Optimizing Ontario’s investments in a “basket” of core mental health services for children and youth – background

Some background

The Ministry of Children and Youth Services (MCYS) in Ontario funds service providers to deliver community-based child and youth mental health (CYMH) services under the authority of the Child and Family Services Act, R.S.O. 1990, c.C.11 (CFSA). The paramount purpose of the CFSA is to promote the best interests, protection and well-being of children.

Some terms

Client

The MCYS defines a client  as “the intended recipient of the child and youth mental health core service.” The client is a child or youth under 18 years of age who is experiencing mental health problems. In addition to mental health needs, clients may also be experiencing additional challenges related to their development or have specific impairments and/or diagnoses, including a developmental disability, autism spectrum disorder or substance use disorder. Other conditions or diagnoses do not preclude clients from receiving mental health services, but may add to the complexity of their needs, and the services they require. Similarly, where children and youth are involved in other sectors (e.g. youth justice and child welfare) these circumstances do not preclude them from receiving core services. Where children and youth have additional needs and are receiving a range of services, the focus must be on how the services connect. A coordinated approach to service delivery must be supported. Families (including parents, caregivers, guardians, siblings and other family members) may also receive services from a core service provider, in order to address the identified needs of the child or youth client. This may occur when the participation in treatment is recommended to support the child or youth’s service plan.

Continuum of needs-based mental health services

Children, youth and their families can benefit from access to a flexible continuum of timely and appropriate mental health services and supports, within their own cultural, environmental and community context. Mental health promotion, prevention, and the provision of services to address mental health problems represent different points along the continuum. Children, youth and their families may enter the continuum of needs-based services and supports at any point. The actual services a child/youth needs will vary. For example, some children/youth may benefit from targeted prevention services, while others will require more specialized mental health services. In addition, a child or youth’s mental health service needs may change over the course of their treatment.

The following schematic outlines the full continuum of needs-based mental health services and supports, and shows how core services fit within this continuum. It also represents the relative demand for services – level one reflects all children and youth, while level four focuses on a smaller subset of the child/youth population with the most severe, complex needs. This schematic is for service planning only – it is not used for diagnosis or for determining the appropriateness of specific mental health interventions.

MCYS - Continuum of core mental health services
Continuum of CYMH Needs-Based Services and Supports. *Includes members of a group that share a significant risk factor for a mental health problem(s).

Service areas

After a thorough review – including an assessment of Statistics Canada’s census divisions – the MCYS has identified 34 service areas in Ontario for the purpose of:

  • ensuring that all clients across the province will be able to access the same core services
  • facilitating planning, and
  • creating pathways to care.

The defined service areas are not barriers to service. Clients will be able to access service from any service area.

Core services

The MCYS has defined a set of core children and youth mental health services (“core services”) to be available within every service area and has established minimum expectations for how core services are planned, delivered and evaluated. Core services may not be available in every service area immediately – the expectation is that they will be made available over time as lead agencies assume their roles and responsibilities.

Core services represent the range of MCYS-funded CYMH services that lead agencies are responsible for planning and delivering across the continuum of mental health needs within each service area. It is recognized that children and youth in receipt of core mental health services may also require other services and supports. For example, children and youth may receive more than one core service as part of a service plan, as well as other services funded by MCYS or other partners.

Seven core services are to be available across all service areas:

  • Targeted Prevention
  • Brief Services
  • Counselling and Therapy
  • Family Capacity Building and Support
  • Specialized Consultation and Assessments
  • Crisis Support Services, and
  • Intensive Treatment Services.

The MCYS funds providers of core services through the following detail codes:

  • A348 – Brief Services
  • A349 – Counselling and Therapy
  • A350 – Crisis Support Services
  • A351 – Family/Caregiver Capacity Building and Support
  • A352 – Coordinated Access and Intake
  • A353 – Intensive Treatment Services
  • A354 – Case Management and Service Coordination
  • A355 – Specialized Consultation and Assessment
  • A356 – Targeted Prevention Term

The MCYS has identified a target population for each core service. This is the population for whom the service is designed, and for whom the service is intended to provide better mental health outcomes. The act of defining a target population is not meant to be exclusionary. Rather, it is a means to support planning and delivery in a way that benefits the children and youth who are in greatest need of the mental health service. In general, the target population for core services includes those children and youth under 18 years of age and their families who are experiencing mental health problems along levels two, three and four of the CYMH continuum. Additional target populations may also be identified within specific core services.

Lead agency

In every service area, the MCYS has identified a lead agency that will be responsible for the planning and delivery of high-quality core services across the continuum of mental health services in the service area.

A lead agency may either directly deliver core services or work with other providers of core services to deliver the full range of core services within the service area. Lead agencies are responsible for engaging cross-sectoral partners in the health and education sectors, including the relevant Local Health Integration Network (LHIN) and school boards. Lead agencies will connect with other providers to plan and enhance mental health service pathways for children and youth and improve transparency, so that everyone will know what to expect.

Providers of core services are required to comply with the Program Guidelines and Requirements #01 (PGR #01): Core Services and Key Processes.

The core services, key processes and functioning of the CYMH service sector will require refinement from time to time as other provincial initiatives and activities are developed and implemented. Within the broader context of these new initiatives, it is important that the roles and responsibilities of all core service providers are made clear and that the linkages between these services are transparent.

Planning to transform child and youth mental health services in Ontario

A key driver of Moving on Mental Health is the need to build a system in which children, youth and their families:

  • Have access to a clearly defined set of core child and youth mental health services
  • Know what services are available in their communities and how they are connected to one another, and
  • Have confidence in the quality of care and treatment. In a mature system, one of the ways in which this vision will be realized is through identification of lead agencies with planning and funding accountability for core child and youth mental health services within defined service areas.

Within each defined service area, the lead agency will be responsible for:

  • Delivering and/or contracting for the range of defined core CYMH services
  • Making them accessible to parents, youth, and children, and

Establishing inter-agency and inter-sectoral partnerships, protocols and transparent pathways to care. These responsibilities fall into two broad categories:

  • Core Service responsibilities – which relate to the defined core services delivered by the community-based child and youth mental health sector, as well as the key processes that enable high-quality service, and
  • Local System responsibilities – which relate to the collaboration of the community-based sector with other parts of the service continuum such as those supports and services delivered by health care providers, schools and others.

The Core Services Delivery Plan and the Community Mental Health Plan for children and youth will set out how the lead agency carries out these responsibilities. The lead agency will be responsible for developing these plans, and is expected to work collaboratively with other mental health service providers and with all sectors that support children and youth and respond to their mental health needs.

The Core Services Delivery Plan will, together with the Community Mental Health Plan, provide critical insight into each service area and guide activities as we move forward with transforming the experience of children, youth and families. The intent is that over time, both of these plans will have a three-year horizon and will be updated annually, since they inform one another. They will also provide content for the Accountability Agreement entered into between the lead agency and MCYS.

Core Services Delivery Plan

The development of a Core Services Delivery Plan (CSDP) is a key planning and communication tool that will document expectations, obligations and commitments for the provision of core services and associated key processes in each defined service area. This reflects the need to establish a consistent approach that will support critical insights into local and provincial child and youth mental health service issues, while recognizing the unique circumstances of lead agencies and service areas. The Core Services Delivery Plan documents how core services will be delivered in the defined service area. It consists of three areas of content:

  • Service Commitments
  • Continuous Improvement Priorities, and
  • Budget.

In developing the plan, the lead agency and child and youth mental health service providers should ask themselves some key questions:

  • Can we demonstrate that the full range of core services is available in our service area, and that minimum expectations set out in the Service Framework are being met?
  • Can we show how our services are getting better at meeting the mental health needs of children and youth in our communities?
  • Are we making the best possible use of limited resources to deliver high-quality services?
A. Service Commitments

This section of the plan will:

  • Identify, with specific activities and time frames:
    • How the lead agency and other child and youth mental health service providers in the service area will address the expectations set out in the Service Framework, including who will deliver what services over the projected three-year time horizon
    • Where changes to services or service providers are proposed, the plan will document how the changes will result in improvement to child and youth mental health outcomes, service quality and efficiencies
  • Indicate how, if a change in service providers or in contracted relationships is proposed, it will be handled in a transparent manner with due regard to minimizing disruption to service
  • Set out how services will be designed and delivered in a culturally responsive manner to address diverse populations including francophone and Aboriginal populations
  • Document how a clear, stable point of contact for children and youth with mental health needs and their families, as well as those seeking services on their behalf, will be established and/or maintained
  • Report on the reach and efficacy of programs and services, including how input from parents and youth has been incorporated to ensure that what has been developed works for them, and
  • Describe the process by which the lead agency has engaged and will continue to engage respectfully with all core child and youth mental health service providers in the service area.
B. Continuous Improvement Priorities

This section of the plan will:

  • Monitor and report on the impact of current programs and services
  • Identify improvement priorities, taking into account priorities established by MCYS and the expectations set out in the Service Framework, in areas such as service quality and outcomes, a purposeful approach to wait list and wait time management, and others over the three-year horizon of the plan
  • Set out specific activities and time frames that will support continuous improvement goals and priorities, and
  • Address matters such as data sharing protocols between the lead agency and other child and youth mental health agencies in the service area, that will support monitoring and reporting on performance indicators in order to enable tracking of trends, challenges and opportunities for continuous improvement.
C. Budget

This section of the plan will:

  • Forecast activities, resource allocations and budget over the three-year horizon, including financial implications of planned changes to service delivery.

Community Mental Health Plan for children and youth

System responsibilities are built on key partnerships and collaborations developed at the local level to support young people and their families across the full continuum of needs. Although service areas may differ in terms of their service profile, service patterns, as well as the degree of pre-existing cooperation and collaboration across systems and sectors, the lead agency will be responsible for bringing partners together to create coherence for children, youth and their families. MCYS is working, together with the Ministry of Health and Long-Term Care and the Ministry of Education, to put in place conditions that will support this important work.

The Community Mental Health Plan for children and youth will be a public document that is developed by the lead agency and describes the processes by which:

The lead agency has engaged and will continue to engage respectfully with sector partners such as organizations funded by Local Health Integration Networks, District School Boards, public health units, hospitals, primary health care providers, and those delivering MCYS-funded services (e.g., child welfare, autism services) and others, and

Input from parents and youth has been incorporated to ensure that what has been developed works for them. It will cover the following topic areas:

  • Understanding current needs and services
  • Collaborative planning, and
  • Pathways to, through and out of care.

In developing the plan, the lead agency, child and youth mental health service providers and partners from all sectors involved with child and youth mental health should ask themselves some key questions:

  • Are all those who serve children and youth working together systematically to address mental health needs in the service area?
  • Are the roles and responsibilities of everyone across the continuum of needs and services clear to parents, youth and those seeking services on their behalf, including how services are accessed?
  • Are there shared commitments to address service gaps and expand on opportunities to better meet identified needs?
A. Understanding current needs and services
  • Report on a needs assessment of the current state of child and youth mental health services across the service area, identifying gaps and opportunities for meeting needs across the continuum, and
  • Identify and maintain an inventory of who is providing which services to meet the needs identified.
B. Collaborative planning
  • Establish mechanisms to explore, on an ongoing basis, opportunities to leverage resources, reduce duplication, enhance outcomes, and create added value for children and youth with mental health needs through collaboration and joint planning, and
  • Identify and document commitments and actions to be taken to address shared and agreed upon priorities, together with associated timelines and measures to assess results.
C. Pathways to, through and out of care

Develop and document protocols, processes and partnerships that exist, or will be developed, that will streamline and strengthen clear pathways to, through and from care across sectors.

Next: Applying Multi-Criteria Decision Analysis to the “basket” of core mental health services for children and youth in Ontario