Championing Innovation and Culture-Competency through Quality ImprovementGregory Di Marino Ashley HogueEuodia Leung Hannah Matthews

Canadian Mental Health Association, Ontario DivisionCanadian Mental Health Association, York and South Simcoe BranchApril 1, 2019

Funded by the Government of OntarioFunded by the Government of Ontario

BounceBack:Championing Innovation and Culture-Competency through Quality Improvement

Agenda

1. BounceBack program overview

2. Quality Improvement to champion:

a. E-QIP BounceBack ON's Experience

b. Cultural competency

BounceBack: Program Overview

BounceBack:Offers two types of service

BounceBack telephone coaching and workbooks (referral required)

BounceBack Today online videos/DVDs(no referral required)

1

2

BounceBack:Telephone coaching & workbooks

Telephone coaching using skill-building workbooks:

• Access to the program is by referral primarily through a family doctor, nurse practitioner, psychiatrist, or client self-referral

• Coaches are extensively trained in the BounceBack program and are overseen by clinical psychologists

• Together, the coaches and clients select from 20 workbook topics that are most relevant to the clients’ current needs

• During 3-6 telephone sessions, the coaches motivate and support clients in working through the self-help workbooks at their pace

• Telephone coaching and workbooks are available in multiple languages

BounceBack:Online videos

BounceBack Today online video series:

• Offers practical tips on managing mood, sleeping better, building confidence, increasing activity, problem solving, healthy living

• Engaging narratives by real people with lived experience

• Can be used as a stand-alone resource, or while waiting to be contacted by our staff after a coaching referral

• Available in English and French, Mandarin, Cantonese, Punjabi, Arabic, and Farsi

Watch videos at:bouncebackvideo.ca(access code: bbtodayon)

Referral form can be accessed or submitted online at: bouncebackontario.ca

Suitable for clients:• 15 years or older• With mild to moderate depression (PHQ-9) score

between 0-21 (with or without anxiety)• Not at risk to harm self or others• Not significantly misusing alcohol or drugs• With no personality disorder and no psychosis or manic

episodes within the past 6 months• With sufficient concentration and motivation to

engage in the program

For telephone coaching + workbooks (referral required)For online videos (referral not required)

BounceBack:How to refer

Excellence in Quality Improvement (E-QIP): BounceBack QI Journey

E-QIP: BounceBack ON – Focus on Client RetentionIdentifying the problem and the aim

Problem statement: # of BounceBack participants referred to the program that are unreachable/not completing sessions after first assessment.

Aim statement: Increase the number of BounceBack Ontario program participants who are completing their telephone coaching sessions.

E-QIP: BounceBack ON – Focus on Client Retention

Data collection through:• Fishbone Diagram (staff voice)• Baseline Data• Experience Survey (participant &

referral source voice)• 5 Whys

E-QIP: BounceBack ON – Focus on Client RetentionFishbone Diagram

Example 1: Fishbone Diagram

E-QIP: BounceBack ON – Focus on Client Retention5 Whys

Exercise 2: 5 Whys

PROBLEM STATEMENT

Why?

Why?

Why?

Why?

Why?

DATE PRESENTATION NAME 13

Change Ideas

Impact-Effort ChartPareto Chart

Driver Diagram

PDSA Cycle!

E-QIP: BounceBack ON – Focus on Client RetentionDiagnostic journey

DATE PRESENTATION NAME 14

E-QIP: BounceBack ON – Focus on Client RetentionPDSA Cycle

E-QIP: BounceBack ONLesson’s Learned and Recommendations for providers

Lessons Learned• Participation in QI training

• Get familiar with the tools• Utilize the QI Coaching early in the process• Important to listen to the Participant Voice• Tailor Communication to:

• All members of the management team• The full service delivery team

Quality Improvement:Cultural competency

Cultural Competency:Steps for quality improvement

1. Why we want to improve cultural competency for the BounceBack program service delivery

2. How we are adapting service delivery

3. Lessons learned

What are the top 5 unofficial languages spoken in Ontario?

1. Chinese - 1,235,805 combined

2. Punjabi - 568,375

3. Spanish - 553,495

4. Tagalog - 525,375

5. Arabic - 514,200

Did you know?

(2016 Census – CBC, 2017)

Ontario has the most culturally diverse population in Canada.

More than 1 in 4residents were born outside the country.

Cultural Competency: Why?

“When English or French is not one’s mother tongue, the ability to convey intended meaning, understand instructions, read prescriptions and understand medical terms (jargon) in either of those languages is more difficult. Language proficiency is a major barrier for some members of IRER (Immigrant, Refugee, Ethno-cultural and Racialized Populations) populations and not only for recent immigrants and refugees. For anyone seeking help, it is extremely important that they be able to communicate in their language of choice.”

Cultural Competency: Why?

• Cultural competency goes beyond language translation

• Plan for a service that meets the diverse needs of residents in Ontario

• Includes recruiting staff that represent this diversity

Cultural Competency: How?Training

CMHA Cultural Competency Strategy

Multi-lingual forum

Role playing practice

Specific cultural competency training• Indigenous cultural safety training• 2SLGBTQ+ competency (gender

identification)

Experiential learning

Cultural Competency: How?Adapting Materials Linguistically and Culturally

Ensure terms and content are culturally-pertinent –both in text, format and images used.

Cultural Competency: How?Adapting Materials Linguistically and Culturally

Example: Chinese Translation of materials

• Cantonese and Mandarin speakers from multiple countries

• Different written formats of Chinese:• Traditional Chinese• Simplified Chinese

Cultural Competency: How?Adapting Materials Linguistically and Culturally

Broccoli vs. Bitter Melon

Culture-Competency: How?Team Dynamic and Culture

• Recognize that there is diversity in workplace customs

• Be self-aware of personal cultural biases or etiquettes

• Live out our organization’s value by learning and sharing

Cultural Competency: Lessons LearnedIntake

Using a client’s preferred name

Asking about gender identity and preferred pronouns

Prioritizing languages by asking clients what languages they speak and/or prefer to speak

Cultural Competency: Lessons LearnedRisk assessment and safety planning

When administering standardized questionnaires such as PHQ-9:

• Some sensitive questions may trigger different responses or questions depending on an individual’s socio-cultural backgrounds.

When surveying for risk factors:

• Identify the difference between actual comments referring to risk and idioms/sayings that compare tough situations but do not necessarily mean there is a risk to a participant’s safety

Cultural Competency: Lessons LearnedRisk assessment and safety planning

Self-Soothing Activities

• Religious practices

• Cultural practices

Breaking down stigma with empathy

Multi-language mental health resources

Translating the word ‘Extreme’ in

Arabic for “Extreme and

Unhelpful Thinking” workbook

Cultural Competency: Lessons LearnedAdapting Materials Linguistically and Culturally

Promotional materials

should reflect:

• Language availability

• Audience diversity:

• Ethnicity

• Gender

• Age

Cultural Competency: Lessons LearnedAdapting Materials Linguistically and Culturally

Acknowledging bias and assumptions

Breaking down stigma with empathy

Fostering independence for clients

Cultural Competency:Recommendations for providers

BounceBack:Who to contact

For more information on BounceBack or to access the referral form or resource materials:Visit: bouncebackontario.ca

Questions about telephone coaching or referral form:Contact BounceBack team at: 1 (866) 345-0224

Questions related to marketing opportunities:Contact BounceBack engagement coordinators at: bounceback@ontario.cmha.ca

Thank you! Any questions?