About this toolkit

This toolkit was created by CPRI to summarize the expertise accumulated after numerous years of working closely with child/youth mental health service providers to support their implementation of the interRAI ChYMH Suite. We have supported over 70 service providers in Ontario using our evidence-based implementation program.

This self-guided resource outlines our four-phase approach to ChYMH Suite implementation, lessons learned, and resources developed along the way. The goals of this toolkit include providing:

  • A useful framework to guide child/youth mental health organizations through ChYMH Suite implementation
  • An overview of key relevant elements of implementation science and change management principles
  • Lessons learned from years of experience with ChYMH Suite implementation
  • Practical resources to support planning and implementation

How to use this toolkit

This toolkit covers three domains of ChYMH Suite implementation: the implementation process, training to support effective use, and using ChYMH Suite data to inform clinical and organizational decision-making. Within the toolkit you will find:

Information to inform and guide implementation decision-making

Brainstorming and self-assessment opportunities

Planning worksheets, templates, and links to other useful resources

Mini case scenarios and “practice wisdom” from CPRI’s extensive experience supporting implementation of the ChYMH Suite

Who should use this toolkit?

This toolkit is designed to be used by staff at organizations who work with children and youth who have an interest in, or who have committed to, implementing the interRAI ChYMH Suite to support service delivery. This includes a broad range of services such as children’s mental health, developmental services, schoolboards, hospitals, child welfare agencies, etc.

Executive leadership will find the toolkit useful for deciding whether or not the ChYMH Suite meets organizational needs, planning implementation, and guiding implementation activities.

Leaders and clinical staff that contribute to the implementation efforts will find the toolkit useful to guide the activities of implementation and to help implementers avoid common pitfalls.

Additionally, all staff at implementing organizations may benefit from the various resources that are provided in the toolkit.

Implementation and the ChYMH suite

Why are implementation best practices important?

You will find that the activities and phases described in this toolkit are based on evidence about implementation best practices.

Research shows that without best practice implementation strategies, interventions in mental health care settings take approximately 15-20 years to even be partially integrated into usual care. With the use of best practice implementation strategies, however, this time can be reduced to 2-4 years.

As you begin to envision what ChYMH Suite implementation might look like at your organization, keep the following principles in mind:

  1. Guidelines and policy alone are ineffective strategies for successful implementation.
  2. Practitioner training alone (regardless of how well thought out or well executed) is ineffective for successful implementation.
  3. Long-term, multilevel implementation strategies are considered the best practice for achieving success.
  4. A successful implementation is the best way to achieve the desired results from the program or practice.

Four stages/phases of implementation

Implementation consists of four overlapping stages. It is best practice to consider each of these stages individually to achieve successful implementation of a practice or program. This aids in the planning, management, and development of the practice to be implemented.

CPRI adapted these stages into an interRAI ChYMH Implementation model where each phase of the model corresponds to one of the four stages of implementation science:

Stage 4: Full Implementation

Characterized by monitoring and managing the implementation drivers, with a focus on fidelity and outcome benchmarks.

Stage 3: Initial Implementation

Requires adjustment of the implementation drivers according to organization needs; deployment of data systems; initiation of improvement cycles; and change management.

Stage 2: Installation

Requires acquiring necessary resources, preparing staff for change, and identifying and preparing the implementation drivers.

Stage 1: Exploration

Consists of assessing how well the new practice might meet the organization’s needs, forming an Implementation Team, and thinking about implementation drivers – the factors known to be related to implementation success (e.g., leadership, training, system changes).

Implementation literature

Phase 4: Sustainability

Focus is on maintaining buy-in, embedding tool use into daily practices, ensuring resource availability, and evaluating and celebrating successes.

Phase 3: Launch and Initial Use

Focus is on supporting staff as they learn, ensuring that the tools are being used clinically, and problem-solving as needed.

Phase 2: Planning

Focus is on putting a solid implem-entation plan in place that includes planning for leadership activities, process mapping, risk management, data use, communication, and training.

Phase 1: Commitment

Focus is on: selecting the right ChYMH tools to meet the organization’s goals and needs; creating the Implementation Team; evaluating readiness.

CPRI’s Adapted Model

Key principles of CPRI’s ChYMH implementation model

  1. Evidence-based and context-specific design is integral for credibility:

    CPRI’s Implementation Model was created by applying principles of change management and implementation science to the unique experience of implementing one or more interRAI ChYMH Suite tools to clinical practice in Ontario’s child/youth mental health sector.

  2. Clinical embedment is paramount.

    The Model reflects a focus on the use of ChYMH Suite tools supporting clinical work first and foremost. At every step of developing supports for implementing organizations we have endeavoured to keep the focus on the question, “How does this help children, youth, and families?” The Implementation Model has been designed to ensure that the ChYMH Suite tools are an integrated part of providing clinical service rather than an add-on that primarily supports data and reporting needs.

  3. Supports for evaluation and evidence-informed decision-making are important:

    Our commitment to evidence-informed decision-making can be seen throughout these resources. One of the major benefits of adopting interRAI ChYMH Suite tools into clinical practice is the way they support evidence-informed decision-making for client care. We have also created resources to support organizations in using their aggregate data to ensure that an ongoing commitment to quality services and program accountability is fulfilled. Lastly, we believe that the implementation process itself should be evaluated.

  4. Implementation is never “done”:

    Movement through the phases of implementation is not always linear. Changes in staffing, funding, leadership, or external pressures can impact best laid plans. Be open to stepping back to an earlier stage to revisit previous decisions within the current context then continue progressing through the stages. Even a positive organizational change such as the addition of a new program or service can warrant revisiting implementation planning activities to ensure the organization stays on track.