Holistic Crisis Planning in Peel Region

This issue of Promising Practices takes a look at the holistic crisis planning intervention that was created and implemented in Peel Region to bridge the gap between formal and informal supports and build a system that better serves the needs of the diverse population in the region.

Read about it below or download the PDF.

Background 

The Region of Peel (which includes Brampton, Caledon and Mississauga) is the most ethnically and culturally diverse region in the Greater Toronto Area. But this is not reflected in the population that is receiving mainstream mental health and addictions services in the region.

The Peel Service Collaborative was a group of service providers and system planners, representing over 60 organizations, working together to improve urgent care pathways for youth in Peel.

They observed that while racialized youth were not accessing the mainstream services, they were over-represented in hospital emergency departments, as well as in the justice and child welfare systems.

The Service Collaborative conducted surveys and focus groups with diverse youth and their supports. Many of the youth who participated in surveys and focus groups indicated that mainstream services need to be more culturally appropriate, inclusive, and client-centred. These youth also indicated that they often rely on informal supports, such as faith leaders, when they experience a crisis. Meanwhile, many informal supports expressed the need to better understand mental health and addiction and the existing service system.

With help from the Provincial System Support Program at the Centre for Addiction and Mental Health (CAMH), the Peel Service Collaborative designed and implemented an intervention to bridge the gap between formal and informal supports and build a system that better serves the needs of the diverse population in the region. 

The approach

Image depicting the ten guiding principles of the holistic crisis planning innitiative, which includes family voice and choice, team based, use of natural supports, collaboration, community based, culturally competent, individualized, strenths based, unconditional, outcome based. One part of this intervention is holistic crisis planning. It is designed to reduce unsafe situations and the likelihood of harm for individuals with mental health and addiction issues and for their families. This intervention puts the focus on the person and family.

The approach was originally developed by Kappy Madenwald, of Madenwald Consulting, and was adapted to meet the unique needs of the Peel community.

The approach encourages service providers to engage the individuals they serve, and with their families, to develop a crisis plan that reflects their voices and choices.

For example, an individual or family’s preference for formal versus informal supports is carefully gauged and incorporated into the plan. Informal supports are seen as key to the wellness and recovery of the person and their family.

The holistic crisis planning approach integrates an idea of risk that is different from most other approaches. The focus is not on the service provider’s view of what safety means, but rather on the individual’s perception of what will support their safety.

This approach focuses on the service provider’s ability to reflect critically on their own biases and worldviews, so they’re able to create rapport and build a relationship of trust with the client and their family members.

The outcome

Since February 2014, over 400 service providers have received training on holistic crisis planning. These service providers are now using this approach with individuals of all ages and their families in a variety of settings, such as schools, emergency departments, day hospitals, mental health and addiction agencies, and other community service agencies. 

The majority of providers have reported better awareness of their biases and worldviews, and 81% said they have better relationships with clients and families.  

What works and why?

“Service users choose what works for them and feel validated … It is empowering for them to see they have the tools to manage challenging situations/interactions.”
-Service provider

Family engagement: Engagement of family members is an important element of success, especially given the region’s cultural diversity. 

Engagement of informal supports: By involving those who help clients informally, this initiative put emphasis on client-centred care and broadened the definition of “mental health supports.” 

Embedding critical reflection: Making critical reflection an integral part of the training sessions resulted in a bigger impact. Service providers were prompted to reflect regularly on their worldview and biases and became better able to have challenging conversations about them.

Keeping it top of mind: Making holistic crisis planning a standing item on agencies’ action plan helped sustain implementation over the long term.

“We may be unaware of some of the biases that we may be placing on these select demographics and working as a small group we were able to expose a lot of that. I imagine some people felt uncomfortable because it was one of those hard discussions but having those conversations was definitely helpful.”
-Service provider 

Co-creation of resources: Engaging providers and champions in the development of resources (such as guides, templates, and training materials) was instrumental to successful implementation.

Train-the-trainer model: Training agency staff in holistic crisis planning not only helped sustain this approach but also allowed trainings to be adapted to the specific needs of each agency.

Learnings & challenges

“We need someone to lead and own it; I think that’s all that’s needed to sustain it. The buy-in is there, people see the importance of it.”
-Service provider

Sustainability: Staff turnover and transitions have sometimes made it challenging for agencies to sustain holistic crisis planning.

System leadership: It has been difficult to sustain the intervention because the organization that initially supported the broader cross-sectoral efforts had a limited time to support the initiative. It has also been difficult to sustain a forum for connections across sectors, such as the community of interest that emerged from the holistic crisis planning collaborative implementation team.

Client feedback: Agencies have found it challenging to gather feedback about the intervention from clients. While many staff said trying to gather feedback in the moment can feel counterproductive to the approach, a more formal evaluation might not be the best way to capture client’s experiences.

Engaging families: It is not always possible for providers to connect regularly with a client’s family members, and including them in crisis planning across a variety of sectors can also be challenging.

Bureaucratic processes: In some cases, the process of replacing old templates and forms with new ones was slowed down by bureaucratic demands. Still, the process of engaging clients through those mandated items shifted for many providers. 

Conflicting system priorities: Many providers, particularly those in adult-serving settings, were not able to fully implement holistic crisis planning because they had to shift their focus to other priorities.

System-level perspective

The holistic crisis planning initiative fits within the larger mandate of Ontario’s service collaborative initiative by improving access to mental health and addiction supports for children, youth, and families, and fostering collaboration across sectors.

This initiative embodies an approach to system improvement that has a strong focus on equity. It aims to connect people in the Region of Peel who have mental health and addiction concerns with the care they need, by acknowledging that some groups face systemic barriers to care and by integrating person- and family-centred care in crisis planning.   

Scaling up or spread holistic crisis planning will require a leadership structure that is accountable and committed to sustainability, as well as a broad interpretation of what mental health and addiction supports can be.

This initiative could be expanded to other services by building on existing resources and collaborating with informal supports in the community that are relevant to the target population.

Community partners

The partners listed below implemented holistic crisis planning in their organizations and contributed to the creation of project resources.

Community of Interest Members

  • Associated Youth Services of Peel
  • Canadian Mental Health Association Peel
  • Hope247
  • Peel Children’s Centre
  • Peel Crisis Capacity Network
  • Peel District School Board
  • Punjabi Community Health Services
  • Rapport Youth and Family Services
  • Region of Peel
  • Services & Housing In the Province
  • William Osler Health System

Previous Community of Interest Members

  • Elizabeth Frye Peel
  • India Rainbow/Indus Community Services
  • Peel Addiction Assessment & Research Centre

Authors

Nitali Tagger & David Phillips

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