Product Details

Author Information

Corresponding Author
Andrew Taylor
Canadian Institute for Health Information
Canadian Population Health Initiative
600-495 Richmond Rd
Ottawa, ON K2A 4H6
Canada
p: 613-694-6522
f: 613-241-8120
ataylor@cihi.ca

Authors (listed in order of authorship):
Andrew Taylor
Canadian Institute for Health Information

Emily Maddocks
Canadian Institute for Health Information

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health, Social & Behavioral Sciences, Social Work, Population health, mental health, delinquency, criminal activity

What specific topics does your product address?

Access to health care, Community development, Community engagement, Community health , Health disparities, Health policy, Institutional change , Interdisciplinary collaboration, Mental health, Partnership building , Poverty, Social determinants of health, Prison health

Does your product focus on a specific population(s)?

Adolescents, Children, Prisoners

What methodological approaches were used in the development of your product, or are discussed in your product?

Case-based learning, Community needs assessment, Problem-based learning, Qualitative research, Community-Institutional Partnership

What resource type(s) best describe(s) your product?

Proceedings Report

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

This product documents a Canadian Population Health Initiative (CPHI) workshop, held in collaboration with Alberta Health Services (AHS), which focused on issues related to mental health, delinquency, criminal activity and inter-sectoral collaboration. It was a forum for sharing research and promising practices, and building relationships across different disciplines and sectors. The product summarizes workshop discussions and represents the cross-sectoral consensus reached by participants from varied researcher, practitioner and decision-maker groups. It includes synopses of speaker contributions, and syntheses of points arising from participant dialogue around success stories, challenges and next steps for research, policy and practice.

This product expands on a literature review and original analyses presented in CPHI’s Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity, by recognizing the additional contributions practice-based evidence and experiential community knowledge and expertise can provide. It is intended as a resource for understanding cross-cutting factors and overlap between fields of delinquency prevention, policing and corrections, and mental health service delivery. It acts as a reference for how to engage stakeholders from a variety of fields in consensus-building activities.

Intended audiences include researchers, clinicians, community organizations, non-governmental associations, and different levels of governments, from public health, mental health, child welfare and justice fields.

2. What are the goals of the product?

The overarching goal of the workshop (project) was to foster and promote inter-sectoral collaboration and knowledge exchange to improve the mental health of Canadians, particularly among those involved with or at risk of being involved with the criminal justice system. It was designed to build on the literature review and analyses presented in CPHI’s Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity report, by recognizing the additional contributions practice-based evidence and experiential community knowledge and expertise can provide. The workshop had three main objectives – sharing current research, sharing promising practices and experiences, and providing a networking / relationship-building opportunity for experts across a number of communities.

The product summarizes the workshop events and discussions. There are several goals implied in the development of the product; they include:
1. To demonstrate the potential for cross-sectoral consensus across varied researcher, practitioner and decision-maker groups;
2. To assist people in understanding the cross-cutting factors and overlap between the sometimes separate fields of delinquency, criminal activity, and mental health;
3. To act as a reference for how to engage community experts from a variety of fields in knowledge exchange and consensus-building activities;
4. To illustrate how qualitative approaches can be applied to population health research, evidence and knowledge; and
5. To use multiple forms of practice-based evidence (including both synopses of speaker contributions as well as syntheses of participant dialogue and activities) to identify potential next steps for research, policy and practice, which are common across a number of fields.

3. Who are the intended audiences or expected users of the product?

The intended audiences include workshop participants, researchers, clinicians, community organizations, non-governmental associations, and different levels of governments, from the broad fields of public health, mental health, child welfare, and justice. Audiences may also include individuals interested in techniques for promoting and facilitating dialogue, consensus-making, relationship-building and formal networking.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

To better understand issues discussed in the resource, users will benefit from reviewing the Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity report, which was the basis for the workshop. The report presents a literature review and new analyses to examine:
• Factors related to mental health within various contexts that are linked to youth delinquency in either a protective or risk capacity
• Characteristics of people with mental illness who are hospitalized and have a criminal history, and
• Issues specific to mental illness among individuals involved with the justice system.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

CPHI selected mental health and resilience as one of four themes to guide its work for 2007 to 2012. In so doing, CPHI is building on recently released reports on mental health (for example, The Human Face of Mental Health and Mental Illness in Canada 2006 and Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada), as well as various efforts at the federal level, such as the launch of the Mental Health Commission of Canada.

CPHI has released a series of major analytical reports on mental health and resilience. These reports aim to synthesize key research findings, present new data analysis, and share evidence on what we know and do not know about what works from a policy and program perspective.

Both the workshop (project) and the subsequent proceedings (product) build on Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity. This second report in the series responded to community-identified gaps in knowledge by focusing on groups identified as at particular risk for mental health issues: those involved in delinquency or the criminal justice system.

CPHI’s published reports are one way to present evidence. CPHI does not make policy recommendations, but supports involvement of the community in identifying recommendations and action steps based on evidence that it produces. As such, the goal of the workshop was to engage people working in a variety of fields to address findings from the report, expand on the report content through engagement in practice-based evidence and experiential knowledge from community experts, and discuss how to effectively change research, practice and policies. The proceedings (product) captures this dialogue and allows for another way of presenting evidence and facilitating a wider dissemination of community expertise.

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

Canadian Institute for Health Information. Improving the Health of Canadians: Mental Health and Homelessness. Ottawa: CIHI, 2007.

Canadian Institute for Health Information. Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity. Ottawa: CIHI, 2008.

Government of Canada. The Human Face of Mental Health and Mental Illness in Canada 2006. Ottawa: Minister of Public Works and Government Services Canada, 2006.

The Standing Senate Committee on Social Affairs Science and Technology. Out of the Shadows at Last – Transforming Mental Health, Mental Illness and Addiction Services in Canada. Ottawa: The Senate, 2006.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

Mental health and resilience was identified as a priority area for CPHI through an action planning process that involved interviews with experts in research and decision-making communities and surveys of CPHI-funded researchers. CPHI’s work is guided by a council of researchers and decision-makers from across Canada. In addition, the production of the report series was supported and guided by an expert advisory group as well as peer reviewers made up of representatives from community, research, practice and policy groups. These groups identified important gaps in knowledge that could be addressed by CPHI research, analyses and knowledge exchange activities.

In response to gaps identified through this process, CPHI has produced a report series on mental health, which focused on the determinants of health and the role they play in mental health. The first report was Improving the Health of Canadians: Mental Health and Homelessness in Canada (released 2007), and the third report was Improving the Health of Canadians: Exploring Positive Mental Health (released 2009). The second report, Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity (released 2008), was the basis for the workshop.

Analyses in Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity examined what factors related to mental health within various contexts are linked to youth delinquency in either a protective or risk capacity. It also explored characteristics of people with mental illness who are hospitalized in a mental health bed and have a criminal history, and issues specific to mental illness among individuals involved with the justice system. In addition to a literature review that included available evaluations of policy and programs, two main sources were used in the data analyses to capture different populations and settings. These were the National Longitudinal Survey of Children and Youth (NLSCY Cycle 6 2004/2005) from Statistics Canada, and the Ontario Mental Health Reporting System (OMHRS) from the Canadian Institute for Health Information. Detailed descriptions of variables, analyses and limitations, which underwent external peer review, are available from the CPHI website.

The method for the workshop was developed to obtain qualitative data from community members. Its aim was to showcase practice-based evidence and community knowledge and expertise by highlighting and sharing findings from relevant research and policy developments, as well as providing a forum for developing action plans and discussing next steps. It utilized and adapted methods to generate discussion (evidence) and synthesize findings (analyze information and create new knowledge).

Presentations at the workshop were delivered by community experts who expanded on topics covered in the report, and drew on experiences with and successes from initiatives that take an intersectoral collaborative approach. The workshop also included small group work and plenary discussions, guided by a facilitator. Participants had the opportunity to collaborate in group activities designed to identify challenges and success stories, and to prioritize among opportunities for action.

The workshop brought together researchers, decision makers and practitioners from the fields of mental health, delinquency, and criminal activity. Participants at the workshop brought their experience with research, promising practices, and relationship-building across different disciplines and sectors. As a summary of the presentations and discussions from the workshop, the proceedings reflects the expertise of communities of research, policy and practice.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

The product was prepared by CPHI staff who attended the event. As sources for content, staff utilized information derived from the group work sessions, their own records of the presentations and discussions, and participant records and reflections on each of the working group activity questions. Throughout the workshop, discussions took place in various configurations. The following list outlines the processes used during the workshop to capture the activities and discussion, with the intention of developing the proceedings:
• Staff generated notes of all presentations and panel discussions.
• Participants shared expectations of the event in small groups and then in plenary, where expectations were recorded on chart paper by the facilitator. Participants also completed individual forms regarding their expectations. This exercise was to assist in a more comprehensive write-up that draws on each of their expertise.
• Also in small groups, participants were invited to identify challenges faced in their work and name these on pieces of paper, which were then posted to a larger working surface that could accommodate all participants working together. All participants were then encouraged to work together to re-arrange the contributions and identify common themes. From this activity, participants were able to consolidate their various concerns into nine main categories and subsequently voted on priorities for action among these identified challenges. These written materials formed additional content for the report.
• In an open forum participants were invited to share stories about successes and promising practices, both big and small. These oral contributions were captured in note form by CPHI staff.
• Workshop attendees participated in a World Café Style discussion to identify action steps and practical strategies for addressing issues identified throughout the workshop. World Café Style methodology is a participatory process that involves open and broad conversations (for further information on the principles of this method see - http://www.theworldcafe.com/). Participants started off in small groups addressing the question of potential action steps. They then discussed their findings with another group of participants to share ideas around the room. In the final round, participants reconvened in their original groups to consolidate their ideas and prioritize them based on level of impact and difficulty to implement, before reporting back to the plenary. Written notes from each working group, along with staff notes, captured these discussions for the report.

CPHI staff developed the report in accordance with newly developed standards for quality assurance in qualitative methods, which were intended to ensure the accuracy of the report contents and serve as a reference for similar activities in the future. Synopses of presentations and success stories were created. Challenges and potential action needs were presented as participants had categorized and prioritized them. Success stories were categorized and main themes were drawn out by the authors. Similarly, information from the World Café Style discussion was categorized into several reoccurring themes using basic qualitative content analysis.

A draft report was reviewed by other staff members who were in attendance, as part of institutional review and in preparation for publication. Members of Alberta Health Services, the collaborators in the project, also reviewed the report. In addition, community experts who presented at the workshop were invited to review their contributions, to ensure that their message had been communicated accurately. This aspect of the review would have been informed by the speakers’ professional expertise, the knowledge and experience for which they were identified as a presenter, and also by their participation in the discussions at the workshop. The report was subsequently translated and copy-edited for publication in both English and French.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

The report draws on a range of community expertise in the areas of:
• Data sources and integrating health care and social service planning with data collection and knowledge generation
• Successful programs, policies and initiatives that aim to reduce delinquency in youth, improve and promote mental health and healthy development of children and youth, divert individuals with a mental illness into appropriate treatment and care as opposed to the route of incarceration, and meet the mental health needs of offenders
• Keys for effective intersectoral collaboration across governments, community groups, researchers and service delivery personnel
• Expectations, challenges and action needs as identified by a diverse group of individuals working in different disciplines and sectors in the community to address the issues of mental health, delinquency and criminal activity

Bringing together different areas builds on existing knowledge by sharing success and common issues across jurisdictions, sectors and disciplines. This collaboration values the practical experiential knowledge of community experts and sheds light on some of the practice-based evidence that is not often captured in population health research. This contributes to the communication of needs, priorities and struggles of different groups who often work separately in the community to meet the needs of various populations. The product demonstrates how qualitative methods and techniques can be applied to a population health approach, thus building on an underdeveloped area of knowledge.

The report documents a methodology that can bring together a wide-range of community members for consensus-building and problem-solving. The workshop engaged different community representatives in a range of discussion activities to meet its overall objectives, so this structure and the kinds of activities used can serve as useful tools for those who are attempting to develop similar knowledge exchange and relationship-building activities.

One key action step identified, was the need for participants to take ownership of work accomplished during the workshop, and for them to champion these issues among their colleagues, in their workplaces and activities, and in their communities. The proceedings is a way to follow-up from the event and to remind, encourage and motivate participants to continue in efforts to address issues that were discussed. The proceedings provides direction needed for targeted action that happens as a result of limited resources and time. In addition, it acts as a resource to continue supporting established networks and relationships that either resulted from or were reinforced by the workshop. The proceedings may also be used as a needs assessment and overview of relevant issues.

Evaluations of the workshop indicated positive process-related outcomes, including successful accomplishment of goals and objectives, and satisfaction with organization and delivery. Respondents rated the opportunity for networking and relationship-building as being particularly high. Respondents felt that follow-up should include a summary report, continued educational events and help to facilitate continued connections among the group. Evaluations indicated the workshop influenced respondents priorities, polices and projects by making them more informed, likely to collaborate and share resources, and more motivated to continue their current work.

The proceedings forms part of the reference material for a larger independent evaluation of CPHI for 2007-2012. No other formal evaluations are planned. The potential significance of the proceedings, based on responses from participants during its release, indicate it will continue to build on foundations laid at the workshop by giving researchers, practitioners and policy makers the support they need to develop, strengthen and enhance their activities to support their communities.

10. Please describe why you chose the presentation format you did.

To ensure that points of conversations and general problem-solving activities occurring at the workshop were not lost, CPHI and workshop participants agreed to the production of a proceedings report. The report represents a written record of the event for those involved, but also serves as a resource, which can act as a stand alone information source for better understanding various issues involved in intersectoral collaboration and the links between mental health, delinquency and criminal activity. The report format was considered to be the most appropriate for allowing participants to reflect on the event but also the most accessible way of presenting the information to allow for knowledge exchange and circulation among participants’ colleagues and community contacts.

The report is structured in a way that highlights main points of discussion, while also providing more detailed understanding of participant identified issues. The main sections of the report highlight key findings and priorities as identified by writers, presenters and participants. The appendices allow for a more detailed breakdown of discussions for those who want to engage in more information. The appendices thus provide detailed syntheses of community contributions, while main sections of the report draw out key points reached during consensus-building activities.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

This product represents the benefits of collaboration in addressing issues related to mental health, delinquency and criminal activity, and the potential for consensus when a variety of community representatives are brought together to discuss these issues. It draws on experiences from a number of different disciplines and sectors, and values the broad range of tacit knowledge and lived experience of those community experts. In so doing, the report demonstrates the value of a qualitative approach in the context of population health. The proceedings can be used as a source of practice-based evidence and, in conjunction with the larger Improving the Health of Canadians report, presents a more inclusive discussion of a complex population health issue.

In addition to these strengths, there are a number of limitations as well as potential for growth and improvement. The workshop was a one-time event, thus the proceedings is based on a single point-in-time interpretation of the issues by a specific subset of a broad range of community representatives. In the future it would be useful to have similar events with different community groups as well as follow-up with the representatives who have already participated. Widening our understanding of community experiences and continuing to strengthen networks and relationships across disciplines and sectors could build on the findings of this report and further contribute to existing knowledge in these areas. The documentation of the proceedings is in the form of a report only; there are no additional resources or tools to accompany it or promote the uptake of its findings. There has been no formal evaluation of the relevance of the proceedings report or its usefulness to various community groups. As CPHI moves forward with broader formal evaluations, a better understanding of the impact of products such as this report will be better understood.

Since CPHI is a large institution, community representatives and collaborators offered much feedback throughout the development of the project and product to ensure the inclusion of community expertise and knowledge. Alberta Health Services, a partner in the development of the workshop, provided names of appropriate people to attend the workshop and also offered feedback regarding the agenda and activities. Their contribution ensured that the local community was appropriately represented at the workshop and that activities designed to generate knowledge and evidence were relevant. They also contributed to the revision process, by suggesting changes that more accurately reflected the situation in Alberta and the background behind a number of initiatives in their jurisdiction. Community experts who presented at the workshop were given the opportunity to review their contributions as well the discussions that followed their presentations. Speakers’ feedback included revisions to the report drafts, to more accurately reflect their points of discussion, as well as to better reflect the knowledge generated from working group discussions. Feedback was incorporated into the document by changing synopses as well as some of the synthesis materials for the group work discussions.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

Both the project and product involved a great deal of collaboration that embodied principles of mutual respect, shared work and shared credit. Community engagement involved incorporating contributions of a range of community groups as well, including larger institutions separate from CPHI, such as government, non-governmental organizations, community groups, and individual experts to name only a few. The CPHI Council and Expert Advisory Group shaped the development of the report series on mental health and resilience, and contributed greatly to the development of the larger mental health, delinquency and criminal activity report. In addition, the planning of the workshop following the report was a collaborative process that involved a number of different CIHI departments and staff from Alberta Health Services. Alberta Health Services ensured that appropriate western Canada representation would attend the event and that a variety of different disciplines and sectors were involved.

The actual implementation of the workshop involved welcoming presentations from CPHI and Alberta Health Services to demonstrate the shared efforts of both collaborators. The workshop also included an opening and closing prayer conducted by an Elder from the Tsuu T’ina First Nations community to demonstrate respect and appreciation for peoples indigenous to the region. Throughout the day-and-a-half workshop, participation from various members of research, practice and policy-making communities shared their experiences, concerns and priorities in an atmosphere of mutual respect and openness, and this disclosure forms the main material and content for the proceedings product.

Throughout the report development, Alberta Health Services and community experts from the event were involved in the revision processes, and the retention of their names and titles demonstrates their willingness to champion these issues and to continue the action started at the workshop. Directly recognizing their contributions throughout the report, and providing an appendix outlining the participants who contributed to the report development also demonstrates respect and credit for the knowledge they worked to create.

All speakers who contributed to the presentation material in the proceedings report have been notified of the CES4Health.info submission and each approved CPHI submitting the report in principle. Upon acceptance of the CES4Health.info application, and posting of the proceedings report on this web resource, participants from the workshop will be notified so they can continue in their work to champion issues related to mental health, delinquency and criminal activity and maintain the relationships and networks created through their participation in the report’s development and exchange.