Health Systems Research
and Consulting
Head: Dr. Paula Goering
Informing and improving systems of mental health and addiction service
delivery -- this is the goal of the Health
Systems Research and Consulting Unit, the base of the University of
Toronto Department of Psychiatry's Mental Health Systems Research and
Development Program. An interdisciplinary team draws on the expertise
of other jurisdictions, reviews current literature, interviews and consults
with local stakeholders, analyses data in existing administrative databases,
and gathers information through epidemiological and program evaluation
studies.
To maximize the possibility of these findings being disseminated and
translated into policy and practice, investigators in the unit regularly
assume roles as administrators, planners, consultants and advocates to
influence decision-making in the education, health care and government
arenas. The unit will assume a leadership role in this area after receiving
a grant from the Ontario Ministry of Health and Long-Term Care to develop
the Research Transfer Training Program, which will offer a course on knowledge
transfer for the University of Toronto Department of Psychiatry and CAMH
researchers. The unit's consultation service is busy transferring knowledge
and keeping research staff in touch with front-line service delivery issues
and problems.
Members of the unit work in close collaboration with the Ontario Substance
Abuse Bureau on system-related issues, such as performance measures and
planning information. We have developed partnerships with the Ontario
and federal mental health policy groups, are affiliated with the Department
of Health Policy, Management and Evaluation at the University of Toronto
and have developed a collaborative relationship with the Institute for
Clinical Evaluative Studies. Unit staff have cross-appointments with other
university departments including: the Faculty of Nursing, Department of
Public Health Science and the Institute for Medical Science.
Hospital Report 2001 --
Mental Health Feasibility Study
As part of the Hospital Report 2001 project, conducted through the Department
of Health Policy, Management and Evaluation at the University of Toronto,
a team is conducting a feasibility study concerning the use of the Balanced
Score Card for hospital-based mental health care. Literature, data, and
site reviews and consultation with content experts and stakeholders are
being used. Our objectives include evaluating the Score Card's usefulness
and feasibility as a performance indicator for mental health care, providing
data at the provincial level and recommending future directions and possible
modifications to this approach.
Community Mental Health
Evaluation Initiative
Availability of evidence on the effectiveness of different forms of community
mental health support varies, and a lack of common client data prevents
us from comparing interventions. The Health Systems Research and Consulting
Unit is the co-ordinating centre for a multi-site evaluation research
project designed to advance understanding of the roles played by case
management, assertive community treatment, crisis services and consumer
and family initiatives. A cohort of over 900 individuals, enrolled in
18 different programs, is being assessed at three points over an 18-month
period. An interim external review gave strong support to the project,
stating it is "working well in meeting its ambitious aims."
Most of the baseline data have now been collected and initial analyses
are underway. We are developing a formal qualitative component to enhance
understanding of program delivery and client responses. Communications
are being conducted in partnership with CMHA-Ontario, and will expand
in the coming year as findings become available.
Explaining Outcomes:
Critical Characteristics of Community Support
Explaining Outcomes is a five-year project of the Community Mental Health
Evaluation Initiative. The goal is to develop an instrument, or package
of instruments, to measure the critical aspects of community support programs
for people with a severe mental illness. Over this second year of the
project, the research team completed 42 interviews with consumers, family
members and service providers from various programs and parts of the province.
From an initial pool of over 7,000 citations, a set of systematic selection
criteria yielded a final pool of 200 articles from the literature deemed
most relevant. Through a content analysis of the literature and a qualitative
analysis of the combined interview data and abstracted material, the first
draft of the instrument is nearing completion. The next step in the project
will be to get additional input from the Project Advisory Committee, field
test the instruments and refine them according to reliability and validity
testing.
Comprehensive Assessment
Projects
This series of needs-based planning projects was commissioned by the
Ontario Ministry of Health and Long-Term Care. Our goal was to employ
a consistent and sound methodology to assess the needs of people who are
currently patients in psychiatric hospitals, and to identify additional
community resources required to meet these needs after hospital restructuring.
To date, projects have been completed in six psychiatric hospitals, representing
almost 9,000 patients/clients. In response to requests from community
planners and mental health task forces, we initiated three community pilot
projects in the fall of 2000. Results from the community projects, in
combination with hospital data, will help to develop a fuller picture
of current service use and extent of unmet need among those using mental
health services in Ontario.
Mental Health Court
Evaluation Project
This research will evaluate the effectiveness of the Mental Health Diversion
Program at Court 102, the Mental Health Court at Old City Hall in Toronto.
Our evaluation will include information on diagnosis, criminal justice
system experience and demographic characteristics of the people served
by the program, the services provided to them and the outcome of the services
provided. The evaluation will analyze human-resource issues, including
the experience, training and organization of mental health staff who interact
with the justice system. It will also analyze systemic factors that promote
or inhibit the effectiveness of programs, including the role and responsibilities
of various ministries involved in program delivery. A detailed cost-effectiveness
analysis is a critical component of the evaluation.
Depression in the Workplace
Rising rates of disability due to depression are of concern to multiple
stakeholders. In response to a request from the Ontario Roundtable on
Appropriate Prescribing, our investigators designed a study entitled Depression
in the Workplace: Examining Antidepressant Use and Worker Characteristics
and Their Associations with Disability. Three Canadian companies with
national employee bases were recruited as project participants. Together,
they represent over 65,000 workers. Data collection was completed this
year and preliminary results are available. The final report will examine
patterns of antidepressant use among workers on short-term disability
and the association between these patterns and return to work.
Best Practice for Concurrent
Disorders
This project, funded by Health Canada, synthesized research literature,
expert opinion and consumer focus group input to arrive at recommendations
for screening, assessment and treatment/support of people with concurrent
mental health and substance use disorders. Recommendations called for
a more integrated approach at the individual program level as well as
at the system level. The advice concerning specific research-based interventions
varied within different clusters of concurrent disorders (e.g., mood and
anxiety versus severe and persistent mental illness). The report will
be distributed across Canada in the fall of 2001, and in Ontario it will
serve as the foundation for many local and provincial initiatives to better
integrate services for this group of people in high need.
Community Model of Co-ordinated
Access to Mental Health and Addiction Services
Better access to services is a consistent theme across current efforts
to reform both the mental health and addiction service systems across
Ontario. In the Niagara Region, our consultants have been working with
a group of mental health and addiction service providers to develop a
more co-ordinated system of access. The project has involved a summary
of relevant literature; an in-depth review of alternative models across
Ontario and elsewhere; and a consensus-building process among participants
to arrive at a model suited to the needs of people in this particular
region of the province. A proposal for funding is pending, and we plan
to publish reports summarizing key features of alternative models and
lessons learned in local application.
Drug and Alcohol Treatment
Information System
Drug and Alcohol Treatment Information
System (DATIS) is a provincial information system that collects, summarizes
and reports information on the volume and characteristics of people being
treated for alcohol, other drug and gambling problems in Ontario. Staff
of the unit help select the performance measures within DATIS and help
with the analysis and interpretation of trends useful for planning, accountability
and research. This past year saw the completion of several major reports
from the DATIS database, including reports on the outcome and cost of
substance use treatment in Ontario and on the utilization of services
for problem gambling.
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