The search for excellence in social services

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The search for excellence in social services

• Presented by Mr. Jean-Pierre Duplantie, Ph.D.
  Social Service Administration
• Contribution Pierre Dagenais, MD, Ph.D.,
• Deputy Scientific Director, AETMIS

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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

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Organization of services
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Canadian context

• The Canada Health Act sets 5 criteria to share
  funding with the provinces and territories

• Comprehensiveness
• Universality
• Portability
• Accessibility
• Public administration

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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

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

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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

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Local centers for health and social services

• Network approach which includes doctors private
  offices as well as community organizations
  through contracts 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

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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

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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

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Search for excellence in social services
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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...).

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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.

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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

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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

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Response -Establishments Association

• Role before the 2000-2001 reform
• Lobbies competing for budget

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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.

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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.

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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.
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Response -Establishments

• Concerns for
• quality of service and good practice
• development of program
• professional development

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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.

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Response -Other bodies or mechanisms
responsible for quality of services

• Departments inspection
• Commission on Human Rights and Youth Protection
• Ombudsman
• Commissioner responsible for complaints (in each
  establishment)
• Professional orders

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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.

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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.

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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

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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.

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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.

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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

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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.
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Mandate of INESSS in regards to Social Services
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Mandate

• As for Health, contribute to services
• Quality
• Efficiency and effectiveness
• Standardization.

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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.

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Response to the three questions raised for the
International Seminar
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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.

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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).

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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.

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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.

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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.
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• 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. 

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

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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.

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Agence dévaluation des technologies et des modes
dintervention en santé2021, avenue Union,
bureau 10.083Montréal (Québec) H3A 2S9
www.aetmis.gouv.qc.ca