Acknowledgements

2. Acknowledgements • The Case Study has been adapted and modified by the EnHANCE Ontario Project. It was originally published through the Canadian Collaborative Mental Health Initiative: Curran, V., Ungar, T., Pauzé, E. (2006). Strengthening Collaboration through Interprofessional Education:  A Resource for Collaborative Mental Health Care Educators. Mississauga, ON: Canadian Collaborative Mental Health Initiative. Available at: www.ccmhi.ca • The EnHANCE Ontario Education Programs have been published in Word and PowerPoint formats to permit for the adaptation of these materials for different educational timeframes, processes, contexts and learners. In the interest of sharing resources and preventing the duplication of work, the project provides permission to individuals to modify the materials, to change the formatting, to use only certain sections, and to add or delete content to suit their needs. Individuals may photocopy, modify and distribute these materials for their use provided that proper attribution is given to the source.

3. Welcome The Case Study Facilitator Guide should be used in conjunction with: • the Leader’s Practice Toolkit, which provides essential background information for both facilitators and participants, and • the Leader’s Facilitator Guide, which provides education program facilitators with the necessary information to plan, implement and evaluate an interprofessional learning program for healthcare students.

4. Meet Gloria • Gloria is a 24 year old First Nations female, who has been an alcoholic for several years. She began drinking when she was 12. She also self-harms by cutting when she is frustrated. • Gloria used to live with her mother and 6 siblings, but recently left home due to conflicts with her mother. Her father, who was also an alcoholic, died when she was 8. • She is currently living in a women’s shelter. 4

5. 1. Care Planning – Roles and Responsibilities • What are the responsibilities of the various organizations in the provision of service to this person and community? • What approaches could be used to manage an ongoing conflict between service providers over administrative requirements (e.g., catchment areas)? • What are the roles of each team member and organization in the provision of care for this client? What can each team member and organization potentially offer this client? • Consider what other team members/individuals/agencies you might involve to meet the care needs of this client. How do you handle these type of care need situations? Have you any policy in this regard? 5

6. Leader/Policy Planner Questions • What is your organization’s mandate and jurisdiction? • Is it clearly stated either formally or informally? • Is it understood and communicated internally? • Is it communicated and stated externally and if so how? • Are your organization’s partners aware of your mandate and jurisdiction? If not how could this be communicated? • Are you aware of your partner organizations’ mandate and jurisdiction? • Are there patient/client populations that your organization often encounters or provides care for who are outside of your mandate? 6

7. Leader/Policy Planner Questions • To whom would you highlight your organization’s mandate limitations? How might you try to revise your organization’s mandate limitations or discovered barriers? Who would you involve in this? • Are there any incentives or disincentives to you and your organization to bring mandate and jurisdiction issues forward? 7

8. 2. Forming a Team • What types of health team members may be of help to this person? What agencies may be able to get involved? • Who is responsible for initiating the interagency referrals and what are the requirements and work in doing so? • How can funding for this person’s medication be obtained and how will you determine who will pay and procure it in a timely fashion? 8

9. Leader/Policy Planner Questions • What bureaucratic requirements are preventing this person from getting care? • Does your organization’s policy assist or impair the ability of providers to meet this person’s needs? • How can leaders, planners and policy makers gain information and feedback on how successfully their policies are upholding the mission, vision, values and objectives of their organization? • Are there any formal or iterative mechanisms for feedback on provider level implementation of policy? • How can leaders and planners respond to this feedback? • What could you do in this case? 9

10. 3. Conflict Resolution • What types of conflict and communication problems can arise between team members in the same or different organizations in this situation? How might you resolve these? • What common inter-organizational barriers exist that might prevent meeting clients’ care needs in your work setting? 10

11. Leader/Policy Planner Questions • Does your organization have qualifying criteria for intake or services? Who determines these? • Do your policies take into account efficiencies and impact on providers or clients such as duplicating intake information and client history? • Can leaders modify or brainstorm better solutions and procedures to overcome structural barriers and support client-centred vs. provider /organization-centred practices? • Can you think of solutions for this case that leaders can implement? 11

12. 4. Communication – Structures, Resources and Culture 1. How can organizations structure communication and resources to meet the needs of this person? 2. Discuss communication, record keeping and information sharing among team members and agencies. How do teams maintain confidentiality amongst each other? 3. Are there any agency or government regulations that can support or impede the provision of care in your organization/partnership? 4. How does Gloria’s culture affect the provider team and agencies’ work in helping her recover? 12

13. Leader/Policy Planner Questions • Does your organization have formal or informal guiding principles? • Do your guiding principles limit collaboration with other organizations? • Are the guiding principles based on any ethnic/spiritual/belief system/ moral or other framework? How were they developed? • How do these principles affect policy and procedures at the provider and client level? Do they support inter-organizational partnerships? • Is diversity, cultural competence and sensitivity explicitly addressed by your organization and you as a leader/ planner? • Are there any legal issues that limit or inform your organization’s guiding principles? 13

14. Leader/Policy Planner Questions • How do organization policies regarding sharing health information affect client care? • What are the medico-legal limitations on confidential information sharing? • What structures can leaders and planners implement within their scope to expedite health information sharing? • What resources does your organization have for health information communication and transfer/ sharing? • Are the resources supported by your information technology (IT)? • Does your IT communicate with your common partner provider groups? • How can leaders and planners assist providers to plan for improved information sharing and interagency communication? 14

15. Leader/Policy Planner Questions (cont’d) • What are the medical-legal limitations on confidential information sharing? • What structures can leaders and planners implement within their scope to expedite health information sharing? • What resources does your organization have for health information communication and transfer/sharing? • Are the resources supported by your information technology (IT)? • Does your IT communicate with your common partner provider groups? • How can leaders and planners assist providers to plan for improved information sharing and inter-organizational communication?

16. 5. Conflict Resolution • Discuss team conflict over the treatment plan and differing mandates of agencies and how to respond to Gloria’s needs and alcohol use. • What framework and guiding principles do organizations bring to the treatment of a client with substance abuse or the treatment of a client that does not follow a care provider or agency’s requirements? • Explain/demonstrate how to resolve the conflict situation when one team member or agency has spoken poorly about another or allegedly done so. 16

17. Leader/Policy Planner Questions • How can leaders address common high conflict client crisis situations? • Are there any developed policies or mechanisms to address gaps after client have fallen between them? • How might your organization’s policies or procedures impact a partner’s services? • Are there ways that leaders can assist their partner organizations in meeting these common services gaps and high acuity inter-organizational service challenges? • How do leaders productively collaborate to resolve conflicts at a leadership level? 17

18. 6. Collaboration • Who in an agency has the responsibility and ability to impact improvements to inter-agency process to meet a client’s needs? How can they go about this? What next steps can Stan and his manager take? • How might the agencies move forward towards inter-agency collaboration agreements? What are the steps and timelines for this process? Who needs to be included in the discussions? 18

19. 6. Collaboration (cont’d) • Are there any guidelines or regulations that can expedite or discourage inter-agency collaboration? How do you work with these? Share your experiences and lessons learned from these inter-agency service/collaboration arrangements from your organization. • Are there any opportunities for shared projects, policy, research or funding submissions between the agencies? Who could lead this and what steps could be taken? Can you share any of your experience with joint agency projects and lessons learned about the process? 19

20. Leader/Policy Planner Questions • How does organizational policy and leadership affect provider recruitment, retention and engagement? • How can organization leaders facilitate productive and improved collaborative relationships among front line staff intra- and inter-organizationally? • What is your experience in collaborative relationship development with partners? • How can leaders develop policy and their own skills to coach others in collaborative relationship development? • How would leaders begin the process of developing a memorandum of understanding for a joint service agreement? • What are your experiences with inter-organizational service agreements? • For this case who could be part of a Memorandum of Understanding for joint services for this client? 20

21. Leader/Policy Planner Questions • What is the role of your organization’s board of directors or governance in developing policy or mechanisms for inter-organizational collaboration? • Who and how do you engage, communicate and liaise with regarding your organization’s governance? • What structures are in place to support communication between your partner organizations’ governance? • Do you engage in collaborative inter-organizational reviews of mandates and policies with your partners to look at overlap or gaps in roles? 21

22. 7. Clients/Families and Caregivers– Roles and Perspectives • What is the client’s role in her recovery? • How can the team help with a support network and family relationships? • Can the team offer any support to family members? • How would a team or agency manage a team member or agency whose value system may preclude him/her/them from working with a client due to personal, racial or stereotypical prejudicial beliefs or different philosophical mandates? 22

23. Leader/Policy Planner Questions • What is the client’s role in collaborating with your organization? • Do you have a policy for client accountabilities? • Do you have a policy or mechanism in place if a client does not collaborate with your organization? • Do leaders or policy makers review and share success stories of inter-organizational collaboration? • Do leaders or policy planners reward inter-organizational collaboration and shift incentives to enhance future collaboration? • How can groups demonstrate and sustain the benefits of their collaboration? • How can groups integrate the sharing of organizational success with front line providers, clients and the community as they develop partnerships? 23