InFocus
DEFINING
INTEGRATION:
A Best Start Working Paper
Ministry of Children and Youth Services
July 2011
Building an integrated child and family services system in Ontario
InFocus
DEFINING INTEGRATION
Table of Contents
1. Defining Integration
i. Need for a Common Language
1
iii. Examples of Indicators in the Integration Continuum
8
ii. Developing a Shared Language
iv. Key Terms
2. A Pathway to Integration
i. The Maturity Model
3. Moving Forward
i. Shared Language: A Factor for Success
ii. Process Matters
4. Discussion Questions
2
9
10
12
12
13
InFocus
DEFINING INTEGRATION
This is the first paper in a new series of papers called ‘InFocus’ intended to facilitate discussion
around key concepts and support communities as we move toward increased integration of
services for children and families. This paper focuses on the concept of integration and
describes key features of four stages of an integration continuum that will be used to monitor
our progress toward integration of services. The paper also introduces the ‘maturity model’ –
a different way to think about and conceptualize the pathway to integration.
We welcome your feedback. Send us your comments about this paper through
our website, www.BestStart.children.gov.on.ca.
1. DEFINING INTEGRATION
NEED FOR A COMMON LANGUAGE
The concept of building an integrated
services system for children and families, has
been an elusive goal for decades, more
recently advanced by the government’s Best
Start Strategy and further refined by the Early
Learning Advisor’s report ‘With Our Best
Future in Mind’. This goal as resonated with
families, communities and the children’s
services sector. An integrated service system
will allow us to better support children and
families in Ontario by overcoming the
fragmentation that makes it difficult for
parents to navigate the system and access
the services they need.
Integration is a process which brings together
two or more service providers and/or
organizations to respond more effectively to
the diverse needs of the people they serve.
As we build an integrated services system,
integration in Ontario will be the process of
bringing together ALL service providers and
organizations that support children’s healthy
development, into a comprehensive and
seamless services SYSTEM.
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Integration means focusing on the needs of
children, families and the community rather
than on the mandate of a particular agency
or organization. It is a new way of thinking
and planning, that requires communities to
come together to plan and organize,
including consolidating and re-engineering
programs and services as necessary, with a
total focus on the needs of individuals,
families and communities. Through this
community approach to service delivery, the
re-design and delivery of programs and
services will be ‘seamless’ for children and
families.
While a provincial framework will provide
direction and guidance, community-based
integration requires clear and accountable
local leadership that fosters trusting
partnerships. Integration requires
communities to respond to locally-defined
needs with teamwork, open communication
and a willingness to explore the
re-engineering of programs and approaches
to build something “larger than the sum of
its parts”.
InFocus
DEFINING INTEGRATION
1. DEFINING INTEGRATION
DEVELOPING A SHARED LANGUAGE
Integration is understood as a continuum, or a set of ordered stages, that
describe the type and degree of connectedness between programs and
services. The concept of integration was a central part of the ministry’s first
report describing Best Start. Since the release of that first report, communities
across Ontario have taken steps toward integration. Their experiences, and the
advice provided to the ministry through discussions with many different groups,
have contributed to a better understanding of the concept of integration.
This report updates our shared language on the integration continuum by
adding a final stage called “integration” to better define the end-goal of an
integrated service system and better articulate the differences
between collaboration and integration.
Integration Index
Integration Continuum
Addendum to the Implementation
Guidelines for Best Start Networks
(November 2006)
Defining Integration:
A Best Start Working Paper
(July 2011)
AWARENESS
AWARENESS
COMMUNICATION
COORDINATION
COOPERATION
COLLABORATION
COLLABORATION
INTEGRATION
There are four stages in the integration continuum described in this report and
presented in the following table: awareness, coordination, collaboration and
integration. Definitions, a description of the parent’s service experience, key
features and example activities are provided for each stage.
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InFocus
DEFINING INTEGRATION
1. DEFINING INTEGRATION
AWARENESS
Definition
Organizations in the community are aware of others’ programs and services
but they organize their activities based solely on their own mandate and
planning processes. There is the potential for service gaps and/or
duplication of services across organizations.
Parent Service
Experience
Families go to different providers for different types of services. Parents
must complete a registration or intake process with each provider. Service
providers tell them which services are available in the community, but
parents are responsible for identifying the services they need and seeking
out services as they require them. Parents and children often wait to
receive services because of multiple appointments and multiple
assessments.
Key Features
Planning
Organizations plan and deliver programs and services according to their
own mandate and goals.
Delivery
Programs and services are delivered independently.
Access
Referral
Children and families access services by going to the service location(s) of
the organization.
Organizations will tell families about other services in the community if
they required them.
Accountability
Accountability is based on organizations reporting information about service outputs to funders and individual governing bodies.
Data
Management
Information about clients and service use is collected by organizations to
meet their own purposes.
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InFocus
DEFINING INTEGRATION
1. DEFINING INTEGRATION
COORDINATION
Definition
Organizations in the community modify their own service planning to avoid
duplication or to improve links among organizations, using their knowledge
of other services or programs. They maintain a master list of local agencies
and refer families to other agencies as necessary.
Parent Service
Experience
Providers promote early learning and care programs and services delivered
by other agencies. Parents must complete a registration or intake process
with each provider. Providers help parents connect to different services
(for example, providing a phone number, contact name and information
about services), but parents are responsible for making appointments and
seeking out individual services as they require them. Parents and children
often wait to receive services because of multiple appointments and
multiple assessments.
Key Features
Planning
Organizations share information about programs and services and future
plans with other groups, and receive similar information from community
partners, for consideration in individual planning and decision-making
processes.
Delivery
Programs and services are often delivered independently, but may also be
available at the same time/place as other programs and services.
Access
Children and families access services by going to the service location(s) of
the organization.
Referral
Organizations actively refer families to other providers if they require
services and maintain a master list or inventory of other providers to help
facilitate referrals.
Accountability
Data
Management
Accountability is based on organizations reporting information about
service outputs to funders and individual governing bodies.
Information about clients and service use is collected by organizations to
meet their own purposes.
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InFocus
DEFINING INTEGRATION
1. DEFINING INTEGRATION
COLLABORATION
Definition
Some, or all, organizations in the community jointly plan programs and
services and modify their own services as a result of mutual consultations
and advice.
Parent Service
Experience
Parents can recognize that programs and services are better organized in
the community and work more closely together. Some programs/events
provide opportunities to engage with multiple service providers (for
example, a Public Health Nurse at an Ontario Early Years Centre program, a
screening clinic with many different professionals) at the same time.
Key Features
Planning Organizations in the community plan and organize programs and services
together.
Delivery Programs and services are delivered independently, as well as in
combination with programs and services from other organizations when
appropriate.
Access Many programs and services are delivered in common community
locations that are near where children and families live, and may also be
available at the service location(s) of the organization.
Referral Organizations establish common processes to help families access services
across multiple providers.
Accountability Accountability is based on organizations reporting information about
service outputs to funders and individual governing bodies; however,
information is also shared with the community planning group to
evaluate the functioning of the system.
Data Information about clients and service use is collected by organizations to
Management meet their own purposes, some data variables are also collected by all
providers in the community; trends across data from different providers
are analyzed to inform community planning.
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InFocus
DEFINING INTEGRATION
1. DEFINING INTEGRATION
INTEGRATION
Definition
Organizations in the community operate as a single system, under a single
governance and resource umbrella and/or memorandum of understanding
that commits all partners to clear processes for decision-making and
resource allocation. There are common values and philosophies, and
common program policies and practices. Children and families experience
seamless, timely and effective supports which are monitored and improved
through shared outcomes and continuous quality improvement. Some
programs may have been consolidated or re-engineered.
Parent Service
Experience
Families experience seamless service - they do not notice transitions
between programs or service providers. Supports are arranged to meet the
needs of children and families; many supports are available at a location
convenient to families, and parents receive help coordinating services not
available at their preferred location with transportation needs supported as
required.
Integrated Services System
Shared
governance,
accountability,
planning, data
collection, etc
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InFocus
DEFINING INTEGRATION
1. DEFINING INTEGRATION
INTEGRATION continued
Key Features
Planning A representative and/or elected group plans and organizes the system of
programs and services for the community and identifies providers with the
strongest capacity to deliver different components of the system.
Delivery Programs and services are delivered in locations that best meet the needs
of children and families; services are co-located and/or delivered in
combination whenever appropriate.
Access There is “no wrong door” for families - families can enter the system
through any provider and have the same high-quality service experience
regardless of how or where they first encounter the system; the provider
will either deliver the service or broker with another provider for the family
to receive the service.
Referral Providers in the system have shared processes that create a seamless
service experience for families; families receive what they need/want,
when they need it by the provider best qualified to meet the need.
Accountability Organizations that deliver programs and services within the system collect
information about clients and service use that feed into an accountability
framework shared by all providers in the system.
Data Information is collected according to shared data definitions and common
Management outcomes by all providers in the system; data is integrated and/or linked
across providers and analyzed to support future planning and decisionmaking so the system can evolve to address changing needs of the
population and continue to improve child outcomes.
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InFocus
DEFINING INTEGRATION
1. DEFINING INTEGRATION
EXAMPLES OF INDICATORS IN THE INTEGRATION CONTINUUM
AWARENESS COORDINATION COLLABORATION
INTEGRATION
DESIRED END STATE
Community agencies deliver
services under a shared governance
and accountability structure
Create new organizations that
merge agencies delivering
similar program functions
Operational funding is pooled into
a single fund that is distributed
across agencies according to
a community plan
Share a client/case
management data system
across community partners
Share
program space
Contribute funding
to community-led
initiative
Seek input from
partners when
planning programs
Share
professional
development
opportunities
Revise programs and/or
service locations to align
with community plan
Share an
information/referral/
intake phone number
Share administrative and
evaluation data with
community network to
support local planning
Run joint programs
with partners
Maintain a
master list of
local agencies
Refer families
to other
programs and
services
Know who to
contact to get/give
information
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Produce shared
communication
materials
Attend meetings
with staff from
other agencies
Distribute information
about programs/
services to partners
InFocus
DEFINING INTEGRATION
1. DEFINING INTEGRATION
KEY TERMS
Integration means focusing on client and community needs rather than on
the mandate of a particular agency or organization. It means local programs
and services are delivered according to a community plan that is based on
information about the needs of local children and families. It may include the
consolidation of resources, the co-location of different service functions and/
or re-engineering certain existing resources. An integrated services system
means there is “no wrong door” - families can enter the system through any
service provider and receive the supports they want and need.
Seamless Service is one outcome of integration. It means that programs
and services are so well connected that children and families may actually
perceive services as being delivered by one agency, though they may actually
be delivered by multiple agencies. “Seamlessness” is about connecting
services in such a way that transitions between different services disappear.
The Ontario Best Start system will provide a seamless service experience for
families.
Family-centred is an approach to planning, delivering and evaluating
programs and services that puts a focus on engaging, empowering,
respecting, strengthening and supporting families. Key principles are to
respect parents as experts on their child’s needs, to build authentic
relationships with children and families to understand their strengths and
needs, to appreciate that all families have competencies that can be
strengthened, and to be sensitive to cultural, ethnic and socio-economic
diversity
Re-engineering is the fundamental rethinking and redesign of services
and processes to achieve dramatic improvements in outcomes. The key to
effective re-engineering is that organisations look at their programs, services
and processes from a clean slate, and determine the most effective way to
work with other organizations to support the best outcomes for children and
families.
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InFocus
DEFINING INTEGRATION
2. A PATHWAY TO INTEGRATION
THE MATURITY MODEL
The integration continuum provides an
overall framework to understand the stages
that build toward an integrated system. The
continuum model defines and describes the
stages but provides little information about
‘how’ to move forward. The “maturity
model” describes a pathway to transform
child and family services from our current
“silo-ed” service state to a dynamic,
integrated service system that can evolve to
respond to the changing needs of the
population.
SERVICE INTEGRATION: Common outcomes and
system measures are identified and collected by all
providers in the system to monitor and analyze the
effectiveness of the system; the system evolves to
respond to changing needs of the population
SERVICE CHAIN INTEGRATION: Processes are
developed and implemented to provide a seamless
service experience for families across the full spectrum
of programs and services for children and families
PROCESS INTEGRATION: Common processes across service
functions are streamlined (e.g. intake–referral–treatment) to
create a more simplified and timely service experience for families
FUNCTIONAL INTEGRATION: Programs and services delivering similar
functions are evaluated then streamlined and/or re-engineered;
providers may be consolidated and/or re-organized for simplified
access and greater integration with the broader service system
SELF INTEGRATION: Organizations evaluate then streamline and strengthen
their own programs, services and processes in preparation for engaging other
partners
SILO-ED
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InFocus
DEFINING INTEGRATION
2. A PATHWAY TO INTEGRATION
THE MATURITY MODEL
The maturity model describes a step-wise
pathway that can be used to guide planning
and community development processes that
build toward an integrated services system.
The other key feature of the maturity model
is that it begins to describe the on-going
work required once a fully-developed,
integrated service system is achieved. At
this stage of maturity, the child and family
services system is dynamic and can evolve
to meet the changing needs of its
population. To achieve this level, system
managers must collect and monitor
information about the population, service
use and client outcomes across the system,
then continuously adjust programs, services
and processes within the system to respond
to changing needs and support better
outcomes for children and families.
In the maturity model, integration begins
within individual agencies and groups – the
organization must evaluate, streamline and
strengthen its own programs, services and
processes before it is ready to engage with,
and integrate with, other organizations.
Integration then progresses from activities at
the level of organizations, to functions and
processes, building on successive stages to
achieve an integrated system.
Step 5.
System
Integration
Step 4.
Service-Chain
Integration
Step 3.
Process
Integration
Functional
Integration
Step 2.
Step 1.
Self
Integration
Self
Integration
Service-Chain
Integration
Process
Integration
Functional
Integration
Process
Integration
Functional
Integration
Self
Integration
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Self
Integration
Functional
Integration
Self
Integration
InFocus
DEFINING INTEGRATION
3. MOVING FORWARD
SHARED LANGUAGE:
A FACTOR FOR SUCCESS
PROCESS MATTERS
The integration continuum provides an overall
framework to better understand the successive stages
of integration, while the maturity model describes a
systematic process for moving from integration at the
level of the individual organization to a fullydeveloped, integrated and dynamic service system.
By adopting this common understanding and language
across the system, professionals across all sectors and
organizations will be able to work together effectively
to plan and organize services for children and families.
Organizations, service managers and planning groups
are encouraged to take an objective and open view of
how services for children and families are currently
delivered in their community. Many communities still
confuse high levels of coordination and collaboration
with a fully integrated local system. Groups are
encouraged to:
•
•
•
refer to the definitions and the description of the
parent’s service experience in the integration
continuum;
compare their own processes with the example
activities and processes provided in the
continuum; and
refer to the descriptions provided in the maturity
model to determine how far the community has
progressed toward integration.
The same tables and figures can then point to the next
strategies and processes the community can work
toward to continue on the path to integration.
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The integration continuum and
maturity model both describe a
step-wise path to an integrated
service system. Some may ask if it is
possible to skip a stage or two. Can a
community with effective
coordination among agencies, with
strong local leadership and incentives
move to full integration? Or can a
community with isolated agencies skip
over coordination and collaboration
stages and move directly into an
integrated system?
Maybe. But a fully integrated service
system is built on a foundation of
clear, accountable and consistent local
leadership and trusting relationships
among service providers. This suggests
that the process of building toward
integration may also be the product.
There is a natural maturation that
develops as communities move
toward integration that may be
required to establish and maintain a
fully functional and dynamic
integrated service system.
Ontario is building an integrated child
and family services system.
Communities should know where they
are on the integration continuum,
have a clear plan about how they will
move forward that is supported by all
local partners, and continue to take
steps toward stronger integration.
We’ll get there together.
InFocus
DEFINING INTEGRATION
4. DISCUSSION QUESTIONS
One of the most important factors for success in any group initiative is effective
communication. Here are three discussion questions to start the conversation about
integration in your community.
1. Does the definition of ‘integration’ resonate with your community? What should be
added?
2. What is your current level of integration? Are all sectors and agencies at the same
level of integration?
3. What are your next steps to continue moving toward integration? Is there
community consensus for these next steps?
Keys to successful conversations:
•
Create a respectful and trusting group environment by establishing a code of conduct
and having group leaders model good behaviours.
•
Encourage open and frank discussion — ignoring the real issues will not make them go
away.
•
Build on different opinions — people may not always see things the same way but open
discussion of differences helps build understanding.
Tell us! Chances are other communities would benefit from hearing about the tools,
resources and strategies you have used to move toward integration. We are particularly
interested in hearing about:
•
Specific processes or tools you have used to assess your level of integration? Why
would you recommend this process or tool to other communities?
•
Other tools or resources you have used to help the community move toward
integration? Why would you recommend this resource to other communities?
•
Strategies that have been successful in moving community discussions away from
traditional silos and individual interests to a focus on the needs of children and
families?
Send us your feedback through our website, http://BestStart.children.gov.on.ca!
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InFocus
DEFINING INTEGRATION
This report is part of a series of working discussion papers
prepared by the Ministry of Children and Youth Services
as part of the Ontario Best Start Child and Family Centre
initiative. The papers are intended to facilitate discussion
around key concepts and support communities as we move
toward an integrated child and family services system in Ontario.
Other papers in this series are available at the new website for
child and family services professionals at
BestStart.children.gov.on.ca
or by contacting the
Ministry of Children and Youth Services.
We welcome your feedback! Post your comments about this
paper or provide other feedback about the Ontario Best Start
Child and Family Centre initiative through the project
website, BestStart.children.gov.on.ca.
© 2011