A Knowledge Transfer Infrastructure for Children’s Mental Health in Ontario Building Capacity for Research and Practice MELANIE A. BARWICK, Ph.D., C.Psych. KATHERINE M. BOYDELL, MHSc., Ph.D. CHRISTINE OMRIN, M.Ed. THE HOSPITAL FOR SICK CHILDREN • TORONTO, CANADA Table of Contents Research Team ii Acknowledgements iii Main Messages iv Executive Summary v Chapter 1 Bringing Knowledge Transfer to Children’s 1 Mental Health Making Research Relevant in Children’s Mental 2 Health: Building Capacity in Ontario Overview of Ontario’s Screening and Outcome 3 Initiative Project Objectives 6 Chapter 2 Knowledge Transfer and Organizational Change: 9 Main Messages and Shortcomings Search Methodology 9 Main Messages from the Literature 10 Shortcomings in the Literature 15 Chapter 3 Key Contacts for Knowledge Transfer in 17 Children’s Mental Health Method 17 Application 18 Chapter 4 The Knowledge Transfer Forum 19 Description 19 Effectiveness 20 Contact List Nominations 21 Chapter 5 Emerging Themes in Research-Related 22 Practices in Children’s Mental Health Focus Groups and Interviews 22 Focus Group Analysis 22 Emerging Themes in Research-Related Practices 24 Summary 42 Chapter 6 Provincial Validation of Research-Related Practices 44 Method 44 Survey Analysis 45 Research-Related Practices Across the Province 45 Summary 51 Chapter 7 A Knowledge Transfer Infrastructure for 52 Children’s Mental Health Regional Community of Practice Meetings 53 Individual Consultations 56 Telephone and Email 56 E-bulletins: CAFAS Update 56 Guidelines for CAFAS Use with Special Populations 56 Sustainability Activities 57 BCFPI and CAFAS Software Training 58 Improved Knowledge Transfer of BCFPI Reports 59 Training in the Clinical Application of the Measures 59 Online Web Community 59 Chapter 8 Final Remarks 61 References 62 Appendices 66 Appendix A Literature Search Strategy 66 Appendix B Annotated Bibliography and Main Messages 67 Appendix C Key Contacts for Knowledge Transfer in 89 Children’s Mental Health Appendix D Knowledge Transfer Forum Evaluation Form 94 Appendix E Focus Group Discussion Outline 95 Appendix F Provincial Survey 97 Appendix G E-Bulletin: CAFAS Update 99 Correspondence regarding this document can be addressed to: Dr. Melanie Barwick Community Health Systems Resource Group The Hospital for Sick Children 555 University Avenue Toronto, ON, M5G 1X8 Canada Telephone: 416-813-1085 Fax: 416-813-7258 Email: [email protected] Recommended Citation: Barwick, M., Boydell, K., & Omrin, C. (2002). A knowledge transfer infrastructure for children’s mental health in Ontario: Building capacity for research and practice. Toronto, ON: The Hospital for Sick Children Copies of this report are available online at www.cafasinontario.ca Funded by i Research Team Melanie A. Barwick, Ph.D., C.Psych Co-Principal Investigator Psychologist, Community Health Systems Resource Group Associate Scientist, Population Health Sciences The Hospital for Sick Children Katherine M. Boydell, MHSc., Ph.D. Co-Principal Investigator Health Systems Scientist, Community Health Systems Resource Group Associate Scientist, Population Health Sciences The Hospital for Sick Children Christine Omrin, M.Ed. Project Coordinator Community Health Systems Resource Group The Hospital for Sick Children H. Bruce Ferguson, Ph.D. Co-Investigator Director, Community Health Systems Resource Group The Hospital for Sick Children Charles E. Cunningham, Ph.D. Co-Investigator Professor, Department of Psychiatry & Behavioural Neurosciences McMaster University Alexander Greer Collaborator Senior Policy Analyst, Mental Health Strategic Policy Unit Ontario Ministry of Health and Long-Term Care Sherilyn Sklar, M.A. Collaborator Quality Improvement and Program Evaluation Specialist Peel Children’s Centre Sheila Weinstock Collaborator Executive Director Children’s Mental Health Ontario Barbara Everett, Ph.D. Collaborator Chief Executive Officer Canadian Mental Health Association-Ontario Division ii Acknowledgements Funding for this study was awarded by the Ontario Ministry of Health and Long-Term Care’s Making Research Relevant: Building Capacity in Ontario Research Initiative. The authors would like to thank the project collaborators for their assistance in developing and executing this project. We would also like to acknowledge the significant contribution of our Project Coordinator, Christine Omrin, who kept the project on track and was instrumental in the collection and organization of data, in maintaining contact with project stakeholders and collaborators, and in writing portions of this report. We would like to recognize and thank all of the people who participated in this project - the families, service providers, policy and decision-makers, and journalists/media who shared their research-related practices with us. We sincerely hope that our work will contribute to a strong and adaptable children’s mental health system in Ontario. iii Main Messages Ø Knowledge transfer can involve the creation and/or the exchange of knowledge. Ø Decision-makers seeking to institute changes in practice need to consider knowledge transfer strategies to support them. Ø Knowledge transfer is essential for achieving organizational change. Ø Improved practice and service delivery necessarily requires that practitioners and managers in children’s mental health and related sectors become more involved in the creation and exchange of research-related activities, in collaboration with policy and decision-makers and researchers. Ø Face-to-face forums, professional networks/contacts, and brief summaries of key information simply stated and accessed through electronic means (Internet, Email) are favoured by decision-makers, practitioners, and service providers in children’s mental health and related sectors. Ø As information technologies become more central in knowledge transfer, children’s mental health service providers need to be given the resources (funds and training) they need to acquire and maintain this new technology. This is also necessitated by the province’s adoption of computer-based screening and outcome assessment tools. Ø Factors related to the knowledge user, knowledge content, and mode of dissemination or exchange hinder the capacity of practitioners and decision-makers in children’s mental health and related sectors to acquire, assess, apply, and adapt research-related information. With only 25 percent reporting they are doing “very well “ in this regard, a great deal of improvement is needed in the interface between research and practice in children’s mental health. Improvement will require that stakeholders partner to promote research-to-practice linkages and address existing barriers. Ø Funders, decision-makers, and researchers need to address the excess of terms used to refer to knowledge transfer and arrive at one term for common use. Ø Building a culture for knowledge transfer requires that research institutions recognize and reward research activities in this area. iv Executive Summary There is a critical need to move research and information from those who generate it to the potential users, and to do so in a way that has direct and immediate application. Traditionally, knowledge transfer has been conceptualized as involving the dissemination of research findings, an activity undertaken at the culmination of research activity. More recently, there is growing appreciation of the role knowledge transfer plays in the creation of new knowledge. In this project, it plays an important role in the creation of new practice in children’s mental health. The distinction between the two functions of knowledge transfer represents the difference between knowledge transfer that supports the development of a new practice as distinct from knowledge transfer that addresses the exchange and application of the new knowledge generated. Both creation-driven and exchange-driven knowledge transfer play a role in this project. The development of this knowledge transfer infrastructure for children’s mental health is embedded in a provincial initiative that seeks to introduce systematic screening and outcome measurement for children receiving mental health services in Ontario. Funded by the Ministry of Community, Family, and Children’s Services, the measurement initiative is mandated for all children’s mental health services and has four main goals. First, to collect standardized aggregate data regarding the mental health problems characteristic of children and youth seeking service (Brief Child and Family Phone Interview - BCFPI; Cunningham, Pettingil, & Boyle, 2000), and assess level of functioning outcomes for children and youth who have received service (Child and Adolescent Functional Assessment Scale - CAFAS; Hodges, 1997). Second, to encourage the adoption of evidence-based interventions by focusing on outcomes and how they relate to different types of services and different populations. Third, to inform policy and practice and to improve service delivery. Fourth, the initiative presents an opportunity to strengthen linkages among mental health services providers and to build linkages among researchers, policy and decision-makers, consumers of mental health services, and the public. The task of implementing the screening (BCFPI) and outcome assessment (CAFAS) tools across the province is significant in scope and will create significant changes in mental health practice and service delivery. The goal of the current project was to develop a knowledge transfer infrastructure that would support the implementation of these