The search for excellence in social services

1. Presented by Mr. Jean-Pierre Duplantie, Ph.D. Social Service Administration Contribution : Pierre Dagenais, MD, Ph.D., Deputy Scientific Director, AETMIS The search for excellence in social services

2. Content : • Organization of services • Canadian context • Provincial organization of services • Search for excellence in social services • Mandate of INESSS with regards to social services • Response to the three questions raised for the international seminar

3. Organization of services

4. Comprehensiveness Universality Portability Accessibility Public administration Canadian context • The Canada Health Act sets 5 criteria to share funding with the provinces and territories

5. Provincial organization of services • The organization and delivery of health and social services: A provincial responsibility • In Quebec: From an organizational point of view, Health and Social Services are integrated

6. Department of Health and Social Services 16 Regional Agencies of Health and Social Services Local and regional establishments Regional specialized centers Local centers for Health and Social Services

7. Department of Health and Social Services • Manages the organization of services • Sets priorities, objectives, and orientations and ensure their application • Establishes policies and ensure follow up by Regional Agencies • Provides budget allocation to the regions, based on equity and priorities • Coordinates the National Public Health Program

8. Regional Agencies of Health and Social Services • Organization of services on their territory • Development and coordination of services • Budget allocation • Planning of human resources • Access to specialized services • Delivery of public health services

9. Local centers for health and social services • Network approach which includes doctors’ private offices as well as community organizations through contract’s agreement • Continuity of services enhanced by the merger of local health and social service centers • Long term care centers (nursing homes) • And in most territories, hospital

10. Regional specialized centers • Youth protection and young offenders services • Rehabilitation centers for persons with: • an intellectual disability • a physical disability • dependency problems (alcohol, drugs, games) • Mental health hospitals • University hospitals who, in addition to their regional mandate, have to ensure the coverage of other regions Note: The institutions are closely linked to the programs defined by the Department

11. Program structure • Populational Programs • Public health • General health and social services including community interventions • Programs aimed at specific patients' groups • Services for frail elderly • Specialized youth services (child protection and young offenders services, including families) • Rehabilitation services for persons with: - a physical disability - an intellectual disability - dependency problems • Services for persons with: - mental health problems - physical problems

12. Search for excellence in social services

13. Social services  • Psychosocial, psychological, rehabilitation and educational interventions • Home care, mutual aid interventions and broker services • Foster homes, group homes, institutional services • Community interventions • Interventions to improve legislations (education, social security, environment, housing, public health, health and social services...).

14. Services aimed at: • preventing, treating or repairing problems; • supporting individuals, families, communities; • protecting and insuring rights; • maintaining and enhancing abilities; • supporting integration in professional and social life.

15. Commission on Health and Social Services - Concerns expressed • Lack of supervision for interveners • Absence of practice evaluation • Applied research desperately under developed • Absence of collaboration between university researchers and interveners in the field

16. Commission on Health and Social Services -Recommendations • Importance of developing concern for quality of services in the social field • Development of applied research aimed at enhancing interventions and optimizing means of helping clients

17. Response -Establishments’ Association • Role before the 2000-2001 reform: • Lobbies competing for budget

18. Response -Establishments’ Association • New role: • Lobbies for recognition of the needs of specific patients’ groups and standards of practice; • Advise on legislation and Departmental policies or programs; • A place for debate on policies, processes, practices; • A place for development of guidelines for practice.

19. Response -Establishments’ Association • E.g. of guides or guidelines: • for psychosocial practice in context of home care for elders; • for risk assessment of psychological mistreatment of children; • for evaluation of parental abilities; • for withdrawal of children from their home and placement.

20. Guidelines have mainly been the result of long term experience and set of social values. In recent years, they have been influenced by more rigorous review of literature and by program or practice evaluation.

21. Response -Establishments • Concerns for: • quality of service and good practice • development of program • professional development

22. Response -Accreditation bodies • Now, a legal obligation to be accredited • has created: • Ongoing concern for quality enhancement; • Participation of all personnel from all departments and all levels of managers in the decision-making process; • Self-evaluation oriented towards results; • Enforcement of legislation and rules set by government; • Partnership built with establishments and community organizations which have a complementary role.

23. Response -Other bodies or mechanisms responsible for quality of services • Department’s inspection • Commission on Human Rights and Youth Protection • Ombudsman • Commissioner responsible for complaints (in each establishment) • Professional orders

24. Response -University affiliated social establishments • A university affiliated social services establishment is an establishment responsible for the delivery of social services with a university mandate. It has an affiliation with one or more universities but is legally independent from them. • The first university affiliated social service establishment was created in 1995.

25. Mandate • As a University institution, an establishment must: • have developed a research program recognized by funding institutions; • have a contract with a university recognizing the establishment as a milieu for students’ field practice and research, and; • be involved in the development of specific area of practice (pratique de pointe). • Important expectation: the research program has to be closely linked to the services offered by the establishment in order to have an impact on practice.

26. Areas of concern • Youth (violence) • Persons with a physical disability (social participation) • Persons with an intellectual disability • Persons with dependency problems • First line health and social services specific mandates (services to elderly, services to immigrants, poverty, proximity) • Elders in lost of autonomy • Mental health

27. Impact in the social field • Development of partnership between universities and establishments • Development of a culture of evaluation. Practitioners and managers have become opened to the evaluation of their practice.

28. Impact in the social field • Implementation of activities related to development of knowledge and knowledge transfer. • Development of the will to experiment (multitude of intervention projects, studies, and evaluations). • Development of the field practice “milieux” which are recognized as settings of best practice that is offering great learning opportunities.

29. Impact in the social field • Development of a research culture in establishments • Formal research structure with a scientific director, usually a university professor paid by the university and the establishment • Team of researchers • Research programs • Contribution of managers and interveners in defining research needs • Research program adopted by the establishments’ Board of Directors

30. The development of university establishments, the mandates of the different organizations in regards to quality of services (establishments, associations, accreditation bodies) and the numerous bodies created to supervise and examine the quality of services demonstrate the extent to which quality of services has become a major issue.

31. Mandate of INESSS in regards to Social Services

32. Mandate As for Health, contribute to services: • Quality; • Efficiency and effectiveness; • Standardization.

33. In the Social Services field, it should more specifically: • Ensure the development of guidelines for interventions based on scientific data in collaboration with university establishments, associations of establishments and professional orders; • To monitor new or emerging social problems, approaches or interventions to deal with social problems; • Review the social services offered by the public systems and make recommendations especially concerning its appropriateness and intensity; • Contribute to the evaluation of programs and interventions; • Contribute to knowledge transfer and to the implementation of new knowledge in programs and social service practice in establishments.

34. Response to the three questions raised for the International Seminar

35. International Seminar : Good practice Is there a sufficient robust evidence base to identify good practice? Much progress has been done over the past 20 years in the development of evidence-based practice. Social sciences are relatively new.

36. International Seminar : Good practice Is there a sufficient robust evidence base to identify good practice? Guides for identifying good practice are currently based on: Years of experience in dealing with some specific problems, on social values, on economic context, Increasingly on review of research and literature for specific problems and on how to intervene in regards to those specific problems, As well as on evaluative research of specific area of practice (but it is emerging).

37. International Seminar : Good practice What are the political issues that need to be addressed in developing good practice? In Quebec, concerns are related to the development of good practice and quality of services because of: Economic reasons (cost of services, efficiency of services) Political reasons (accountability of politicians in regards to quality of services, questions at the national assembly); High expectations of the population.

38. International Seminar : Good practice Examples Obligation for all establishments to be accredited every three years; Mechanisms to ensure that framework, guidelines, policies are implemented by establishments (unannounced or last minute Departmental visits in foster homes, rehabilitation centers, homes for the aged); Development of recognition process.

39. International Seminar : Good practice In general, studies demonstrate that the population is satisfied with the services they receive. The area of dissatisfaction involves the access and the waiting periods to obtain the services.

40. International Seminar : Good practice • Practitioners are stimulated by projects for good practice. • Just as the development (financing) of social services remain an issue, defining and obtaining proper level of financing for research is an important issue. It relates to the status of social services in our society. 

41. International Seminar : Good practice International collaboration is always important. It offers basis of comparison, benchmark and therefore helps in questioning practice and conditions for good practice.

42. International Seminar : Good practice What are the practical delivery mechanisms to promote the adoption of good practice? • Legislation that states: • The rights of the population • The obligation: • to have a written service plan for each client; • that the client participates to the definition of his (or her) service plan; • for each public establishment to be accredited every three years.

43. International Seminar : Good practice What are the practical delivery mechanisms to promote the adoption of good practice? (continued) • Development of guidelines or framework for good practice: • A special contribution comes from the creation of university establishments. It fosters a culture of knowledge, research and practice evaluation in establishments. • The creation of the National Institute for Excellence in Health and Social services (INESSS) is welcomed by social establishments and should offer great support in the development of evidence-based social service practice.

44. International Seminar : Good practice Agence d’évaluation des technologies et des modes d’intervention en santé2021, avenue Union, bureau 10.083Montréal (Québec) H3A 2S9 www.aetmis.gouv.qc.ca