Service collaboratives: From exploration to implementation

In brief

image of service collaboratives initiative brochure that shows a group of people standing together, holding up a sign that says Systems Improvement through Service Collaboratives Systems Improvement through Service Collaboratives (SISC) is one of the initiatives under the first three years of Ontario’s Comprehensive Mental Health and Addictions Strategy, released in 2011. As SISC’s sponsor, the Centre for Addiction and Mental Health is implementing 14 geographically-based service collaboratives and four justice collaboratives. These service collaboratives would be groundbreaking in their cross-sectoral representation, based in evidence, and informed by implementation science, quality improvement, and health equity tools.

This issue of Evidence in Action looks at the overall initiative, the research it is based on, and the lessons learned. Evidence in Action profiles knowledge generation, exchange, and implementation activities across Ontario.

Read it below or download the PDF.

What is the initiative?

Systems Improvement through Service Collaboratives (SISC) is one of the initiatives under the first three years of Open Minds, Healthy Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy (2011).1

As SISC’s sponsor, the Centre for Addiction and Mental Health (CAMH) is implementing 14 geographically-based Service Collaboratives and four Justice Collaboratives.2

The announced Service Collaboratives would be groundbreaking in their cross-sectoral representation involving partners from education, mental health, addictions, client and family representatives,  justice, Aboriginal, Francophone and other community organizations. The initiative would also be based on evidence and informed by implementation science,3 quality improvement, and health equity tools.

The overall initiative is attempting to address system fragmentation and to support local systems to improve coordination and enhance access to mental health and addictions services.

SISC began with the roll out of four developmental sites including Service Collaboratives in the areas of London, Ottawa, Simcoe-Muskoka, and Thunder Bay. This initial set of Service Collaboratives first engaged community partners in early 2012 and soon after formed initial memberships. SISC uses implementation science to identify system gaps and respond with an intervention. The goal: system change.

The research4

Stages of implementation

The Service Collaborative initiative is applying the Implementation Science framework developed primarily by National Implementation Research Network (NIRN), led by Dr. Dean Fixsen.

Dean first began his career in 1963 as a Psychiatric Aide and received his doctorate in Experimental Psychology from the University of Kansas in 1970. Beginning in 1969 he was Co-Director of the Achievement Place Research Project. This research led to the development of the Teaching-Family Model, an early example of an evidence-based program.

The first attempt to replicate the Teaching-Family Model in 1971 failed. In 1986, Dean and his colleagues helped to establish and test adaptations of the Teaching-Family Model in home-based treatment, treatment foster care, and semi-independent transitional living settings in Canada.

In 1995, Dean began to focus on the critical pieces of implementation and scaling evidence-based programs. This led to a major review of the implementation evaluation literature and the publication of, Implementation research: A synthesis of the literature. Meetings about successful implementation work led to a network of program supporters, implementation sites, family and cultural experts, state and federal policymakers, and researchers.

The development of the Active Implementation Frameworks provides a foundation for the field of Implementation Science and guidance for those attempting to do the work.

The application

The Implementation Science framework has been adopted by the SISC initiative and has been adapted to fit the specific demographic and contextual needs of the Service Collaborative work. The SISC initiative is adhering to the Implementation Science stages outlined: exploration, installation, initial implementation, and full implementation.

The Implementation Science framework and the implementation of the SISC initiative is being supported by a significant team from the Provincial Systems Support Program at CAMH. 

The overall initiative was envisioned by a six-Ministry Oversight Committee and is supported by an Advisory and Accountability structure that includes a Provincial Collaborative Advisory Group (PCAG), a Service User Expert Panel, a Scientific Expert panel, and a team of leadership located at CAMH in Toronto.

Each regional service collaborative is supported by a Regional Implementation Team (RIT) that is comprised of a Regional Manager, a Regional Implementation Coordinator (RIC), a Regional Evaluation Coordinator (REC), a Coach, a Knowledge Exchange Lead and a Health Promotion and Prevention Lead.

At all levels of SISC, there is ongoing training and capacity-building in the area of Implementation Science.

The overall response to the SISC initiative has been primarily positive; many stakeholders find the use of an evidence-based framework refreshing and encouraging for true system change. Furthermore, although it is too premature in the process to determine the overall impact of the SISC initiative, initial feedback from stakeholders indicates that there has been a positive impact on cross-sectoral partnerships being formed and interactions among community organizations.

Lessons learned

As the SISC initiative is still in the process of rolling out Service Collaboratives and some Service Collaboratives are at different stages of implementation, there have been many slight alterations and improvements made to the SISC process.

The initial timelines set out for the Service Collaboratives to complete specific stages of the Implementation Science framework have required continuous revision due to the need to balance the community level process with the provincial mandate.

An important consideration for starting an initiative at the scale of SISC is the substantial resource and capacity supports required to facilitate the process.  In addition, replication of a process like the SISC initiative would require a community desire to work collaboratively and potentially alter the current ways of working.

The SISC initiative may be difficult to replicate in communities that are not ready to work collaboratively; however, some initial conversations that get all potential stakeholders to buy into the process may overcome this barrier. SISC’s interim successes include:

  • Cross-sectoral interaction;
  • Cross-sectoral communication;
  • Cross-sectoral consensus about a shared intervention and a gap that can be improved by working together in the mental health and addiction system;
  • The substantial time allocation that members of the Service Collaboratives are willing to give in order to create meaningful system change; and
  • Ministerial support for the SISC initiative.

The EENet perspective

SISC’s ground-breaking cross-sectoral partnerships have the potential to create lasting, system-level changes. Elements that are key to SISC’s success include:

  • The adherence to an evidence-based framework that is committed to action-oriented implementation.
  • The ongoing use of evidence throughout the stages of implementation to help inform the selection of the system gap, the intervention and the implementation of the chosen intervention.
  • The resource allocation and capacity building to adhere to an evidence-based framework that requires specific supports and resources.

For more information about the SISC initiative and/or the SISC use of Implementation Science please contact:

Alexia Jaouich, Ph.D.

Senior Project Manager

Provincial System Support Program

Center for Addiction and Mental Health (CAMH)

(416) 535-8501 x 30015

Alexia [dot] Jaouich [at] camh [dot] ca

References and suggested reading:

Read more about Open Minds, Healthy Minds.

  1. Read more about SISC.
  2. Read more about implementation science.
  3. Read more about quality improvement.
  4. Dean Fixsen’s Biography provided by Michelle A. Duda, Ph.D., BCBA-D, Associate Director and Scientist, National Implementation Research Network, PG  Child Development Institute.

Author: Shauna MacEachern