Office Analysis Work Team Business Case
Provider & Operating Costs
Function or Service
CMHA-KL
Function
CMHA-P
$000
Function
$000
Est.
Reinvestment Transition
Integration Fit
Potential
Costs $000
$000
(Excluding labour
adjustment)
Finance
9
$73.2
9
Human Resources
9
$45.9
9
Payroll & Benefits
9
$14.2
9
Amalgamate
$165.1
Partner
Amalgamate
$75.4
Partner
Amalgamate
$44.5
Partner
$0
9
$101.3
Client Management
$5.0
$5.0
$0
$0
$5.0
$5.0
$10.0
$5.0
$0
$0
$2.0
$2.0
$0
$0
$181.2 Amalgamate
$105.0
$25.0
Amalgamate
$5.0
Partner
Amalgamate
$3.6
Partner
$8.0
$8.0
$10.0
$10.0
$0
$0
$0
$0
$253.0
$102.0
$58.0
$62.0
$4.7
9
$92.7
Procurement
9
$0
9
$0.7
Health & Safety
9
$11.5
9
$68.3
Accreditation
9
$19.3
9
$9.9
Legal
9
$0
9
$1.4
External Reporting
9
$22.9
9
$23.0
$141.6
Privacy & Security
$8.1
9
9
9
Property Management
9
$16.1
9
Board & Mgt. Support
TOTALS ($000)
$2.7
$355.7
Defer to Front-Line Direct Client Services Team
$0.0
$0.0
$5.0
$5.0
$10.0
$15.0
$20.0
$5.0
$0
$0
$20.0
$10.0
$0
$0
9
9
9
9
$20.0
$10.0
$30.0
$30.0
$5.0
$5.0
Amalgamate
Partner
Amalgamate
Partner
Amalgamate
Partner
Amalgamate
Partner
Amalgamate
Partner
Amalgamate
Partner
Amalgamate
Partner
Information Technology
Fundraising
$45.0
$0
$15.0
$0
$15.0
$5.0
$0.7
Total
$772.8 Amalgamate
Total Partner
In almost every case supporting amalgamation or partnering one of the primary pros is the
development of standardized systems, processes, policies and procedures. With both CMHAKL and CMHA-P using the same systems (albeit independent from one another), both being
members of CMHA-Ontario, accredited to the same standards by Accreditation Canada, and
providing similar front-line client services, it is reasonable to conclude that the back-office
functions can be standardized. This change, the resulting staff related reduction in effort and
saving of some unique costs are the major contributors to the identified reinvestment potential.
With many of the smaller functions, while there are benefits to integration, there is no identified
reinvestment potential as staff effort devoted to these functions is quite small (e.g., Privacy &
Security) or the service is outsourced on a fee for service basis (e.g., Legal).
The most significant opportunity to reinvest in front-line services is derived from the
amalgamation of the Board and Management Support function ($105.0K). This opportunity
arises primarily from eliminating senior leadership support (e.g., Executive Director) to the
Boards of Directors. Through amalgamation the assumption is there is only one organization
serving the CE LHIN North East Cluster with a single Board of Directors.
10
Back-Office Analysis Work Team Business Case
The major reason for the significant difference in reinvestment potential between the
amalgamation and partner options is derived from reduced senior leadership/management
supporting one Board and single management structure in an amalgamated model; versus
maintaining two organizations and structures in the partner model.
Transition costs are estimates of one-time costs to transition functions. These costs are largely
comprised of staff costs (e.g., overtime, temporary contracts), some outsourced work to
consultants and/or systems changes. These costs do not include estimates of labour adjustment
costs that might be required should staff have to be retrained, reassigned and or terminated.
The risks associated with the integration options for each back-office function do not appear to
be significant. These risks could be mitigated quite easily by applying project management and
change management best practices (including stakeholder communications) throughout any
transition process.
F. Decision Factors The Planning Team provided the following decision factors for consideration by each Analysis
Work Team in arriving at its recommendation(s).
•
•
•
•
•
•
•
•
Adherence to guiding principles (client focus, do no harm, etc.)
Opportunity for reinvestment to support expanded or new client services across the
CE LHIN North East Cluster
Takes into account the key themes from the stakeholder and community
engagement process
Strengthens unique community mental health services in the CE LHIN North East
Cluster
Contributes to broader system integration among other providers
Annual operating costs to remain within current CMHA-KL and CMHA-P funding
envelope
One-time transition costs should not inhibit a longer-term integration opportunity to
reinvest in client services
Integration should result in maintained or improved quality and adherence to best
practices with minimal or no impact on service delivery
The Back-Office Analysis Work Team`s Terms of Reference (Appendix A S4.3) preferred
approach to achieving its recommendation(s) is through a consensus. In the event the Analysis
Work Team cannot reach consensus, the details of the team`s deliberations, supporting material
and options will be provided to the Planning Team for consideration and a decision. The BackOffice Analysis Work Team has formulated its recommendation and prepared this business
case using the consensus approach.
G. Summary Comparison of Opportunities With the exception of the Board and Management Support function there are two primary
options identified to integrate back-office services 1) amalgamate, and 2) partner. The only
viable option for Board and Management Support is to amalgamate the function.
11
Back-Office Analysis Work Team Business Case
The analysis of CMHA-KL and CMHA-P back-office functions demonstrates that the estimated
reinvestment potential associated with the amalgamation of the back-office functions is
significantly greater ($253.0K) than partnering in the delivery of these functions ($58.0K).
Of the two options, amalgamation may be the option most resisted, where there is a perception
organizational culture, business processes and autonomy are likely to be affected the most.
H. Recommendation and Rationale The Planning Team identified a range of possible integration opportunities for the back-office
functions including coordination and partnering with gradual increases in scope concluding with
a full amalgamation of all of these functions. These opportunities represented a starting point for
the Back-Office Analysis Work Team as it commenced its work.
The Back-Office Analysis Work Team, having considered the decision factors provided by the
Planning Team, is recommending the full amalgamation of all back-office functions. The
greatest benefit in terms of reinvestment potential, conservatively estimated at $253.0K
annually, to front-line direct client services will be realized with a single service provider
organization serving the community mental health needs in the CE LHIN North East Cluster.
This represents both potential real cost savings and reallocation of staff effort from back-office
functions (e.g., committee work) to front-line services.
Since the back-office functions are provided with a relatively small number of staff who often
support multiple functions, consideration of a stepped approach to integration as initially
identified by the Planning Team, is not considered feasible. A stepped approach or even a mix
of partnering, amalgamation and status quo would almost certainly create confusion, added
complexity, ultimately affect delivery of services and could be expected to result in increased
operating costs.
Full amalgamation of the back-office functions meets the principles established by the CE LHIN,
CMHA-KL and CMHA-P and in particular focuses on the clients by providing the best
opportunity for reinvestment to expand or create new front-line direct client services.
Amalgamation, by definition, will result in a single standardized set of systems, policies,
procedures and processes with minimal or no negative impact on the delivery of client services.
Amalgamation will strengthen the overall delivery of back-office functions and provide greater
organizational flexibility. A single back-office operation will also establish a stronger platform for
CMHA community mental health services upon which to engage community partners and
agencies in further integration discussions.
Given the similarities in the back-office functions and that both CMHA-KL and CMHA-P use the
same core systems, the amalgamation of back-office functions could potentially be
implemented for the start of the 2012/2013 fiscal year on April 1, 2012.
12
Back-Office Analysis Work Team Business Case
a) Constraints The following constraints are factors that are outside the control of the Back-Office Analysis
Work Team that may impact on the above recommendation:
•
•
•
•
•
The Planning Team must consider the work of the Front-Line Direct Client Services
Analysis Work Team and assess options for organizational leadership and
governance before developing an overall integration recommendation.
A decision to proceed with integration action rests with the Planning Team and the
Boards of Directors of CMHA-KL, CMHA-P and the CE LHIN.
Transition and any labour adjustment costs cannot be funded internally by CMHA-KL
or CMHA-P from existing allocations.
As all back-office functions are funded by a number of funding sources approval to
proceed will require the support of all funding organizations.
Staff salary equalization costs may be required should amalgamation of back-office
functions be accepted.
b) Assumptions The following are assumptions that are considered true, real or certain for planning purposes.
•
•
•
•
•
•
The greatest benefit for back-office functions occurs if there is a single community
mental health organization serving the CE LHIN North East Cluster.
Back-office integration is unlikely to proceed on its own – it is best implemented in
conjunction with other integration recommendations that may be developed by the
Front-Line Direct Client Services Analysis Work Team and any organizational
leadership and governance recommendation developed by the Planning Team.
Transition, labour adjustment and staff equalization costs will be available from the
CE LHIN.
Decision makers are motivated by what is in the best interest of clients.
Back-office functions are not influenced by unique needs of the geographic
communities in the CE LHIN North East Cluster.
Potential for job loss/redistribution exists and will be managed to limit disruption of
back-office functions.
13
Back-Office Analysis Work Team Business Case
I. Transition Requirements Ideally any decision to move to integrate CMHA services will consider the opportunities across
the full spectrum of back-office functions, front-line direct client services, leadership and
governance. Proper oversight, project management and change management practices will
need to be established in the context of the overall integration proposal.
The current senior management and staff at CMHA-KL and CMHA-P have the necessary skills
to successfully manage the amalgamation of back-office functions. Their skills and expertise
may need to be supplemented by temporary resources to ensure systems, policies, processes
and procedures are standardized and there is historical continuity and understanding related to
financial, human resources and performance reporting.
A conservative estimate of transition costs associated with an amalgamation of back-office
functions are in the order of $102K and at this time, given current contractual performance
commitments, are unlikely to be found from within existing CMHA-KL and CMHA-P funding
allocations.
Depending on the broader integration recommendation transition of back-office functions could
occur as early as April 1, 2012.
14
Back-Office Analysis Work Team Business Case
Appendix A: Back­Office Analysis Work Team Terms of Reference 16
Canadian Mental Health Association (CE
LHIN North East Cluster) Integration
Planning
Back-Office Analysis Work Team
Terms of Reference
Author:
Barry Hyde
Status:
Final
Version Number:
Version Date:
3
September 7, 2011
Table of Contents
1. BACKGROUND/CONTEXT..........................................................................................................................................3 1.1. 1.2. 1.3. Purpose.......................................................................................................................................................................................................................5 Scope...........................................................................................................................................................................................................................5 Authority.......................................................................................................................................................................................................................6 2. ROLES & RESPONSIBILITIES OF THE WORK TEAM ....................................................................................6 2.1. 2.2. Role of the Work Team..........................................................................................................................................................................................6 Responsibilities of the Work Team.....................................................................................................................................................................6 3. MEMBERSHIP & ROLES OF INDIVIDUAL PLANNING TEAM MEMBERS ............................................7 3.1. 3.2. 3.3. 3.4. 3.5. Membership ..............................................................................................................................................................................................................7 Reporting Relationships.........................................................................................................................................................................................7 Linkages & Partnerships........................................................................................................................................................................................7 Duration of Service...................................................................................................................................................................................................7 Individual Roles of Work Team Members.......................................................................................................................................................8 4. LOGISTICS AND PROCESSES..................................................................................................................................8 4.1. 4.2. 4.3. 4.4. 4.5. 4.6. 4.7. 4.8. 5. 6. 7. 8. 9. Role of Chair ..............................................................................................................................................................................................................8 Frequency of Meetings ..........................................................................................................................................................................................8 Decision-Making Process.....................................................................................................................................................................................9 Quorum Requirements..........................................................................................................................................................................................9 Proxies to Meetings.................................................................................................................................................................................................9 Meeting Agenda Items...........................................................................................................................................................................................9 Minutes & Meeting Papers...................................................................................................................................................................................9 Issue Resolution.......................................................................................................................................................................................................9 ACCEPTANCE & SIGN-OFF..................................................................................................................................... 10 APPENDIX A: BUSINESS CASE OUTLINE........................................................................................................ 11 APPENDIX B: BACK-OFFICE FUNCTION DESCRIPTIONS....................................................................... 12 APPENDIX C: BACK-OFFICE FUNCTIONS STAKEHOLDER ANALYSIS .......................................... 15 APPENDIX D: ANALYSIS OF BACK-OFFICE INTEGRATION OPPORTUNITIES ............................ 16 Canadian Mental Health Association Integration – Back Office Analysis Work Team
Page 2 of 16
1. Background/Context
The Canadian Mental Health Association – Kawartha Lakes Branch (CMHA-KL) and Canadian
Mental Health Association – Peterborough Branch (CMHA-P) have joined with the Central East
Local Health Integration Network (CE LHIN) in discussions to explore integration opportunities.
The impetus for the discussions stems from the March 23, 2011 CE LHIN Board of Directors
meeting where the Board asked to receive a report back on the alignment and integration
possibilities between CMHA-KL and CMHA-P. The CE LHIN has brought CMHA-KL and CMHA-P
together in a facilitated integration process to develop a stronger integrated community mental
health services delivery model for the North East Cluster.
Under the provisions of the Local Health Services Integration Act, 2006 (LHSIA), the LHIN, the
Minister of Health and Long-Term Care and health service providers can integrate in several
ways.
1.
2.
3.
4.
5.
Coordinate services and interactions between different persons and entities.
Partner with another person or entity in providing services or in operating.
Transfer, merge or amalgamate services, operations, persons or entities.
Start or cease providing services.
Cease to operate or to dissolve or wind up the operations of a person or entity.
For purposes of this integration initiative, mental health is defined as “a state of well-being in
which the individual realizes his or her own abilities, can cope with the normal stresses of life, can
work productively and fruitfully, and is able to make a contribution to his or her community"1.
Mental health services in Ontario are considered to include the following functions:
•
•
•
•
•
•
•
•
•
•
•
•
•
Identification/Early Intervention
Treatment
Crisis Supports
Consultation
Coordination
Residential Support and/or Housing
Case Management/Coordination
Social Support
Vocational Support
Self-Help/Peer Support
Family Support and Advocacy
Health Promotion/Public Education
Court Support/Diversion/Release from Custody
It is the LHIN’s mandate to promote integration opportunities that enhance both the client
experience and achieve greater value for money (e.g., efficiency). It is the position of the CE
LHIN that additional integration of mental health services across its North East Cluster will
improve ease of access and navigation to community services for mental health clients and will
leverage existing local governance, management, back office support, front-line service delivery,
volunteerism and fund raising currently provided by CMHA-KL and CMHA-P.
On April 11, 2011CMHA-KL, CMHA-P and the CE LHIN agreed to a set of principles to guide
integration discussions and integration planning activities. An Integration Planning Team
(Planning Team) was established in mid-April with representatives from CMHA-KL, CMHA-P and
the CE LHIN. The work of the Planning Team to date has been focused on understanding the
1
World Health Organization Canadian Mental Health Association Integration – Back Office Analysis Work Team
Page 3 of 16
current services provided by both CMHA’s, conducting due diligence and engaging the
community and key stakeholders, through focus groups, an on-line survey and in-person
meetings, to solicit their input on community mental health opportunities.
The Planning Team created several documents describing key operational information, the
services currently being delivered and in which communities, to support identification of gaps and
opportunities. These documents were used to provide context and to support the community and
stakeholder engagement process. These documents and additional background information are
available on the CE LHIN website as follows:
http://www.centraleastlhin.on.ca/Page.aspx?id=19612
During the information sharing and due diligence process, and in consideration of the input
received through the community and stakeholder engagement process, the Planning Team
identified a number of integration opportunities, with increasing levels of scope, to generate
operating flexibility to support the expansion and/or creation of new programs and services for
clients of CMHA-KL and CMHA-P. These integration opportunities address:
•
•
•
Back-office Functions
Front-Line Direct Client Services
Organizational Leadership and Governance
The Planning Team agreed to move forward initially with analysis of Back-Office and Front-Line
Direct Client Services. Analysis of Organizational Leadership and Governance was deferred until
the recommendations were available for the other categories as the “functions” may provide
direction for the “form” of operational leadership and governance.
The Planning Team agreed to establish two work teams to undertake an analysis and
development of recommendations for Back-office and Front-Line Direct Client Services
opportunities.
The Planning Team’s identified Back-Office integration opportunities are as follows:
Category
Scope
0
1
Back-Office
2
3
4
Opportunity Description
Status Quo
As above + partner in combining Financial, Human Resource and Payroll
systems, operations and support – normalize staff responsibilities and job
descriptions
As above + partner in combining policies, procedures, standards, best
practices and related systems, accreditation, safety and quality
assurance, staff training functions, procurement
As above + coordinate preparation of financial and performance reporting
processes
As above + create a single back-office/administration function supporting
both organizations – one organization to be primary provider of services
Canadian Mental Health Association Integration – Back Office Analysis Work Team
Page 4 of 16
1.1. Purpose
The purpose of the Back-Office Analysis Work Team (Work Team) is to conduct a high-level
analysis of CMHA-KL and CMHA-P back-office integration opportunities sufficient to make a
recommendation to the Planning Team on the scope of back-office integration that can be
achieved.
The analysis and recommendation will be documented in a Business Case (outline is provided in
Appendix A) to be submitted by October 14, 2011 to the Planning Team. The Business Case will
include: 1) a high-level description of the back-office services reviewed; 2) summary details on how
the services are currently provided; 3) an analysis of integration potential; 4) associated risks; 5)
high-level estimate of annualized reinvestment potential for front-line services; 6) high-level
estimate of one-time transition costs; 7) a recommendation and associated rationale.
1.2. Scope
The Work Team is concerned only with the analysis of back-office functions currently provided by
CMHA-KL and CMHA-P.
“IN” Scope
•
•
•
•
•
•
All back-office functions currently
provided by CMHA-KL and CMHA-P.
These functions include but are not
limited to:
o Finance
o Human Resources
o Payroll and Benefits
o Client Management
o Information Technology Services
o Procurement
o Health and Safety
o Accreditation/Quality Improvement
o Legal
o External Reporting
o Fundraising
o Board and Management Support
(including Reception and Proposal
Development)
o Property Management
Risks associated with opportunities
High-level estimate of reinvestment
potential in expanded or new front-line
direct client Services
Estimate of high-level one-time
transition costs
Development of a business case
outlining the analysis and associated
recommendation
Presentation and engagement with the
Planning team
Canadian Mental Health Association Integration – Back Office Analysis Work Team
“OUT” of Scope
•
•
•
•
Front-line direct client services,
organizational leadership and governance
functions at CMHA-KL and CMHA-P
Services and programs not funded by the
CE LHIN
Back-office services provided by other
service providers
Transition planning
Page 5 of 16
1.3. Authority
The authority of the Work Team does not extend beyond the individual authorities of its members
and their respective decisions and sphere of influence.
The Work Team does:
•
Have the authority to share information with Work Team and Planning Team members
about their organizations services, management and operations for purposes of
supporting the development of the Business Case.
•
Have the authority to make a recommendation on the integration of back-office services.
•
Not have the authority to approve the business case and associated recommendation as
this is reserved for the Boards of Directors of each organization.
2. Roles & Responsibilities of the Work Team
2.1. Role of the Work Team
The Work Team will focus on the analysis of back-office functions sufficient for developing a
recommendation to integrate these functions. In this role the Work Team will:
•
Define and describe back-office functions provided by CMHA-KL and CMHA-P.
•
Analyse opportunities to integrate these services considering the scope of opportunities
identified by the Planning Team.
•
Consider the full-scope of integration as it applies to back-office functions.
•
Identify approximate annualized reinvestment potential for front-line direct client services.
•
Identify approximate one-time transition costs required to integrate back-office services.
•
Identify risks associated with the integration of back-office services and potential mitigation
strategies.
•
Liaise with other CMHA-KL, CMHA-P and CE LHIN representatives to clarify information,
test planning assumptions and receive feedback on proposed actions/measures.
•
Provide regular status reports to the Planning Team.
•
Write the Business Case.
•
Present the completed Business Case and recommendations to the Planning Team by
October 14, 2011.
•
Present recommendations to the Boards of Directors (if required).
2.2. Responsibilities of the Work Team
The main function of the Work Team is to take responsibility for the development of the Business
Case and presentation of its recommendation to the Planning Team and potentially Boards of
Directors.
Canadian Mental Health Association Integration – Back Office Analysis Work Team
Page 6 of 16
3. Membership & Roles of Individual Planning Team Members
3.1. Membership
The Work Team will be chaired by an independent analysis lead to be designated by the CE LHIN
and agreed to by the Planning Team.
The Work Team membership will be composed of senior representatives from the following
organizations/stakeholder groups:
Name
Organization/Stakeholder Group
•
Barry Hyde
•
Analysis Lead
•
Carolyn Jones
•
Manager, Financial and Organizational Services,
CMHA-KL
•
Kim Smith
•
Staff Member, CMHA-KL
•
Linda Saunders
•
Director of Human Resources, Finance &
Housing, CMHA-P
•
Colleen De La Haye
•
Staff Member, CMHA-P
3.2. Reporting Relationships
The Work Team will report to the Planning Team.
3.3. Linkages & Partnerships
The Work Team will seek input from existing CMHA staff providing services and may engage a
wider group of subject matter experts including other back-office service providers, other
community support services and mental health and addictions service agencies, etc.
3.4. Duration of Service
The members and chair of the Work Team will serve until the completion of the Business Case,
with a target completion date of October 14, 2011, and presentation to the Planning Team.
New members of the Work Team may be added from time-to-time to address a perspective and
set of skills of benefit to the Work Team that may have been overlooked in the identification of the
original Work Team membership.
Canadian Mental Health Association Integration – Back Office Analysis Work Team
Page 7 of 16
3.5. Individual Roles of Work Team Members
Name
•
Barry Hyde
Individual Role
•
•
•
•
•
•
Carolyn Jones
•
•
•
Kim Smith
•
•
•
Linda Saunders
•
•
•
Colleen De La Haye
•
•
Chair the Work Team.
Lead the development of the Business Case.
Direct the work of the Work Team.
Ensure due diligence is completed, provide project support
to the team and take the lead in writing the Business Case
Primary contact with the Integration Planning Team.
Educate the team on the back-office functions, management
and operations of CMHA-KL. Provide information to support
the analysis of back-office integration opportunities and
contribute to the development of a recommendation to
integrate back-office functions.
Support the development of the Business Case.
Educate the team on the back-office functions, management
and operations of CMHA-KL. Provide information to support
the analysis of back-office integration opportunities and
contribute to the development of a recommendation to
integrate back-office functions.
Support the development of the Business Case.
Educate the team on the back-office functions, management
and operations of CMHA-P. Provide information to support
the analysis of back-office integration opportunities and
contribute to the development of a recommendation to
integrate back-office functions.
Support the development of the Business Case.
Educate the team on the back-office functions, management
and operations of CMHA-P. Provide information to support
the analysis of back-office integration opportunities and
contribute to the development of a recommendation to
integrate back-office functions.
Support the development of the Business Case.
4. Logistics and Processes
4.1. Role of Chair
The Work Team Chair will determine the time, date and location of the meetings, approve the
meeting Agenda and conduct the meeting.
4.2. Frequency of Meetings
Work Team meetings will be held as required to ensure timely preparation of a Business Case.
Teleconference, video conference and/or webinar meetings are an acceptable alternative to inperson meetings.
Canadian Mental Health Association Integration – Back Office Analysis Work Team
Page 8 of 16
4.3. Decision-Making Process
Work Team decisions will be reached by consensus and reflected in the meeting minutes. If the
Work Team cannot reach consensus, the details of their deliberation/supporting material and
options will be provided to the Planning Team for a decision.
4.4. Quorum Requirements
To constitute a formal meeting, the Chair and one representative each from CMHA-KL, CMHA-P
must be present. Decisions or actions taken in the absence of a quorum are not binding on the
team.
4.5. Proxies to Meetings
Proxies or substitutions for Work Team members are accepted with advance notice. However, due
to the sensitive nature of the activities of the Work Team and the short time period to complete the
analysis it is not recommended to regularly have proxies or substitutions.
The Chair, in conjunction with the team members, will determine attendance by invited guests on a
meeting-by-meeting basis
4.6. Meeting Agenda Items
Meeting Agendas and related materials will be prepared and distributed in advance of Work Team
meetings.
4.7. Minutes & Meeting Papers
Meeting Minutes and Meeting Papers preparation and distribution will be the responsibility of the
Chair. Minutes will be prepared and distributed by e-mail following each meeting to the Work Team
and Planning Team.
4.8. Issue Resolution
All issues raised before the Work Team will be provided on an Issue Sheet that includes a
description, impact assessment and proposed issue resolution. Issues that cannot be resolved by
the Work Team will be escalated to the Planning Team for resolution and/or further escalation to
the CMHA-KL, CMHA-P or CE LHIN sponsors.
Canadian Mental Health Association Integration – Back Office Analysis Work Team
Page 9 of 16
Back-Office Analysis Work Team Business Case
Appendix B: Back­Office Function Descriptions Provider
Function or
Service
CMHA-KL
CMHA-P
FTE: 1.0
Operating Costs: $73.2K ($65.7 S&B + $7.5
Audit)
Finance FTE: 2.1
Funding Source: Hybrid Operating Costs: $ 165.1K ($153.1 S7B + $12.0
Audit)
Funding Source: Hybrid
Brief Description of Sub-Functions:
Accounts Payable: Payment of vendor invoices, internal payments,
expense claims, reconciliation of accounts
Brief Description of Sub-Functions:
Accounts Payable: Payment of vendor invoices, internal payments, expense
claims, reconciliation of accounts
Accounts Receivable: Revenue from grants and government agencies,
income from other service providers, fundraising
Accounts Receivable: Revenue from grants and government agencies,
income from other service providers, fundraising
Monthly Financials: Internal statements, expenditure analysis, budget
cash flow
Monthly Financials: Internal statements, expenditure analysis, budget cash
flow
Reconciliation: Reconciling sub-ledgers (AP, AR) to GL, donations,
vendor statements
Reconciliation: Reconciling sub-ledgers (AP, AR) to GL, donations, vendor
statements
Budgeting: LHINs (CAPS), supportive housing, City of Kawartha Lakes,
United Way, fundraising, grants, etc.
Budgeting: LHINs (CAPS), supportive housing, MCSS, MTCU, United Way,
fundraising, grants, etc.
Charitable Donations: Issue tax receipts, depositing funds, reporting
Charitable Donations: Issue tax receipts, depositing funds, reporting
Banking: Deposits, on-line payments, reconciliation, signing authority,
internal controls, investment management
Banking: Deposits, on-line payments, reconciliation, signing authority,
internal controls, investment management
Audited Statements: Mid-year and year-end audits, test internal controls
Audited Statements: Mid-year and year-end audits, test internal controls
Policies and Procedures: Financial controls, reviewing, communication
Policies and Procedures: Financial controls, reviewing, communication
Trustee Management: Receipt of social assistance cheques, direct deposit
to two separate accounts (case management and homelessness),
reconciliation, distributing funds, repayments.
Housing Rent Supplements: MOHLTC housing program funds deposited Housing Rent Supplements: MOHLTC housing program funds deposited to
to CMHA accounts, meeting financial obligations of agreements (rent),
CMHA accounts, meeting financial obligations of agreements (rent),
disbursement of funds (rent, utilities, maintenance), reporting to program disbursement of funds (rent, utilities, maintenance), reporting to program
Petty Cash: Reconciliation, KL- manages float for on-call and social rec., Petty Cash: Reconciliation, P- manages float for administration staff,
Support for Other Organizations: Provide full range of back-office
functions for two not-for-profit organizations– fee for service and/or
services in-kind.
Financial System: GP Dynamics (CCIM sponsored project – 2 years).
Web based system, CCIM winding down support for system and will be
charging an annual support – amount unknown.
Financial System: GP Dynamics (CCIM sponsored project – 2 years). Web
based system, CCIM winding down support for system and will be charging
an annual support – amount unknown.
Strengths: Qualifications and experience of staff, low staff turnover,
segregation of duties and internal controls, flexibility of staff, back-office
Strengths: Qualifications and experience of staff, low staff turnover,
segregation of duties and internal controls, flexibility of staff, GP Dynamics
27
Back-Office Analysis Work Team Business Case
Provider
Function or
Service
CMHA-KL
CMHA-P
for other organizations, GP Dynamics
Weaknesses: Not enough staff to complete the work, scope of work
exceeds job descriptions.
Weaknesses: Not enough staff to complete the work, scope of work
exceeds job descriptions.
FTE: 0.8
FTE: 1.1
Operating Costs: $45.9K S&B
Funding Source: Hybrid Operating Costs: $75.4K S&B
Funding Source: Hybrid
Brief Description of Sub-Functions:
Recruitment: Posting positions, screening applications, interviews,
reference checks, CPIC, on-boarding, employee exits, orientation,
volunteer coordination, student internship
Brief Description of Sub-Functions:
Recruitment: Posting positions, screening applications, interviews,
reference checks, CPIC, on-boarding, employee exits, orientation,
volunteer coordination, student internship
Training & Development: Registrations, update employee records,
organize group training
Training & Development: Registrations, update employee records, organize
group training
Performance Management: Set standards and criteria, manage
Performance Management: Set standards and criteria, manage evaluation
evaluation process with managers, consultation, attendance management process with managers, consultation, attendance management
Personnel File Management: Maintain personnel files, ensuring
Personnel File Management: Maintain personnel files, ensuring
completeness, audits, management of information, security of information completeness, audits, management of information, security of information
Human Resources Policies and Procedures: Write, distribute and manage policies and
procedures manual
Policies and Procedures: Write, distribute and manage policies and
procedures manual (PPM system – P only)
Job Position Evaluation: Evaluation positions for skills, effort,
responsibility and working conditions
Job Position Evaluation: Evaluation positions for skills, effort, responsibility
and working conditions – point value system. Ongoing committee with
responsibility
Workplace Culture: Manage Work-Life Pulse survey (part of
Workplace Culture: Manage Work-Life Pulse survey (part of Accreditation),
Accreditation), culture survey (annual process), share results, seek input culture survey (bi-annual process), share results, seek input for
for improvement
improvement
Payroll and Quadrant HR: CCIM sponsors implementation. Web based system, CCIM
winding down support for system and will be charging an annual support
– amount unknown. Drives Payroll – input shared by payroll (timesheets)
and HR (tombstone data).
Quadrant HR: CCIM sponsors implementation. Web based system, CCIM
winding down support for system and will be charging an annual support –
amount unknown. Drives Payroll – input shared by payroll (timesheets) and
HR (tombstone data).
Strengths: Collaboration with front-line, co-located with finance supports
efficient processing, Quadrant HR – integrates with GP Dynamics,
supports MIS and Common Data System reporting, not unionized,
organizational culture, regarded as employer of choice in community.
CHRP certified staff member.
Strengths: Collaboration with front-line, Policy & Procedure Manual System
(PPM), co-located with finance supports efficient processing, Quadrant HR
– integrates with GP Dynamics, supports MIS and Common Data System
reporting, not unionized, organizational culture, regarded as employer of
choice in community
Weaknesses: Not enough staff to complete the work, scope of work
exceeds job descriptions.
Weaknesses: Not enough staff to complete the work (don’t meet industry
standard ratios), scope of work exceeds job descriptions.
FTE: 0.2
FTE: 0.6
Operating Costs: $14.2K S&B
Funding Source: Hybrid Operating Costs: $44.5K S&B
Funding Source: Hybrid
28
Back-Office Analysis Work Team Business Case
Provider
Function or
Service
CMHA-KL
CMHA-P
Brief Description:
Remuneration to Staff: Production of bi-weekly payment of staff wages,
direct deposit, use QHR/QHR Net, some manual pay statements by
request, review of timesheets, recording of sick time and vacations,
approval of timesheets (manager), verify information recorded into
scheduler and credits are available, employee deductions and
remittances.
Benefits Entitlements: Negotiating benefits package with carrier (CMHAKL Great-West Life part of CMHA-O negotiated at Ontario Level), CMHAP is with Green Shield extended health and dental and RBC Financial
(Insurance, LTD, etc.) Pension with Sun Life through CMHA-National.
Benefits Administration: Deductions, enrolling staff, internal/external
reporting, responding to staff enquiries, reconciliation of accounts,
functional centre management.
T4 and YE Reporting: Reporting and production of T4 statements, and
reconciliation of mandatory employer costs.
Brief Description:
Remuneration to Staff: Production of bi-weekly payment of staff wages,
direct deposit, use QHR/QHR Net, some manual pay statements by
request, review of timesheets, recording of sick time and vacations,
approval of timesheets (manager), verify information recorded into
scheduler and credits are available, employee deductions and remittances.
Benefits Entitlements: Negotiating benefits package with carrier (CMHA-KL
Great-West Life part of CMHA-O negotiated at Ontario Level), CMHA-P is
with Green Shield extended health and dental and RBC Financial
(Insurance, LTD, etc.) Pension with Sun Life through CMHA-National.
Benefits Administration: Deductions, enrolling staff, internal/external
reporting, responding to staff enquiries, reconciliation of accounts,
functional centre management.
T4 and YE Reporting: Reporting and production of T4 statements, and
reconciliation of mandatory employer costs.
Strengths: QHR system, data management, training and expertise of
staff, support provided by QHR, system.
Strengths: QHR system, data management, training and expertise of staff,
support provided by QHR, system.
Weaknesses: Involves everyone meeting deadlines to support the
processes, turnaround time very short.
Weaknesses: Involves everyone meeting deadlines to support the
processes, turnaround time very short.
FTE: 0.0
FTE: 1.4
Benefits Operating Costs: $0
Client Management Information Technology Services Funding Source:
Operating Costs: $101.3K
Funding Source: Hybrid
Brief Description:
Function is a front-line service responsibility at CMHA-KL
Brief Description:
Trustee program management – cheque signing, legal agreements with
ODSP, attend client updates with ODSP, approving of invoices, and
supervise staff. Trustee workers are front-line service responsibility at
CMHA-P.
Strengths:
Strengths: Enhanced client service, separation of financial supports from
case management doesn’t jeopardize client relationship. Program managed
by staff member with a financial background.
Weaknesses:
Weaknesses: Not enough time, another-add-on function.
FTE: 0.1
FTE: 1.3
Operating Costs: $4.7K
Funding Source: Hybrid Operating Costs: $92.7K S&B
Brief Description:
IT hardware, network and software support/training, support OTN
coordination and set-up and trouble shooting, cell phone support, server
management, website support and management, manage system
Funding Source: Hybrid
Brief Description:
IT hardware, network and software support/training, support OTN
coordination and set-up and trouble shooting, cell phone support, server
management, website support and management, manage system
29
Back-Office Analysis Work Team Business Case
Provider
Function or
Service
CMHA-KL
CMHA-P
security/credentials, intranet.
security/credentials, intranet .
CMHA-KL sub-contracts services to private sector service provider.
CMHA-P has one dedicated staff person .8 FTE.
Strengths: Services available remotely and not a lot of costs given service Strengths: IT staff on-site, knowledge of systems/networks, back-up
is contracted, knowledge of systems/networks, back-up support.
support. External consultant also available when required – also a member
of the IT committee
Weaknesses: Budget for IT not sufficient to support staff and
organizational needs.
Weaknesses: Budget for IT not sufficient to support staff and organizational
needs.
FTE: 0.0
FTE: 0.0
Operating Costs: $0.0
Funding Source:
Brief Description:
Purchase of goods and services, preparation of purchase requisition,
purchase orders, verify process followed, distribute to payables and
managers to proceed with purchase. Managers limit $500 (P), corporate
cards (P) and (L) in name of senior management, can be signed out by
staff. Tendering responsibility of management. Preferred vendors for
certain goods and services. Management of corporate plans for
Procurement computers, cell phones, etc. Establish policies and procedures for
procurement, approval authorization.
Funding Source: Hybrid
Brief Description:
Purchase of goods and services, preparation of purchase requisition,
purchase orders, verify process followed, distribute to payables and
managers to proceed with purchase. Managers limit $500 (P), corporate
cards (P) and (L) in name of senior management, can be signed out by
staff. Tendering responsibility of management. Preferred vendors for certain
goods and services. Management of corporate plans for computers, cell
phones, etc. Establish policies and procedures for procurement, approval
authorization.
Strengths: All staff aware of budgetary constraints – staff driven to get the
best deal for goods and services. Value for money for goods and services
purchased. Good controls and oversight. Vendors are aware of CMHA
procurement rules.
Strengths: All staff aware of budgetary constraints – staff driven to get the
best deal for goods and services. Value for money for goods and services
purchased. Good controls and oversight. Vendors are aware of CMHA
procurement rules.
Weaknesses: Unforeseen breakdown of computer equipment – lack of
funding base to support replacement – creates pressures on other
operations.
Weaknesses: Unforeseen breakdown of computer equipment – lack of
funding base to support replacement – creates pressures on other
operations.
FTE: 0.2
FTE: 1.0
Operating Costs: $11.5K S&B
Health and Safety Operating Costs: $0.7K S&B
Funding Source: Hybrid Operating Costs: $68.3K S&B
Brief Description:
Occupational Health & Safety of Staff: Managing emergency procedures,
new hire orientation, ensuring a safe workplace/inspections, completion
of roles and responsibilities under OHSA, WSIB claims management,
training and development, policies and procedures, CMHA-P participates
in a safety group to improves systems and reduce costs, incident reports,
legislative compliance, workplace wellness
Client Safety: Physical environment, manage client safety committee,
apartment inspections, fire safety, emergency preparedness, medication
Funding Source: Hybrid
Brief Description:
Occupational Health & Safety of Staff: Managing emergency procedures,
new hire orientation, ensuring a safe workplace/inspections, completion of
roles and responsibilities under OHSA, WSIB claims management, training
and development, policies and procedures, CMHA-P participates in a safety
group to improves systems and reduce costs, incident reports, legislative
compliance, workplace wellness
Client Safety: Physical environment, manage client safety committee,
apartment inspections, fire safety, emergency preparedness, medication
30
Back-Office Analysis Work Team Business Case
Provider
Function or
Service
CMHA-KL
CMHA-P
management, policies and procedures, protocol development, complaint
incident management
Infection Prevention and Control (IPAC): Business continuity planning,
mask fit testing, training and education, procurement of personal
protective equipment, health & safety mandatory training, developing
internal training, first aid training
management, policies and procedures, protocol development, complaint
incident management
Infection Prevention and Control (IPAC): Business continuity planning,
mask fit testing, training and education, procurement of personal protective
equipment, health & safety mandatory training, developing internal training,
first aid training
Strengths: Ensures safe working environment for staff, invested in client
safety, reducing lost days work, incidence, costs, employer of choice.
Strengths: Ensures safe working environment for staff, invested in client
safety, reducing lost days work, incidence, costs, employer of choice.
Weaknesses: Expensive and time consuming, no ministry resources to
support.
Weaknesses: Expensive and time consuming, no ministry resources to
support.
FTE: 0.2
FTE: 0.0
Operating Costs: $19.3K ($13.7 S&B + $5.6
membership and survey)
Funding Source: Hybrid Operating Costs: $9.9K ($2.9 S&B + $7.0
membership and survey)
Brief Description:
External peer review to assess the quality of services based on standards
of excellence. Quality improvement of processes and procedures to meet
or exceed best practices or nation standards related to all functions and
services. Coordinate assessment by Accreditation Canada, self
Accreditation assessment by staff and clients, creates a roadmap for verification by
Accreditation Canada. Follow-up on recommended changes, provide
evidence standards are being met ROP (required organizational
practice).
Funding Source: Hybrid
Brief Description:
External peer review to assess the quality of services based on standards
of excellence. Quality improvement of processes and procedures to meet or
exceed best practices or nation standards related to all functions and
services. Coordinate assessment by Accreditation Canada, self assessment
by staff and clients, creates a roadmap for verification by Accreditation
Canada. Follow-up on recommended changes, provide evidence standards
are being met ROP (required organizational practice).
Strengths: Ensures organization is meeting high standard of service, lets Strengths: Ensures organization is meeting high standard of service, lets
partners know services are of high quality, helps compare services
partners know services are of high quality, helps compare services across
across continuum, reduces risk management
continuum, reduces risk management
Weaknesses: Expensive and time consuming, no ministry resources to
support
Weaknesses: Expensive and time consuming, no ministry resources to
support
FTE: 0.0
FTE: 0.0
Operating Costs: $0.0
Legal Funding Source: Hybrid Operating Costs: $1.4K S&B
Funding Source: Hybrid
Brief Description:
Procurement of legal advice from legal service providers largely for
human resources and corporate matters. Typically role of Executive
Director and/or Finance Manager/Director. No retainers – strictly fee for
service per engagement.
Brief Description:
Procurement of legal advice from legal service providers largely for human
resources and corporate matters. Typically role of Executive Director and/or
Finance Manager/Director. No retainers – strictly fee for service per
engagement.
Strengths: Only purchase service when needed – responsive access to
expertise.
Low legal costs. No regular ongoing costs. Cost effective.
Strengths: Only purchase service when needed – responsive access to
expertise.
Low legal costs. No regular ongoing costs. Cost effective.
31
Back-Office Analysis Work Team Business Case
Provider
Function or
Service
CMHA-KL
CMHA-P
Weaknesses:
Weaknesses:
FTE: 0.3
FTE: 0.3
Operating Costs: $22.9K S&B
External Reporting Funding Source: Hybrid
Brief Description:
Financial and performance/statistical reporting to external funders e.g.
government sources (LHIN, MOHLTC, MCSS, MTCU, MOH), charity
returns, annual audit, MIS/CDS submissions, budget and quarterly reports,
local municipality funders (City of Peterborough), United Way.
Strengths: Financial and human resources and client record management Strengths: Financial and human resources and client record management
databases provide ready access to information for reporting purposes.
databases provide ready access to information for reporting purposes.
Weaknesses: Differing requirements of stakeholders, inconsistency
between stakeholders, changing sources of funds, requirements and
funders are not static, not enough staff to complete the work, scope of
work exceeds job descriptions.
Weaknesses: Differing requirements of stakeholders, inconsistency
between stakeholders, changing sources of funds, requirements and
funders are not static, not enough staff to complete the work, scope of work
exceeds job descriptions.
FTE: 0.1
FTE: 0.0
Operating Costs: $2.7K S&B
Fundraising Funding Source: Hybrid Operating Costs: $23.0K S&B
Brief Description:
Financial and performance/statistical reporting to external funders e.g.
government sources (LHIN, MOHLTC, MOH), charity returns, annual
audit, MIS/CDS submissions, budget and quarterly reports, local
municipality funders (City of Kawartha Lakes), United Way.
Funding Source: Hybrid Operating Costs: $0.7K S&B
Funding Source: Hybrid
Brief Description:
Coordination and management of fundraising events to supplement
program operating costs including advertising/marketing, supplies
purchase, application for licenses. Range of events from small one-off to
larger annual events e.g. Lindsay Fair Parking CMHA-KL, regular Bingo
events.
Brief Description:
Coordination and management of fundraising events to supplement
program operating costs including advertising/marketing, supplies
purchase, application for licenses. Range of events from small one-off to
larger annual events e.g. golf tournament (CMHA-P), bike race (CMHA-P),
regular Bingo events.
Strengths: Community awareness of Mental Health, keeps clients and
volunteers active and involved. Good staff participation and goodwill.
Strengths: Community awareness of Mental Health, keeps clients and
volunteers active and involved. Good staff participation and goodwill.
Weaknesses: Lot of work over and above job description, staff participate Weaknesses: Lot of work over and above job description, staff participate
as volunteers. Relies on goodwill of staff – very fragile.
as volunteers. Relies on goodwill of staff – very fragile.
FTE: 1.7
Board and Management Support (incl. Reception, Proposal Development) FTE: 2.4
Operating Costs: $141.6K ($131.6 S&B + $5.0 Funding Source: Hybrid Operating Costs: $181.2K ($174.7 S&B + $5.0
CMHA-Ontario membership + $0.5 strategic
CMHA-Ontario membership + $1.5 strategic
planning)
planning)
Brief Description:
Primary responsibility of the role of Executive Director. Administrative
support to Board, senior management, front-line, committees e.g.
minutes, agendas, copies, room bookings, conferences, faxes, ordering
of office supplies, etc. Reception dealing with clientele, booking
appointments for intake and consulting Psychiatrists, metabolic clinic and
Funding Source: Hybrid
Brief Description:
Primary responsibility of the role of Executive Director. Administrative
support to Board, senior management, front-line, committees e.g. minutes,
agendas, copies, room bookings, conferences, faxes, ordering of office
supplies, etc. Reception dealing with clientele, booking appointments for
intake and consulting Psychiatrists, metabolic clinic and dietician. Manage
32
Back-Office Analysis Work Team Business Case
Provider
Function or
Service
CMHA-KL
CMHA-P
dietician. Manage parking passes, credit cards, bank deposits (CMHAKL), and collect rents and other monies. Manage policies and procedures
distribution and updates. Add staff to internal servers/systems. Manage
equipment inventory sign-in/out. Volunteer Coordination.
parking passes, credit cards, and collect rents and other monies. Manage
policies and procedures distribution and updates. Add staff to internal
servers/systems. Manage petty cash (CMHA-P), equipment inventory signin/out. Volunteer Coordination.
Strengths: Skills enable front-line staff more time with clients, wear many Strengths: Skills enable front-line staff more time with clients, wear many
hats, know a lot about the organization, can handle some of the more
hats, know a lot about the organization, can handle some of the more
routine client requests.
routine client requests.
Weaknesses: Much of the work falls outside the job description, many
competing demands, stressful.
Weaknesses: Much of the work falls outside the job description, many
competing demands, stressful.
FTE: 0.1
FTE: 0.1
Operating Costs: $8.1K S&B
Privacy and Security Funding Source: Hybrid Operating Costs: $5.0K S&B
Brief Description:
Role of Privacy Officer (Executive Director) to manage policies and
federal/provincial legislation related to clients and personnel information
including managing requests, investigating and managing breach
incidents, coordinate freedom of information requests.
Funding Source: Hybrid
Brief Description:
Role of Privacy Officer (Director) to manage policies and federal/provincial
legislation related to clients and personnel information including managing
requests, investigating and managing breach incidents, coordinate freedom
of information requests.
Strengths: Clients/staff feel safer as privacy and security of information is Strengths: Clients/staff feel safer as privacy and security of information is
protected.
protected.
Weaknesses: Add-on responsibility, function not budgeted for, more work Weaknesses: Add-on responsibility, function not budgeted for, more work
than initially anticipated, growth function with limited staff capacity and
than initially anticipated, growth function with limited staff capacity and
associated funding.
associated funding.
FTE: 0.3
Operating Costs: $16.1K S&B
Property Management FTE: 0.1
Funding Source: Hybrid Operating Costs: $3.6K S&B
Funding Source: Hybrid
Brief Description:
Manage mortgages, building maintenance and capital improvements for
owned properties.
Brief Description:
Manage mortgages, building maintenance and capital improvements for
owned properties. CMHA-P Director of Finance also manages front-line
housing services.
Strengths: Knowledge of properties and community vendors, linkages
with Health & Safety.
Strengths: Knowledge of properties and community vendors, linkages with
Health & Safety.
Weaknesses: Fractionalized responsibility between back-office and front- Weaknesses: Fractionalized responsibility between back-office and frontline.
line.
Total FTE: 5.0
FTE: 10.4
Operating Costs: $355.7K ($337.1 S&B + $18.6 Other)
Operating Costs: $772.8K (747.3 S&B + $25.5 Other)
33
Back-Office Analysis Work Team Business Case
Appendix C: Back­Office Functions Stakeholder Analysis Function or Service Stakeholders Interests & Needs Management Strategies Stakeholders impacted by the function/service. How are the stakeholders involved with the function/service? Why will they be interested in this integration or how might they be affected? How will stakeholder expectations be managed, and how will their needs be met? What factors might impact on meeting stakeholder needs? Vendors Sell goods and services and receive on‐time payments for same. Notification of any changes affecting delivery of goods and services and any payments owing. Provide assurances that all commitments will be honoured and commitment to on‐time payments. Bank Holds organizations funds in designated accounts, provides statements, and processes details of transactions. Discuss potential changes in arrangements and work with banks during transition. Board of Directors Evidence of financial stewardship, reporting on financial well being of the Provide assurances that potential changes will address stewardship organization and financial obligations are being met according to of financial resources. generally accepted accounting policies. Funders Assurance that funds are being allocated and spent appropriately on front‐line services and value for money is achieved. Demonstrate continued accountability for funding, value for money and focus on client services. Landlords On‐time payment for housing accommodation. Provide assurances that all commitments will be honoured. Front‐Line Staff On‐time payments to meet operational obligations for services to clients. Provide assurances that all commitments will be honoured and payments will be paid on time. Clients Organization has stewardship of their trustee accounts, funds are Demonstrated stewardship of financial resources entrusted and managed appropriately, on‐time payments. Services are available to meet commitment to on‐time payments. No disruption in front‐line direct their recovery needs. client services. Source Deductions Agencies Payments for legislated amounts are provided on‐time i.e. WSIB, HST, etc. Provide assurances that all commitments will be honoured and payments will be paid on time. All Staff Payroll is paid on time and is accurate. Management Staff Support is provided in managing staff processes from recruitment through Continue to provide support and guidance for management through termination. any potential change that may occur. Clients That staff are meeting their needs for services efficiently and professionally according to high standards and best practices. Finance Human Resources Demonstrate that payroll will be met. Obtain feedback from clients on their satisfaction with the services received. Colleges/Universities Meaningful placement opportunities for students. Emphasise ongoing commitment to the programs and continue to provide placement opportunities throughout any potential change/transition period. Lawyer Continue to provide accurate and timely information. Information to develop legal opinions and establish due process in matters involving the legal system. 34
Back-Office Analysis Work Team Business Case
Function or Service Payroll and Benefits Client Management Stakeholders Interests & Needs Management Strategies Stakeholders impacted by the function/service. How are the stakeholders involved with the function/service? Why will they be interested in this integration or how might they be affected? How will stakeholder expectations be managed, and how will their needs be met? What factors might impact on meeting stakeholder needs? Regulatory agencies Source deductions are accurate and remitted on time. Continue to remit payments accurately and on‐time. All Staff Timely and accurate pay cheques. Demonstrate that payroll will be met. Vendors (benefit carriers, source deduction agencies) Remittances and payments are accurate and submitted within expected time frames. Demonstrate that all vendor payments are submitted within the expected time frames. Financial Institutions Payroll file is accurate and received on time for deposit into employee/vendor accounts. Continue to provide accurate payroll files on time for deposit into staff /vendor accounts. Clients Knowledge that their funds are secure and available when they are needed. Continue to demonstrate that funds are secure and available at time of need. ODSP Assurance that recipient’s funds are secure and managed effectively on behalf of the clients with the correct controls in place. Continue to demonstrate that client’s accounts are managed effectively. Bank (trustee accounts) Funds are deposited to meet client’s financial commitments and that funds are managed effectively on behalf of the clients with the correct controls in place. Continue to demonstrate that client’s accounts are managed effectively. Vendors (clients bills) Timely payment for goods and services rendered to/for recipients. Everyone Information Technology Services Procurement Health and Safety Continue to demonstrate timely payments to vendors. Assurance that all systems will be available and reliable to support both front‐line direct client services and back‐office functions. Continue to provide uninterrupted IT systems and services. Clients Goods and services are available to support their recovery plans. Continue to provide uninterrupted services. Staff Goods and services are available on a timely basis to support service delivery to clients. Continue to provide uninterrupted services. Vendors Timely payment for goods and services rendered. Continue to demonstrate timely payments to vendors. Staff Assurance that the workplace is safe and they are protected from harm. Continued monitoring of the workplace and continued implementation of programs and measure to improve health and safety. Clients Services they receive will be delivered safely and they will not be placed in Continued monitoring of the client services and continued unsafe situations. implementation of programs and measure to improve health and safety. Vendors They are able to provide safe services to clients and staff. Continued monitoring of vendors services and continued implementation of programs and measure to improve health and 35
Back-Office Analysis Work Team Business Case
Function or Service Stakeholders Interests & Needs Management Strategies Stakeholders impacted by the function/service. How are the stakeholders involved with the function/service? Why will they be interested in this integration or how might they be affected? How will stakeholder expectations be managed, and how will their needs be met? What factors might impact on meeting stakeholder needs? safety. Government Agencies All legislated workplace health and safety measures have been implemented so as to minimize the risk of harm to staff and clients. Board The agency complies with its legal obligations related to health and safety Continued compliance with health and safety legislation and of staff and clients. continued support for health and safety programs to continually improve health and safety for staff and clients. Accreditation Agency Agency meets recognized standards for delivery of services and back‐
office functions. Continued compliance with health and safety legislation. Continued participation in the accreditation process and to quality improvement. Community Partners Assurance that common clients receive services that meet recognized and Continued participation in the accreditation process and to quality accepted standards and are of high quality. improvement. Staff Services they are involved in delivering meet recognized and accepted standards and are of high quality. Continued staff participation in accreditation and quality improvement processes. Clients Services received meet recognized and accepted standards and are of high quality. Continued client participation in accreditation and quality improvement processes. Government Agencies Funding supports the delivery of high quality health services and programs that meet or exceed expected outcomes. Continued participation in the accreditation process and to quality improvement. Board The organization is recognized as providing services that meet or exceed Continued participation in the accreditation process and to quality standards and are or of high quality. improvement. Board Organization’s legal liabilities are mitigated. Continue to engage legal advice and take necessary action where appropriate. Management Organization’s legal liabilities are mitigated. Continue to engage legal advice and take necessary action where appropriate. Legal Firms Payment is received for legal services rendered. Continue to demonstrate timely payments for legal services. Funders Allocated funding is being used to meet contracted services and Continue to provide complete reports at scheduled times. Identify performance measures, is managed effectively with appropriate oversight any variances to planned spending and performance commitments. and controls. Reports meet requirements and filed on‐time. Board Contracted commitments and obligations and regulatory requirements are being met, appropriate oversight and controls in place to ensure Accreditation Legal External Reporting Continue to provide complete reports at scheduled times. Identify any variances to planned spending and performance commitments. 36
Back-Office Analysis Work Team Business Case
Function or Service Stakeholders Interests & Needs Management Strategies Stakeholders impacted by the function/service. How are the stakeholders involved with the function/service? Why will they be interested in this integration or how might they be affected? How will stakeholder expectations be managed, and how will their needs be met? What factors might impact on meeting stakeholder needs? effective management of funds. Fundraising Board and Management Support Privacy and Security Auditor Organization’s have appropriate oversight and controls in place to enable Timely response to information requests from auditors. Ensure effective operational and financial management. Requests for information appropriate oversight and controls are in place. to support development audit opinion are responded to in a timely manner. Payment for services rendered. Regulatory Agencies Organizations meet their scheduled reporting obligations and that the information is accurate and reliable. Continue to meet regulatory reporting requirements and timelines. Clients Programs and services are available to support their recovery. Continue to provide uninterrupted services.
Board Programs and services are available to support client services and programs. Continue to provide uninterrupted services.
Staff Programs and services are available to support client services and programs. Ability to provide volunteer support for client programs. Continue to provide uninterrupted services.
Community Donors Donated funds are managed effectively are designated according to their Ensure oversight and controls are in place for the effective preferences. Tax receipts are issued and are accurate and timely. management of donations. Provide timely and accurate Tax receipts as appropriate. Clients/Visitors Availability of a knowledgeable staff member to assist them. Continue to provide reception function as first point of contact for clients and visitors. Staff Support is available for routine administrative matters. Ensure availability of administrative support staff. Board Support is available to help meet governance obligations. Ensure availability of administrative support staff. Management Support is available to support the management of the organization. Ensure availability of administrative support staff. Volunteers Services are valued and are directed appropriately to support the work of Ensure availability of staff to coordinate and support volunteers. the organization. Clients Their personal information is secure and protected. Ensure policies and processes are in place to meet regulatory obligations. Resolve any breaches quickly and effectively. Staff Their personal information is secure and protected. Ensure policies and processes are in place to meet regulatory obligations. Resolve any breaches quickly and effectively. Board Regulatory obligations toward the privacy and security of client and staff Ensure policies and processes are in place to meet regulatory personal information are met. obligations. Resolve any breaches quickly and effectively. 37
Back-Office Analysis Work Team Business Case
Function or Service Property Management Stakeholders Interests & Needs Management Strategies Stakeholders impacted by the function/service. How are the stakeholders involved with the function/service? Why will they be interested in this integration or how might they be affected? How will stakeholder expectations be managed, and how will their needs be met? What factors might impact on meeting stakeholder needs? Tenants Safe, clean, comfortable and affordable housing. Continue to provide housing suitable to the needs of clients. Staff Safe, clean working environment to ensure their safety and recovery needs of clients. Continue to provide housing suitable to the needs of staff and clients. Landlords Timely and accurate payment for housing services provided. Accurate and timely payment for services rendered. Vendors Timely and accurate payment for building maintenance and capital services provided. Accurate and timely payment for services rendered. Bank Timely and accurate payments according to contracted mortgage arrangements. Accurate and timely payments. 38
Back-Office Analysis Work Team Business Case
Finance
9 9
X
X
Amalgamate
• Standardized processes and
systems
• Reduced staff effort to manage
functions e.g. single chart of
accounts, single financial
audit, singe processes and
systems, single banking
arrangements
• Potential for reinvestment of
savings to front-line services
• Enhanced staff coverage,
back-up support
Amalgamate
Amalgamate
• Anticipated loss/reassignment • Potential for labour
of finance staff jobs
adjustment costs to
transition staff
• Expected transitional costs
• Potential loss of
• Differential pay scales - need
existing partnering
to equalize
arrangements (
• Additional work to generate 1st
KLHMHS and
year year-over-year reporting
Neighbourhood
Housing)
Partner
• Standardized processes and
systems among CMHA
locations
• Enhanced staff coverage,
back-up support
Partner
• Duplicate services/functions
remain
• Limited opportunity for
reinvestment
• Expected transitional costs
• More cross organizational
meetings to support
standardization among
locations
Partner
• Operating cost may
actually increase (more
joint meetings to
standardize between
locations)
(Excluding labour
adjust)
Risks
Cease
Cons
Reinvestment
Potential $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Est. Transition
Costs $000
Appendix D: Analysis of Back­Office Integration Opportunities $45K
$20.0K
(staff and
audit costs)
(Staff costs)
$0
$10.0K
(Staff costs)
39
Human Resources
9 9
X
X
Amalgamate
• Standardized processes and
systems
• Reduced staff effort to manage
functions e.g. single set of
policies, procedures
• Potential efficiencies in
process e.g. PPM
• Opportunity for joint
participation in staff culture
activities/projects
• Increase potential for
succession planning and job
opportunities
• Some potential for
reinvestment of savings to
front-line services
• Increased opportunity for staff
development
• Enhanced staff coverage,
back-up support
Amalgamate
• Expected transitional costs
• Differential pay scales - need
to equalize
• Loss of personal face-to-face
access to HR staff
Partner
• Standardized processes and
systems
• Staff coverage, back-up
support
Partner
• Limited opportunity for
reinvestment
• Duplicate services/functions
remain
• Expected transitional costs
• More cross organizational
meetings
(Excluding labour
adjust)
Risks
Cease
Cons
Reinvestment
Potential $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Est. Transition
Costs $000
Back-Office Analysis Work Team Business Case
Amalgamate
• Potential decline in
staff satisfaction due to
change to
organizational culture
• Potential cultural
conflict
Partner
• Operating cost may
actually increase (more
joint meetings to
standardize between
locations)
$15.0K
$30.0K
(staff costs)
(Staff costs)
$0
$30.0K
(Staff costs)
40
Payroll and Benefits
Client Management 9 9
9
X
X
Amalgamate
• Standardized processes and
systems, input documents
• Reduced staff effort to manage
functions e.g. single payroll
system, remittances, set of
policies, procedures
• Potential for savings through
tendering for group benefits
service provider – economies
of scale
• Expected efficiencies in
process
• Some expected reinvestment
to front-line services
• Enhanced staff coverage,
back-up support
Amalgamate
Amalgamate
• Potential delay in flow of input • Process delays may
documents to central location
impact payroll run
for processing
• Increase in volume may impact
on timelines
• Expected transitional costs
• Differential pay scales - need
to equalize
Partner
• Standardized processes and
systems, input documents
Partner
Partner
• Duplicate services/functions
• Operating cost may
e.g. double reporting to
actually increase (more
providers, double remittances.
joint meetings to
$5.0K
standardize between
• Limited opportunity for
(Staff costs)
locations)
reinvestment
• Expected transitional costs
• More cross organizational
meetings
$15.0K
(Staff and
group
benefits
costs)
(Excluding labour
adjust)
Risks
Cease
Cons
Reinvestment
Potential $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Est. Transition
Costs $000
Back-Office Analysis Work Team Business Case
$5.0K
(Staff costs)
$5.0K
(Staff costs)
• Defer to Front-Line Direct Client Services Team
41
Information
Technology
Services
9 9
X
X
Amalgamate
• Standardization of systems
processes, procedures,
security (telephone, voicemail,
1-800)
• Enhanced options for IT
support (staff and/or
contractor)
• Anticipate some procurement
savings for IT hardware.
software, and support
• Continuity in back-up and
hardware/software
• Ability to resolve issues
remotely
• CMHA-P is a licensed OTN
site – potential to request
additional equipment for KL
site
Amalgamate
Amalgamate
• Increased travel between sites • Potential loss of
to support systems if onexisting partnering
site/local support not available
arrangements
(KLHMHS and
• Expected transitional costs
Neighbourhood
•
Housing)
Partner
• Standardization of systems
processes, procedures,
security
• Enhanced options for IT
support (staff and/or
contractor)
• Anticipate some procurement
savings for IT hardware.
software, and support
• Continuity in back-up and
hardware/software
Partner
Partner
• Increased travel between sites • Potential longer
to support systems if onsystem down time to
site/local support not available
resolve issues if onsite/local support not
available
• Potential loss of
existing partnering
arrangements (KL
Neighbourhood
Housing)
$0.0K
$0.0K
42
(Excluding labour
adjust)
Risks
Cease
Cons
Reinvestment
Potential $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Est. Transition
Costs $000
Back-Office Analysis Work Team Business Case
$5.0K
(HW & SW
alignment)
$5.0K
(HW & SW
alignment)
Procurement Health and Safety 9 9
9 9
X
X
X
X
Amalgamate
Amalgamate
• Standardization of systems
•
processes, procedures
• Some anticipated savings from
bulk procurement activity
Amalgamate
• Potential loss of
existing partnering
arrangements
(KLHMHS and
Neighbourhood
Housing)
Partner
Partner
• Standardization of systems
• More work /delay to obtain
processes, procedures
approvals – increase cost of
• Some anticipated savings from process due to duplicate
approval structures
bulk procurement activity
Partner
• Potential loss of
existing partnering
arrangements
(KLHMHS and
Neighbourhood
Housing)
Amalgamate
• Standardization of systems
processes, procedures and
training programs
• Anticipated reinvestment
resulting from less staff backoffice and front-line staff
involved in various committees
• Less trainers required – cross
use of trainers
• Reduced coordination effort
and reporting
• Economies of scale
Amalgamate
Amalgamate
• Increased travel between sites • Potential loss of
to inspect premises if on-site
existing partnering
support not provided
arrangements
(KLHMHS and
• Expected transitional costs
Neighbourhood
• Differential pay scales - need
Housing)
to equalize
• Potential loss of
volunteer base (i.e.
Client Safety
Committee)
$5.0K
(Excluding labour
adjust)
Risks
Cease
Cons
Reinvestment
Potential $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Est. Transition
Costs $000
Back-Office Analysis Work Team Business Case
$0
(Goods &
services)
$5.0K
$0
(Goods &
services)
$10.0K
$5.0K
(Staff costs)
(staff costs)
43
Partner
Partner
Partner
• Standardization of systems
• Increased travel between sites • Potential loss of
processes, procedures and
to inspect premises if on-site
existing partnering
training programs
support not provided
arrangements (KL
Neighbourhood
• Anticipated reinvestment
• Duplicate reporting
Housing)
resulting from less staff backoffice and front-line staff
involved in various committees
• Less trainers – cross use of
trainers
• Reduced coordination effort
and reporting,
• Economies of scale
Accreditation 9 9
X
X
Amalgamate
• Standardization of systems
processes, procedures and
training programs
• Anticipated reinvestment of
reduced survey costs
• Increased front-line direct
client services from reduced
front-line staff involvement in
committees and processes
• Enhanced options for
accreditation support and
coordination (staff and/or
contractor)
• Reduced coordination effort
and reporting
• Economies of scale
Amalgamate
• Mapping of processes to
support transition
• Differential pay scales - need
to equalize
Amalgamate
• Uncertainty of how
Accreditation Canada
manage this process
• Timing of an
amalgamation is
crucial – (i.e. before
survey tools are
required to develop
roadmaps)
(Excluding labour
adjust)
Risks
Cease
Cons
Reinvestment
Potential $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Est. Transition
Costs $000
Back-Office Analysis Work Team Business Case
$15.0K
$5.0K
(staff costs)
(staff costs)
$20.0K
(staff,
survey,
membership
costs, and
reduced
committee
work)
$10.0K
(consultant)
44
Legal External Reporting
9 9
9 9
X
X
X
X
Partner
• Standardization of systems
processes, procedures and
training programs
• Enhanced options for
accreditation support and
coordination (staff and/or
contractor)
• Some reduced coordination
effort
• Economies of scale
Partner
• Mapping of processes to find
similarities
• Duplicate survey fees and
reporting
• More cross organizational
meetings to support
standardization among
locations
Partner
• Operating cost may
actually increase (more
joint meetings to
standardize between
$5.0K
locations)
Amalgamate
• Consistent legal opinions for
similar issues
Amalgamate
• N/A
Amalgamate
• N/A
Partner
• Consistent legal opinions for
similar issues
Partner
• N/A
Partner
• Potential loss of
autonomy in selecting
legal advice
Amalgamate
• Standardized processes and
systems among CMHA
locations
• One reporting structure,
reduced staff effort to manage
the functions
• Reinvestment potential to
front-line services
• Enhanced staff coverage,
back-up support
Amalgamate
Amalgamate
• Anticipated loss/reassignment • Potential loss of
of external reporting staff jobs
continuity of year-overyear reporting
• Expected transitional costs
• Additional work to generate 1st • Potential loss of
$20.0K
existing partnering
year year-over-year reporting
(Staff costs)
arrangements
(KLHMHS &
Neighbourhood
Housing)
(Excluding labour
adjust)
Risks
Cease
Cons
Reinvestment
Potential $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Est. Transition
Costs $000
Back-Office Analysis Work Team Business Case
$5.0K
(staff costs)
(staff costs)
$0
$0
$0
$0
45
$2.0K
Partner
• Standardized processes and
systems among CMHA
locations
• Enhanced staff coverage,
back-up support
Partner
• Duplicate services/functions
remain
• Limited opportunity for
reinvestment
• Potential transitional costs
• More cross organizational
meetings to support
standardization requirements
between locations
Amalgamate
Amalgamate
• Anticipated critical mass to
• Loss of unique community
support dedicated coordination fundraising identity
function
• Share ideas on what works
Fundraising Board and Management Support (incl. Reception, Proposal Development) 9 9
9 9
X
X
X
Partner
• Share ideas on what works
Partner
• Operating cost may
actually increase (more
joint meetings to
standardize
$10.0K
requirements between (staff costs)
locations)
(Excluding labour
adjust)
Risks
Cease
Cons
Reinvestment
Potential $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Est. Transition
Costs $000
Back-Office Analysis Work Team Business Case
$2.0K
Amalgamate
• Potential loss of
community donations
• Possible confusion by
donors
$0
$0
Partner
Partner
• Extra work for one
• Potential loss of
organization that’s not
goodwill, decreased
compensated
staff motivation,
possible confusion by
• Stretch goodwill of participants
donors
• Difficulty allocating donations
and expenses among
organizations
$0
$0
Amalgamate
Amalgamate
Amalgamate
• Some potential for
• Reassignment/loss of
• Potential loss of
reinvestment related to
administrative support position
existing partnering
organizational leadership and
arrangement
governance support
(KLHMHS &
Neighbourhood
• Some potential for
Housing)
reinvestment of administrative
support for committees
• Reduction in Board
development costs
• One strategic planning process
$105.0
K
(Staff costs,
CMHA-Ont.
membership
, strategic
planning)
46
$25.0K
(legal, wind
down)
Privacy and Security Property Management 9 9
9 9
X
X
X
X
Amalgamate
• Standardization of policies,
procedures and processes
• Some reinvestment potential
Amalgamate
Amalgamate
• More travel to other sites to
• N/A
investigate breaches
• Reassignment/loss of
administrative support position
Partner
• Standardization of policies,
procedures and processes
Partner
• N/A
Partner
• N/A
Amalgamate
Amalgamate
Amalgamate
• Standardization of policies,
• Increased travel between sites • Potential loss of
procedures and processes
if managed centrally
existing partnering
arrangements
• Some potential for
(KLHMHS and
procurement savings on larger
Neighbourhood
capital projects
Housing)
Partner
• Standardization of policies,
procedures and processes
Partner
• N/A
Partner
• N/A
$8.0K
$0
(staff costs)
$8.0K
(staff costs)
$10.0K
(staff costs)
$10.0K
(staff costs)
(Excluding labour
adjust)
Risks
Cease
Cons
Est. Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Back-Office Analysis Work Team Business Case
$0
$0.0K
$0
Total Amalgamate
Total Partner
$253.0K $102.0K
$58.0K
47
$62.0K
Appendix E: Front­Line Direct Client Services Analysis Work Team Business Case Front-Line Direct Client Services Analysis Work Team Business Case
Canadian Mental Health Association (CE
LHIN North East Cluster) Integration
Planning
Front-Line Direct Client Services Analysis
Work Team Business Case
November 21, 2011
CONFIDENTIAL
Front-Line Direct Client Services Analysis Work Team Business Case
Table of Contents Executive Summary ..................................................................................................................... .2 A. Background .......................................................................................................................... .3 B. Need, Problem or Opportunity Statement ............................................................................ .4 C. Description of Back-Office Functions (cross referenced to Worksheet in Appendix B) ........ .5 D. Stakeholder Analysis (cross referenced to Worksheet in Appendix C) ................................ .5 E. Analysis of Integration Opportunities (cross referenced to Worksheet in Appendix D) ........ .6 F. Decision Factors ................................................................................................................. .10 G. Summary Comparison of Opportunities ............................................................................. .10 H. Recommendation and Rationale ........................................................................................ .11 a) Constraints ......................................................................................................................... .12 b) Assumptions ....................................................................................................................... .12 I. Transition Requirements .................................................................................................... .13 J. Acceptance and Sign-Off .................................................................................................... .14 Appendix A: Front-Line Direct Services Analysis Work Team Terms of Reference .............. .15 Appendix B: Front-Line Direct Client Services Descriptions................................................... .26 Appendix C: Front-Line Direct Services Stakeholder Analysis ............................................... .49 Appendix D: Front-line Integration Opportunities Analysis ..................................................... .56
Appendix E: Front-Line Direct Services Partial Stakeholder Table ........................................ .68 1
Front-Line Direct Client Services Analysis Work Team Business Case
Executive Summary The purpose of the Front-Line Direct Client Services Analysis Work Team (Front-Line Team) was to
conduct a high-level analysis of CMHA Kawartha Lakes (CMHA-KL) and CMHA Peterborough
(CMHA-P) front-line direct client services integration opportunities sufficient to make a
recommendation to the Integration Planning Team on the scope of integration that can be achieved.
The Front-Line Team was also tasked with identifying reinvestment opportunities and transition costs.
This report has been prepared by a team of operational management staff from CMHA-KL and
CMHA-P, without an Analysis Lead (a Lead was originally anticipated in the Terms of Reference).
The Front-Line Team commenced its work on October 6, 2011, and this final report and attached
appendices were completed for November 22, 2011. The details of the Front-Line Team’s analysis
are contained in Appendices B, C, D, E and summarized in the body of this document.
Appendix B contains a brief description of CE LHIN and MOHLTC funded programs which were
within the scope of the Front-Line Team’s analysis. Not all services were able to be compared as
they did not exist in both organizations and not all services were able to be analyzed as there are
some that are funded by other sources. There were a number of strengths and similarities noted in
direct client services across both agencies.
Appendix C contains an analysis of stakeholder interests. This does not represent an in-depth
assessment of the varying impacts each of the integration approaches may have on
stakeholders. Broadly speaking, the higher the degree of integration (i.e., amalgamation vs.
coordination), the more significant the impact will be on stakeholders. For the purpose of the
Front-Line Team’s analysis, clients are considered the primary stakeholders and uninterrupted
client service is paramount. Other service providers are essential stakeholders in ensuring
organizational ability to provide seamless client service; thus, mitigation strategies to ensure
their continued partnership need to be more fully developed when considering integration
options (see Appendix E).
Using definitions agreed upon by the Front-Line Team, integration options are described in
Appendix D. The Front-Line Team conducted a thorough analysis of each integration option for
each front-line program, considering pros, cons, and risks. It was noted that operational
differences between programs under the same functional centre complicated this analysis.
There was no reinvestment potential identified, and transition costs should be considered as
estimates without supporting data.
The analysis revealed that both CMHA-KL and CMHA-P already integrate in a variety of their
existing programs where this is in the best interest of client service.
The Front-Line Team is putting forward two possible recommendations for further integration:
partnership and amalgamation. Benefits and risks of both options were explored and are
included in the body of this report. Whichever option is implemented, it is crucial that due
consideration be given to mitigating risks in order to protect the diverse interests of clients and
other stakeholders in the community mental health system.
2
Front-Line Direct Client Services Analysis Work Team Business Case
A. Background The Canadian Mental Health Association – Kawartha Lakes Branch (CMHA-KL) and Canadian
Mental Health Association – Peterborough Branch (CMHA-P) have joined with the Central East
Local Health Integration Network (CE LHIN) in discussions to explore integration opportunities.
The discussions began as a result of the March 23, 2011 CE LHIN Board of Directors meeting
where the Board requested a report on the potential for alignment and integration between
CMHA-KL and CMHA-P. The CE LHIN has brought CMHA-KL and CMHA-P together in a
facilitated integration process to develop a stronger integrated community mental health
services delivery model for the North East Cluster. An Integration Planning Team comprised of
members from the CE LHIN, CMHA-KL, and CMHA-P was struck in April, 2011.
While the Integration Planning Team is focused on a service delivery model for the North East
Cluster, this report focuses on integration opportunities between CMHA-KL and CMHA-P.
Under the provisions of the Local Health Services Integration Act, 2006 (LHSIA), the Ministry of
Health and Long-Term Care and health service providers can integrate in several ways:
1.
2.
3.
4.
5.
Coordinate services and interactions between different persons and entities.
Partner with another person or entity in providing services or in operating.
Transfer, merge or amalgamate services, operations, persons or entities.
Start or cease providing services.
Cease to operate or to dissolve or wind up the operations of a person or entity.
The Front-Line Direct Client Services Analysis Work Team (Front-Line Team) created working
definitions for these integration options. These are captured in Section E of this report.
The Front-Line Team analyzed the following functional centres/programs:
•
•
•
•
•
•
•
•
•
•
Case Management
Housing
Housing Supports
Health Promotion/Education
Crisis Services
Consumer Survivor Initiatives (CSI) (Peer Support including Social Recreation)
Family Caregiver Network
Early Psychosis Intervention
Court Programs
Sessional Fees
Within these functional centres, the Front-Line Team considered only the scope of service and
front-line staff. Program Leadership is integral to the delivery of high quality services. The
Front-Line Team recognizes that leadership is outside the scope of their analysis; however, it is
imperative that it is considered in any integration planning.
The following key themes were identified through a series of community and stakeholder
meetings. They were included as part of the package of documents received and reviewed by
the Front-Line Team prior to its analysis:
3
Front-Line Direct Client Services Analysis Work Team Business Case
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Shared training for CMHA staff and coordinated internship programs.
Common job descriptions for staff.
Coordinated accreditation process and standards.
Standardized/common/shared intake philosophy and process – common selection
criteria.
Standardized care across all geographic areas.
Common/shared best practices and standards and coordinated service plans.
Standardized and coordinated social recreation programs.
Coordinated volunteer services (i.e. recruitment, training and retention).
Streamlined service delivery, improved efficiencies, reduction in duplication.
Consistent, standardized, shared systems, databases and reporting processes.
Enhanced performance measurement and consistency in measures and outcomes.
Standardized policies, processes and procedures.
Shared planning, risk management, quality assurance and priority setting.
Shared/coordinated community education, awareness and promotion.
Coordinated community fundraising – create a foundation to manage fundraising and
awareness programs.
Consistency to support client relocation between geographic areas.
More integration of services with other community partner agencies and police.
Improved equity in resource allocation between CMHAs.
Creation of a single leadership and governance structure – standardized administrative
functions.
The Front Line Team included the following members:
Name
Organization/Stakeholder Group
Beth Day
Director of Programs and Services, CMHA-P
Maggie Stephens
Director of Programs and Services, CMHA-P
Jan Waters
Manager of Community Mental Health Programs, CMHA-KL
Laurie Green
Team Leader of Justice Services and Social Recreation, CMHA-KL
The Terms of Reference for the Front-Line Team is in Appendix A, which provides a more
detailed description of the background of this initiative. The Front-Line Team commenced its
work on October 6, 2011, and submitted this report November 22, 2011.
B. Need, Problem or Opportunity Statement To analyze integration opportunities for the front-line direct client services at CMHA-KL and
CMHA-P.
Where possible, reinvestment potential and transition costs (one-time and
annualized) have been estimated.
C. Description of Front­Line Direct Client Service Functions 4
Front-Line Direct Client Services Analysis Work Team Business Case
Both CMHA-KL and CMHA-P have been offering community mental health services to their
respective communities for decades. Both agencies have grown significantly over this time
(programs and staff), especially in the last six to seven years. Both agencies are well-respected
in their communities and have a reputation for providing high quality services to meet the needs
of people they serve. Both agencies are leaders in their communities, establishing effective
partnerships and developing an integrated network of services to enhance client care and
improve mental health. Both agencies are accredited by Accreditation Canada, demonstrating
an adherence to best practice standards for community mental health providers. Both agencies
have consistently demonstrated financial accountability, high client satisfaction, and a
commitment to continued positive client outcomes. Staff in both agencies are highly dedicated
to client care and committed to the mission, vision, values, and culture of their respective
organizations; they consistently express a high degree of job satisfaction.
Front-line functions within this report include all direct client services offered by CMHA-KL and
CMHA-P that are funded by the CE LHIN and MOHLTC. Appendix B outlines program FTEs,
operating costs, funding sources, and provides a brief description of each program including
strengths and weaknesses.
A comparison of services utilizing the Appendix B template has limitations. With regard to
funding, some programs are entirely funded by MOHLTC, some programs are funded by
MOHLTC and another funding source, some programs are funded by multiple sources, and
some are not funded at all by MOHLTC. The scope of this report is to consider only those
programs that are MOHLTC funded (in its entirety or partial funding); however, when
considering integration planning, all programming, despite its funding source, needs to be
considered. Another challenge is that in some cases, one organization is allocated funds for a
service and the other is not. In addition, best practice standards require flexibility and portability
of services to meet client needs; therefore it is insufficient to consider programs as stand-alone
entities. In other words, the whole of service provision in a community is different than the sum
of its parts.
In summary, from the perspective of clients, there is a high degree of similarity between some
programs offered by CMHA-KL and CMHA-P (e.g., Intake, Brief Services, Case Management,
Housing Supports and Court Services). From an organizational perspective, there is significant
variance in how these programs are delivered due to community needs and the differences in
available resources in each community. This results in differences in eligibility criteria, program
structure and design.
Many programs offered by CMHA-KL and CMHA-P already demonstrate a high degree of
integration. Some programs are mandated to serve the Four Counties (e.g., Crisis Services,
EPI, Consumer Survivor Initiatives, Release from Custody). Other programs have become well
integrated over time through the efforts of staff and management (e.g., Court Programs).
D. Stakeholder Analysis An analysis of stakeholders was conducted, including their involvement, needs, and strategies
to manage their interests. An overview of this analysis is captured in Appendix C.
A
preliminary and partial list of community partners that could be impacted by integration is
attached as Appendix E. This list graphically illustrates the broad range of partnerships that
currently exist and the extent to which both CMHA-KL and CMHA-P are highly integrated in their
local communities. More analysis of this list would be necessary for it to be useful for any
5
Front-Line Direct Client Services Analysis Work Team Business Case
transitional planning. It is acknowledged that community stakeholders will have a broad and
varied range of interests in any type of integration.
The Front-Line Team acknowledges that the CE LHIN and MOHLTC have a high level of
support for and a significant impact on this initiative. Other Ministry funders (e.g., MCSS,
MCTU, and MCYS) are anticipated to be neutral regarding integration between CMHA-KL and
CMHA-P. Municipal funders and United Ways would have a strong vested interest in an
integrated organization accounting for funding.
The Front-Line Team is aware that clients have a vested interest in the impact of this integration
as it relates to the services they receive. Access to local services, hours of operation, eligibility
for programming, and maintaining existing therapeutic relationships are all very important to our
primary stakeholders, clients.
The Front-Line Team acknowledges that staff and program management are integral to the
provision of high quality client service. These stakeholders are highly invested and committed
to working in their home communities and making a difference in the lives of those they serve.
The therapeutic relationship is the single most important determinant of positive client
outcomes. It is critical not to underestimate the need to support staff and management through
any integration so that client service is not negatively impacted.
E. Analysis of Integration Opportunities Using the description of services (Appendix B) and the stakeholder analysis (Appendix C), the
Front-Line Team analyzed the integration options for each function/service across CMHA-KL
and CMHA-P. The analysis is captured in Appendix D. For the purposes of this analysis, the
Front-Line Team developed and used the following working definitions for the integration
options:
Status Quo – assumes both CMHA organizations continue to exist and there is no change to
existing service delivery.
Coordinate – assumes both CMHA organizations continue to exist and they coordinate in the
delivery of a front-line service; this may include regular structured communication to identify and
problem-solve gaps in service delivery, and to discuss opportunities for shared training,
education and resources.
Partner – assumes both CMHA organizations continue to exist and they partner in the delivery
of front-line service; this may include sharing a common set of policies, procedures, and
processes (where appropriate), a formal Memorandum of Understanding (MOU) outlining roles
and responsibilities, joint participation in funding opportunities, joint decision-making in service
planning and delivery, and access to a shared client database.
Amalgamate – assumes there is a single CMHA organization providing community mental
health services in the CE LHIN North East Cluster; this would include maintaining existing
services based out of offices in both Kawartha Lakes and Peterborough. This relies on the
service delivery principle “leveraging the local” which states that “community mental health
services are best supported by an understanding of the communities being served and by local
management that can maximize the use of local volunteers, fundraising opportunities, and other
community supports”.
6
Front-Line Direct Client Services Analysis Work Team Business Case
The following table summarizes the integration fit, reinvestment potential, and estimated
transition cost (one-time and annualized) for each integration option for each function or service.
FROM TEMPLATE B
Provider & Operating Costs
Function or Service
CMHA-KL
Function
Case Management
9
$
667,789
CMHA-P
Functio
$
n
9
N/A
Housing
Housing Supports
9
9
(as $
captured
under
housing
supports)
414,544
(+45,000
COKL)
9
9
9
Consumer Survivor
Initiatives (CSI) (Peer
Support)
FROM TEMPLATE B
0
9
ranking)
Option 1:
Status Quo
Option 2:
Coordinate
Option 3:
961,060 Partner
Option 4:
Amalgamate
None Identified
None Identified
None Identified
None Identified
None Identified
$10K for policy
development
None Identified
Option 1:
Status quo
490,379 Option 2:
Amalgamation
None Identified
*$200K per annum
for wage equity +
**$30K for HR
consultant (policy
development +
aligning position
descriptions
None Identified
Option 1:
Status Quo
Option 2:
Coordinate
1,023,789 Option 3:
Partner
None Identified
Legal fees (re: titles,
land transfers) –
unable to quantify
None Identified
None Identified
None Identified
None Identified
None Identified
Option 4:
Amalgamate
Option 1:
Coordinate
Option 2:
Partner
Option 3:
Amalgamate
None Identified
$5K (restructuring,
development of
policies, staff
training)
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
Crisis:
1,647,481
Safe Beds:
522,529
Option 1:
Status quo
Option 2:
Amalgamate
None Identified
None Identified
None Identified
None Identified
Option 1:
Status Quo
Option 2:
Partner
Option 3:
Amalgamation
None Identified
None Identified
Clubhouse:
183,964
COKL
R4R:
209,137
None Identified
None Identified
None Identified
None Identified
Health Promotion &
Education
Crisis Services
FROM TEMPLATE D
Integration Fit
Reinvestment Est.
(Note: Option # Potential
Transition
does not reflect $000
Costs $000
FROM TEMPLATE D
7
Front-Line Direct Client Services Analysis Work Team Business Case
Provider & Operating Costs
Family Caregiver
Network
Early Psychosis
Intervention (EPI)
Court Programs
Integration Fit
(Note: Option #
does not reflect
ranking)
Function or Service
9
9
9
Option 1:
Status Quo
Option 2:
Coordinate
Option 3:
Partner
20,629
38,871
Court
Support/
Diversion:
$71,455
9
9
Option 4:
Amalgamate
Option 1:
Status quo
1,419,042
Option 2:
Amalgamate
Court
Option 1:
Support/ Status quo
Diversion: Option 2:
202,284
Amalgamate
Forensic:
Reinvestment Est.
Potential
Transition
$000
Costs $000
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
$2K (restructuring,
development of
policies, staff
training)
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
None Identified
$20K for OTN in KL
91,834
Sessional Fees
TOTALS ($000)
Please ensure these are
correct totals
9
50,000
$1,303,587
9
50,000
$6,801,499
Option 1:
Status Quo
Option 2:
Amalgamate
Total: Partner
Total:
Amalgamate
$17K
$250K + Legal
Fees ($200K will
be
an
annualized cost
* Reflects wage equity across all front-line service staff and program management
** Reflects costs across all programs
The Front-Line Team’s analysis revealed that there currently is a high degree of integration in
the programs and services that serve the Four Counties (e.g., Crisis Services, Consumer
Survivor Initiatives, EPI). In other programs, there is little apparent benefit to the clients in
further integration, as services currently meet client and community needs (e.g., Case
Management, Housing and Housing Supports). There is also no identified reinvestment
potential across all direct client services. Amalgamation carries with it significant transitional
costs (one-time and ongoing).
In the cases where status quo was considered as an integration option, it often reflected an
existing degree of coordination and partnership to better meet the needs of clients. For
example, in the case of Court Programs, CMHA-KL and CMHA-P already coordinate and
partner in the following ways: partner with bail support program, HKPR Justice Network, shared
communication between Local HSJCCs, shared psychiatry, Regional HSJCC conference
planning, shared education resources, and CMHA-P sharing office space for the Release from
Custody program.
Greater integration of Court Programs between jurisdictions (i.e.,
standardizing policies and procedures) would not be practical, nor would it benefit the client,
given the complexity of the justice system and the significant local differences in the way the
judicial system and mental health system intersect.
In the case where coordination was considered as an integration option, it was acknowledged
that the two CMHAs already engage in a variety of coordination activities and these activities
are seen as a definite benefit in service delivery. Because coordination is already such an
8
Front-Line Direct Client Services Analysis Work Team Business Case
integral process between the agencies, there were concerns that any benefits gained from
further coordination (i.e. coordinated discussion at the management level, discussion of quality
improvement processes and coordinated training efforts) may not outweigh the costs associated
with these efforts (i.e. travel, staff time). Further, it is unclear whether greater coordination
would improve client service.
Partnership was also discussed and identified as a viable integration option for a number of
programs. At the partnership level, the Front-line Team noted that a shared common database
would provide a significant enhancement to service delivery and provide a clear benefit to
clients receiving service. For example, a client receiving case management service from
CMHA-KL who also uses the crisis line would benefit significantly if there was a shared
electronic record which all service providers could access in a timely manner. If integration
were to occur at a partnership level, risk involved with a shared database would arise around
privacy, security and consent practices with regard to client information. This could lead to
liability issues for the agencies as well as accessibility issues for clients seeking services (e.g.,
clients may be reluctant to share their data across two agencies). This risk would need to be
addressed and mitigated (e.g., development of common policies and procedures for shared
health information and consent management). A significant advantage of partnership is the
ability to maintain local autonomy which allows for flexibility in service delivery decisions at a
local level and provides the structure to continue relationships with vital community
stakeholders. Also, partnership would continue to allow for local community input to service
planning and design. The success of this partnership model has been demonstrated by the
crisis program and to an even greater extent by the joint management model of the EPI
program. It was identified that a partnership would allow the agencies to standardize some
systems and services, including, for example, staff training in order to meet best practice
standards. Also, partnership would allow the agencies to fill existing service gaps. Transition
costs involved with partnership would be minimal (e.g., policy and procedure development
costs, MOUs, greater travel expenses and time involved in travel and coordination efforts).
Amalgamation was also discussed as an integration option on a program by program basis.
The Front-Line Team recognized that amalgamation would not be feasible on an individual
program basis and can only be considered across all services. One expressed goal of
integration was the identification of any potential for reinvestment so that identified funds could
be directed to enhancing existing or creating new front-line services. There were no
reinvestment savings identified in the analysis front-line services. A rough estimate of
transitional and on-going costs related to the amalgamation of front line services is $250,000
plus legal fees associated with the housing programs. It was noted that the majority of these
costs would be related to on-going salary equalization, and therefore would not necessarily
result in enhancements to client services. A risk associated with amalgamation would be the
potential for loss of client services as a result of service standardization; for example, the Senior
Support Program exists in one community and not in the other. If the program were
standardized to both communities, it would either result in a significant increase of service
demand in one community or the discontinuation of a well-established and necessary service
that exists in the other community. Other risks associated with amalgamation include the loss of
local autonomy and decision making, and an increased complexity in decision-making, which
could result in a negative impact on client service.
On the other hand, a positive outcome of amalgamation is the potential for the larger, single
agency to be better positioned to receive enhancements for mental health services across the
North East Cluster. The extent and nature of these enhancements have not been clearly
defined. Other positive outcomes of amalgamation would include consistencies in staff training,
9
Front-Line Direct Client Services Analysis Work Team Business Case
opportunities to fill service gaps, and opportunities for standardization of processes and
procedures where appropriate. Amalgamation may also result in more equitable distribution of
resources across the North East Cluster.
It was noted by the Front-Line Team that amalgamation would have less impact on programs
currently providing service to the Four Counties (e.g., Crisis Program, CSI and EPI).
F. Decision Factors The Front-Line Team was provided with the following decision factors from the Integration
Planning Team:
•
•
•
•
•
•
•
•
Adherence to guiding principles (client focus, “do no harm”, etc.)
Opportunity for reinvestment to support expanded or new client services across the CE
LHIN North East Cluster
Takes into account the key themes from the stakeholder and community engagement
process
Strengthens unique community mental health services in the CE LHIN North East
Cluster
Contributes to broader system integration among other providers
Annual operating costs to remain within current CMHA-KL and CMHA-P funding
envelope
One-time transition costs should not inhibit a longer term integration opportunity to
reinvest in client services
Integration should result in maintained or improved quality and adherence to best
practices with minimal or no impact on service delivery
In our decision-making process, this team also focused on service delivery priorities of: being
consumer centred, sustaining quality services, valuing regional access, and leveraging local
community resources.
To the extent possible, the Front-Line Team has examined all integration options, and in putting
forward recommendations, this team is utilizing the consensus approach as per the Terms of
Reference (see Appendix A, Section 4.3).
G. Summary Comparison of Opportunities The Front-Line Team identified two primary options for further integration: Partnership and
Amalgamation. Through the course of discussions, it was noted that there is already a
significant degree of coordination and partnership between numerous programs within CMHAKL and CMHA-P where this produces benefits to client service.
H. Recommendation and Rationale 10
Front-Line Direct Client Services Analysis Work Team Business Case
Having considered the decision-factors listed above, the Front-Line Team is unanimous that a
partnership is a viable option for integration. Within both CMHA-KL and CMHA-P, there are
successful programs that currently utilize a partnership model (e.g., Crisis Services, EPI, CSI,
Court Services), and future opportunities exist that could result in further benefits to client
service through additional formal partnering. The Front-Line Team has considered the risks of
partnership and believe that they can be managed appropriately though a shared management
structure. In a partnership, best practices for service delivery can be maintained and enhanced,
local autonomy and decision-making remain, and programming continues to align with
community need. A shared database would enhance client outcomes.
Amalgamation was also considered, and there was consensus that this is an option for
integration. Some of the benefits that flow from additional partnering also apply to an
amalgamation. These include:
• Shared client database would enhance client outcomes,
• Maintenance and enhancement of best practices for service delivery,
• Shared policies (e.g., privacy, security, consent management, client safety),
• Aligns with some of the key themes from the stakeholder consultations (e.g., shared
training for staff, enhanced performance measurement and consistency in measures and
outcomes, standardized and coordinated social recreation programming).
Additional benefits to amalgamation include:
• Contributes to broader system integration among other providers – perceived to be a
stronger platform for enhancements to services,
• Consistent staff training,
• Aligns with some of the key themes from the stakeholder consultations (e.g., shared
intake philosophy and process – common selection criteria).
There are potential benefits to amalgamation, both initially and over time. These are dependent
on the form and philosophies of management and leadership of an amalgamated organization,
as well as funding bodies. Such benefits could include:
• More equitable distribution of the array of existing programming,
• Improved equity in new resource allocation across the North East Cluster,
• Being recognized as a centre of excellence in community mental health services across
a broader geographic region.
Some risks involved with amalgamation, initially and over time, are known and some are hard to
quantify. The known risks include:
• Required annualized costs (e.g., wage equity),
• One-time transition costs (e.g., policy development, human resources),
• Aligning eligibility criteria for programming could negatively affect access to client
services, with possible legal, political and/or financial risks.
Amalgamation risks to clients that have an unknown impact include:
• Potential loss of community partners and relationships,
• Potential erosion of services,
• Potential loss of local autonomy and decision-making,
• Potential disruption of staff, which would adversely affect service delivery,
11
Front-Line Direct Client Services Analysis Work Team Business Case
•
•
The time and energy that management will need to devote to amalgamation, which will
reduce their availability to the programs and front-line staff,
Shift in organizational culture and philosophy resulting in loss of client and staff
satisfaction.
In order to maximize the benefits outlined in both integration options and minimize the risks in
the amalgamation option, the Front-Line Team recommends that the following be considered
critical components to a successful integration, whatever its form.
• Any reinvestment potential identified by the Back-Office Analysis Work Team will
enhance front-line direct client service,
• Transition costs can not be funded internally from CMHA-KL and CMHA-P from existing
allocations,
• Current management staff in CMHA-KL and CMHA-P would participate in the
development of the structure to ensure needs of the local community are met,
• The structure of the new entity would include local management to support programming
to meet the needs of the local community,
• Sufficient time and resources are required for a well-planned and thoughtful transition,
with minimal impact on clients and staff.
a) Constraints The following constraints are factors that are outside the control of the Front-Line Team that
may impact on the above recommendations:
• Analysis of Back-Office and Front-Line reports, assessment of options, and decisionmaking rest with the Integration Planning Team and the Boards of Directors of CMHAKL, CMHA-P, and the CE LHIN,
• Other program funders (e.g., MCSS, MCYS, MCTU and United Ways) would need to
approve a decision of an amalgamation.
b) Assumptions The following are assumptions for planning purposes:
• The best interests of clients will remain paramount throughout any integration initiative,
• Wage equity costs will be available from the CE LHIN,
• Unique needs of geographic communities will be honoured,
• No loss of service to clients,
• Integration will provide a foundation for the ongoing enhancement of community mental
health programming across the North East Cluster,
• Appropriate and ongoing support will be given to staff who provide front-line services
throughout any integration process,
• Sufficient time will be allotted for a well-planned and thoughtful transition, with minimal
impact on clients and staff.
12
Front-Line Direct Client Services Analysis Work Team Business Case
I. Transition Requirements Regardless of the integration option that is implemented, the following are essential elements of
a successful transition:
• Time
o Partnership is currently happening and can continue to happen over time; it does
not require a defined start date,
o Amalgamation of a complex variety of programming will require significant
investment of time (estimated six to nine months of planning).
• Money
o See transition costs (Appendix D),
o There will be unanticipated costs not factored into this report.
• Resources
o See transition costs (Appendix D),
o Appropriate office space to accommodate enhanced investments in community
mental health programming,
o Temporary resources to competently manage human resources and
programming transitions,
o Use of current operational management staff to assist with design of front-line
services.
13
Front-Line Direct Client Services Analysis Work Team Business Case
J. Acceptance and Sign‐Off The following signatures represent agreement on the contents of the Business Case.
14
Front-Line Direct Client Services Analysis Work Team Business Case
Appendix A: Front­Line Direct Client Services Analysis Work Team Terms of Reference Canadian Mental Health Association (CE
LHIN North East Cluster) Integration
Planning
Front-Line Direct Client Services Analysis
Work Team
Terms of Reference
(Minor revisions made to Titles of Participating Staff members, then Approved at Oct 6, 2011
Analysis Work Team Meeting)
15
Front-Line Direct Client Services Analysis Work Team Business Case
Table of Contents 1. Background/Context ....................................................................................................... 17 1.1. Purpose.................................................................................................................... 19 1.2. Scope ....................................................................................................................... 19 1.3. Authority ................................................................................................................... 20 2. Roles & Responsibilities of the Work Team ................................................................... 20 2.1. Role of the Work Team ............................................................................................ 20 2.2. Responsibilities of the Work Team .......................................................................... 21 3. Membership & Roles of Individual Planning Team Members ......................................... 21 3.1. Membership ............................................................................................................. 21 3.2. Reporting Relationships ........................................................................................... 21 3.3. Linkages & Partnerships .......................................................................................... 22 3.4. Duration of Service .................................................................................................. 22 3.5. Individual Roles of Work Team Members ................................................................ 22 4. Logistics and Processes ................................................................................................. 23 4.1. Role of Chair ............................................................................................................ 23 4.2. Frequency of Meetings ............................................................................................ 23 4.3. Decision-Making Process ........................................................................................ 23 4.4. Quorum Requirements............................................................................................. 23 4.5. Proxies to Meetings ................................................................................................. 23 4.6. Meeting Agenda Items ............................................................................................. 24 4.7. Minutes & Meeting Papers ....................................................................................... 24 4.8. Issue Resolution ...................................................................................................... 24 5. Acceptance & Sign-Off ................................................................................................... 25 16
Front-Line Direct Client Services Analysis Work Team Business Case
Background/Context The Canadian Mental Health Association – Kawartha Lakes Branch (CMHA-KL) and
Canadian Mental Health Association – Peterborough Branch (CMHA-P) have joined with the
Central East Local Health Integration Network (CE LHIN) in discussions to explore
integration opportunities.
The impetus for the discussions stems from the March 23, 2011 CE LHIN Board of Directors
meeting where the Board asked to receive a report back on the alignment and integration
possibilities between CMHA-KL and CMHA-P. The CE LHIN has brought CMHA-KL and
CMHA-P together in a facilitated integration process to develop a stronger integrated
community mental health services delivery model for the North East Cluster.
Under the provisions of the Local Health Services Integration Act, 2006 (LHSIA), the LHIN,
the Minister of Health and Long-Term Care and health service providers can integrate in
several ways.
1.
2.
3.
4.
5.
Coordinate services and interactions between different persons and entities.
Partner with another person or entity in providing services or in operating.
Transfer, merge or amalgamate services, operations, persons or entities.
Start or cease providing services.
Cease to operate or to dissolve or wind up the operations of a person or entity.
For purposes of this integration initiative, mental health is defined as “a state of well-being in
which the individual realizes his or her own abilities, can cope with the normal stresses of
life, can work productively and fruitfully, and is able to make a contribution to his or her
community"1. Mental health services in Ontario are considered to include the following
functions:
•
•
•
•
•
•
•
•
•
•
•
•
•
Identification/Early Intervention
Treatment
Crisis Supports
Consultation
Coordination
Residential Support and/or Housing
Case Management/Coordination
Social Support
Vocational Support
Self-Help/Peer Support
Family Support and Advocacy
Health Promotion/Public Education
Court Support/Diversion/Release from Custody
It is the LHIN’s mandate to promote integration opportunities that enhance both the client
experience and achieve greater value for money (e.g., efficiency). It is the position of the
CE LHIN that additional integration of mental health services across its North East Cluster
will improve ease of access and navigation to community services for mental health clients
and will leverage existing local governance, management, back office support, front-line
1
World Health Organization 17
Front-Line Direct Client Services Analysis Work Team Business Case
service delivery, volunteerism and fund raising currently provided by CMHA-KL and CMHAP.
On April 11, 2011CMHA-KL, CMHA-P and the CE LHIN agreed to a set of principles to
guide integration discussions and integration planning activities. An Integration Planning
Team (Planning Team) was established in mid-April with representatives from CMHA-KL,
CMHA-P and the CE LHIN. The work of the Planning Team to date has been focused on
understanding the current services provided by both CMHA’s, conducting due diligence and
engaging the community and key stakeholders, through focus groups, an on-line survey and
in-person meetings, to solicit their input on community mental health opportunities.
The Planning Team created several documents describing key operational information, the
services currently being delivered and in which communities, to support identification of
gaps and opportunities. These documents were used to provide context and to support the
community and stakeholder engagement process. These documents and additional
background information are available on the CE LHIN website as follows:
http://www.centraleastlhin.on.ca/Page.aspx?id=19612
During the information sharing and due diligence process, and in consideration of the input
received through the community and stakeholder engagement process, the Planning Team
identified a number of integration opportunities, with increasing levels of scope, to generate
operating flexibility to support the expansion and/or creation of new programs and services
for clients of CMHA-KL and CMHA-P. These integration opportunities address:
•
•
•
Back-office Functions
Front-Line Direct Client Services
Organizational Leadership and Governance
The Planning Team agreed to move forward initially with analysis of Back-Office and FrontLine Direct Client Services. Analysis of Organizational Leadership and Governance was
deferred until the recommendations were available for the other categories as the
“functions” may provide direction for the “form” of operational leadership and governance.
The Planning Team agreed to establish two work teams to undertake an analysis and
development of recommendations for Back-office and Front-Line Direct Client Services
opportunities.
18
Front-Line Direct Client Services Analysis Work Team Business Case
The Planning Team’s identified Front-Line Direct Client Services integration opportunities
are as follows:
Category
Scope
0
1
Front-Line
Direct Client
Services
2
3
4
5
6
Opportunity Description
Status Quo (some 4 county-wide programs i.e. EPI, 4 County Crisis)
Combine Sessional Fees – partner in recruitment and services of a parttime psychiatrist (possibly expand resources from other providers)
As above + coordinate all social recreation programs, rural outreach,
support groups, mental health education and awareness, and volunteer
coordination
As above + coordinate/standardize client access, intake process, criteria,
assessment of need (OCAN) and service allocation
As above + coordinate/standardize program delivery (trustee program,
housing services and support, etc.)
As above + merge all front-line service operations and management
As above + normalize staff positions, duties and responsibilities
Purpose The purpose of the Front-Line Direct Client Services Analysis Work Team (Work Team) is to
conduct a high-level analysis of CMHA-KL and CMHA-P front-line direct client services
integration opportunities sufficient to make a recommendation to the Planning Team on the
scope of integration that can be achieved.
The analysis and recommendation will be documented in a Business Case (outline is
provided in Appendix A) to be submitted by October 31, 2011 to the Planning Team. The
Business Case will include: 1) a high-level description of the front-line direct client services
reviewed; 2) summary details on how the services are currently provided; 3) an analysis of
integration potential; 4) associated risks; 5) high-level estimate of annualized reinvestment
potential for front-line services; 6) high-level estimate of one-time transition costs; 7) a
recommendation and associated rationale.
Scope The Work Team is concerned only with the analysis of front-line direct client services
currently provided by CMHA-KL and CMHA-P..
“IN” Scope
“OUT” of Scope
•
•
Back-Office functions, organizational
leadership and governance functions
at CMHA-KL and CMHA-P
•
Services and programs not funded
by the CE LHIN
•
front-line direct client services
provided by other service providers
•
Transition planning
All front-line direct client services
currently provided by CMHA-KL and
CMHA-P. These services include but
are not limited to:
o Case management
o Housing
o Housing Supports
o Health Promotion/Education
o Crisis Services
o Peer Support (CSI)
o Family Caregiver Network
o Early Psychosis Intervention
19
Front-Line Direct Client Services Analysis Work Team Business Case
“IN” Scope
“OUT” of Scope
o Court Diversion
•
Risks associated with opportunities
•
High-level estimate of reinvestment
potential in expanded or new front-line
direct client Services
•
Estimate
of
transition costs
•
Development of a business case
outlining the analysis and associated
recommendation
•
Presentation and engagement with the
Planning team
high-level
one-time
Authority The authority of the Work Team does not extend beyond the individual authorities of its
members and their respective decisions and sphere of influence.
The Work Team does:
•
Have the authority to share information with Work Team and Planning Team
members about their organizations services, management and operations for
purposes of supporting the development of the Business Case.
•
Have the authority to make a recommendation on the integration of front-line direct
client services.
•
Not have the authority to approve the business case and associated recommendation
as this is reserved for the Boards of Directors of each organization.
Roles & Responsibilities of the Work Team Role of the Work Team The Work Team will focus on the analysis of front-line direct client services sufficient for developing a
recommendation to integrate these functions. In this role the Work Team will:
•
Define and describe front-line direct client services provided by CMHA-KL and
CMHA-P.
•
Analyse opportunities to integrate these services considering the scope of
opportunities identified by the Planning Team.
•
Consider the full-scope of integration as it applies to front-line direct client services.
•
Identify approximate annualized reinvestment potential for new or expanded front-line
direct client services.
20
Front-Line Direct Client Services Analysis Work Team Business Case
•
Identify approximate one-time transition costs required to integrate front-line direct
client services.
•
Identify risks associated with the integration of front-line direct client services and
potential mitigation strategies.
•
Liaise with other CMHA-KL, CMHA-P and CE LHIN representatives to clarify
information, test planning assumptions and receive feedback on proposed
actions/measures.
•
Provide regular status reports to the Planning Team.
•
Write the Business Case.
•
Present the completed Business Case and recommendations to the Planning Team
by October 31, 2011.
•
Present recommendations to the Boards of Directors (if required).
Responsibilities of the Work Team The main function of the Work Team is to take responsibility for the development of the
Business Case and presentation of its recommendation to the Planning Team and potentially
Boards of Directors.
Membership & Roles of Individual Planning Team Members Membership The Work Team will be chaired by an independent analysis lead to be designated by the CE
LHIN and agreed to by the Planning Team.
The Work Team membership will be composed of senior representatives from the following
organizations/stakeholder groups:
Name
Organization/Stakeholder Group
•
Matt Melinyshyn
•
Analysis Lead
•
Janice Waters
•
Manager,
Community
Programs, CMHA-KL
•
Laurie Green
•
Team Leader – Justice Services and Social
Recreation, CMHA-KL
•
Beth Day
•
Director, Programs and Services, CMHA-P
•
Maggie Stephens
•
Director, Programs and Services, CMHA-P
Mental
Health
Reporting Relationships The Work Team will report to the Planning Team.
21
Front-Line Direct Client Services Analysis Work Team Business Case
Linkages & Partnerships The Work Team will seek input from existing CMHA staff providing services and may engage
a wider group of subject matter experts including other front-line direct client services
providers, other community support services and mental health and addictions service
agencies, etc.
Duration of Service The members and chair of the Work Team will serve until the completion of the Business
Case, with a target completion date of October 31, 2011, and presentation to the Planning
Team.
New members of the Work Team may be added from time-to-time to address a perspective
and set of skills of benefit to the Work Team that may have been overlooked in the
identification of the original Work Team membership.
Individual Roles of Work Team Members Name
Individual Role
•
Janice Waters
•
Educate the team on the front-line direct client
services, management and operations of CMHA-KL.
Provide information to support the analysis of front-line
direct client services integration opportunities and
contribute to the development of a recommendation to
integrate front-line direct client services. Support the
development of the Business Case.
•
Laurie Green
•
Educate the team on the front-line direct client
services, management and operations of CMHA-KL.
Provide information to support the analysis of front-line
direct client services integration opportunities and
contribute to the development of a recommendation to
integrate front-line direct client services. Support the
development of the Business Case.
•
Beth Day
•
Educate the team on the front-line direct client
services, management and operations of CMHA-P.
Provide information to support the analysis of front-line
direct client services integration opportunities and
contribute to the development of a recommendation to
integrate front-line direct client services. Support the
development of the Business Case.
22
Front-Line Direct Client Services Analysis Work Team Business Case
Name
•
Maggie Stephens
Individual Role
•
Educate the team on the front-line direct client
services, management and operations of CMHA-P.
Provide information to support the analysis of front-line
direct client services integration opportunities and
contribute to the development of a recommendation to
integrate front-line direct client services. Support the
development of the Business Case.
Logistics and Processes Role of Chair The Work Team Chair will determine the time, date and location of the meetings, approve the
meeting Agenda and conduct the meeting.
Frequency of Meetings Work Team meetings will be held as required to ensure timely preparation of a Business
Case.
Teleconference, video conference and/or webinar meetings are an acceptable alternative to
in-person meetings.
Decision­Making Process Work Team decisions will be reached by consensus and reflected in the meeting minutes. If
the Work Team cannot reach consensus, the details of their deliberation/supporting material
and options will be provided to the Planning Team for a decision.
Quorum Requirements To constitute a formal meeting, the Chair and one representative each from CMHA-KL,
CMHA-P must be present. Decisions or actions taken in the absence of a quorum are not
binding on the team.
Proxies to Meetings Proxies or substitutions for Work Team members are accepted with advance notice.
However, due to the sensitive nature of the activities of the Work Team and the short time
period to complete the analysis it is not recommended to regularly have proxies or
substitutions.
The Chair, in conjunction with the team members, will determine attendance by invited guests
on a meeting-by-meeting basis
23
Front-Line Direct Client Services Analysis Work Team Business Case
Meeting Agenda Items Meeting Agendas and related materials will be prepared and distributed in advance of Work
Team meetings.
Minutes & Meeting Papers Meeting Minutes and Meeting Papers preparation and distribution will be the responsibility of
the Chair. Minutes will be prepared and distributed by e-mail following each meeting to the
Work Team and Planning Team.
Issue Resolution All issues raised before the Work Team will be provided on an Issue Sheet that includes a
description, impact assessment and proposed issue resolution. Issues that cannot be
resolved by the Work Team will be escalated to the Planning Team for resolution and/or
further escalation to the CMHA-KL, CMHA-P or CE LHIN sponsors.
24
Front-Line Direct Client Services Analysis Work Team Business Case
Acceptance & Sign­Off The following signatures represent acceptance of these Terms of Reference.
25
Front-Line Direct Client Services Analysis Work Team Business Case
Appendix B: Front­Line Direct Client Integration Opportunities Analysis Function Provider
or Service CMHA-KL
Case Mgmt FTE: Total 10.27; (MOS (Management and Operational
Support) = 1.0 and UPP (Unit Producing Personnel) = 9.27)
CMHA-P
FTE: MOS FTE =1.2, UPP FTE = 9.7 Total = 10.9
Funding Source:
MOHLTC
Funding Source:
Operating Costs:
MOHLTC
$667,789
Note: All services listed
under the Case Management
function and the Release
from Custody Program (in
Court Programs) are funded
from this total.
Operating Costs:
$961,060
(Paymaster = $34,018; so
CMHA-P operating costs =
$927,042)
Note: All services captured
under Case Management,
except Dual Diagnosis, are
funded from this total.
Brief Description:
Brief Description:
Case Management
Case Management provides intensive case management
services to support individuals with a serious and persistent
mental illness, concurrent disorder or mental health clients
involved in the justice system to be able to live in the
community.
Case Management
Case Management provides intensive case management
services to support individuals with a serious and persistent
mental illness, concurrent disorder or mental health clients
involved in the justice system to be able to live in the
community.
Aspects of the service include: community outreach,
assessment/referral, crisis prevention and intervention, life
and social skills development, stress management,
education/coping strategies, symptom and medication
management, leisure skills, linkage, advocating and
coordinating services with other community agencies and
health care providers
Intake
The central point of entry and contact for prospective clients.
Intake services respond to phone calls and walk‐ins. The
service determines eligibility and access to CMHA‐P services
and links and/or refers to external programs when required.
Prospective clients may also enter directly through specific
programs (e.g., Court Support/Diversion; Short Term Case
Management).
26
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Case Mgmt Intake
The central point of entry and contact for prospective clients.
Cont’d
Intake services respond to phone calls and walk‐ins. The
service determines eligibility and access to CMHA‐KL
services and links and/or refers to external programs when
required. Prospective clients may also enter directly through
specific programs (e.g., Court Support/Diversion).
CMHA-P
Brief Services
Brief Services provide intensive, short‐term case
management and/or brief supportive counselling services for
individuals with mental health issues. The brief services
format allows a timely response to meet the needs of more
people in the community.
Trustee Services
A flexible financial management program offered to
Brief Services
individuals who lack money management skills to achieve
Brief Services provide intensive, short‐term case
management and/or brief supportive counselling services for short‐term financial stability and long‐term security.
individuals with mental health issues. The brief services
format allows a timely response to meet the needs of more Community Treatment Order (CTO)
CMHA‐P provides a Community Treatment Order (CTO)
people in the community. Case Managers in the program
program. A CTO is an order to provide a person who suffers
use clinically‐ based solution‐focused counselling and
techniques from reality therapy, narrative therapy, CBT, and from a serious mental disorder with a comprehensive plan of
community‐based treatment or care and supervision that is
Dialectical Behaviour Therapy (DBT) to address an
less restrictive than being detained in a psychiatric facility.
individual’s unique mental health needs.
The program assists individual’s follow‐up in the community
Trustee Services (partial MOHLTC funding)
as an alternative to hospitalization. The CTO plan identifies
A voluntary financial planning program with a range of
what the person and their supports (e.g., family, friends and
services to allow individuals to work on goals related to
health care professionals) must do to help them stay out of
financial planning and financial stability. Individuals can
the hospital; this includes intensive case management
attend budgeting classes, receive budgeting support, and
support provided by case managers. CTOs are intended for
choose to sign on with a Trustee who will co‐manage their
those who have a serious mental illness and a history of
funds with them while working together to help them learn to repeated hospitalizations where a doctor has examined the
individual and believes the person requires continuing
manage their finances successfully. Individuals can also
treatment and care or supervision while residing in the
receive assistance in reducing and eliminating debt.
community.
Community Treatment Order (CTO)
CMHA-KL receives no additional MOHLTC funds to provide
this service. CTO clients are managed on existing
caseloads.
27
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
CMHA-P
Note: The following “Dual Diagnosis” program is currently
Case Mgmt Note: The following “Dual Diagnosis” program is currently
captured
in
this
draft
table,
but
receives
no
MOHLTC
funding.
captured in this draft table, but is completely funded by
Cont’d
MCSS (Not MOHLTC).
Dual Diagnosis
Dual Diagnosis
Intensive case management services for individuals living
with both a mental health issue and an intellectual disability. Intensive case management services for individuals living
with both a mental health issue and an intellectual disability.
CMHA-KL receives no additional MOHLTC funds to provide Services include a supportive group home, supportive
this service. Clients living with both a mental health issue
independent living (SIL) and day program supports and
and an intellectual disability may be managed on existing
services.
caseloads and there are established partnerships with other
services providers (e.g., Adult Protective Services) to
enhance client care.
Psycho Educational Support Groups
(Most scheduled and run on an as needed basis)
• Dialectical Behaviour alTherapy: Taking control of
life through practicing mindfulness techniques,
learning emotional regulation skills, practicing
distress tolerance and setting and achieving
personal goals.
• Assertiveness Training: Learning the differences
between aggressive, passive and assertive
personalities; practising conflict management and
other assertiveness skills.
• Depression Support Group: Identify the types of
depression, common symptoms, coping skills and
information on anti‐depressant medication.
• Health and Empowering Relationships: Definition
and maintenance of healthy boundaries, clear
communication and recognition of boundary
violations.
• Grief Support: General group session for anyone
dealing with the death of a loved one.
28
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Case Mgmt
Cont’d
•
•
•
•
CMHA-P
Anxiety Management: Defining, dealing with anxieties
and phobias, as well as understanding the causes
and remedies for worry and panic. Includes learning
relaxation techniques.
Suicide Bereavement: Provides factual information
after a suicide has occurred and assists individual
survivors, families, and the community to develop an
understanding of their own grief process.
Points to Recovery: Addresses the myths of
mental illness, medication, taking charge, signs of
change, strengths, organizing help and coping
strategies.
Living a Healthy Life with Chronic Conditions:
Learning how to feel better, do more activities, make
changes to diet and exercise, strategies to manage
medications and communicate with the doctor.
Senior Support
The Senior Support Network is a specialized Mental Health
case management program geared to the needs of seniors.
The program offers a rapid response service where seniors
living in the community with a mental illness are identified as
being in crisis. They will be assessed face-to-face within 72
working hours of notification to the program. Seniors
enrolled in the program on a longer-term basis receive
intensive case management services from staff members
who have been trained in seniors’ mental health.
Strengths:
• Intake, Brief Services, and Case Management are a
continuum.
• Case Managers: most have college degrees and
personal/professional experience.
Strengths:
• Intake, Brief Services, and Case Management are a
continuum.
• Case Managers: have, as a minimum, a University
degree and experience.
29
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Case Mgmt
Cont’d
•
•
•
•
•
•
•
•
•
•
•
•
In the Seniors Support Program, there is a
commitment to a face-to-face 72 hour response time.
In the Case Management Program, there is a
commitment to a contact within 72 hours of contact
with the agency.
Brief Services address clients’ needs in a timely
fashion.
Case Management services assist in keeping the
client in the community; keeping them out of hospital.
Referrals can be from anyone (e.g., client/self, family,
police, or other community agency).
A person with a suspected mental health or
diagnosed mental health concern can access all
case management services.
A high percentage of referrals are from client/self, or
family members.
Case Managers may meet clients in the office, the
client’s home or in the community; accompaniment
can be requested, if needed (e.g., police).
Case Managers are well integrated/interface with
other service providers in the local community.
There are Case Managers who have specific training
in seniors’ mental health, psychosocial rehabilitation,
and community building.
Case Managers have received training in
Motivational Interviewing, Dialectical Behavioural
Therapy, Cognitive Behavioural Therapy, and
concurrent disorders.
Regarding Trustee Services, it was noted that the
programs at CMHA-KL and CMHA-P have many
similarities.
CMHA-P
•
•
•
•
•
•
•
•
•
•
In the Case Management Program, there is a
commitment to a contact within 72 hours of contact
with the agency.
Brief Services address clients’ needs in a timely
fashion.
Case Management services assist in keeping the
client in the community; keeping them out of hospital.
Referrals can be from anyone (e.g., client/self, family,
police, or other community agency).
There is no need for a diagnosis in accessing intake
or brief services
Case Management requires a confirmed mental
health diagnosis.
Case Managers may meet clients in the office, the
client’s home or in the community; accompaniment
can be requested, if needed (e.g., police).
OTN (Ontario Telemedicine Network) capability
Case Managers have received training in
Motivational Interviewing, Dialectical Behavioural
Therapy, Cognitive Behavioural Therapy, concurrent
disorders and advanced case management practice.
Regarding Trustee Services, it was noted that the
programs at CMHA-KL and CMHA-P have many
similarities.
30
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
CMHA-P
Case Mgmt
Cont’d
Weaknesses:
• CMHA-KL office is on the second floor; there are
stairs but no elevator.
• Clients’ needs outweigh the funds available (or
exceed the services that could be provided).
• Other services that CMHA-KL can refer to in the
community are limited, or not available.
Housing
FTE: UPP = 1.0
Operating Costs: N / A,
operating cost incorporated
into Housing Supports
budget
Funding Source:
MOHLTC
Weaknesses:
• In the Trustee Program the need for the program is
greater than the available resources.
• Very limited access in the community to resources
for Axis II diagnoses, (personality disorders) and
other complex presentations
FTE: (MOS FTE = 0.12; UPP FTE = 0.96) Total 1.08
Operating Costs:
Funding Source:
$490,379
MOHLTC
(includes salary and benefits)
Brief Description:
Brief Description:
Housing
CMHA-KL owns Harrison House, a transitional, eight‐bed,
co‐ed psychosocial rehabilitative housing program for
individuals with serious mental health concerns. Rental
agreements are time limited and geared toward the goal of
returning to independent living. Individuals residing at
Harrison House are provided with case management
support through CMHA‐KL. Supports are flexible and
depend on the needs of the individual. Residents have the
opportunity to participate in social recreation and psycho‐
educational programming provided in the home and in the
community. As well, residents participate collaboratively in
activities of daily living and household duties. The residents,
as a whole, are responsible (under staff supervision) for the
Housing
CMHA‐P owns and manages 11 rental properties
consisting of a total of 35 Rent Geared to Income (RGI)
units dedicated to the seriously mentally ill and dually
diagnosed population. CMHA-P also owns and manages
their office at 466 George Street in Peterborough and 24
Paddock Wood which houses the Four County Crisis
program. CMHA‐P also administers a total of 104 Rent
Supplement units (including 24 in Northumberland) along
with 10 Strong Community Rent Supplement units with the
City of Peterborough.
An additional eight Rent Supplement units have recently
31
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Housing
Cont’d
financial matters of the house.
CMHA-P
been allocated for the addiction population. CMHA‐P will
provide the property management and FourCAST will
provide the case management supports.
There has recently been an announcement that CMHA-P will
get an additional 10-12 new rental supplement units
(MOHLTC funding).
Strengths:
• CMHA-KL owns Harrison House
• Property Management is at arms-length from client
support (no conflict between property management
and CMHA-KL staff, therefore staff can advocate on
behalf of the client)
• A very collaborative relationship with the City of
Kawartha Lakes, and other local housing providers.
Strengths:
• CMHA-P owns many units/properties; they are wellmaintained and integrated into the community.
• Several properties are smaller homes divided into
apartments (e.g., 2-4 persons per building)
• CMHA-P has been in the property business for more
than 20 years.
Weaknesses:
Weaknesses:
• Not enough housing to meet community/client need.
• Not enough housing to meet community/client need.
• Transportation is an issue, given the rural geographic
• Transportation is an issue, given the rural geographic
nature of the catchment area.
nature of the catchment area.
Housing
Supports
FTE: UPP = 7.8
FTE: MOS FTE = 1.26; UPP FTE = 6.22 (Housing Supports)
plus 4 (Case Management) = 10.22
Operating Costs: $414,544 Funding Source:
(MOHLTC)
MOHLTC and City of Kawartha
Plus City of Kawartha Lakes: Lakes:
$45,000 (for the
Homelessness program)
Operating Costs:
Funding Source:
$ 1,023,789 (LHIN allocation) MOHLTC
Paymaster = $170,088
Operating Costs = $853,701
32
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Housing
Supports
Cont’d
Brief Description:
•
•
•
Market Square Apartments: Provide safe, decent,
permanent and affordable housing to people who
suffer with a mental health concern, but who are
capable of living independently in the community.
The apartment complex includes 6 one bedroom
apartments.
Hamilton Street Apartments: Provide safe, decent,
permanent and affordable housing to people who
have suffered with a mental health concern, but who
are capable of living independently in the community.
The apartment complex includes 18 one bedroom
apartments.
Mental Health Services Program: Provides Rent
Supplements as well as financial assistance to
individuals in the Kawartha Lakes region ages 18
and over. Individuals enrolled in this program work
with a case manager to complete a thorough psychosocial assessment and create a service plan with
individualized goals geared to help the individual
meet his or her personal goals. Individuals are linked
with community resources based upon their identified
needs. CMHA-KL manages 50 rental units with 37
landlords and 3 seniors units with the Fenelon Area
Independent Living Association.
CMHA-P
Brief Description:
CMHA-P also administers a total of 104 Rent Supplement
units (including 24 in Northumberland) along with 10 Strong
Community Rent Supplement units with the City of
Peterborough. Supports in this program are provided by a
multidisciplinary team of Case Managers and Housing
Support Workers.
Homelessness Partnering Strategy
A collaboration between CMHA‐P, Peterborough Social
Planning Council, the Peterborough County‐City Health Unit
and VON Peterborough office to provide assertive outreach
and aftercare services to homeless and hard-to-serve
individuals in both Peterborough city and the county. Clients
admitted to this program typically present with heightened
mental health presentations including longer duration of
symptoms, increased frequency of relapse, long‐term chronic
And/or co-morbid symptoms, and transient housing patterns.
The program includes community outreach and trustee
services, for the homeless to find and maintain housing,
income supports, employment and vocational opportunities.
This program is primarily funded through federal
homelessness funding flowing through the United Way of
Peterborough & District.
Homelessness
The program addresses the needs of people with serious
mental illness who are homeless or at risk of becoming
homeless by offering Intensive case management services,
sometimes in combination with rent supports, in order to find
and/or maintain their home in the community. Clients
admitted to this program typically present with heightened
33
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Housing
Supports
Cont’d
CMHA-P
mental health presentations including longer duration of
symptoms, increased frequency of relapse, long‐term chronic
and/or co-morbid symptoms, and transient housing patterns.
Direct services provided by this program include, but are not
limited to: Intensive Case Management, rent supplements,
psychosocial assessment, brief supportive counselling,
outreach, advocacy, community education, program
development, training, and consultation.
Strengths:
• CMHA-KL owns Harrison House.
• All housing support staff are Case Managers.
• Property Management is at arms-length from client
support (no conflict between property management
and CMHA-KL staff, therefore staff can advocate on
behalf of the client).
• A strong working relationship with City of Kawartha
Lakes and other housing providers.
Strengths:
• CMHA-P owns many units/properties, and they are
well maintained and integrated into the community.
• CMHA – P have both housing support workers and
case managers.
• Several are smaller homes (e.g., 3 – 4 persons per
building).
• CMHA-P has been in the property business for more
than 20 years.
• CMHA-P has both property management and
housing supports funded services: benefit to help
keep individuals housed (e.g., if goes to housing
tribunal).
• Have diversity of options for clients (e.g., RGI and
rent supplements).
Weaknesses:
Weaknesses:
• Not enough housing.
• Housing support workers and case managers report
to different individuals in the organization.
• Transportation is an issue, given the rural geographic
nature of the catchment area.
• When new money is allocated from MOHLTC, the
agency often receives only rent supplements, but no
• When new money is allocated from MOHLTC, the
funding for supports to accompany them.
agency often receives only rent supplements, but no
funding for supports to accompany them.
34
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
FTE: 0
Health
Promotion Operating Costs: $0
and
Education Brief Description:
CMHA-P
Funding Source:
Note: The following HP and Education is currently included
in the table, however CMHA-KL receives no MOHLTC
funding for this (funding comes from fundraising and
donations).
Health Promotion and Education
• Lectures: CMHA-KL lectures help local businesses,
organizations with their productivity issues by
addressing mental health, mental illness and worklife conflicts within the work environment. Lectures
range from full-day sessions, to quick and informative
lunch and learn presentations.
• Workshops: Offer a number of different workshops
for the community addressing a wide range of issues
related to mental health including: Whistle While You
Work, time management, stress management, anger
management, and grief and loss.
• Applied Suicide Intervention Skills and Training
(A.S.I.S.T.): A two-day interactive training program
that emphasizes suicide first aid.
• Non-Violent Crisis Intervention: An intensive two-day
training program that teaches non-harmful
interventions; using verbal and physical techniques.
• Mental Health First Aid: A public education program
that helps to improve mental health literacy, and
provide the skills and knowledge to help people
better manage potential or developing mental health
problems in themselves or others.
• Other: CMHA-KL staff is active in the Kawartha
FTE: 0
Operating Costs: $0
Funding Source:
Brief Description:
Note: The following HP and Education is currently included
in the table, however CMHA-P receives no MOHLTC funding
for this (funding comes from United Way, donations and
fundraising).
Health Promotion and Education
• Presentation/Workshops/Seminars: Speakers are
available to interested groups requesting information
on mental wellness and mental illness.
• Suicide Intervention Training: The Living Works
model of suicide prevention uses trained facilitators
to address attitudes, skills and knowledge required
by professionals and caregivers to enable them to
recognize and utilize a model to prevent a life being
taken.
• Interlink Choir: An intergenerational program
connecting seniors and grade six children through
music and letters.
• Information and Referral: A service to assist
individuals in accessing information on mental health
or mental illnesses. An on-site library houses books
and videos specific to mental illness. Community
resources available to meet the needs of those
inquiring are provided.
• Support Groups: CMHA-P refers clients to groups
offering self help support to individuals dealing with a
variety of issues. Support with space and resource
development is also provided.
• Non-Violent Crisis Intervention: An intensive two-day
35
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Health
Promotion
and
Education
Cont’d
•
Lakes Community, attending community fairs, and
spreading information regarding mental health and
mental illness in a variety of ways.
Information and Referral: A service to assist
individuals in accessing information on mental health
or mental illnesses. An on-site library houses books
and videos specific to mental illness. Community
resources are available to meet the needs of those
inquiring.
CMHA-P
•
•
training program that teaches non-harmful
interventions; using verbal and physical techniques.
Mental Health First Aid: A public education program
that helps to improve mental health literacy, and
provide the skills and knowledge to help people
better manage potential or developing mental health
problems in themselves or others.
Kids on The Block: A troupe of life size puppets
available to young (elementary school) audiences
relaying mental health and mental wellness
messages.
Strengths:
Strengths:
• There are good in-house facilitators.
• There are good in-house facilitators.
• It can be revenue generating.
• It can be revenue generating.
• Health promotion workshops are provided by CMHA• Health promotion and education is an excellent
KL for businesses.
networking opportunity for staff with allied partners.
• Health promotion and education is an excellent
• The programs reduce stigma regarding mental
networking opportunity for staff with allied partners.
illness, and are a good outreach opportunity.
• The programs reduce stigma regarding mental
• CMHA- P is well integrated within their community.
illness, and are a good outreach opportunity.
• Great opportunity to work with marginalized
populations.
• CMHA-KL is well integrated within their community.
• Great opportunity to work with marginalized
• CMHA-P is well-integrated within their community
populations.
• CMHA-KL is well-integrated within their community.
Weaknesses:
• No specific MOHLTC funding.
• More requests to do health promotion/education
initiatives than there are dollars.
• There is an expectation in the community for the
CMHA to do health promotion and education.
Weaknesses:
• No specific MOHLTC funding.
• There is an expectation in the community for the
CMHA to do health promotion and education
36
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Crisis
Services
CMHA-P
FTE: 0
Operating Costs:
FTE: Total Crisis = 22.13 ( MOS=1.82 UPP= 20.31 );
Total Crisis Safe Beds =7.47 FTE
Funding Source:
Funding Source:
Operating Costs:
MOHLTC
Crisis:$1,647,481
(Paymaster is $50,000 to
Haliburton Highlands Mental
Health Services and
Northumberland Hills Hospital
Community Mental Health)
Safe Beds: $522,529
Brief Description:
Brief Description:
Crisis Service
First response to clients in crisis (e.g., suicidal, experiencing
loss, emotional first‐aid, etc.) who call‐in or drop‐in to CMHA‐
KL directly during normal business hours (rather than
contacting Four County Crisis). Clients are stabilized before
being transferred or redirected to Four County Crisis, CMHA‐
KL Case Manager or to external partner (e.g., hospital,
police, etc...).
Crisis Service
First response to clients in crisis (e.g., suicidal, experiencing
loss, emotional first‐aid, etc.) who call‐in or drop‐in to CMHA‐
P directly during normal business hours (rather than
contacting Four County Crisis). Clients are stabilized before
being transferred or redirected to Four County Crisis, CMHA‐
P Case Manager or to an external partner (e.g., hospital,
police, etc...).
Four County Crisis
• Telephone Crisis Intervention: A non-medical
service providing assistance to individuals
experiencing mental health problems with 24 hour
telephone support and referral to appropriate
services.
• Mobile Crisis Intervention/Short-Term Case
Management: Assessment may lead to outreach
through a mobile team or short term case
management services available within the program.
37
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Crisis
Services
Cont’d
CMHA-P
•
•
•
•
•
Specialized Network of Care: Two FTE positions: (1)
a coordinator position which is MCSS funded only
and (2) an MOHLTC funded position which provides
short-term intensive case management services to
individuals with a dual diagnosis (intellectual
disability and mental illness) and intellectually
challenged individuals. Services include: community
outreach, assessment/referral, crisis prevention and
intervention, life and social skills development linking,
coordinating and advocating services with other
organizations.
Consultation service (MOHLTC funded) through a
partnership with Tri-County Behavioural Support
Services.
Crisis Safe Beds: Six crisis safe beds are available
for individuals living within the HKPR region who are
experiencing a mental health crisis and who through
a 3-10 day stay will be diverted from the criminal
justice system or hospital. Clients entering the
program receive supportive counselling to provide
stabilization, assistance with obtaining funds, and
referrals to other agencies/organizations to address
mental health, housing, medical and legal needs.
Specialized services are available to address
concurrent disorders or behavioural issues.
Integrated Outreach Worker: Police-ER diversion
through an integrated position working in the
community with police to assess and triage calls
regarding “emotionally disturbed persons” in order to
divert them from the emergency department.
Two new Case Manager positions (PeterboroughPRHC, COKL- Ross Memorial) to assist with
diversion of clients from emergency departments and
38
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Crisis
Services
Cont’d
CMHA-P
early discharge from hospital, and to facilitate
management at home and connection to other
resources.
Strengths:
Strengths:
• The fact that an integrated Four County Crisis
• CMHA-KL does not get funding for crisis services,
Service exists is a strength.
yet they treat any crisis that walks into their KL office.
• 24/7 Telephone Crisis Line is an advantage and it
• The local Four County Short Term Case Manager is
also permits clients of other organizations to access
well integrated with the CMHA-KL Case
crisis services after hours.
Management team.
• The Short Term Crisis Case Managers are not
duplicating the services of other Case Managers in
the Four County catchment area.
• The availability of specialized services for dually
diagnosed and concurrent disorders clients are also
an asset.
• Internal client database allows communication
between programs.
• The Short Term Case Management staff are
embedded in the communities they serve (i.e. can
provide services locally).
• More opportunity for staff from both agencies to
communicate with each other, internally or between
organizations, to better serve clients.
Weaknesses:
Weaknesses:
• There is local Short Term Case Management, but no
• Large geographic area and distanced, and the need
local crisis safe beds in KL area.
to send two staff on mobile visits, for safety.
• The short-term case manager in KL area is local, but
• All the crisis safe beds are in Peterborough, and
reports to a supervisor at CMHA-P.
there are challenges in getting clients there. (e.g.,
transportation issues).
• Criteria for access to crisis safe beds may need to be
39
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Crisis
Services
Cont’d
Peer
Support
(CSI)
CMHA-P
•
clarified.
Need to bring hospitals more into the process of
coordinated crisis services.
FTE: 0
Operating Costs:
$0
FTE: Peterborough = 2.56 R4R CKL = 2.91
Funding Source:
Funding Source:
Operating Costs:
MOHLTC
Peterborough Clubhouse:
$183,964 (Paymaster of
$17,289 to Haliburton) so
operating costs are $166,675;
COKL R4R =$209,137
Brief Description:
Brief Description:
Consumer Survivor Initiatives (CSI) Peer Support
Peer Support
The Social Recreation program is not funded by MOHLTC, The REACH Centre in Peterborough provides informal
but is funded through CMHA–KL fundraising, etc. Also,
support through peer counselling and social recreational
there is a team of CMHA-KL staff, within their working
activities Monday to Friday, 8:30am‐4:30pm. The REACH
hours, who commit their time to this service. The program
Centre vision is to provide a place where consumers of
is not run by peers.
mental health services receive support from those who
understand best (i.e., their peers). They require a place
The Social Recreation program (also called “Friends in
where quality of life is improved, vital supports are created
Motion”) offers a wide range of social, recreational and
and where consumers direct services in a place they call
vocational opportunities for individuals with mental illness.
their own. REACH is an acronym for Recovery,
The focus is on providing recreation leisure opportunities to Empowerment, Advocacy, Community, and Hope. A
improve social skills, quality of life and enjoyment.
resource room is staffed by qualified consumers /survivors
Participation in the program activities assists members to
who assist those with mental illness to develop computer
develop and build their self‐ confidence, learn a variety of life literacy and other life skills training. Rural and local outreach
services are provided through Peer Outreach workers.
skills, increase socialization activities, strengthen informal
Peer Outreach support is offered in the communities of
support contacts, foster peer support and belong to a
Lakefield, and Northumberland County (Campbellford).
supportive community setting.
The facility offers a Saturday Activity Group Experience
(SAGE).
Catering PLUS (People Learning Useful Skills) (MOHLTC
40
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Peer
Support
(CSI)
Cont’d
CMHA-P
funded) is an alternative business providing employment
opportunities in a community business setting to consumer
survivors.
Kawartha Lakes REACH for Recovery (KLR4R) (MOHLTC
funded) located in downtown Lindsay is part of CMHA–P’s
Consumer Survivor Initiatives; it has a life skills and peer
support focus. Groups, individual support, outings, referrals
and a computer lab are some of the resources available. In
addition, rural outreach and social recreation programs
highlight this community–based program. The Centre is
open Monday to Friday 9:00am–5:00pm and currently
Saturday from 11:00am–3:00pm.
Note: the following is fully funded by MCSS:
• REACH@ Charlotte is a day program in
Peterborough; it provides a supportive learning
environment, offering social recreational activities
and life skills building for adults who live with a dual
diagnosis. The facility is also open on Saturdays and
in the evenings for social recreation activities.
Strengths:
Strengths:
• Consumers often identify social recreation as a need,
• Peer Support is embedded in all programs at CMHAand CMHA-KL staff are able to respond to that need
P.
with the financial support of the agency.
• CMHA-P Peer Support was recognized by
Accreditation Canada as a leading practice.
• Programming assists with activities of daily living
(e.g., cooking club).
• Peer Outreach Worker attends both Peterborough
and Lindsay hospitals to meet with inpatient clients.
• Social recreation creates opportunities for inclusion
into activities that may otherwise not be available to
• Peer Support also provided to the community of
individuals.
Campbellford.
• Paymaster for peer support in Haliburton
• Programming assists with activities of daily living
41
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
CMHA-P
Peer
Support
(CSI)
Cont’d
•
Weaknesses:
• CMHA-KL is not funded by MOHLTC for peer
support.
• CMHA-KL is not funded by MOHLTC for Social
Recreation, however, consumer many times identify
social recreation as a need, so CMHA-KL is
responding to that need.
FTE: 0.33
Family
Caregiver Operating Costs:
Network $20,629
Funding Source:
MOHLTC
Brief Description:
(e.g., cooking club).
Opportunities for inclusion into activities that may
otherwise not be available to them.
Weaknesses:
• Need is greater than the available resource
FTE: 0
Operating Costs:
0
Funding Source:
0
Brief Description:
Family Services
The Family Support Program provides support, education,
and advocacy in order to improve the lives of families and
caregivers of people with serious mental illness. The goal of
the program is to educate families, paid caregivers, and the
general public about mental illness, stigma, and care for
caregivers. Direct services provided by the program include,
but are not limited to: outreach, advocacy, community
education, support, and consultation. While family members
and caregivers are provided with one-on-one supportive
counselling and education as needed and requested, a major
42
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
focus of the program is the “Journeying Together” curriculum.
“Journeying Together”: Family members and caregivers
share their experiences with each other in facilitated
discussions around understanding stigma, overcoming
stress, navigating the mental health system, developing a
crisis plan and community resources. There is a peer
support component built into this program linking family
members of individuals who have serious mental illness to
other families who have similar experiences.
Strengths:
• Designed based on family needs through
consultations.
• Good process: staff do a full assessment and family
plan.
• Partnership with Ross Memorial Hospital.
Weaknesses:
• Not enough money or staff FTEs to provide service
to satisfy community need.
FTE: 0.60
Early
Psychosis Operating Costs:
Funding Source: MOHLTC
Intervention $38,871 (paymaster from
(Funding from CMHA-P
CMHA-P)
paymaster)
CMHA-P
Family
Caregiver
Network
Cont’d
Brief Description:
Strengths:
Weaknesses:
FTE: MOS = 1.05; UPP FTE = 4.73; Total = 5.78
Operating Costs: $1,419,042 Funding Source:
MOHLTC
(Paymaster to Four County
sites = $707,609 so operating
costs are $711,433)
Psychiatry costs $166,000 for
four counties.
Schizophrenia Society of
Ontario contribution (CMHA
is paymaster to SSO for
$50,000/year)
Brief Description:
43
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Early
Psychosis
Intervention
Cont’d
Early Psychosis Intervention
Funds received from CMHA‐P to provide information and
intensive support to family members of individuals who are
enrolled in the Early Psychosis Intervention program.
Services provided by the program include a full psychosocial
assessment completed with the family and the development
of family service plan. On an on‐going basis, the Family
Support Worker provides the family education and
information regarding mental illness. A family support group
is also offered on a monthly basis.
CMHA-P
Note: this CMHA-P program and operating costs cover
travel, training, and program supplies, for all four counties.
Early Psychosis Intervention
CMHA–P is the lead agency for a four county rapid response
treatment program (Lynx) for individuals in early stages of a
psychotic illness. The Lynx program also provides family
supports and community education.
“Open Your Mind”: A program available to high schools
offering information on mental illnesses and the stigma and
myths associated with the illness.
Another goal of the program is to enhance the knowledge
and skills of professionals in the community (e.g., teachers,
nurses, social workers, personal support workers, and
clergy) regarding mental illness including enhancing skills in
identification and appropriate intervention.
Strengths:
• An example of a true partnership, with a joint
management committee.
• Standardized service provision.
• Recognized as “leading practice”.
Strengths:
• An example of a true partnership, with a joint
management committee.
• Standardized service provision.
• Recognized as “leading practice”.
Weaknesses:
• There are differing program/agency policy and
procedures and reporting.
• Administration versus clinical supervision can create
complexity.
Weaknesses:
• There are differing program/agency policy and
procedures reporting.
• Administration versus clinical supervision can create
complexity.
44
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
FTE
Court
Programs Operating Costs
CMHA-P
Funding Source
FTE: MOS FTE = 0.11, UPP FTE = 1.00 Total = 1.11
Operating Costs:$91,834
Funding Source:
MOHLTC
1) Forensic:
Not available, as captured under the broader case
management function.
2) Court Support and Court Diversion:
FTE: 1.0
Operating Costs:
Funding Source:
$ 71,455 (paymaster
MOHLTC
received from CMHA-P)
2) Court Support and Court Diversion:
FTE: MOS FTE = 0.20, UPP FTE = 1.00 Total = 1.20
Operating Costs:
Funding Source:
$202,284
MOHLTC
Paymaster to CMHA-KL =
$71,455
Operating costs = $130,829
Brief Description:
Brief Description:
Court Services
Court Services
• Court Diversion: Provides assistance for individuals
• CMHA–P is the lead agency for a four county Court
with mental illness or symptoms of mental illness
Support Service. This service assists those
who are in conflict with the law. A diversion plan is
individuals experiencing a mental illness, dual
facilitated as a suitable alternative within the criminal
diagnosis or concurrent disorder who have been
justice system. CMHA-KL works collaboratively with
charged or could be charged with a minor criminal
community partners including court officials, police,
offense, who are in the Peterborough court system. It
Crown Attorney, legal counsel, mental health
provides these individuals with supports and referrals
agencies, social services and other community
from within the court to direct them away from the
agencies to provide linkages for treatment and
criminal justice system.
support where required, in order to minimize the
• Court Diversion: Provides assistance for individuals
possibility of further involvement in court and ensure
with mental illness or symptoms of mental illness
appropriate mental health supports and follow-up as
who are in conflict with the law. A diversion plan is
needed. Participants may qualify if they have been
facilitated as a suitable alternative within the criminal
45
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Court
Programs
Cont’d
CMHA-P
diagnosed with or are suspected to have a mental
justice system. CMHA-P works collaboratively with
health concern, are 16 years of age or older, have
community partners including court officials, police,
been charged with an offense, agree to voluntarily
Crown Attorney, legal counsel, mental health
participate in our program and have approval from
agencies, social services and other community
the Crown Attorney. Court diversion services are
agencies to provide linkages for treatment and
available out of both Lindsay and Minden courts.
support where required, in order to minimize the
possibility of further involvement in court and ensure
• Court Support: This program allows staff to provide
appropriate mental health supports and follow-up as
advocacy, support and case management for clients
needed. Participants may qualify if they have been
not accepted for diversion in the criminal justice
diagnosed with or are suspected to have a mental
system, by working collaboratively with them and
health concern, are 16 years of age or older, have
their community partners. Court support services are
been charged with an offense, agree to voluntarily
available out of both Lindsay and Minden courts.
participate in our program and have approval from
• Justice Services- provides Intensive Case
the Crown Attorney.
Management support services to people with mental
• Court Support: This program allows staff to provide
illness who are also in conflict with the law for up to 1
advocacy, support and case management for clients
year. The program provides appropriate linkages with
not accepted for diversion in the criminal justice
other mental health services as well as criminal
system, by working collaboratively with them and
justice, corrections, and social services, in order to
their community partners.
improve service coordination and support.
Assistance is provided with access and maintenance
Forensic Case Management
of psychiatric services, systemic advocacy and
• Intensive Case Management: Provides support
coordination, and supporting people to manage
services to people with mental illness who are also in
crises.
conflict with the law for up to 1 year. The program
• CMHA-KL manages a bail support program providing
provides appropriate linkages with other mental
monitoring, information and referral services to
health services as well as criminal justice,
individuals with a mental illness who are involved in
corrections, and social services, in order to improve
the court and are released on bail to provide them
service coordination and support. Assistance is
with the necessary supports and linkage to needed
provided with access and maintenance of psychiatric
services.
services, systemic advocacy and coordination, and
supporting people to manage crises.
Release from Custody (FTE and operating costs are
captured in Case Management function)
• The Release from Custody program assists
46
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
Court
Programs
Cont’d
CMHA-P
individuals with mental illness in the transition from
incarceration to their home community in the
province of Ontario. This service is offered primarily
in partnership with Central East Correctional Centre.
Direct services include, but are not limited to:
psychosocial assessment, treatment planning,
linkage and referral, outreach, advocacy, community
education, program development, training, and
consultation. Short Term Intensive Case
Management services are provided to clients
released from custody who are living in Kawartha
Lakes, Haliburton, Northumberland, and
Peterborough. CMHA‐KL acts as the paymaster for
Release from Custody services in Durham Region.
Strengths:
• Development of a Mental Health Court.
• Developed a bail support program, partner with
CMHA-P to monitor bail clients living in
Peterborough.
• Participation in HKPR Justice Network.
• Good relationship with Crown Attorney, court
services and CECC.
• Chair local Human Services and Justice Committee
(HSJCC).
• Shared psychiatric resources.
Strengths:
• Development of a Community Support Court.
• Partner with CMHA-KL bail support program.
• Participation in HKPR Justice Network.
• Good relationship with Crown Attorney, court
services.
• Chair local Human Services and Justice Committee
(HSJCC).
• Shared psychiatric resources.
Weaknesses:
• Large geographic area.
• Only one Case Manager for Release from Custody
service in Durham; high volume of clients referred.
Weaknesses:
• Large geographic area.
47
Front-Line Direct Client Services Analysis Work Team Business Case
Function Provider
or Service CMHA-KL
CMHA-P
OTHER Function or Services to Consider
Sessional Brief Description:
Sessional Fees - $50,000 (MOHLTC)
Fees
Sessional fees allow for access to psychiatrists and family
doctors for non-client related services (e.g., staff and client
consultations, education, case conferences, etc...).
Brief Description:
Sessional Fees - $50,000 (MOHLTC)
Sessional fees allow for access to psychiatrists and family
doctors for non-client related services, for example, staff and
client consultations, education, case conferences, etc...
Strengths:
Strengths:
• There is access to sessional fees.
• There is access to sessional fees.
• Cooperation with other agencies to pool resources
• Cooperation with other agencies to pool resources
and utilize local services.
and utilize local services.
Weaknesses:
Weaknesses:
• Sessional fees do not cover direct services, travel, or
• Sessional fees do not cover direct services, travel, or
reporting.
reporting.
48
Front-Line Direct Client Services Analysis Work Team Business Case
Appendix C: Front­Line Direct Client Service Stakeholder Analysis Function or Service
Stakeholders
Identify the stakeholders impacted by
the function/service. List individuals,
groups or organizations.
Management Strategies
How will stakeholder expectations be
managed, and how will their needs be met?
What factors might impact on meeting
stakeholder needs?
Clients
Clients require case management services that
are accessible, timely, and appropriate to their
needs
Open communication and providing reassurance
to clients that their case management services
will not be negatively impacted
Clients’ families, caregivers, and informal
support network
Clients’ families, caregivers, and informal support
network are encouraged to participate in a client’s
care plan
Open communication and providing reassurance
to clients’ families, caregivers, and informal
support network that services will not be
negatively impacted
Members of the public
Members of the public can participate in psychoeducational programming at CMHA-KL
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Community Partners that provide health
and human services and banks (Trustee
Program)
Community partners that provide health and
human services require timely response to
referrals and active and collaborative case
coordination. Banks support Trustee clients.
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Hospitals
Hospitals require timely response to
referrals/discharges and active and collaborative
case coordination
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Funders (e.g., MOHLTC, MCSS, United
Way)
Funders financially support programming
Demonstrating continued accountability, value
for money, and focus on client services
Staff
Staff deliver case management services
Open communication, providing reassurance to
staff that case management services will not be
negatively impacted , and including staff in the
process as much as possible and appropriate
Board of Directors
Board of Directors are responsible for ensuring
high quality case management services and that
they meet the needs of the community
Continue to provide high quality uninterrupted
case management services tailored to the needs
of the community
Clients
Clients expect and require safe, clean,
comfortable and affordable housing
Open communication and continuing to provide
housing services with clear direction regarding
access to services in the client’s community of
choice
Case Management
Housing
Interests & Needs
How are the stakeholders involved with the
function/service? Why will they be interested
in this integration or how might they be
affected by the integration?
49
Front-Line Direct Client Services Analysis Work Team Business Case
Function or Service
Housing Supports
Stakeholders
Identify the stakeholders impacted by
the function/service. List individuals,
groups or organizations.
Interests & Needs
How are the stakeholders involved with the
function/service? Why will they be interested
in this integration or how might they be
affected by the integration?
Management Strategies
How will stakeholder expectations be
managed, and how will their needs be met?
What factors might impact on meeting
stakeholder needs?
Clients’ families, caregivers, and informal
support network
Clients’ families, caregivers, and informal support
network expect and require safe, clean,
comfortable, and affordable housing for their
loved one
Open communication and continuing to provide
housing services with clear direction regarding
access to services in the client’s community of
choice
Members of the public, neighbours, and
neighbouring tenants
Members of the public, neighbours, and
neighbouring tenants have an interest in
maintaining property standards and safety
Open communication and providing reassurance
to members of the public, neighbours, and
neighbouring tenants that housing standards will
be maintained
Community Partners that provide housing,
health and human services
Community partners that provide housing, health,
and human services expect that housing is
available for eligible candidates; may be involved
through partnerships in seeking funding for
housing; City of Kawartha Lakes and City of
Peterborough are involved with providing funding
for housing and in the selection process for
clients receiving services/supplements
Maintain current partnerships by continuing to
provide uninterrupted services
Staff
Staff are involved in property management (e.g.,
inspections, leases, maintenance) and tenant
selection
Open communication, providing reassurance to
staff that housing services will not be negatively
impacted, and including staff in the process as
much as possible and appropriate
Board of Directors
Board of Directors are responsible for ensuring
high quality housing stock that meets the needs
of the clients
Open communication and assurance that
housing standards will be maintained
Independent Contractors
Independent Contractors may be involved in
property maintenance
Discuss potential changes and arrangements,
work with contractors during transition, and
provide assurances that commitments will be
honoured
Funders
Funders financially support housing
Demonstrate continued accountability and value
for money
Clients
Clients expect housing supports that are
accessible, timely, and appropriate to their needs
Open communication and providing reassurance
to clients that their housing supports will not be
negatively impacted
50
Front-Line Direct Client Services Analysis Work Team Business Case
Function or Service
Health
Promotion/Education
Interests & Needs
How are the stakeholders involved with the
function/service? Why will they be interested
in this integration or how might they be
affected by the integration?
Management Strategies
How will stakeholder expectations be
managed, and how will their needs be met?
What factors might impact on meeting
stakeholder needs?
Clients’ families, caregivers, and informal
support network
Clients’ families, caregivers, and informal support
network expect housing supports that are
accessible, timely, and appropriate to the clients’
needs
Open communication and providing reassurance
to clients’ families, caregivers, and informal
support network that housing supports will not be
negatively impacted
Members of the public, neighbours, and
neighbouring tenants
Members of the public, neighbours, and
neighbouring tenants have an interest in ensuring
that clients are supported to remain stable and
maintain their housing
Open communication and continuing to provide
uninterrupted services
Landlords
Landlords have an interest in ensuring that clients
are supported to remain stable and maintain their
housing
Notification of any changes affecting service
delivery and provide assurances that all
commitments will be honoured
Community Partners that provide housing,
health and human services
Community partners that provide housing, health,
and human services expect that housing supports
assist clients to remain stable and maintain their
housing
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Staff
Staff provide housing support and case
management services
Open communication, providing reassurance to
staff that housing supports will not be negatively
impacted , and including staff in the process as
much as possible and appropriate
Board of Directors
Board of Directors are responsible for ensuring
high quality housing supports that meet the
needs of the community
Continue to provide high quality uninterrupted
housing support services tailored to the needs of
the community
Funders
Funders financially support programming
Demonstrate continued accountability, value for
money, and focus on client services
Clients
Clients require, expect, and need health
promotion, education, and information
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Clients’ families, caregivers, and informal
support network
Clients’ families, caregivers, and informal support
network require, expect, an need health
promotion, education, and information
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Members of the public
Members of the public require, expect, and need
health promotion, education, and information
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Stakeholders
Identify the stakeholders impacted by
the function/service. List individuals,
groups or organizations.
51
Front-Line Direct Client Services Analysis Work Team Business Case
Function or Service
Crisis Services
Stakeholders
Identify the stakeholders impacted by
the function/service. List individuals,
groups or organizations.
Interests & Needs
How are the stakeholders involved with the
function/service? Why will they be interested
in this integration or how might they be
affected by the integration?
Management Strategies
How will stakeholder expectations be
managed, and how will their needs be met?
What factors might impact on meeting
stakeholder needs?
All community collaterals (e.g., local
businesses, schools, First Nations
Reserves)
All community collaterals require, expect, and
need health promotion, education, and
information
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Staff
Staff deliver health promotion and education
activities
Open communication and providing reassurance
to staff that health promotion and education will
not be negatively impacted, and including staff in
the process as much as possible and appropriate
Board of Directors
Board of Directors have an interest in promoting
mental health in their communities
Continue to provide high quality health promotion
and education activities to enhance mental
health in their communities
Funders (e.g., United Way, MHPS,
fundraising)
Funders expect outcomes and that services are
offered only in defined geographic areas
Demonstrate continued accountability, value for
money, and focus on client services
Any community member in the Four
Counties
Anyone in the Four Counties expects and needs
access to 24/7 crisis service
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Police
Police expect access to 24/7 crisis service to
assist with managing mental health calls as well
as provision of training
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Hospital
Hospitals require timely response to
referrals/discharges and collaboration for
immediate client support
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Justice System (e.g., courts, correctional
centre, probation)
Justice System require a timely response to
referrals/discharges and collaboration for
immediate client support
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
All community collaterals (e.g., ACTT,
University/College, shelters, addiction
support) – see Appendix E
All community collaterals require a timely
response and collaboration for client support
(e.g., formal MOU)
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Staff
Staff deliver a continuum of crisis services
Open communication, providing reassurance to
staff that crisis services will not be negatively
impacted, and including staff in the process as
much as possible and appropriate
Board of Directors
Board of Directors have an interest in maintaining
high quality crisis services
Continue to provide high quality crisis services to
enhance mental health in their communities
52
Front-Line Direct Client Services Analysis Work Team Business Case
Function or Service
Stakeholders
Identify the stakeholders impacted by
the function/service. List individuals,
groups or organizations.
Management Strategies
How will stakeholder expectations be
managed, and how will their needs be met?
What factors might impact on meeting
stakeholder needs?
Funder
Funder financially supports crisis programming
Demonstrate continued accountability, value for
money, and focus on client services
Clients
Clients benefit from peer support and social
recreation
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Clients’ families, caregivers, and informal
support network
For client’s families, caregivers, and informal
support network, it is an adjunct to what is
currently provided to their loved one
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Community partners that provide health
and human services or provide support to
program
Added resources for clients of other community
agencies; other organizations offer space and
resources to programming
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Hospitals
Hospitals partner with peer support on in-patient
units
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Staff
Staff deliver peer support and social recreation
programming
Open communication, providing reassurance to
staff that peer supports and social recreation will
not be negatively impacted, and including staff in
the process as much as possible and appropriate
Board of Directors
Board of Directors have an interest in maintaining
high quality peer supports
Continue to provide high quality peer support
and social recreation programming to enhance
mental health in their communities
Funders
Funders partially support peer support and social
recreation programming
Demonstrate continued accountability, value for
money, and focus on client services
Clients
Clients benefit from family caregiver network
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Clients’ families, caregivers and informal
support network
Clients’ families, caregivers and informal support
network benefit from support offered by family
caregiver network
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Hospital
Hospital refers and provides space to program
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Peer Support (CSI)
Family Caregiver
Network
Interests & Needs
How are the stakeholders involved with the
function/service? Why will they be interested
in this integration or how might they be
affected by the integration?
53
Front-Line Direct Client Services Analysis Work Team Business Case
Function or Service
Early Psychosis
Intervention
Stakeholders
Identify the stakeholders impacted by
the function/service. List individuals,
groups or organizations.
Interests & Needs
How are the stakeholders involved with the
function/service? Why will they be interested
in this integration or how might they be
affected by the integration?
Management Strategies
How will stakeholder expectations be
managed, and how will their needs be met?
What factors might impact on meeting
stakeholder needs?
Staff
Staff deliver programming
Open communication, providing reassurance to
staff that family services will not be negatively
impacted, and including staff in the process as
much as possible and appropriate
Board of Directors
Board of Directors has an interest in providing
high quality family services
Continue to provide high quality programming to
enhance mental health in their communities
Funders
Funders financially support family program
Demonstrate continued accountability, value for
money, and focus on client services
Clients
Clients require EPI services that are accessible,
timely, and appropriate to their needs
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Clients’ families, caregivers and informal
support network
Clients’ families, caregivers and informal support
network are an essential part of the EPI program
and are also clients receiving services specific to
their needs
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Hospital partners
Hospital partners are part of the EPI structure,
providing services and supports to clients
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Community partners (see Appendix E)
Community partners are educated through an
EPI function to enable them to refer for consult
and assessment
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Staff (including Joint Management
Committee)
Staff deliver EPI services and oversee
management of the program
Open communication, providing reassurance to
staff that EPI services will not be negatively
impacted, and including staff in the process as
much as possible and appropriate
Board of Directors
Board of Directors has an interest in ensuring
high quality EPI services
Continue to provide high quality programming to
enhance mental health in their communities
Funders
Funders financially support programming
Demonstrate continued accountability, value for
money, and focus on client services
Clients
Clients require and need access to court
support/diversion, and release from custody
services
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Clients’ families, caregivers, and informal
Clients’ families, caregivers, and informal support
Open communication and continuing to provide
Court Programs
54
Front-Line Direct Client Services Analysis Work Team Business Case
Function or Service
Stakeholders
Identify the stakeholders impacted by
the function/service. List individuals,
groups or organizations.
Interests & Needs
How are the stakeholders involved with the
function/service? Why will they be interested
in this integration or how might they be
affected by the integration?
Management Strategies
How will stakeholder expectations be
managed, and how will their needs be met?
What factors might impact on meeting
stakeholder needs?
support network
network require and need access to court
support/diversion and release from custody
services for their loved ones
uninterrupted services with clear direction
regarding access to services
Justice System (e.g., Judges, Lawyers,
Police, Court Administrators, Probation,
Corrections)
The Justice System expect, need, and require
court support/diversion and release from custody
services
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Community partners
Community partners expect services to be
available to support mutual clients
Open communication and continuing to provide
uninterrupted services with clear direction
regarding access to services
Staff
Staff deliver court support/diversion and release
from custody services
Open communication, providing reassurance to
staff that court programs will not be negatively
impacted, and including staff in the process as
much as possible and appropriate
Board of Directors
Board of Directors has an interest in ensuring
high quality court programs.
Continue to provide high quality programming to
enhance mental health in their communities
Funders
Funders financially support programming
Demonstrate continued accountability, value for
money, and focus on client services
55
Front-Line Direct Client Services Analysis Work Team Business Case
Appendix D: Front­Line Direct Client Integration Opportunities Case Management
9 9
9
Risks
Cease
Status Quo
- no disruption of service
- local autonomy remains
9
Cons
Status Quo
- no reinvestment of dollars
Status Quo
- not being well positioned for
further enhancements to case
management services
Coordinate
Coordinate
- regular coordinated
- travel between locations (time,
meetings between program expense)
managers of both
organizations to identify best
practices and problem-solve
service gaps
- share training, education,
and resources to be cost
effective and enhance case
management services (e.g.,
IAR)
Coordinate
- uncertain if benefit outweighs
the cost (time)
Partner
Partner
- opportunity for
- time intensive
standardization to meet best - expected transitional costs
practices and accreditation
standards
- opportunity for filling service
gaps
- joint decision-making and
collaboration in service
planning and delivery
Partner
- potential of losing local
autonomy with standardization
of policies, procedures, and
processes
56
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Please align checkmarks with corresponding integration fit
Risks
Amalgamate
- expected transitional costs
(approx. $200,000 for wage
equality across all program
personnel)
- increased complexity in
decision-making
- variances in job descriptions
that would need to be
standardized ($30,000 to hire HR
consultant)
Amalgamate
- eligibility criteria for case
management vary between
the two CMHAs – eligibility
would need to be standardized
which will impact service
delivery – either more
individuals eligible for service,
thus creating a waitlist or a
more restrictive eligibility
criteria, thus decreasing
access to service
-perceived negative impact on
service delivery by local
partners (e.g. hospitals)
- considerable disruption to
current staff composition (e.g.
CMHA-P has case managers
and housing support workers
and CMHA-KL has all case
managers) - will negatively
impact client service
- potential loss of community
resources
Cease
Cons
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
- opportunities for
consistency in staff training
9
Housing
* should also be
considered by backoffice
9 9
Amalgamate
- opportunity for filling service
gaps
- consistent staff training
- perceived to be a stronger
platform in which to enhance
case management services
across the North East Cluster
- opportunity for
standardization to meet best
practices and accreditation
standards
Status quo
Status quo
- remain localized within each - no reinvestment of dollars
community and continue to
strengthen existing local
relationships
9
$200K
per
annum
$30K
Status quo
- not being well positioned for
further expansion to housing
Amalgamate
Amalgamate
Amalgamate
- better positioned for further - expected transitional costs to
- loss of established
expansion to housing
transfer assets to new entity (e.g., relationships with local
Legal
fees
57
Housing Supports
9 9
9
Risks
legal fees)
- upsetting local community
partners
- loss of credibility and
accountability to local community
(e.g., fundraising may be
negatively impacted)
- philosophical differences in
property ownership that would
need to be standardized
community partners (e.g . City
of Kawartha Lakes, Housing
Corporations)
- loss of local voice in
decision-making and advocacy
- complexity in decisionmaking (e.g. risk from small
community perspective that in
the event that more housing
dollars are awarded, the funds
may go to the larger
community)
- potential loss of investment
in local community (e.g.,
property management) or
process delays in attaining
maintenance services
- change in philosophy may
have a negative impact on
client (e.g., landlord and client
disputes)
Status quo
- Remain localized within
each community, and
continue to strengthen
existing local relationships
Status quo
- no reinvestment of dollars
Status quo
- not being well positioned for
further enhancement to
housing supports
Coordinate
- regular coordinated
meetings between program
managers of both
organizations to discuss
current processes
- share training, education,
and resources to be cost
Coordinate
- travel between locations (time
and expense)
Coordinate
- uncertain if benefit outweighs
the cost (time)
Cease
Cons
58
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
Risks
Cease
Cons
effective and enhance
housing support/case
management services
9
9
Partner
- regular coordinated
meetings between program
managers of both
organizations to discuss
current processes
- develop a formal MOU for
sharing of housing support
staff
- share training, education,
and resources to be cost
effective and enhance
housing support/case
management services
Partner
- time intensive (e.g., creating
structure and policies)
- expected transitional costs
- ongoing operational costs (e.g.,
staff, travel)
Partner
-not enough volume for
CMHA-P model in City of
Kawartha Lakes
- disruption to clients (e.g.,
changing workers, delay in
response to client need)
- confusion of roles (housing
support worker/case manager)
to clients
Amalgamate
- consistent staff training
- perceived to be a stronger
platform in which to enhance
housing support/case
management services across
the North East Cluster
- opportunity for
standardization to meet best
practices (e.g., psychosocial
rehabilitation) and
accreditation standards (e.g,
client safety standards)
Amalgamate
- expected transitional costs
(approx. $200,000 for wage
equality across all program
personnel – see Case
Management above)
- increased complexity in
decision-making and housingrelated processes
- variances in job descriptions
that would need to be
standardized ($30,000 to hire HR
consultant – see Case
Management above)
- adjust all housing-related
documentation (e.g. referral
agreements, leases) to reflect
Amalgamate
- risk of standardization may
jeopardize client services
because of philosophical
differences/current practices
which are reflective of local
housing resources (e.g., City
waitlists) and client needs
- considerable disruption to
current staff composition (e.g.
CMHA-P has case managers
and housing support workers
and CMHA-KL has all case
managers) - will negatively
impact client service
-perceived negative impact on
service delivery by local
59
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
Health
Promotion/Education
9 9 9
9
Risks
Cease
Cons
new entity
partners (e.g. landlords,
Housing Corporations,
Municipalities)
- perceived loss of local
responsiveness to landlord
issues
Coordinate
- opportunity to use
reinvestment dollars in this
area for both CMHAs
- regular structured
communication to identify
gaps and opportunities for
health promotion (e.g. early
identification, prevention
strategies, stigma)
- share training, education,
and resources
Coordinate
- no MOHLTC funding currently
being allocated to CMHAs to do
health promotion/education
- challenges in providing equitable
health promotion across North
East Cluster
Coordinate
- the more outreach, the more
expectation and need for
service from community
Partner
- opportunity to use
reinvestment dollars in this
area for both CMHAs
- regular structured
communication to identify
gaps and opportunities for
health promotion (e.g. early
identification, prevention
strategies, stigma)
- share training, education,
and resources
- joint participation in funding
opportunities
- more opportunity for
revenue generation
- collaboration in delivering
Partner
- no MOHLTC funding currently
being allocated to CMHAs to do
health promotion/education
- challenges in providing equitable
health promotion across North
East Cluster
Partner
- the more outreach, the more
expectation and need for
service from community
60
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
Risks
Amalgamate
- perceived to be a stronger
platform in which to receive
health promotion funding
-enhanced access to inhouse trainers (e.g., NonViolent Crisis Intervention,
CPR/First Aid)
- more opportunity for
revenue generation
Amalgamate
- no MOHLTC funding currently
being allocated to CMHAs to do
health promotion/education
- challenges in providing equitable
health promotion across North
East Cluster
Amalgamate
- the more outreach, the more
expectation and need for
service from community
Status Quo
- currently an integrated Four
County Program –
coordination and partnership
is an ongoing component of
status quo
Status Quo
- no reinvestment of dollars
- gaps in service remain
- fitting service to community
- large geographic area prevents
timely response and service
delivery
Status Quo
- gaps in service remain (not
able to meet all community
needs)
Cease
Cons
training opportunities (e.g.,
ASIST) via formal MOU
9
Crisis Services
9
9
Amalgamation
Amalgamation
- enhancement of service
- N/A
delivery
- enhancement of
communication between staff
and programs (e.g., shared
electronic client record)
- perceived to be a stronger
platform in which to receive
additional Crisis funding to
meet the needs of all four
counties
- leverage staff resources to
meet crisis response needs
Amalgamation
- N/A
61
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
Risks
Cease
Cons
in the community (this could
be accomplished in a
partnership)
Consumer Survivor
Initiatives (CSI) Peer
Supports
9
9
Status Quo
Status Quo
- coordination of Social
- no MOHLTC funding for peer
Recreation activities (e.g.,
support or social recreation for
creation of calendars,
CMHA-KL
planning and running
activities together, sharing of
space)
Status Quo
- erosion of services due to
lack of funding for Social
Recreation at CMHA-KL
Partner
- develop a formal MOU
outlining roles and
responsibilities to extend
peer support services to
CMHA-KL clients
- clients would benefit from
having additional supports
(e.g., have case manager
and peer support worker)
- collaborative approach to
client care
- enhancement of
communication between staff
and programs (e.g., shared
electronic client record)
- opportunities for combining
resources (e.g., finances,
staff) for Social Recreation to
achieve better value for
money
Partner
- loss of current local
resources (e.g., donations)
- loss of reciprocal
relationships (e.g., space for
training)
- loss of reward for staff (e.g.,
community development,
participation in activities)
- loss of clinical component to
client care (e.g., seeing client
individually and in group
setting)
- from client’s perspective, loss
of therapeutic relationships
with case managers being less
involved in Social Recreation
Partner
- stretching limited resources
across a larger geographic area
and larger client base
62
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
9
Family Caregiver
Network
9
9
Risks
Cease
Cons
Amalgamate
- reallocation of resources
(peer support could be
distributed across COKL and
Peterborough), leading to an
enhancement of client
services
- opportunity for management
of resources at the local level
- seamless continuum of
support for clients
- equitable allocation of
resources for peer support
and Social Recreation across
North East Cluster
- enhancement of
communication between staff
and programs (e.g., shared
electronic client record)
- perceived to be a stronger
platform in which to receive
additional Peer Support (CSI)
funding to meet the needs of
all four counties
Amalgamate
- stretching limited resources
across a larger geographic area
and larger client base
Amalgamate
- loss of current local
resources (e.g., donations)
- loss of reciprocal
relationships (e.g., space for
training)
- loss of reward for staff (e.g.,
community development,
participation in activities)
- loss of clinical component to
client care (e.g., seeing client
individually and in group
setting)
- from client’s perspective, loss
of therapeutic relationships
with case managers being less
involved in Social Recreation
Status Quo
- no disruption of service
- local autonomy remains
Status Quo
- CMHA-P does not receive
funding to provide this service
Status Quo
- Unmet needs in
Peterborough community
remain
Coordinate
- regular coordinated
meetings between program
managers of both
organizations to discuss
current processes
Coordinate
- CMHA-P does not receive
funding to provide this service
Coordinate
- Unmet needs in
Peterborough community
remain
63
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
Risks
Cease
Cons
- share training, education,
and resources
9
9
Early Psychosis
Intervention
9 9
Partner
- regular coordinated
meetings between program
managers of both
organizations to discuss
current processes
- develop a formal MOU for
sharing of services
- share training, education,
and resources
Partner
Partner
- time intensive (e.g., creating
- current resources may not be
structure and policies)
sufficient to meet need
- expected transitional costs
- ongoing operational costs (e.g.,
staff, travel)
Amalgamation
-reallocation of resources
(Family Caregiver Network
could be distributed across
COKL and Peterborough),
leading to an enhancement of
client services
- perceived to be a stronger
platform in which to receive
equitable distribution of
funding
Amalgamation
-erosion of service (not enough
funds to offer service in larger
geographic area)
Amalgamation
- current resources may not be
sufficient to meet need
Status quo
- currently an integrated Four
County Program –
coordination and partnership
is an ongoing component of
status quo
- joint management
committee (shared decision
making)
- fitting service to community
Status Quo
- no reinvestment of dollars
- different service providers
implement different processes
and standards for service
provision
- there are differing
program/agency policy and
procedures and differing
program/agency reporting
Status Quo
- N/A
64
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
Court Programs
9 9
Risks
Cease
- recognized as “leading
practice”
9
Cons
- administration versus clinical
supervision creates complexity
Amalgamation
Amalgamation
- enhancement of
- N/A
communication between staff
and programs (e.g., shared
electronic client record)
- perceived to be a stronger
platform in which to receive
additional EPI funding to
meet the needs of all four
counties
Amalgamation
-N/A
Status quo
Status Quo
- this is a well integrated
- no reinvestment of dollars
program - coordination and
partnership is an ongoing
component of status quo
(e.g., partner with bail
support program, HKPR
Justice network, shared
communication between local
HSJCCs, shared psychiatry,
Regional HSJCC conference
planning, shared education
resources, CMHA-P sharing
office space for Release from
Custody program)
- maintain existing
relationships with Justice
System (Judiciary, Crown,
Lawyers, Police Corrections,
CECC)
- different service providers
Status Quo
- N/A
65
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
Risks
Cease
Cons
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
implement different
processes and standards for
service provision - a
necessary element when
working with another system
(i.e., Justice)
9
Sessional Fees.
9 9
9
Amalgamate
- N/A
Amalgamate
- standardization (e.g., policies,
processes, job descriptions)
would be an impediment to
meeting the needs of the Justice
system in each local community
- no reinvestment of dollars
Amalgamate
- deterioration of relationships
with Justice System (judiciary,
Crown, lawyers, police,
corrections, CECC)
Status Quo
- partnership is an ongoing
component of status quo pool sessional dollars for
improved access to
psychiatrists and family
doctors for non-client related
services (e.g., staff and client
consultations, education,
case conferences)
Status Quo
- complex reporting and
bookkeeping (e.g., retroactive
payments)
Status Quo
- N/A
Amalgamate
- time efficiencies (e.g., in
recruiting psychiatrist,
bookkeeping, reporting)
- potential to expand OTN to
CMHA- KL to ensure
equitable access to sessional
resources
- enhances community profile
Amalgamate
Amalgamate
- costly
- N/A
- OTN requires space for storage
- requires specialized training for
staff
$20K
(OTN in
KL)
66
Cease
Cons
Risks
for agency through open
access to OTN
67
Transition
Costs $000
Analysis
Pros
Start
Transfer,
Merge or
Amalgamate
Partner
Integration Fit (X)
Coordinate
CMHA-P
Function or Service
CMHA-KL
Provider
Reinvestment
Potential $000
Front-Line Direct Client Services Analysis Work Team Business Case
Front-Line Direct Client Services Analysis Work Team Business Case
Appendix E: Front­Line Direct Services Partial Stakeholder Table Organization
Peterborough Regional Health Centre
Peterborough
City of Kawartha
Lakes
Haliburton
Northumberland
X
Ross Memorial Hospital
X
Haliburton Highlands Hospital
X
Haliburton Highlands Mental Health Services
X
Northumberland Hills Hospital
X
Northumberland Hills Community Mental Health
X
Campbellford Hospital – Community Mental Health Program
X
Police / OPP
X
X
Children’s Aid Societies
X
X
Trent University
X
Sir Sandford Fleming College
X
CMHA-Peterborough
X
CMHA-Kawartha Lakes
X
X
X
X
X
KINARK (children’s mental health)
X
Crown Attorney / Courts / Justice system
X
Shelters: Brock Mission; Cameron House; Youth Emergency Shelter
X
Probation / Parole
X
YWCA
X
John Howard Society
X
Salvation Army
X
Elizabeth Fry Society
X
Our Space
X
Crisis Network
X
X
X
X
X
X
X
X
X
X
X
X
X
Central East LHIN
X
X
Community Living
X
X
Tri County Behavioural Support Services
X
X
X
X
68
Front-Line Direct Client Services Analysis Work Team Business Case
Alternatives
X
Family Home program
X
X
Kawartha Participation Project
X
X
Assertive Community Treatment Team
X
X
X
X
Fourcast
X
X
X
X
Telecare
X
X
Four County Crisis Services
X
X
X
X
Community Care Access Centre
X
X
X
X
Schizophrenia Society of Ontario
X
X
X
X
X
X
X
X
X
X
Family Health Teams
X
Kawartha Sexual Assault Centre
X
Abuse Prevention of Older Adult Network
X
Four County Acquired Brain Injury Network
X
Central East Correctional Centre
X
A Place Called Home
X
Women’s Resource
X
CHIMO
X
Boys and Girls Club
X
Adult Protective Services
X
Niijkiwendidaa Anishnaabekwewag Services Circle
X
Ontario Shores Outreach Program
Ontario Works
X
X
X
City of Kawartha Lakes
X
X
X
X
Clients of mental health services
X
X
X
X
Family members, general public
X
X
X
X
Others:
- Durham Mental Health Services
- Ontario Shores Centre for Mental Health
Reserves within Peterborough area:
- Alderville
- Hiawatha
- Curve Lake
69