At Home/Chez Soi Program: An Integrated KT Approach to Policy and System Change. Paula Goering RN PhD Research Lead CAMH and U of T May 15, 2014

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1 At Home/Chez Soi Program: An Integrated KT Approach to Policy and System Change Paula Goering RN PhD Research Lead CAMH and U of T May 15, 2014

2 Outline for today Describe our approach to Integrated Knowledge Translation Define Sustainability Review national level activities to achieve sustainability Consider the role of research evidence and the issue of timing / 2

3 Integrated Knowledge Translation Evidence of effectiveness alone is rarely enough to ensure adoption of interventions (Leff & Mulkern, 2002) Research involves exchange and linkage with decision-makers Requires allegiance to scientific and participatory principles Science requires orderly, phased process of scientific investigation Participation requires that the interests and values of various groups in public systems be reflected / 3

4 Goals of Knowledge Translation Support AH/CS sustainability efforts Contribute to scaling up of Housing First in Canada Advance policy and practice for people who are homeless and living with mental health issues Contribute to international awareness of research findings about implementation and outcomes of Housing First / 4

5 Key Strategies for Knowledge Translation Build Housing First literacy and competency in the field Ensure broad scale engagement in At Home Housing First implementation and findings Build national linkages to address homelessness and affordable housing issues / 5

6 What we did to increase engagement? Wide consultation on project definition Joint participation of local and national perspectives in planning and implementation Decision making at all levels informed by stakeholder perspectives Boundary spanner roles Advisory structures locally and nationally Government relations Media relations Commitment of resources (human and $) to support engagement / 6

7 Structure and Governance Mental Health Commission of Canada National Working Group National Consumer Panel Providers Researchers People with lived experience National and local teams National Research Team National Project Team Vancouver Local Advisory Committee Project Team Researchers Providers Winnipeg Local Advisory Committee Project Team Researchers Providers Aboriginal Cultural Lens Committee Toronto Local Advisory Committee Project Team Researchers Providers Persons with Lived Experience Caucus Montreal Local Advisory Committee Project Team Researchers Providers Moncton Local Advisory Committee Project Team Researchers Providers Communities of Practice / 7

8 Colour= how involved Core team Key Partner Partner Audience Not yet involved Stakeholder map Families for Mental Schizoph renia Resource Assistance for Youth Health Canada UGM addictions residence, meal drop ins Shelter CMHA, Mood disorders / 8 Native Addict Conc First Nations Health Centres Siloam Mission AMC southern Chiefs Organization MKO MMF First nation Government Mental health and addictions PACT Salvation Army Tribal councils Assembly of Manitoba Chiefs Manitoba keewatinowi Okimakaak Inc, Manitoba Metis Federation Winnipeg Regional Health Authority Downto wn Watch Patrol Elizabeth Fry Society JHS Aboriginal Council of Winnipeg Downtown Prosecutor U of M psychiatry Mount Carmel Clinic Winnipeg Soup kitchens & drop ins Our Place chex nous, Lighthouse Fire and Paramedic Community prosecutions Main Street Project Uof W IUS Aboriginal Health & Wellness Aboriginal Media Winnipeg Police Department of Justice Ma Mawi Downtown Winnipeg Business Improvem ent Zone United Way Sunshine House IPDA drunk tank Center for Aboriginal Human Resource Development Province of Manitoba family services and housing, health and health living Health Sciences Centre, ED U of M Medicine & Aboriginal research Inner city Research Alliance Detox and Main street drunk tank Uof M depart of Family Med NMU Addictions Foundation of Manitoba Winnipeg Public/Audience Canada research Chair, Urban Adaptation Andres Street Family centre Media, Winnipeg News, Gordon Sinclair Manitoba Center for Health Policy City of Winnipeg Community Services Province of Manitoba Health, Employment and Income assistance Community Aboriginal Groups

9 / 9 What have we done to communicate? Key event media coverage Media engagement in learning Community events to celebrate work Speakers Bureau Release of Early Findings with preliminary economic analysis Posting of reports on MHCC website and Homeless Hub Partnership with the NFB to create Here At Home interactive website Engagement of national allies Extensive government relations work in final years of the project

10 The Final Deliverable: Report and dissemination At Home/Chez Soi ended March 31, 2013 Final data cleaning and analysis Formulation of policy recommendations policy forum October 2013 Final report and media launch April 2014 Ongoing dissemination of findings through MHCC s Knowledge Exchange Center and ongoing publications and local KE activities / 10

11 Program Sustainability What happens to demonstration projects after their initial limited time funding ends. Continued benefits for individuals, continued activities for programs and continued capacity for communities. Theoretically the stage after implementation and before dissemination to other sites. In reality.overlapping, non-linear and continuously evolving) Multi-factors influence outcomes (innovation, context, capacity, processes and interactions) Evaluation has limited utility although perceived benefits often cited positive influence. Scheirer, MA 2005 / 11

12 Sustainability knowledge base near absence of studies focusing primarily on the sustainability of complex service interventions Greenhalgh, T. et al 2004 we have identified a body of literature that is fragmented and underdeveloped Stirman, S. et al out of 56 studies reported lower levels of implementation post project. Varying changes across different program components common. / 12

13 A common problem The project should include rigorous evaluation and enough time after the results of the evaluation are known to plan for the sustainability of program interventions shown to be effective The timing of evaluation findings is often too late in the project life cycle to be useful in promoting sustainability; evaluation could be more useful if interim data about outcomes would be available before the initial funding ends. Scheirer, M 2005 / 13

14 Post Project Funding Activities MHCC s comprehensive government relations efforts January 2012 through September 2012 Interim results presented to senior leaders in multiple briefing sessions Request to federal government for two years of post project housing Formal request to Health Canada for transition funding from four of five provinces August 2012 Interim report released in September, extensive media coverage Federal government response communicated to MHCC October 2012 Federal/provincial/MHCC negotiations November 2012 to Spring 2013 Provincial decisions re continuation-2013-present / 14

15 Principles to Guide Transitions Best possible housing and support options for participants National and local collaborations with internal and external partners Strengths based approach to guide all transition work Participants supported to deal with outstanding income related issues and to access any and all possible entitlements Flexibility and individualized solutions will inform transition work Maximum autonomy, choice and full disclosure to participants / 15

16 Current Status In Ontario, teams and housing subsidies were annualized effective April 2013 In New Brunswick the majority of people receiving Housing First services continue to receive those services and remain housed In Quebec, housing subsidies for those currently housed are being continued and most people have been transitioned to existing services in the community In Manitoba the three Housing First Teams are continuing to provide support and the housing subsidies are continuing In BC the housing subsidies are continuing, housing first supports are being provided to a number of people and others have been transitioned to existing services; BC Housing and the Health Authority are working with people still living at the Bosman to find housing and supports / 16

17 Current status cont d Mixed picture re continuation or modification of Housing First program components. Serious attention to annualized funding for the existing group of project participants but may take time to achieve for all, Consideration of scaling up and expanding Housing First like programs throughout some provinces. Accelerated by HPS policy shift. / 17

18 Where are we now? Federal government budget announcement in spring of 2013 pledged $600 million for Homelessness Partnering Strategy (HPS) extension to focus upon Housing First MHCC advisory and training/technical assistance role in HPS roll out Interactive Toolkit to be released this month Continued research in each site moving forward, as well as PHSI and SSHRC grants focused upon KT evaluation 36 published or in press, 18 submitted articles and book chapters / 18

19 Role of research evidence One of many factors that influence decision making - politics, personalities, financial cycles also key Interim results and experiential knowledge both influence governments Strong governmental relations and communications supports an asset Pressure to release findings in timely manner creates risks re consistency. e.g. economic results will change / 19

20 Learnings and Reflections Different kinds of expertise required to achieve knowledge uptake Different voices saying the same thing champions from different sectors or groups as influencers Bottom up and top down approaches necessary Seeing is believing Timing and relevance for intended audiences Nimbleness and adaptability Risk tolerance commitment to journey of learning / 20

21 Acknowledgements The national At Home/Chez Soi project team: Jayne Barker, PHD ( ),Cameron Keller, and Catharine Hume, MHCC National Project Leads; and approximately 40 investigators from across Canada and the US. In addition there are 5 site coordinators and numerous service and housing providers as well as persons with lived experience. This research has been made possible through a financial contribution from Health Canada to the Mental Health Commission of CanadaThe views expressed herein solely represent the authors. / 21

22 Thank you! Contact us: Visit: The views represented herein solely represent the views of the presenters. Production of this document is made possible through a financial contribution from Health Canada. / 22

Findings from the At Home / Chez Soi Demonstration Project in Canada. Paula Goering and Catharine Hume May 2, 2013

Findings from the At Home / Chez Soi Demonstration Project in Canada Paula Goering and Catharine Hume May 2, 2013 Outline for today Overview of Project Design Na8onal level findings re one year outcomes