Integrated knowledge translation approaches are one way to facilitate knowledge exchange and support the use of research in practice. This paper explores the elements of an integrated knowledge translation approach using the Systems Enhancement Evaluation Initiative (SEEI) as a case study. SEEI was a 4-year project (2005-2009) that explored the impacts of new funding in Ontario's community mental health system. Here, we describe the process, relationships, and challenges of this collaborative research initiative using a building analogy: getting the right people to do the work, designing the architectural blueprints, establishing the structure, and coordinating all facets of the project. We pay particular attention to the associated constraints and benefits when conducting a large-scale multisite evaluation.

In this paper we examine the changes in continuity of care (CoC) likely to be affected by new system investments and the contributing factors. A mixed method approach was used. Decision-makers participated in two rounds of qualitative interviews. A 3-year cross-sectional quantitative data collection approach was used with clients and case managers. A main finding was that new system investments can improve CoC in terms of increased care access. However, it is not clear how other CoC dimensions will be affected. New funding can also have negative consequences related to the service models in which investments are made.

Studies of continuity of care (CoC) have largely been quantitative and have originated outside of Canada. This qualitative study examined CoC using verbatim transcripts of interviews with 45 clients and 22 family members of early intervention or court support programs in Ontario. Data were analyzed drawing on Dewa et al.'s (this volume) conceptualization of CoC, which has orderliness, and temporal and cross-sectional aspects. Our analysis revealed a high degree of convergence in clients' and families' perspectives regarding key features of each of the five dimensions, indicating that indeed all dimensions are important to clients and families.

The present study surveyed police services in Ontario to learn about changes in volume of contacts with persons with mental illness and use of pre-arrest diversion practices between 2003 and 2007, when significant new funding was provided to community mental health services. Participants included 37 municipal services (54% of services serving 92% of provincial population) and the Ontario Provincial Police. Findings indicated a trend of increasing police encounters with persons with mental illness. Police services had a range of diversion practices in place although actual implementation was lower. Some of these practices were implemented after 2005, coinciding with the entry of the new resources, although other system activities during that period also promoted police-mental health system collaboration and pre-arrest diversion. Police service ability to report data improved over the study period, but common reporting practices are lacking. Continuing work to create a provincial standardized database of police-citizen encounter data would facilitate efforts to better understand when and how diversion practices are implemented and with what results.

This study compared communities with three models of crisis service: (a) police as part of a specialized mental health team, (b) mental health worker as part of a specialized police team, and (c) informal relationship between police and mental health crisis service. Rural and urban areas were examined and compared. Data included focus groups and participant observation. Analysis revealed that while all communities valued their crisis services, all identified limitations in responsiveness, access, and systems-related issues. Quick access to psychiatric beds was important to services. Rural communities had no public transportation, and an important police role was safe transportation. In rural communities, mental health workers were generalists because they had to be able to address situations on their own. In urban areas, transportation was more readily available, and more specialization developed among mental health team members.

The province of Ontario, Canada, with a population of 13 million people, has a large Assertive Community Treatment (ACT) program. Despite the large uptake of ACT in Ontario, to date there has been no comprehensive evaluation of the degree to which the model has been successfully implemented. This project assessed the fidelity of 67 ACT teams (85%) in the province using the Dartmouth Assertive Community Treatment Scale. Scores fell in the high fidelity range in the human resources and organizational boundaries domains, and in the medium fidelity range for the nature of services domain. Areas requiring more attention include achievement of higher caseloads; recruitment and retention of staff (specifically vocational, substance abuse, and psychiatry staff); and key areas of recovery, specifically employment and substance abuse.

We evaluated service access and match in Southeastern Ontario following community mental health funding increases using repeated samples drawn before and after the enhancements. Access to care increased by an estimated 12% (350 clients) between 2001 and 2006, but only about a third of clients were appropriately matched to their needed level of care. Service match increased slightly after the funding increases, but changes were non-statistically significant. Almost half of the clients remained underserviced and 20% were overserviced, suggesting that a more targeted and systematic approach to care planning is necessary to shift systemwide resources to client groups who are in the greatest need.

This study assessed the effectiveness of a discharge planning service that was remodelled and relocated from a hospital to community-based setting. The study used a single group program evaluation strategy. In this “in-reach” model, the discharge planner is based with the community service, and visits the hospital daily to meet with all admitted clients to offer discharge services. Through analyses of administrative data and interviews with clients, the study found that readmission rates were 40% lower in the year following the change in service delivery model. This change was statistically significant. Agency partners used the findings to modify their program during the course of the evaluation. Findings will be helpful for other acute care mental health services.

This study presents findings of an evaluation of a community-based crisis service that used systems enhancement funding to modify services. In addition to developing timelier crisis services and increasing mobile capacity, the service adaptations focused on broadening the scope of the crisis service and addressing the follow-up needs of individuals served. While service development was guided by the research and best practice literature, there was little guidance available on how to address the latter two goals. The development of a transitional case management model integrated with crisis services was an innovation in service delivery. The evaluation used existing databases to compare crisis service delivery between two distinct periods (i.e., “old model” vs. “new model”). Study findings suggest that the new model did lead to the expected changes in service utilization patterns, specifically to increased service capacity, greater access to mobile crisis services, improved access to a broader community population, and more appropriate patterns of service delivery with respect to fewer days of crisis service and exit dispositions more consistent with crisis resolution. Rankings of acceptance of the new crisis service by the local service network varied greatly across service sectors, suggesting the need for more strategic community outreach efforts. The findings indicate that policy and funding opportunities within the mental health system need to be flexible and sensitive enough to address emerging issues in the field and to facilitate service innovations.

This paper describes an implementation evaluation of a Court Outreach Program that provides outreach and community-based treatment and support to people with mental illness in the legal system. The paper describes the Court Outreach Program and presents evaluation findings. Program strengths included competent and knowledgeable court outreach staff who contribute to the legal and mental health systems and provide access for clients to a range of community supports and treatments. Challenges included a limited program capacity to serve all potential clients and bottlenecks in the intake/assessment process. Recommendations are made to improve the implementation of the program.

The current study evaluated the outcomes of an outreach program that provides individualized services to people with severe mental illness who are legally involved. Client outcomes included increased community ability and reduced homelessness for a group of 45 clients still receiving services from the program, and increased community ability and diminished severity of mental health symptoms for 50 clients who had been discharged from the program. Only 2 of the 50 discharged clients (4%) were found to be incarcerated at termination; 1 other client (2%) was detained at termination through the Ontario Review Board.