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CFPC Conflict of Interest Presenter Disclosure Presenters: Uppala Chandrasekera, Marg Connor, Rachel Solomon Relationships to commercial interests: N...
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CFPC Conflict of Interest

Presenter Disclosure Presenters: Uppala Chandrasekera, Marg Connor, Rachel Solomon Relationships to commercial interests: None

Data and Performance Measurement in Ontario’s Mental Health and Addictions Sector

Association of Ontario Health Centres Conference June 8, 2016 An Initiative of Ontario’s Mental Health & Addictions Leadership Advisory Council

Overview of Ontario's Mental Health & Addictions Leadership Advisory Council

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Ontario’s Mental Health and Addictions Strategy (2011-2021): Overview •

Launched in 2011, Open Minds, Healthy Minds is Ontario’s comprehensive mental health and addictions strategy, which aims to address systemic issues.



Strategy vision statement: Every Ontarian enjoys good mental health and well-being throughout their lifetime, and all Ontarians with mental illness or addictions can recover and participate in welcoming, supportive communities.



The Strategy is divided into two phases:

Phase 1: 2011 -2021 • • •

Led by MCYS. Focused on children and youth mental health. Ongoing transformation in children and youth mental health system

Phase 2: 2014 - 2021 • • •

Led by MOHLTC. Supported by MH&A Leadership Advisory Council (2014-2017) Expands scope and focus to include adults, transitional aged youth, and addictions

2012: Action Plan for Health Care  2015: Patients First 4

Phase 1 Accomplishments

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Moving On Mental Health (MOMH)

Lead by MCYS, MOMH is a key step in continuing the transformation of the child and youth mental health system. We are accomplishing this system change by:

 Establishing lead agencies for every community – with responsibility for planning and delivery of services;  Defining core services;  Creating and supporting pathways to care;  Developing a transparent, equitable funding model; and  Putting in place appropriate legislative/regulatory/ accountability tools.

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Ontario’s MH&A Strategy: Phase 2 Objectives and Priorities Phase 2 of the Strategy is guided by five strategic pillars for action: Open Minds, Health Minds Vision: Every Ontarian enjoys good mental health and well-being throughout their lifetime, and all Ontarians with mental illness or addictions can recover and participate in welcoming, supportive communities

By 2020, the strategy will support the following outcomes: • • • •

Better service experiences for people and their families Improved access to services More people stably housed Fewer avoidable hospital admissions or readmissions





More people identified and • served through integrated primary care and community • services Reduced reliance on emergency • departments

Improved transitions of youth to • adult system • More people receiving evidencebased programs More students graduating high school

Reduced absenteeism at work More people feel safe, engaged and supported at work

Phase 2: Strategic Pillars Pillar 1:

Pillar 2:

Pillar 3:

Promote resiliency & well-being in Ontarians

Ensure early identification and intervention

Expand housing, employment supports & diversion and transitions from the justice system

Pillar 4:

Pillar 5:

Right service, right time, right place

Fund based on need and quality

Integrated system planning and system accountability: Establish and strengthen the critical functions of provincial quality, oversight and accountability of mental health and addictions services 7

Phase 2: MH&A Leadership Advisory Council

• Appointed by the Minister of Health and Long-Term Care in November, 2014 for a threeyear mandate. • The members of the Council represent diverse sectors that work on mental health and addictions issues. • The Council meets 3 times per year and is supported by a Secretariat from the Ministry.

People with Lived Experience

Housing

Community Mental Health

Community Addictions THE COUNCIL

Hospital

Local Health Integration Networks Caregivers/ Families

Primary Care

A Multi-Sectoral Advisory Body

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MH&A Leadership Advisory Council 2015 Annual Report

Better Mental Health Means Better Health (2015) •

The first annual report of the Council



Released on December 16, 2015



Outlines the Council’s first year of work and identifies:



Key challenges with the current system of services and supports



Five priorities the Council is working on to overcome these challenges and drive transformation



Some initial advice to government on items that the Council unanimously believes require immediate attention

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MH&A Leadership Advisory Council 2015 Annual Report Recommendations 1 Make it easier for young people to transition from youth to adult mental health and addictions services and supports

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• • •

MCYS-MOHLTC Directors established a work group Undertake baseline exercise with SWOT and Gap Analysis, incl. transition models and input from stakeholders Options analysis to support informed policy discussions

Expect the same focus on quality • Develop a comprehensive plan for quality services from Ontario’s mental health and • Fund CMHA Ontario & AMHO to work on: data management & decision support, quality improvement coaching, education & addictions system as you do from training, peer-to-peer learning events, & online toolkit/resources other parts of the health care system Move on key First Nation, Métis, Inuit and urban Aboriginal mental health and addictions needs

4 Prioritize investments in supportive housing focused on meeting the needs of individuals with mental illness and addictions

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Current Status

Clarify which provincial ministry should lead the development and implementation of youth addictions policy and programming

• •



Established MOHLTC Methadone task force Planning underway to potentially expand clinical scope of practice for Nurse Practitioners to prescribe Suboxone Move on Aboriginal engagement strategy on MH&A

• •

New investments as part of LTAHS update & 2016 budget Council's Supportive Housing WG and others to develop and implement tools (e.g., supportive housing policy framework, performance measurement framework)

• •

MCYS-MOHLTC Directors established a work group Undertake baseline exercise with SWOT and Gap Analysis, incl. transition models and input from stakeholders Options analysis to support informed policy discussions



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MH&A Leadership Advisory Council Priorities The Council has created five working groups to develop cross-sectoral advice to government on how to begin to solve challenges in the system. The working groups will focus on the following five themes: Community Funding Reform

• Improving Ministry to LHIN Funding • Improving LHNIN to Community Provider Funding • Improving System Integration

System Alignment and Capacity

• Basket of Core MHA Services • Data and Performance Measurement • Quality Improvement • Structural Barriers

Prevention, Promotion and Early Intervention

• Advocate for Upstream Impact • Enhance Quality and Coherence • Build Capacity • Bring Awareness

Youth Addictions

Supportive Housing

• System Planning and Coordination • Youth and Family Engagement • Improve Access to Services

• Expert Advice • Strategic Leadership • Supply and Supportive Housing Stock • Bring Awareness



Cross-cutting these issues are topics and concepts such as health equity, access, harm reduction, a focus on recovery and impacts on specific population groups (for example Aboriginal communities, marginalized and racialized groups, immigrants, etc.).



Each working group is chaired by a Council member, and membership has been sought from a broad spectrum of organizations, communities and perspectives. 11

Anticipated MH&A Council 2016 Recommendations

TOWARDS A HIGH PERFORMING MH&A SYSTEM Enhancing Person – Centred Care

Additional Investments in supportive housing

Highlight mental health promotion and prevention

Fostering a culture of quality improvement in the MH&A sector

10 standardized MH&A performance indicators

Core set of MH&A services across the province

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Overview of the Data & Performance Measurement Initiative for the Mental Health & Addictions Sector

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What does the data landscape look like for mental health and addictions in Ontario?

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Overview of Meeting re: Data & Performance Measurement Meeting held on July 30th was co-hosted by: • Addictions & Mental Health Ontario

• Canadian Mental Health Association Ontario • Centre for Addiction & Mental Health • Ministry of Health and Long-Term Care • Meeting participants included experts in health systems data and performance measurement, experts in health and public policy and leaders from mental health and addictions community agencies and hospitals, representing over a dozen organizations from across the province Meeting Objectives: • Enhance our collective knowledge of the current data landscape • Identify the challenges with existing data, and the opportunities currently available for alignment • Identify how the existing data can inform effective performance measures • Develop recommendations for future work in this area

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Overview of Meeting re: Data & Performance Measurement

Meeting participants identified multiple data challenges: • Challenges at the agency-level • Challenges at the Local Health Integration Network level • Challenges at the level of the Province/Ministry

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Challenges in Data & Performance Measurement Agency Level Data Challenges: • Immense documentation burden and time commitment required to complete data collection and reporting requirements, especially for agencies with a small number of staff • Lack of capacity in the collection, analysis and utilization of data • Technological challenges; Smaller agencies still have paper files and/or dated technology • Multi-LHIN funded agencies have different data requirements • Barriers due to lack of appropriate data sharing agreements

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Challenges in Data & Performance Measurement LHIN Level Data Challenges: • Lack of consistency and standardization of data across all LHINs; challenges in obtaining comparable information across LHINs

• Lack of data sharing agreements create barriers to accessing data • Current performance indicators are not as effective as they could be due to the lack of evidence-based performance indicators for the mental health and addictions sector • Much pressure is placed on Health Service Providers (HSPs) in terms of staff time and costs associated with data collection and reporting

• Much need for developing viable and meaningful indicators that are consistent across LHIN boundaries (this is especially problematic for multi-LHIN funded agencies)

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Challenges in Data & Performance Measurement Province/Ministry Level Data Challenges: • Duplication in data collection and a lack of consistency and standardization across the Province • Challenges around data sharing due to legislative and administrative barriers • Data collection is not outcome focused; often it is just simple number counting without consideration for how the data relates to actual outcomes for the client • Agencies collecting data often lack timely access to the data they collect and submit; When data does come back to agencies, it is often too late for the data to add value to improving the quality of performance • Agencies lack capacity as well as financial and technical resources for data collection

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Opportunities for Data & Performance Measurement Meeting participants identified opportunities for addressing data challenges:

• It was noted that the mental health and addictions sector needs to develop a logic model to establish a common understanding around data collection, analysis and reporting that will effectively inform performance measurement • It was noted that the mental health and addictions sector needs to establish a scorecard with a common set of performance indicators • Data & Performance Measurement Task Group was struck to carry out this work

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Opportunities for Data & Performance Measurement The logic model should: • Consider the data currently available, and the quality of the data available

• Build in a mechanism for ensuring fidelity in the process of data collection by service providers • Consider issues relating to client consent and privacy The scorecard should: • Be evidence-based and focus on health outcomes • Reflect the realities of service users, as the health outcomes for mental health and addictions clients may be very different from clients with other types of illnesses

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Opportunities for Data & Performance Measurement Both the logic model and scorecard should: • Be applicable across the continuum of services for mental health and addictions, and across hospital and community • Be grounded in quality improvement and the attributes of a high performing health care system • Consider equity and the impact on marginalized populations • Be developed in collaboration and partnership with agencies across the health sector • Be validated by service users, service providers, and funders • Ultimately inform standards of care across the mental health and addictions sector, and across hospital and community

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Data & Performance Measurement Task Group Purpose of Task Group:

• Map the current data landscape across the continuum of MH&A services and supports (who collects MH&A information, what data elements are collected, how the data is linked, etc.) • Identify key challenges at the agency, regional, and system levels • Identify and recommend opportunities to overcome challenges at each of these levels

• Identify resources to enable better data collection • Validate recommendations with service users and service providers • Draft logic model and scorecard for review and approval by System Alignment & Capacity Working Group of Ontario’s Mental Health & Addictions Leadership Advisory Council

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Data & Performance Measurement Task Group

• Angela Batra Jodha, MCYS • Debbie Bang, St. Joseph’s Hospital Hamilton • Frank Sirotich, CMHA Toronto Branch • Marg Connor, MOHLTC (previously Sean Court) • Mike O'Shea, North East LHIN • Mohamed Badsha, Reconnect Mental Health Services • Naushaba Degani, Health Quality Ontario • Paul Kurdyak, CAMH & ICES • Rachel Solomon, CAMH • Uppala Chandrasekera, CMHA Ontario

Ex-officio members: • Julie Yang, ICES • Saul Melamed, MOHLTC (previously Celine Mulhern) • Zahir Din, CMHA Ontario

• Zarsanga Popal, CMHA Ontario

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Achieving a High Performing Mental Health & Addictions System for Ontario Draft vision: A high performing mental health and addictions system that is appropriately resourced and accountable to the public ensures that services and supports are provided in a safe, effective, client-centred, timely, efficient and equitable manner.

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Achieving a High Performing Mental Health & Addictions System for Ontario

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Achieving a High Performing Mental Health & Addictions System for Ontario

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Achieving a High Performing Mental Health & Addictions System for Ontario

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Achieving a High Performing Mental Health & Addictions System for Ontario

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Achieving a High Performing Mental Health & Addictions System for Ontario

* Core services are those with dedicated funding support that are available and accessible for everyone across Ontario, and will be further defined by the Mental Health and Addictions Leadership Advisory Council’s Basket of Core Services Task Group.

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Achieving a High Performing Mental Health & Addictions System for Ontario

* Core services are those with dedicated funding support that are available and accessible for everyone across Ontario, and will be further defined by the Mental Health and Addictions Leadership Advisory Council’s Basket of Core Services Task Group.

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Achieving a High Performing Mental Health & Addictions System for Ontario

* Core services are those with dedicated funding support that are available and accessible for everyone across Ontario, and will be further defined by the Mental Health and Addictions Leadership Advisory Council’s Basket of Core Services Task Group.

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Indicator Review • Task Group reviewed a list of mental health and addictions performance indicators that currently exist across the sector in Ontario • 216 indicators were identified Sources of the indicators included: • CAMH Monitor • Mental Health and Addictions Quality Initiative Comparative Scorecard • Mental Health Accountability Framework (2003) • Hospital Service Accountability Agreements, Multi-Sectoral Agency Accountability Agreements • Community Mental Health and Addictions Quality Improvement Plan Template (draft) • Toronto Central LHIN Community Mental Health & Addictions Indicators (2013)

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Indicator Assessment • Task Group used a modified Delphi method to select the indicators for the scorecard using criteria developed by Health Quality Ontario • Indicators that were measurable were prioritized (i.e. indicators where there are available data sources that could potentially be used to measure the indicator) • 60 indicators were prioritized

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Indicator Assessment • Task Group conducted an online survey to review and score the 60 indicators on three criteria: • Important/Relevant • Actionable • Interpretable • Each criterion was scored along a seven-point Likert scale

• Indicators were categorized according to the following domains: • Access • Co-ordination/Transition • Human Resources/Visit Rates • Perceptions of Care • Quality/Impact • Other

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Indicator Assessment Survey

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Indicator Assessment Survey Results Use o f p hysica l re stra ints in fa cilitie s p ro vid ing a cute me nta l he a lth ca re Numb e r o f p a tie nts who ha d me cha nica l re stra int use ind ica te d o n the ir OMHRS re co rd s / T o ta l numb e r o f ind ivid ua ls who we re d ischa rg e d fro m a d e sig na te d a d ult me nta l he a lth b e d in a n Onta rio ho sp ita l a nd ha d a full a sse ssme nt Onta rio Me nta l He a lth Re p o rting Syste m # who ra te d % who ra te d Stro ng ly Stro ng ly Ra ting Re sp o nse Answe r Op tio ns 'Ag re e ' o r 'Ag re e ' o r Ag re e Disa g re e Ave ra g e Co unt Hig he r hig he r Important & Relevant 3 3 1 1 1 0 0 2.33 7 9 77.8% Actionable 2 2 2 2 1 0 0 2.78 6 9 66.7% Interpretable 1 1 4 1 1 0 0 3.00 6 8 75.0% a nswe re d q ue stio n 9 skip p e d q ue stio n 0

Use of physical restraints in facilities providing acute mental health care Number of

Interpretable

Actionable

Important & Relevant

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

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Indicator Selection After a lengthy discussion, the Task Group identified about 20 indicators that were measurable, important/relevant, actionable and interpretable along three levels of measurement: • Population-level • System-level • Organizational-level (including at the level of community-based services and hospital services)

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Indicator Selection • Task Group further refined the list of indicators • To align with existing quality improvement initiatives, the original indicator domains were replaced with the six quality dimensions identified by Health Quality Ontario: • Safe • Effective • Client-Centred • Timely • Efficient • Equitable • With regards to the Equity domain, all indicators calculated from ICES administrative data, and other indicators where possible, will be assessed through five equity dimensions: (1) Geography, (2) Neighbourhood income, (3) Immigration status, (4) Age, and (5) Sex

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Performance Indicators for the Mental Health & Addictions System in Ontario

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Task Group Recommendations • The Performance Indicators for the Mental Health & Addictions System in Ontario scorecard be used to measure the outcomes of Ontario’s Mental Health & Addictions System • That all of the scorecard indicators be standardized across all parts of the Mental Health & Addictions System, including hospitals and community-based mental health and addictions organizations • That common data tools that yield high quality, comparable data be standardized across all hospitals and community-based mental health and addictions organizations. We believe that the data sources identified in the scorecard are currently the most effective in yielding high quality, comparable data • That a standardized definition of “wait-times” be established that can capture high quality, comparable data consistently across multiple data sources such as OCAN, DATIS and ConnexOntario, as currently different definitions are being used by all three sources

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Overview of the Stakeholder Consultations

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Stakeholder Consultations Total of 350 people were consulted • 10 in-person meetings • 3 webinars • online survey

Additional information and webinar recordings available online at: http://ontario.cmha.ca/public-policy/data-and-performance-measurement-task-group-formental-health-and-addictions-in-ontario/

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Stakeholders Consulted • • • • • • • • • •

Provincial Human Services and Justice Coordinating Committee Community Health Ontario Ontario Association of Patient Councils Local Health Integration Network Provincial Mental Health and Addictions Advisory Group Addictions and Mental Health Ontario Board of Directors Ontario Peer Development Initiative Ontario Hospital Association Mental Health and Addictions Leadership Council Canadian Mental Health Association Executive Directors Network Health Quality Ontario Performance Monitoring and Reporting Group Evidence Exchange Network People with Lived Experience and Family Members Panel

• Consultation with LHIN CEOs planned 47

Questions posed during Stakeholder Consultations • What are your general impressions of the logic model and scorecard? • What are the critical gaps? • As a service provider, what are the considerations for data collection and reporting? (i.e. What supports are needed to adequately report on these performance indicators? What is needed at an agency- regional- and provincial-level?) • As a service user, what information do you want to know about the performance of the mental health and addictions sector? (i.e. What do you want to know is working well or not working well about the sector?)

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Stakeholder Feedback • Overwhelming positive feedback --- much excitement and support for this work • Many expressed that although there are limitations to this work, the work needed to get started and the timing was right to start this work now • Many were pleased that the mental health and addictions sector could use this scorecard to publicly report on key indicators just like other parts of the health care system

• Stakeholders from other sectors were interested in this work and wanted to explore opportunities to do similar type of data and performance measurement work

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Stakeholder Feedback Limitations of the Scorecard: • Little engagement with people with lived experience from the beginning • Too much focus on hospital sector • Need for consistency in data collection and reporting Critical Gaps on the Scorecard: Stakeholders would have liked to see indicators focused on: • Effectiveness in terms of client outcomes • Experience of families and caregivers • Prevention and promotion • Social determinants of health • Equity 50

Data Initiatives Underway in the Mental Health and Addictions Sector MHA Council Data Strategy

Mental Health and Addictions Quality Initiative (MHAQI) Considerations: • Documentation burden • Duplication & redundancy • Data infrastructure needs • Impact of primary care reform

E-Health 2.0

Ensuring Alignment DTFP Projects? MCYS?

Excellence through Quality Improvement Project (E-QIP)

Health Quality Ontario

Current Data Reporting Capability What is the process agencies use to gain access to their own data? • What is the primary purpose of the reports provided and/or data it contains? (e.g. planning, supporting agencies at point of care, performance measurement and management, etc.) • What reports are available to agencies? • Are reports available by request or automatically? • Do the reports show functional centres? • Frequency of when agencies can access reports? • Is the data aggregated or available at the individual record level? • Can organizations run their own data and/or produce their own reports from the system? • How often is the data refreshed? • Is personal health information included? • Who else has access to this data? • Is decision support provided/available?

Reports available through:

AOHC CBI CCIM ConnexOntario CIHI DATIS ICES 52

Key Components of a Data & Performance Measurement Strategy for the Mental Health & Addictions Sector in Ontario We want to be able to answer: • What is the real time capacity and utilization for mental health and addictions services, both in hospital and in the community? • What are client wait times? • Where are people living while accessing services? • Who is using services, when and which services, and for how long? • What combination of services are they using? Ensure a process for accountability, alignment, and cohesion across: • Mental health and addictions • Hospital and community-based services

• All LHINs (via MLAA) • Adults and youth (MCYS) • Other initiatives of the Council

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Group Discussion • What key components are necessary to develop a comprehensive data strategy for the mental health and addictions sector? • What are the data infrastructure needs across the mental health and addictions sector? • What resources are needed to better enable data integration across the mental health and addictions sector? • When there is duplication and redundancy of data collection, what processes need to be in place to rationalize resources?

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Contact Information Marg Connor Director, Mental Health & Addictions Branch Ministry of Health and Long-Term Care [email protected] Uppala Chandrasekera Director, Public Policy Canadian Mental Health Association, Ontario [email protected] Rachel Solomon Executive Director, Performance Improvement Centre for Addiction & Mental Health [email protected] Dr. Paul Kurdyak Medical Director, Performance Evaluation and Director of the Health Outcomes and Performance Evaluation (HOPE) Research Unit, Centre for Addiction & Mental Health Core Senior Scientist and Lead, Mental Health and Addictions Research Program, Institute for Clinical Evaluative Sciences [email protected] 55