Service Coordination in Employment and Mental Health Service Networks
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SERVICE COORDINATION IN EMPLOYMENT AND MENTAL HEALTH SERVICE NETWORKS Final Report North Superior Workforce Planning Board Local Employment Planning Council August 1, 2018 Prepared by Dr. Mirella Stroink With assistance from Wendy Leppanen and Karen Arnold of Human Network Analytics 2 CONTENTS Executive Summary 4 Background and Rationale 6 Literature Review 6 Situation Table Approach 8 Stakeholder Presentation 9 Scoping Review 9 Network Analysis and Survey 10 Results: Descriptive Statistics 10 Results: Referral Network 13 Results: Collaboration Network 16 Results: Open-ended Responses 24 Stakeholder Focus Group 25 Discussion 26 Deliverables and Summary 28 Appendix #1 – Resources 30 Appendix #2 – Scoping Review 34 This project is funded in part by the Government of Canada and the Government of Ontario. EXECUTIVE SUMMARY This report provides the deliverables for the project are included in this report. It was decided that prior to “Research and report on strengthening service pursuing further service coordination, a scoping review coordination currently among service provider was required through which employment service networks” sought by the Local Employment Planning organizations throughout the District could be identified, Council for the Thunder Bay District in August, 2017. The and then mapped. Thus there were two further phases purpose of that call was to increase service coordination to the project. The first was the scoping review, in which in the employment service network of providers, with 51 organizations were identified along with select the ultimate goal of providing more holistic and information. The resulting scoping review was shared coordinated supports to Employment Service clients, with all of these organizations and is included as an particularly those who have multiple concurrent needs appendix. The second phase involved a survey that was (e.g., employment, mental health, housing, literacy). This sent to all 51 organizations. Complete responses were project sought to approach that goal by (1) conducting received from 25 organization representatives. a review of the literature on service coordination, (2) conducting a scoping review of employment services Information gathered through the survey and in the Thunder Bay District, and (3) conducting a survey presented in the report below include reports of through which the existing referral and collaboration the services required by clients, the degree to networks in the system could be examined. which further collaboration is sought with other organizations, referral networks outbound In this report, literature is summarized on the various and inbound, presented both as tables of models of service coordination that have been organizations reporting the most referrals in examined, as well as some of the issues that arise and out, and visually as network maps, and in service coordination and collaboration. At the collaboration maps depicting networks of formal request of Employment Service stakeholders, the and informal collaboration that exist within Situation Table model was explored in more detail. the current service system. Open ended survey This model, which is particularly effective in situations questions also provided further information on of acute risk involving multiple organizations, is respondents’ perceptions of best practices in serving well documented and researched. The Situation complex clientele and barriers to such practices. Table approach is contrasted with the typical case management approach and a table of issues for A second Stakeholder focus group was held in July further consideration is provided. of 2018. Findings from the scoping and mapping phases of the project were presented and discussion A stakeholder focus group was held in November of provided context and meaning for the findings. These 2017 where the above findings were presented and a are discussed further in the report below, along facilitated discussion regarding how to increase service with discussion of the limitations of the project and coordination was held. The findings of this session potential future directions. 4 SERVICE COORDINATION IN EMPLOYMENT AND MENTAL HEALTH SERVICE NETWORKS 5 BACKGROUND AND RATIONALE The remainder of this report follows the timeline of the project. The first step was a review of the literature This project builds on 6 years of work with the North on service coordination, which was presented at a Superior Workforce Planning Board (NSWPB), examining facilitated discussion of employment service and the workforce as a complex adaptive system. This work mental health stakeholders in November of 2017. From included the development and provisioning of training on this session it was identified that a scoping review of innovation and leadership through the lens of complex existing service providers was needed, followed by a systems theory, and two projects on the use of social survey of service providers and mapping of existing network analysis to visualize segments of the workforce. collaboration and referral networks. Through this work, we examined network maps and analyzed network statistics in relation to the network’s performance. The findings of one of these latter projects LITERATURE REVIEW were presented at a focus group in March of 2017 (NSWPB report, 2017). In attendance were several stakeholders As service organizations have become increasingly from among Employment Ontario service organizations specialized to meet the varied and complex needs in Thunder Bay. These stakeholders identified service of clients (Best Practice Briefs, 1999), an unintended coordination for client referral as a critical issue, and saw consequence has been that providers have become that the interconnections among service organizations separated and siloed in their functioning (Gillespie & could also be mapped and visualized as a network. With Murty, 1994). As a result, clients report experiencing such mapping as a guide, it was thought that services and difficulties navigating between service providers; there client referral could be more effectively coordinated, and may be no relationships between service providers that this was necessary to increase service uptake and that would give guidance to clients, and challenges client employment outcomes. may be encountered moving between providers due to systemic or client barriers (i.e., transportation or Thus, the current project was developed and proposed literacy), or sometimes the needed service may not to the Local Employment Planning Council for funding in exist (Gillespie & Murty, 1994). August, 2017. The proposal was supported, and the project was initiated in September, 2017. The ultimate goal of This silo of services has been identified as a large the project is to provide more holistic and coordinated hurdle for service providers to overcome that presents supports to Employment Service clients, particularly those a significant barrier to clients receiving services, often who have multiple concurrent needs (e.g., employment, to the detriment of the client, their families, and the mental health, housing, literacy). The purpose of the community (Bunger, 2010; Russell, 2017). Dismantling project was to approach this goal by examining the the silos through which service providers operate is service system and the movement of clients within that transformative and requires a paradigm shift in the space as a social network and to explore how different way providers meet the needs of clients (Jenkins, 1998; models of service coordination, with particular attention Nilson, 2015). This involves reconceptualizing where risk to the situation table model, might impact that network. is: instead of seeing risk as being housed in the client themselves or their circumstances, risk is within the Findings from the current study can serve as a system where agencies may have policies or mandates baseline against which the outcomes of further service that are limiting, or a lack or resources which coordination activities can be compared. Deliverables renders them unable to meet the needs of complex from the current project include a literature review on clients (Brown & Newberry, 2015). To improve these service coordination and presentation to stakeholders circumstances then, service providers are called upon (November, 2017), a scoping review of existing to collaborate to meet needs beyond what one agency employment service organizations, network maps is able, or willing, to provide (Brown & Newberry, 2015). and statistics, interpretation and analysis, and a set of recommendations for pursuing service coordination. 6 Organizations with a goal of better coordinating Service coordination takes many different forms, services are called upon to engage in further including the following (Best Practices Brief, 1999; Bunger, collaboration. Inter-agency collaboration that crosses 2010; Swanson, et al., 2014; Brown & Newberry, 2015: silos related to funding, mandate, or culture, presents both unique challenges and opportunities. Cross-silo Case Actions taken by a service agency to assist an collaboration (e.g., mental health, employment) can be Management individual or family navigate multiple required a powerful tool in social change, maximizing resources, services through the service delivery process. adding value, broadening reach, and enhancing Usually associated with one service provider, innovation. Alternatives may be developed that case management involves introducing a reach more people with more holistic supports.