Siu Mee Cheng, MHSc., BASc., CHE
Siu Mee Cheng possesses over 20 years experience in the public, health and social services sectors at the local, provincial and national levels in order to drive services delivery performance, quality and accountability, all with the aim towards improving client/patient care. She has held leadership positions for several governments and agencies including the Governments of Alberta and Ontario and Cancer Care Ontario, and has led not-for-profit organizations including the Ontario Public Health Association and the Toronto Central Palliative Care Network. She is the Executive Director for the Canadian Centre for Accreditation, a national not-for-profit whose mission is to provide excellence and leadership in accreditation by assuring quality and continuous improvement in community-based health and social services. Siu Mee is committed to volunteerism and is Board Director to the Canadian Mothercraft Society whose focus is to support family health and healthy child development, and has previously served on the Boards of The Surrey Place Centre and the Canadian Cancer Society. She has a MHSc in Community Health from University of Toronto, and is a PhD candidate in the Social Policy Studies at Ryerson University with a focus on health and social services integration
Integrated Health and Social Care Initiative within a Canadian Context
She is Chief Executive Officer of CHATS – Community & Home Assistance to Seniors, Christina is an acclaimed public affairs professional and community advocate whose career has included an impressive range of accomplishments that have benefited numerous stakeholder groups and industry sectors. Her unique combination of association leadership positions has contributed to her skills and strength in issues management, government and stakeholder relations, public policy and communications. Christina has served as CEO and a senior executive with a number of organizations, including the Ontario Long Term Care Association, Canadian Association of Chain Drug Stores, Canadian Association for Pharmacy Distribution Management, Consumers Council of Canada, the Ontario Association of Police Services Boards, and Food and Consumer Products Canada. In addition, she served as a Vice President with Patient Care Automation Services Inc., an innovative healthcare technology company, and operated NiceWorks, an independent consulting company. In October, 2014 Christina was elected Ward 7 Councillor for the Town of Newmarket. She serves on the Boards of York Region Human Services Planning Board, Advertising Standards Canada, CARP’s Newmarket-Aurora-East Gwillimbury chapter, and is a member of the Seneca College Non-Profit Leadership and Management Program Advisory Committee. Christina graduated from the University of Toronto with an Honours Bachelor of Arts degree.
Prof. Réjean Hébert, MD MPhil
Dr. Réjean Hébert is Dean of the School of Public Health of the Université de Montréal and Professor in the Department of Health Management, Evaluation and Policy. He was the founding Scientific Director of the of the Institute of Aging of the Canadian Institutes of Health Research. From September 2012 to April 2014, he was Minister of Health and Social Sciences of the province of Québec, Canada.
The 2016 Census indicated that, for the first time, there were more Canadian seniors than there were young Canadians. From a health and social care perspective, this population group faces complex health and social care needs. Integrated health and social care for older adults is an emerging policy and programming trend in Canada, with such initiatives occurring at the community-level, rather than at the system level, except for the province of Quebec. The panel will comprise a discussion on a case definition that was developed to assist in identifying integrated health and social services initiatives in Canada. The case definition was based on a review of literature that identified common characteristics of integrated health and social care initiatives, and eight themes were identified for 20 characteristics: patient-care, program goals, measurement, quality, accountability and responsibility, information sharing, culture and leadership, performance monitoring, and staff and professional interaction. A search of Canadian-based integrated initiatives reveal that such initiatives are at the community-level, and that they tend towards linkage and coordination forms of integration. The aims of these initiatives have been to coordinate services delivery across both the health and the social services delivery partners and/or to enhance communication amongst the partners. Reasons for the slow emergence of this phenomena in Canada include: lack of government policies, the continued existence of silos within Canadian governments on the matter of social and health care issues; and the impact of New Public Management within the social and health care broader public sectors. Despite these contextual challenges, there are examples of integrated health and social care initiatives across Canada. The panel will also showcase Canadian-based examples, including the CHATS initiative, Home At Last, an Aging at Home initiative that seeks to meet the health and social care needs of older adults in Ontario, and is uniquely driven by a social care service provider organization that has established partnerships with its regional health partners to help maintain discharged older adult patients in the home. Quebec’s internationally renowned demonstration project, PRISMA, a coordination integration model comprised of public, private and voluntary health and social service organizations, will also be outlined, including the evaluative results of this project, that was developed to support continuity of care for seniors living at home.
There are many definitions of integrated care and integrated health and social care. Often, these definitions do not account for the contextual issues associated with the countries that are undertaking such initiatives, and so, the meaning of such initiatives vary depending on the initiative under study. A case definition was developed to assist in defining an integrated health and social care initiative. The definition will be used to assist in identifying Canadian-based integrated health and social care initiatives. This definition provides a description of an integrated health and social care initiative, including 20 characteristics that reflect these initiatives, grouped in to eight themes: patient-care, measurement, quality, accountability and responsibility, information sharing, culture and leadership, performance monitoring, and staff and professional interaction.
Because health and social care integration is an emerging policy and programming phenomena in Canada, there are no formal and comprehensive sources or repositories listing such initiatives at a national level. An on-line search of Canadian-based health and social services initiatives was undertaken, in which less than sixteen initiatives were identified on English sites. These initiatives: were being driven at the community-level, rather than at the system level; and tended towards lower degrees of integration, linkage and coordination, with the aim of improving coordination of services delivery across health and the social services delivery partners and/or to enhance communication amongst the partners; and were generally being led or facilitated by partners in the health-care sector, instead of the social care, with exceptions. The initiatives were found in four provinces: British Columbia, Manitoba, Ontario and Quebec, with the majority from Ontario. Reasons for the existing landscape can be tied the policy and government planning and funding landscape in these provinces, including the impact of New Public Management on the publicly-funded not-for-profit services delivery sector in the provinces.
CHATS – Community & Home Assistance to Seniors is a community-based support service organization comprised of over 340 staff and 520 volunteers, supporting the health and well-being of over 8100 seniors and caregivers in York Region, and South Simcoe in the province of Ontario. CHATS has developed an integrated health and social program, Home At Last (HAL) that works with regional health and social care partners to improve seamless services delivery, there by reducing hospital readmissions. It provides home and personal support services that includes providing transitional support for patients that are being discharged from hospital. HAL has four hospital partners, and they provide acute care and discharge planning for patients into the community. CHATs provides home-support: social care coordination (i.e., meals), transportation, medication and medical equipment pickup, grocery shopping, and other activities to support daily living (i.e., advocacy, bathing, banking).
Program of Research to Integrate Services for the Maintenance of Autonomy, PRISMA, is one of Canada’s most renowned integrated health and social services initiatives. PRISMA was implemented in 2001 as a four-year research pilot project to evaluate three integrated services delivery networks in the Estrie region of Quebec: Sherbrooke, Granit, Coaticook. Its goal was to address the lack of continuity of care experienced by seniors with chronic conditions, and is a coordination integration model comprised of public, private and voluntary health and social service organizational. The drivers of the initiative were: inappropriate utilization of costly resources; poor transitions from hospital care into community and home settings; delayed services delivery for seniors; and service needs being defined by providers rather than patients. PRISMA is comprised of a single point of entry; case management; individualized service plans; single assessment instruments; case-mix management systems; and computerized charts. Evaluation of the project was done through a multiple-case study methodology. The outcomes that were identified included: reductions in functional decline; improvements in unmet needs; and patient satisfaction and feelings of empowerment. This initiative was adapted in 2003 by the Government of Quebec into their provincial integrated health and social services policy for older adults, RSIPA.