Substance use is a complex issue, with many diverse needs and pathways. There are approximately 32,500 people in the Toronto Central LHIN who need services every year for substance use, and every one of these has a unique story, and a deeply human, individual need. While many of the people needing services and care in the Toronto Central LHIN are being well served by the extremely committed providers within the system, and over the past decade, this community has led multiple innovations to improve services. However, there continue to be significant gaps in access and services. These gaps particularly affect underserved populations, people with no primary care, people with no housing, people with concurrent mental and physical disorders, transitional aged youth (16-23), people from underserved groups, and the “1 and 5%” of the population who are the heaviest users of the health system.
In October 2014, we were retained to design and lead a community-based strategy that would guide the LHIN’s priorities and resource allocation in this sector for the next three years.
The TCLHIN partnered with the University Health Network and treatment services provider Renascent to initiate a community-based engagement process from October 2014 – March 2015. The purpose was to create a client-centred, seamless, accessible system for addictions services in the Toronto Central LHIN that meets diverse needs and creates the best possibilities for recovery for all. This process was a form of action research and community engagement informed by principles of appreciative inquiry and understanding of how to transform complex adaptive systems, based on the principle that when the community can elevate its own knowledge and insight to collaborate, the engagement itself becomes part of the transformation. The expected outcomes of the process were defined as a set of clear, concrete recommendations to guide the LHIN’s decision making for system design and enhancements for this population.
Phase 1: October, 2014: Foundations
Outcomes: Clarity around scope and process and desired impact, crisp understanding of influencing insights and environmental needs, and clarity around relevant community
Phase 2: October – December, 2014: Community Inquiry
Outcomes: Emerging understanding of priorities and potential initiatives as well as the deep strength of the community to enact change; understanding of community need and sense of being under-resourced; emerging understanding that a community that felt quite fragmented and divided on questions such as “abstinence vs. harm reduction” in fact had multiple shared principles.
Our focus became creating a community vision based in these shared aspirations and principles that would enable diverse action that matched clients to different, appropriate services.
Phase 3 (January, 2015)
Outcomes: Creation of initial vision and strategic priorities, along with community guiding principles. This resulted in the elevation of the community as holding a shared, deep desire to collaborate differently on change. (Several people commented that it was the most meaningful strategic conversation they had had as a community ever).
Phase 4 (February – April, 2015)
Outcomes: Finalized articulation of strategy, which included a community vision for the system of substance use supports and services, an agreed upon high level client pathway and map of reformed, integrated network, “Always events” for every client interaction, and 10 strategic recommendations that were directly aligned with community needs, supported by evidence and reflective of emerging insights across the country.
The Transforming Pathways strategy is a direct reflection of our basic approach to engagement, combining lived experience, stories, data and evidence to explore “what would be most meaningful, significant change here in this particular context?” and then emerging with a very concrete, actionable plan in which everyone can see their work. While the community was certainly a source of insight and experience that resulted in a strategy, the process was simultaneously mobilizing the community and building connectivity so that the recommendations could be enacted. While the strategy was led by the LHIN, the community deeply felt that they owned it and are poised to bring it to life.