On June 6, the Knowledge Institute (formerly known as the Ontario Centre of Excellence for Child and Youth Mental Health) opened its doors with a small staff and a big vision: “Daring to dream of an integrated system meeting the mental health needs of children, youth and their families.” Our vision has been refined over the years, and our approach has evolved, but our core purpose remains the same: better mental health and well-being for all infants, children, young people and families.

One of the first big projects we launched was an evaluation program to set the groundwork for a more effective and accessible system. Within our first 10 years of operations, we supported more than 160 agencies in close to 300 evaluation projects, building knowledge and capacity and supporting systemic change every step of the way. To this day, evaluation expertise and support is among the key services we provide the sector. In 2024 we released our revamped program evaluation toolkit, reflecting new best practices including how to incorporate an equity-based and collaborative approach.

Building on the successful launch of The New Mentality, a provincial network we helped establish, in 2007 we released a practical primer on meaningful youth engagement in child and youth mental health. We took it a step further in 2010, partnering with young people to bring evidence-based youth engagement training to agencies for the first time, and again in 2016 with our toolkit for engaging young people in mental health. A few years later, we set the bar for the entire sector with our co-developed provincial quality standard for youth engagement, the implementation of which we continue to support through coaching and an engagement community of practice. Then, as Youth Wellness Hubs began to be established throughout Ontario, we partnered to support meaningful engagement at local hub sites and at the provincial level. Engagement support remains one of the primary services we offer our provincial partners, and we now have opportunities to have an influence beyond Ontario: In 2023 we received a CIHR catalyst grant as one of 25 research projects to inform the development of national standards for mental health and substance use health services.

Our first policy paper was released just in time to inform the development of Ontario’s poverty reduction strategy. Since then, we have produced nearly two dozen policy papers specifically tailored to support evidence-based decision-making at the agency, community and provincial levels. This includes a 2011 paper about transitioning young people from child and youth mental health services to adult services, a 2017 paper focused on strengthening French language service delivery and 2023’s Stemming the tide: Investing early in the mental health of Ontario’s 7- to 12-year-olds.

Our measures database is a free online directory that profiles a growing number of measurement tools related to child and youth mental health and addictions and program evaluation. It was designed to help agencies and service providers generate and use evidence to strengthen care. Within the first 10 years, the measures were accessed over 150,000 times by more than 25,000 unique visitors from across Ontario — and well beyond!

As the sector evolved, we began offering innovative implementation supports to agencies. Services included funding, consultation, toolkits and learning modules. Many of these services became integrated into the very fabric of who we are and what we do at the Knowledge Institute. So much so in fact that in 2024, we became implementation partners in groundbreaking cross-sectoral collaborations. This was a catalyst for some restructuring and the creation of new roles to establish a dedicated implementation and evaluation team.

We saw the gap between agency operations and the real-life experience of Ontario families and knew that we could do something. Building on the success of our youth engagement training and in partnership with families we developed and delivered Bringing Family Engagement into Action to help agencies tap into the transformative power of family engagement. Later, we worked with Parents for Children’s Mental Health to develop a family engagement road map and resource guide. But we did not stop there — in 2019 we laid the foundation for consistent, measurable family engagement across Ontario with the establishment of a provincial quality standard for family engagement, which we continue to support agencies in implementing.

With a growing body of evidence demonstrating the impact of early childhood on lifelong mental health and well-being and growing political will to develop relevant policy, in 2014 we published a policy paper, outlining six recommendations to invest in the mental health of children under the age of six and set the foundation for long-term system change. In 2019 we published a second policy paper, deepening our focus on the mental health and social-emotional development of children between three and six years old. We then embarked on a pilot project with our partners at Infant and Early Mental Health Promotion (IEMHP) to put two of the paper’s recommendations into action in three Ontario communities. In 2023 we released a guide for developing community care pathways to support timely access to infant and early mental health services, rooted in lessons learned from the pilot and the latest evidence.

While we’ve always been mindful of the many inequities and disparities that make it more challenging for some to access quality mental health and addictions care and endeavored to apply appropriate equity lenses to our work, our commitment to equity, diversity and inclusion took on a new dimension in 2015 with the release of our policy paper about responding to the mental health needs of newcomers to Canada. This commitment deepened in 2021 as we collaborated with Children’s Mental Health Ontario (CMHO) to lay the groundwork for our sector’s collective next steps to advance racial equity. We surveyed our sector and produced “We journey together”, a report that identified existing gaps and promising practices, tools and resources that can be leveraged to foster equity. After a series of relevant resources, in 2023 were leased A guide to culturally adapting mental health and addictions programs and supported five projects to do just that through the fifth round of our Innovation Initiatives.

After years of operating with separate governance and advisory committees, we opted to launch a new streamlined strategic advisory council. Combining the responsibilities of a traditional board of directors — reviewing finances and performance metrics — with hands-on strategic work, our new council was designed to push us in new and innovative directions. The council is made up of young people and family members with lived expertise, organizational leaders representing lead and core service agencies and individuals with expertise in finance and management. 

We created our Innovation Initiatives grants to help agencies and services providers across Ontario test new ideas to address system priorities. Through five cycles, we have supported 33 projects with up to $75,000 each to implement new, evidence-based or promising practices that demonstrate potential for broader impact in the provincial child and youth mental health and addictions system. Along with the funding, we provide 12 to 18 months of tailored coaching support to implement and evaluate each initiative. Since 2020 we’ve also partnered with Mental Health Research Canada for studentships, fellowships and impact grants, to bridge the gap between research and practice by creating opportunities for community-based child and youth mental health and agencies and academic researchers to work together to improve child and youth mental health and addictions services in Ontario. 

When agencies told us they needed better support to deal with specific and complex issues, we listened. From 2016 to 2017, we responded by re-organizing our staff and leadership structure to create a dedicated team with expertise in quality improvement (QI), performance measurement and system planning. In 2020, we launched Quest, a cohort-based continuous quality improvement program for child and youth mental health and addictions agencies, using Lean Six Sigma methodology. Since 2022 we’ve also partnered with E-QIP and Ontario Health on an annual QI Innovations conference.

In 2018 we began to focus efforts on actioning key recommendations from our policy papers in collaboration with key partners. We began to pilot primary care pathways with two partner communities, intent on bridging the gap between primary care providers and community-based mental health care providers, as outlined in a 2017 policy paper. Over the following year, this grew into a demonstration project in half a dozen communities. The pandemic brought about many challenges, delays and changes –some for the better, like the move from a fax-based communication loop at the core of the pathway to an e-referral platform. Our work to strengthen integrated care pathways between primary care and community-based settings continues, including a collaboration with Ontario Public Health and ongoing efforts to share and mobilize the HEADS-ED screening tools.

We recognize that to be true leaders in youth engagement, we need to walk the talk. In 2015, we hired three part-time youth advisors to support us in building our capacity to enhance youth programs. Since then, we’ve always had one or more youth advisors on staff and added a family engagement specialist. In 2019, these became full-time positions. Additionally, while we had long included young people and family members with lived expertise in our governance bodies, we knew that we could better reflect our commitment to meaningful engagement. Our youth advisory council was also established in 2019, followed soon thereafter by our family advisory council. Made up of diverse individuals from across the province, the councils provide valuable perspectives and integral input, expertise and guidance to ensure our policies, approaches, initiatives and other work are responsive to the evolving needs of young people and families.

As agencies throughout the province shifted to deliver care using a range of technologies early in the COVID-19 pandemic, we initiated an evaluation project with Children’s Mental Health Ontario (CMHO) to understand what worked well and identify areas for improvement to help service providers continue to add or improve virtual mental health service options. Over the next two years, we produced dozens of evidence summaries, webinars and other resources to help our sector adapt to hybrid workspaces, transition to virtual care and get the information they needed on priority topics during the early pandemic recovery period, all while conducting primary research to understand the pandemic’s impact on young people and families. Notably, at the beginning of 2020, we assembled an advisory committee of experts to co-develop a quality guideline for virtual walk-in services in the child and youth mental health and addictions sector – a resource that would help inform the development of One Stop Talk.

After 17 years of operating as a centre of excellence, it was time for a change! In late 2021, we took on a new identity to better reflect our existing and evolving role in Ontario’s child and youth mental health and addictions sector. Our new name, the Knowledge Institute on Child and Youth Mental Health and Addictions, also spoke to our growing focus on understanding and addressing the intersections that underlie complex mental health needs, including the overlaps between mental health and substance use health and addictions. This wasn’t entirely novel for us – we’d produced a policy paper on precisely that topic back in 2014. In 2023, after many months of consultations with agency leaders, service providers, young people and families, we released a report capturing our sector’s priorities, strengths, challenges and needs related to substance use and addictions. The report informed our own next steps, including developing other resources, and is now helping to guide our sector’s shared path forward in this area. 

We have long known that schools are uniquely positioned to identify mental health needs and support early intervention because children and young people spend much of their time there – and this knowledge is reflected in resources we’ve produced stretching as far back as 2009, including a policy paper we published on school-based mental health for Ontario. It was the 2022 release of Right time, right care: Strengthening Ontario’s mental health and addictions system of care for children and young people, though, that really made an impact. The Ministry of Education used this resource as a foundation for Policy/Program Memorandum 169 (2024), which sets out expectations for school boards and community-based organizations to jointly develop plans and strategies to ensure that children and young people receive the right level of care in the right setting. Our team will continue to collaborate with our partners, including School Mental Health Ontario and the Ministry of Health to support the implementation of this important, evidence-based approach to care. This groundbreaking cross-sectoral work will impact many young Ontarians and pave the way for future collaborations with other ministries, including youth justice and child welfare.

Throughout the pandemic the number of children and young people with complex needs– significant, multiple, rare or persistent mental health challenges requiring more intensive services – grew and their needs became more acute. In addition to ongoing participating on the steering committee for the Lead Agency Consortium’s Provincial Training Initiative (which aims to expand the range of intensive treatment options available throughout Ontario), in 2022 we published Mental health treatment programs for young people in secure settings: What does the evidence show? It captures some of the evidence we’ve provided to the Ministry of Health as we continue to work with them and the three agencies providing secure treatment in Ontario to develop a framework for secure treatment in the province. After leading work to gain consensus on a harmonized intake process, we outlined the shared vision in a 2024 report to the Ministry.

It’s one thing to direct people toward appropriate and timely care. It’s another thing to be sure that when they do get through the door, they’re getting consistent, high-quality care, no matter where they are in Ontario. That’s a big part of why we’ve been investing in developing quality standards for the child and youth mental health and addictions sector since 2018. After establishing a standard development process, in 2023 we began work to bring together a team of sector experts, young people, and families to co-develop a new quality standard focused on levels of care. The goal is to ensure that all children and young people get the care that best matches their needs and goals. By aligning this with the right level of care, it’s possible to optimize the use of resources within the sector so that more children and young people receive necessary services in a timely manner. Public consultation on the new draft standard begins in fall 2024.

In addition to being our 20th anniversary year, 2024 is a significant year of change for the Knowledge Institute, including a new strategic plan, new leadership, an increase in funding and the expansion of our team by almost 20%. Our new strategic plan, informed by the insights of nearly 250 individuals, sets a clear course for the next 3 to 5 years. Some notable highlights in our new strategy include a focus on accelerating system change at the forefront and branching out further into equity, diversity, inclusion and anti-racism. Expanding work in those areas will help us remain attuned to the needs of families across sectors for years to come.