Quest cohort 3 consisted of seven teams beginning their Quest journey in January 2023. Teams finished the cohort activities in December 2023 (one project is still being finalized and will be added at a later date). Cohort 3 projects focused on themes related to improving access, brief services, and organizational systems. Read their projects' summaries below.
Children's Mental Health of Leeds and Greenville (CMHLG): Ensuring timely and effective care with limited staff |
What was the opportunity?CMHLG wanted to ensure they were effectively using their clinical time to meet the ever-growing needs of their community. They had experienced a recent increase in demand and clients were being impacted by longer wait times. A previously created target for direct services hours did not consider significant service coordination work and was not representative of the current landscape. The agency identified an opportunity to increase their understanding of not only what goes into direct service hours, but also all clinical hours, to become more efficient and better serve the needs of their clients. What was the goal?The team set out to create an accurate expectation for how clinicians spend their time (direct, indirect, other) and use the information to build efficiencies in how they serve their clients. What were the improvements?
What was the impact?Much of the work of the project implementation is still ongoing so the agency does not yet have data on improvements.
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FIREFLY: Episode of care |
What was the opportunity?FIREFLY observed that the majority of clients were experiencing lengthy wait times for counselling after receiving brief services. This led to inconsistencies in the client journey, which resulted in frequent changes in clinicians, clients retelling their stories multiple times, less therapeutic engagement, and client confusion. Clinicians also expressed frustration navigating the multiple pathways for themselves, as well as for clients and families. This issue was consistently reported by clients, families, clinicians, clinical managers, and community partners. What was the goal?The team set out to shorten the average wait time between brief services and counselling/therapy and to reduce the percentage of clients going on a waitlist. Additionally, they aimed to prioritize high-risk clients by appropriately rating severity at the initial assessment using a new screening tool. The goal was to increase overall client outcomes and satisfaction as well as shorten length of time in services. Over time, the team would like to eliminate any wait time between brief services and counselling/therapy for all clients. What were the improvements?
What was the impact?Much of the work of the project implementation is still in progress so the agency does not yet have complete data on the improvements. However, with the first set of improvements in the summer (primarily involving data clean-up), they observed a 20% decrease in their wait numbers. The team plans to replicate and spread their wins – particularly in communication and change management – across their agency. |
Hands TheFamilyHelpNetwork.ca: Enhancing data and evidence-informed system planning |
What was the opportunity?HANDs, the lead agency, in collaboration with Simcoe Muskoka Family Connexions (SMFC) and Community Counselling Centre of Nipissing (CCCNip), identified limitations in their data, the quality of their data infrastructure, standardized data processes, and human resource capacity. Insufficient data was evident in their client information system (EMHware) and other data sources. This resulted in increased effort and duplication when collating useful data for the core service table. Ultimately, these limitations restricted the depth and breadth of evidence available for the service agencies to make informed decisions on how to effectively meet the needs of their clients and communities. What was the goal?The objective of this project was to standardize key performance indicators (KPIs) across the three agencies. The team ultimately focused on 10 KPIs from the Business Intelligence (BI) solution, developing a process that can be applied to standardizing future indicators, including aspects such as data definitions, data entry/extraction practices, and more. They also aimed to have a standardized location to store their data. The goal is to replicate this process until all KPIs from the BI solution are standardized. This will enable all three agencies to build and extract reliable and accurate data to support evidence-based decision-making and planning for their service area. The project also focused on improving data literacy and competency of staff within the agency. What were the improvements?
What was the impact?Establishing a shared data space on SharePoint has streamlined access to local data, fostering collaborative efforts in decision-making. Simulation of extraction workflows and the data validation and analysis process were discovered through a pilot test of three indicators. Mock dashboards have been created and are being used as a communication tool to engage support from the leadership team. Hands, SMFC, and CCCNip anticipate achieving a standardized set of KPIs as they replicate this process in the future. They plan to continue effective communication between all partners to facilitate buy-in. Once they have collected enough data, they plan to set short- and long-term targets and benchmarks to help inform decisions and future QI initiatives. |
Keystone Child Youth & Family Services: Brief services quick response model review and redesign |
What was the opportunity?Since the onset of the COVID pandemic, Keystone was seeing an increase in referrals for service and in the complexity of cases, while also experiencing staffing shortages. Families were wanting to have ongoing counselling service at intake; however, the demand for ongoing counselling services was higher than the agency’s capacity, due to staff turnover. As well, Keystone’s intake process was not fully streamlined, causing their waitlist to grow, as there was no definition or structure for their brief services and counselling services. In addition, there was an increase in no-shows, cancellations, and rebooking of appointments for brief services. What was the goal?Keystone’s goal was to streamline and standardize the internal processes. They wanted to have clear definitions for walk-in, single session, and brief services that would be communicated amongst staff and partners, and with the community. They also wanted these definitions reflected in the client information system (EMHware) and on Keystone’s website. They aimed to meet ministry targets and client satisfaction for clinical services, and to decrease no-shows by having clearly defined and streamlined internal processes communicated across the organization. What were the improvements?
What was the impact?The pathway for brief and ongoing counselling services at Keystone incorporates clinical insights to guide the journey and implement measures to prevent bottlenecking of clients. The improvements include a standardized definition of brief service that did not exist before, enhancing clarity for clients and staff. This standardized definition incorporates changes in language, aligning Keystone brief service and CIS terminology with Ontario Ministry of Health terminology. The team made discoveries related to the validity of their data, prompting Keystone to advocate for changes within EMHware to improve monitoring of their services. A new process of regularly collecting and incorporating client feedback was also developed and implemented, fostering Keystone’s commitment to a continuous improvement mindset. |
Phoenix Centre: Questing towards strong recruitment and retention at the Phoenix Centre |
What was the opportunity?The Phoenix Centre recognized the need to improve the recruitment and retention of skilled and experienced family and child therapists. This challenge impacted their service delivery model, organizational reputation in the community, clinician well-being, and quality of services. Clients often expressed frustration regarding frequent changes of therapists and needing to "start over" when a transfer from an existing therapist to a new therapist occurred. What was the goal?The goal of this project was to improve both the recruitment process and retention practices to decrease the number of therapist vacant positions and decrease their therapist turnover rate. What were the improvements?
What was the impact?The Phoenix Centre has seen a significant reduction in the time it takes from posting a job opening to completing interviews with selected candidates. Changes to their supervision template and team meeting agenda have fostered an environment of open and transparent communication, particularly in the areas of self-care and mutual support. They continue to monitor changes, such as the availability of evening appointments and the expectations regarding how those appointments are scheduled. Implementing new employee incentives, as well as increasing emphasis on honest and transparent communication, have made positive changes in the overall agency culture. Staff have reported feeling supported and heard in relation to work-life balance. |
Woodview Mental Health and Autism Services: Improving access to services |
What was the opportunity?After implementing CAPA (Choice and Partnership Approach) at Woodview’s Brantford location, new challenges with intake began to emerge. Receiving referrals through multiple channels with an unclear internal process post-referral led to inconsistencies in the intake process. This resulted in confusion for families and service providers, inefficient use of time and resources, and internal staff inconsistencies. What was the goal?The goal of this project was to improve the efficiency of the intake process by increasing the number of staff who find the process easy to understand, communicating better with families and service providers, and decreasing the number of steps in the process. The changes would be measured by overall satisfaction from staff, families, and referral sources. What were the improvements?
What was the impact?Though most data on the improvement results is still forthcoming, the project has had some positive impacts so far. Staff members now have a better understanding of the intake process. Feedback from referral sources, such as pediatricians, has been positive, citing improved clarity of the intake process and a better understanding of what services are available. Complaints from families concerning duplicate intake appointments have also decreased significantly. |
Quest cohort 2 consisted of six teams who began their Quest journey in July 2021. Teams finished the cohort activities in September 2022. Their Quest projects focused on themes related to supported transitions, better service and quicker access. Discover their summaries below.
Boost Child & Youth Advocacy Centre (CYAC): Improving care pathways for child and youth victims of the Internet Child Exploitation (ICE) |
What was the opportunity?Boost CYAC identified that their client tracking and invoice process with service providers resulted in missed opportunities to engage clients with counselling and maximize allotted funding. Intake workers spent most of their time tracking down forms and invoices from service providers. These challenges stemmed from the process gaps in the Internet Child Exploitation (ICE) program, as well as the lack of a consistent process to document, report, and send invoices. What was the goal?The goal was to improve the service flow and invoicing processes to alleviate daily inefficiencies and better serve ICE clients by tracking their use of funding and engagement with service providers. The aim was to identify clients who ended their therapeutic relationships early before maximizing their allotted funding. What were the improvements?
What was the impact?It is hoped that the enhanced processes will ensure that better matches are made between clients and service providers, that client records are up-to-date, accurate, and appropriate, and that a follow-up with clients who end their counselling sessions early is completed. The enhanced tracking and follow-up mechanisms put in place will see a percentage increase in clients accessing therapeutic services in a timely way, engaging fully in the therapeutic process, and maximizing their allotted funds. At the time of project completion, the team was still implementing improvements. They saw some early gains in terms of better communication with service providers, including the onboarding of new service providers with the new forms that had been created. Improved communication with the accounting office was another early gain, with processes put in place to better track invoice payments within the agreed-upon timelines. Creating an automated client master list allowed for better data entry, tracking, and the elimination of multiple data sources, which in turn allowed the intake worker to spend less time reconciling clients’ records. |
Hands TheFamilyHelpNetwork.ca: Beyond Brief: Improving client service matching and pathways to mental health services |
What was the opportunity?Hands observed challenges in their client brief services, as they did not have a formalized tool to assess the specific mental health needs of their clients. This made it difficult to identify a consistent care pathway option. As a result, clients were placed on a long waitlist for generalized counselling services, with minimal oversight and limited interactions. This often led to a need for re-assessments and redefining treatment goals if clients’ circumstances changed during the waiting period for services. This subsequently impacted the overall quality of services. What was the goal?Their goal was to develop recommendations to implement needs-driven assessments and planning processes. To achieve this, Hands aimed to incorporate clear eligibility, exclusion, and priority criteria to define the pathways for waitlists categorized by specific interventions. They also aimed to focus on strategies for waitlist management and triaging recommendations that will help set priorities for the level of urgency to ensure timely services. To improve efficiency, they aimed to map current services with clear definitions to inform a stepped care model approach that sub-categorizes interventions. Through this project, they also planned to identify areas of need from EMHware/software to track workflow. What were the improvements?
What was the impact?The project focused on initiatives that will inform and complement other recommended projects. By identifying key indicators, the team made recommendations to leverage their data to guide subsequent steps in the improvement phase. They intend to mobilize the learnings from their improvement journey by adopting and incorporating the Quest methodologies and tools into future projects. This is part of a larger effort to develop a QI culture with the capacity to attain meaningful change beyond Quest. |
Maltby Centre: Improving concurrent mental health and addictions services in KFL&A |
What was the opportunity?Maltby Centre partnered with Kairos, a youth diversion program, to work on improving concurrent mental health and addictions services in the Kingston, Frontenac and Lennox & Addington (KFL&A) area. Young people with concurrent mental health and substance use and addictions needs lacked consistent access to concurrent and integrated mental health and substance use and addictions services. These services were provided in silos in KFL&A, with limited integration between various service providers in the community. The staff at Kairos reported an underlying mental health issue in many of the young people they are supporting. They noted that treating a substance use issue without addressing an underlying mental health need can negatively impact outcomes for young people. Mental health clinicians at the Maltby Centre were aware that their client population reporting a substance use issue did not reflect the percentage of the general population with such needs and surmised that this information was underreported. Additionally, not all Maltby Centre therapists felt they had the knowledge and capacity to deal with substance use and addictions needs with their clients. What was the goal?Their goal was to ensure that young people with both mental health needs and substance use concerns were identified and able to access concurrent and integrated services through the Maltby Centre and the Kairos Program at Youth Diversion in an efficient and effective way. What were the improvements?
What was the impact?At the time of project completion, the team was still implementing improvements and they continued to meet as a team to monitor and implement the key activities in a phased approach. Early feedback identified that these changes have led to improvements in the cross-collaboration between the two service providers, with important activities already carried out and concrete plans well underway. As of April 2024, Maltby Centre has fully implemented the GAIN-SS and has started to see an uptick in its use among clinicians. Maltby Centre has been able to track referral data and do data checks to confirm that those identified with substance use needs as per the GAIN-SS are being referred to the Kairos program. Maltby Centre has adjusted their training materials for staff as needed to make the implementation easier and hopes to continually see an increase in collaborative service offerings with Kairos. Maltby Centre and Youth Diversion are currently working with The Knowledge Institute on a research project related to this work to better understand the pathways for young people with mental health and substance use and addictions needs. |
Open Doors for Lanark Children and Youth: Integration across the lifespan |
What was the opportunity?The youth engagement group at Open Doors for Lanark Children and Youth identified challenges that deterred their successful transition between child and youth mental health and adult mental health services. Young people frequently disengage when transitioning from child to adult mental health services, making them more vulnerable to the emergence of chronic mental health and addictions issues. What was the goal?Open Doors aimed to identify and implement standardized processes and pathways for transitional-aged youth that reflect their unique needs and goals to successfully engage with adult mental health services. Their goal was to improve the rate of successful transitions between providers to support continued mental health support and service during this challenging life stage for young people. What were the improvements?
What was the impact?Following Quest, Open Doors began a standardization project in the agency which involved all clinical and organizational processes. The result of this work, aside from any relevant program and process updates within the agency, will be a manual of all the information about the agency processes, documents, and resources. This manual will help to onboard new staffand also serve as a reference point for current staff. Creating a more streamlined transition protocol related to the Quest project is a part of this standardization project. Due to changes in process from Lanark County Mental Health for a period of time, the transition protocol experienced a delay as this was outside of the team’s control and other processes were prioritized through the standardization project. However, creating and implementing processes and protocols related to transitional-aged youth remains a priority. |
Peterborough Youth Services (PYS): Improving access to mental health services and embedding a culture of continuous quality improvement at PYS |
What was the opportunity?Clients and families at PYS expressed concerns about lengthy wait times, which hindered their access to services. In addition, with significant changes within the agency, leaders recognized the need for adaptability and deemed it an appropriate time to reassess the agency’s internal infrastructure and cultivate a culture of quality improvement (QI). What was the goal?The long-term goal was to reduce wait times to align with the Ministry's definition on service wait lists. PYS hoped to move towards developing a performance measurement indicator based on the Ministry’s definition that will continue beyond their Quest project and become part of the balanced scorecard performance measurement process. In the short term, the agency recognized the need to focus on revitalizing their organizational infrastructure on quality. They wanted to work towards enhancing their QI culture across the agency to ensure they had the appropriate structures and capacity in place to make the meaningful improvements to their services in a sustainable way. What were the improvements?
What was the impact?As a result of the initial scoping work with the Knowledge Institute, several initiatives were launched. Due to identified improvements in the intake process, the agency developed a separate triage function that now precedes intake for its various services. The result has been greater confidence on the part of the staff and clients that children, young people, and families are being directed to the “right service at the right time.” A secondary consequence of the development of the PYS triage function has been a coordinated access and service process with their partner and Lead Agency, Kinark Child and Family Services, in which they are now able to easily identify and move clients to and from each agency without a secondary intake required. The PYS triage function is directly connected to Kinark’s local triage function so that the two agencies work together, when needed, to determine the “right service at the right time” for their referrals. Children, young people, and families do not have to know which service they need or agency to call, as either agency will ensure that they get the services they need. Drawing on the benefit of these initiatives, PYS has developed a new strategic plan that aligns with the principles and objectives of the new triage and coordinated access and service processes. Consequently, the performance measurement processes that will be developed to support the new strategic plan will become the basis of the work of the new Continuous Quality Improvement Committee which they hope to implement in 2024. |
ROCK: Reach Out Centre for Kids: Reducing client wait time to access counselling and therapy services |
What was the opportunity?On average, children and young people experienced an extended wait time to access counselling and therapy mental health services. This wait time was longer for high-risk children and young people. Recognizing that delayed treatment adversely affects the mental health outcomes for children and young people, ROCK sought to address their challenges with wait times. What was the goal?Their goal was to reduce the average wait time for young people assigned to counselling and therapy services. What were the improvements?
What was the impact?At the time of project completion, the QI team at ROCK continues to monitor wait times on an ongoing basis to assess if the changes implemented during this project continue to reduce wait times for accessing counselling and therapy services. |
In 2020, 10 teams joined our Quest program to work on QI projects around the theme of care pathways. Project topics include streamlining intake and triage processes and improving wait times. The teams completed their Quest journey in 2021.