A journey towards community ownership and sustainable collaboration


TORONTO, November 22, 2016 - Children, youth and families living with mental illness and addictions often struggle to access appropriate services. Getting help early in life can help improve long-term outcomes and reduce the likelihood that mental illness and addictions will follow children and youth into adulthood.

With the help of CAMH’s Provincial System Support Program (PSSP), as a part of the Systems Improvement through Service Collaboratives initiative, the Durham Service Collaborative successfully implemented a collaborative care model to support young people up to age 21 and their families, leading to timely access to care. The 30+ member Collaborative includes stakeholders from mental health, health, developmental, justice, child welfare, education, and settlement sectors, as well as Aboriginal and Francophone services, family members and youth.

Since 2012, the Collaborative has worked towards better serving children and youth with multiple needs, who are already accessing services but whose needs are not being met. They developed a multi-component intervention that includes:

  • working with clients to develop a shared achievement plan
  • a Community of Practice (Network of Champions) and,
  • an Oversight Committee

Between November 2015 and June 2016, five youth and their families have been formally supported through the intervention while approximately 16 youth accessed additional support through the Network of Champions table.

“We struggled trying to find services all in one area; with the Collaborative everything was brought together,” said one parent participant. “To see that many resources available was amazing. The way this intervention helped us, I can see this being helpful for anyone in our situation.” 

This collaborative, multi-organization approach builds upon best practices in the field of mental health and addictions. It ensures that youth and their families’ voices are involved in service delivery from intake to planning; that approaches are holistic, culturally safe, and value a variety of supports; that there is shared governance in the Durham Region; and finally, that shared capacity building and education is developed, delivered and maintained by the community.

Without the right support, however, local contexts, resources and time constraints can make implementing this type of intervention challenging.

For the Durham Service Collaborative, a consideration from the start was the sheer size of the region, spanning from Lake Ontario up to Lake Simcoe and including Ajax, Pickering, Whitby, Oshawa, and the townships of Scugog, Brock and Uxbridge. Tying the region together and connecting service providers with each other was a clear need early on.

“We heard a lot of important feedback from the community,” said Jill Davidson, Co-Chair of the Durham Service Collaborative Framework’s Network of Champions and Clinical Supervisor for Frontenac Youth Services. “We heard concerns that the system is fragmented, that there was not a lot of communication within and across sectors, and that families were feeling like their voices weren’t contributing to treatment plans or supports being put in place, to name a few.”

Other important considerations were how First Nations, Inuit and Métis, and Francophone populations are being served in the region.

Using a variety of tools and evidence-based processes as part of PSSP’s implementation approach, the GTA Regional Implementation Team reviewed findings from community consultations and best practice evidence. They returned to the community with two intervention options.

“The response was quick and quite resounding,” said Jonathan Berges, GTA Regional Implementation Coach. “The community liked components of both, but they didn’t feel that any one model fit their needs. So as a team we took those lessons and continued our consultations to find out, if not those two interventions, what was needed to make the intervention successful and sustainable in the community?”

Back at the drawing board, the team identified system-specific elements that were needed for a successful intervention model. One unique approach was to leverage the robust system of non-traditional organizations in Durham, like the Boys and Girls Club. Non-traditional organizations in this case are services that aren’t necessarily resourced to provide mental health and addictions support, but through their activities often come across individuals with those needs.

“Including these organizations built on recognized community strengths and addressed the Collaborative’s desire to create individualized, strengths-based approaches to service,” said Berges. “That promoted a holistic view of mental health and addictions care.”

Key to the intervention is the specific collaborative planning process. Service providers work together to offer recommendations for services that might best fit the unique needs of the child or youth and their family. Through a collaborative process, the child or youth and their family will select how they’d like to move forward with a shared achievement plan.  A service coordinator then follows up with the selected agencies and the plan is put into action.