Transition to Single Plan of Care and Research Study Backgrounder
- What is Children's Treatment Network?
- Transition to Single Plan of Care System - An Overview
- Research Study Information
What is Children's Treatment Network?
- In response to the need to provide more services closer to home to support kids with multiple disabilities, service providers in Simcoe and York have joined together to form Children's Treatment Network.
- The Network is a new service delivery model that links existing service providers so they can take a team approach to each child's care. Through one point of contact, the Network will provide a single plan of care and coordinate services from many agencies for children and youth from birth to age 19 who have special physical, developmental and communication needs.
- Network partners include over 40 healthcare, education, recreation and social services organizations that serve over 4,500 kids with multiple disabilities in Simcoe and York.
- Since the Network was officially launched one year ago, Network partners have expanded and added services critically needed in the community. They have also created the new "single plan of care" tools, systems and processes that are needed to provide kids and families with intensive coordinated and integrated rehabilitation and support services.
- Over the next 3 years, all children with multiple disabilities in Simcoe and York will transition into the new single plan of care system. This new system includes developing an integrated care plan for each child, coordinating services and monitoring each child's progress through all the phases of their development through the use of a shared electronic record.
Transition to Single Plan of Care System - An Overview
- There are approximately 4,500 kids and families to be transitioned into the new system. In order to ensure an effective transition for each child while managing resources, capacity to provide services, waitlists and equitable access to services, there will be waves or groups of children and families scheduled to transition into the single plan of care system over the next 3 years.
- The first group to transition consists of 300 families participating in a special research study conducted by McMaster University. The study will help evaluate which families and children most benefit from intensive integrated care and measure effectiveness of the new system. All families participating in the research study will be confirmed by October 1st and will transition into the single plan of care system throughout the fall of 2007.
- Network partners are currently developing the process and tools for prioritizing the remaining 4,200 kids and families who will transition over the next 3 years. This will involve a systematic approach as well as Network partners working together to identify high-priority, at-risk kids and families in complex situations where the need for intensive coordinated care is urgent.
- The prioritization process will be developed by the end of September. Detailed information will be distributed to all Network partners so that work can begin on identifying the next wave of children to transition into the single plan of care system. Transition information will also be posted on the Children's Treatment Network website.
Rehab Transfers
- As a temporary measure, approximately 500 children have been receiving rehab services over the last 18 months funded by Children's Treatment Network and provided by the community care access centres (CCACs). During that period, the Network contracted with some Network partners to add over 80 rehab professionals to their staff and build more service capacity into the community.
- With this recruitment drive almost complete, some of the children whose rehab services were provided by the CCACs will now receive those services from other Network partner organizations. For some families, this could mean a shift to a new therapist. These children are also included in the 4,500 kids to be transitioned into the single plan of care system over the next 3 years.
Training front line professionals on new single plan of care tools and systems
- Some Network partner staff have already been trained in single plan of care processes, tools and software, including the shared electronic record. Training sessions will continue to be held for all remaining Network partner staff. These sessions will be scheduled in concert with the waves of children transitioning to the single plan of care system and will be conducted in agency or local team groups.
- Single Plan of Care SuperUsers, consisting of staff from Network agencies, will provide ongoing user support to Network staff on a day-to-day basis. If you are interested in being a SuperUser or scheduling a training session, contact Rhonda Jacobson (
) at 1-877-719-4795 Ext 2382.
Research Study Information
- Parents and the children's services community strongly believe that this integrated system is necessary to improve outcomes for some kids with special needs. Given this is the only model of its kind, the Network is conducting a research study to fine tune the new single plan of care system and tools and to evaluate which families and children most benefit from intensive integrated care. The research is being conducted by McMaster University.
- While all families are waiting to transition to the new system, 600 families are being asked to participate in this special research project which will be conducted throughout the next 3 years. All of these families will continue to access the full range of rehabilitation and support services provided by all Network partners, including case management.
- Half of the research group will be randomly assigned into the single plan of care system, where a service coordinator and their child and family team will use a shared electronic record to develop and coordinate a single plan of care. These 300 families are the first to transition into the new system and may have faster access to assessment services, as part of the integrated care plan development process.
- All families participating in the research study will have equal access to all other treatment services and will experience the same wait times, where there is a wait list for services.
- Once a year, members of the McMaster research team will conduct a telephone interview with each family to evaluate service, coordination levels and effectiveness from their perspective. Each family will receive a $25 Wal-Mart gift certificate after each interview as thanks for their participation.
- Results of the research will help guide Network partners to identify situations where more intensive coordination significantly improves outcomes for the child, the family and the system. Research findings will also help inform policy makers about the benefits of an integrated Network approach for children with special needs in other communities.
Continuing to provide service during the transition
While transition to single plan of care takes place, the Network and its partners will continue to support all kids by providing the full range of services currently available, which includes existing case management, rehabilitation and new specialty services being introduced into the community.
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During the transition period, an electronic record will be created for each child and parents will be advised as this occurs.
- The new single plan of care system cannot eliminate waitlists. However, the Network will continue to expand services in the community and manage wait times, based on priority needs.
For more information on the Research Study or transition to the single plan of care system, please contact Children's Treatment Network of Simcoe York at