Redefining and improving intensive out-of-home treatment services

Following the completion of seven residential treatment* assessments—of four Kinark programs and three offered by other community service providers—using the agency’s new Scoring Tool for Assessing Residential Treatment (START), the project team completed the analysis of the results and delivered its final report, including 84 recommendations at the local, agency and system levels, to all project participants last year.

The team has since refined the assessment tool, using feedback received from staff, kids and families, and external partners involved in the assessments, as well as advice from other clinical experts and academics. It has also developed guiding principles to inform and support the use of START and continues to validate the tool.

START was developed two years ago by a partnership of staff in Kinark’s Research and Evaluation department and our Child and Youth Mental Health Program as well as clinical and intensive out-of-home treatment staff. The comprehensive assessment tool is based on Strengthening Children’s Mental Health Residential Treatment through Evidence and Experience, a policy paper published in 2015 in which Kinark identified nine factors critical to the quality and effectiveness of intensive residential treatment and proposed an integrated, multi-tiered treatment system.

The START Project Team (from left to right): Dr. Laurel Johnson, Clinical Director – Child and Youth Mental Health and Chief of Psychology, and Dr. Alex Elkader, Senior Director – Planning and Research. Unavailable for photo: Dr. Claire Baxter, Research and Evaluation Advisor; Dr. Kelli Phythian, Research and Evaluation Advisor/Team Lead; and Larry Shaw, Director – Programs and Operational Support.
Strengthening Children’s Mental Health Residential Treatment through Evidence and Experience, (October 2015); Page 44.

A new task group was established last year to review the high priority recommendations from the assessments that are applicable to all Kinark intensive out-of-home treatment programs, and to develop an implementation plan to act on them.

“The goal,” says Larry Shaw, Project Lead and Director, Programs and Operational Support, “is to improve the quality of the intensive treatment services we provide for young people with the most complex needs as well as the outcomes these children and youth experience.”

The group has been researching clinical intervention models to determine whether a single, evidence-based approach is appropriate for all Kinark programs to meet the diverse needs of the children and youth they serve. Also under consideration, are the training and operational requirements that would be needed to implement a new service model across some or all programs. At the same time, intensive out-of-home staff started to make changes based on recommendations specific to their individual programs to improve local service delivery.

Other service providers, who helped pilot and validate START, are going through a similar process to act on the assessment findings to further enhance both service and system capacity.

Dr. Alex Elkader, Senior Director of Planning and Research at Kinark, and his team, meanwhile, focused on the development of a consistent approach to defining and measuring the quality of the agency’s intensive-out-of-home services. Several key performance indicators and outcome measures have been proposed, based on the nine critical success factors. “First, we’ll develop a scorecard for our own use,” Dr. Elkader says. “In time, as it evolves, it may be useful more broadly within the sector.”

Since this major initiative to define and improve the quality of intensive out-of-home treatment services began a few years ago, Kinark has presented its work at several professional conferences in Canada and the United States. Last year, the work was shared at Children’s Mental Health Ontario’s annual conference and, more recently, at the Association of Children’s Residential Centers conference in New Orleans, Louisiana. The response to this groundbreaking work has been both positive and gratifying.

In the year ahead, Kinark will begin implementing changes to its own intensive out-of-home treatment programs to further enhance service quality and client outcomes.

Strengthening Children’s Mental Health Residential Treatment through Evidence and Experience (October 2015); Critical Success Factors for a Successful Residential Treatment System.

*Kinark now refers to its residential treatment programs as intensive out-of-home treatment programs.

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