Multi-Disciplinary Teams: Issues, challenges and protocols
The PowerPoint for this presentation can be seen at Realizing a Vision
This session traced the evolution of the governance structure for BOOST, the Toronto CYAC that opens in July 2013. The session was presented by Jay Kaufman [biography], President of the public sector focused consulting firm KTA Inc., who assisted with the development of their governance development; and Karyn Kennedy, Executive Director of Toronto’s CYAC.
They began by showing a short video – Every Day which is on YouTube, that has become a valuable tool for explaining to potential funders and operational partners why a CYAC is needed, what it does, and how that is different from what child protection agencies do.
The film uses a cartoon graphic from the SeaStar CYAC in Halifax, to demonstrate why the one-stop CAC model is better than the conventional, multi-agency approach to handling the many stages of disclosure, investigation, charging, trial preparation and therapy in child abuse cases.
Karyn Kennedy explained that their CYAC has been in formal development for over 12 years; that different agencies have been at the table at different points; and that the basic concept has undergone major revisions over time. Slide 5 in the PowerPoint shows the early organizational efforts, which stalled in 2009.
The business plan for the project assumed that it could be self-financing, through service efficiencies among the partner organizations providing services at the CYAC. It became clear — when this assumption was tested within the new prevailing fiscal climate in the province — that this was no longer the case.
When Kaufman was brought in as a consultant to drive the new re-boot, his first questions were around structure and governance: “Will the CYAC be a new organization with its own Board? Will it be a program of an existing organization, in which case how are the partners to be involved in governance of CYAC services within the larger organization? Who is the legal entity responsible and accountable for the multi-disciplinary services being provided? The partners thought they were ready with answers. But they weren’t. It was after the 2008 financial meltdown; the landscape and appetite for new initiatives had changed. They had to re-think — fast.”
When the partners re-grouped in 2011, they embarked on a detailed, practical process to move beyond theories and research findings, and into a functioning service.
Slide 6 shows the main elements of the new structure. Other key new decisions included:
– a new model less centred on police
– that the many partners have equal voices and make collective decisions
– 2 lead groups — one (the executive leaders) making policy decision, and the steering committee that was the practical working group [See Slide 7 + 8]
They agreed to make their decisions based on evidence from the experience of about 15 already long-established CACs — mostly in the US, but also from Zebra in Edmonton. KTA interviewed people in those organizations, asking: What works by way of governance? What about the relationships between partners on an on-going basis? How do you decide on leadership? What have been some of the critical success factors in implementing and sustaining CACs?
The core messages from established CACs are summarized in Slide 9. The key decision was to NOT try to develop the CAC as a program under the auspices of an existing organization, such as a police service, children’s aid society or a hospital. “To raise funds, you need a completely separate entity — and you need to incorporate it.” (Kaufman) This led to a decision that Boost, a well-established community-based agency, would become the Toronto CYAC.
A major frustration along the way? It is impossible to find reliable data they could show to government funders about how CACs affect results. They used Zebra statistics to fill that gap. They advise new CACs to collect data from the outset.
Slide 10 lists the key steps in their development plan. They realized that the vision for the CYAC was not clear to all partners — and so it had to be re-cast — and all partners had to sign-off on the revised vision [See slide 11 about vision]. Management roles and responsibilities had to be thought through in fine detail. High profile donors had to be confirmed and in place, before the community would get on board. They broadened the mandate to include youth (older teens) — which was challenging, as agencies in the group had conflicting age cut-offs. Other challenges arose around roles, as various CASs in the group, for example, saw themselves as having a strong child advocate role similar to that envisaged for the CYAC. “We put together a highly structured decision-making process, to get from A to B on the tough issues about organization and governance. We also got agreement on assessment criteria. All that was very precisely defined. Executive leads agreed to them. We did not want anyone to bring something new into the equation at a later date.” (Kaufman)
They faced a major challenge demonstrating to the provincial government why a new CYAC would be a “value proposition.” They piloted a multi-disciplinary team (MDT) model which showed that cooperation between agencies can be improved but isn’t good enough. Instead, service providers in the pilot came strongly to the belief that services would work best for both children and families and professional staff if they worked together out of the same physical location. The core elements of MDTs must be in place from the beginning, as it’s very difficult to integrate new elements farther down the road.
Eventually, the groups agreed that the best bet for government support was to build the CYAC through a re-configured version of BOOST [see Slide 13]. It became clear that BOOST had to re-configure its Board to include service partners. Four of the 14 seats are designated for service partners, one for police, 2 for child welfare and an additional seat to represent the remaining group of partners. Each partner selects their own representative on the board.
The final stage of “closing the deal” presented other challenges. [See slides 17, 18, 19]. Lawyers for all the agencies involved are crafting two separate legal agreements: one to delineate the terms of cooperation and accountability between BOOST and all its partners; the other is a service agreement that will be signed individually with each service provider agency that operates in the BOOST facility. “We did not want to have open service agreements that could change, when a service providing agency changed.” (Kaufman).
The agreements will also describe a very clear dispute resolution mechanism, and how intellectual property (videos, brochures, etc.) will be owned or shared by partner agencies.
On the advice of CACs in the US, they are also developing a firm protocol on communications. BOOST partners have to agree how to handle media inquiries about specific cases that become a hot news story.
Kaufman listed these as key Lessons Learned:
- Stay focused on which methods / procedures / decisions are better for the kids.
- Always be listening … but also decide what needs to be responded to… and what doesn’t.
- Showcase your key community supporters in the media.
- Realize that you will have to face some tough issues…. In the earlier, failed phase, they erred by glossing over the hard stuff.
- Everyone comes to the table with bias and history. The way to get beyond that is to agree on assessment criteria… and then everyone has to live with what comes out at the end … based on that agreed criteria.
Kennedy added that Kaufman’s involvement as a formal, objective consultant made a huge difference. “We were going around in circles, with our own biases and history. His objectivity and respect for process got us through.”
QUESTIONS, ANSWERS, COMMENTS
QUESTION: Where did you get funds to hire a consultant?
ANSWER: (Kennedy) – We originally put out a call for a project manager….. then we realized we didn’t actually have a viable plan to implement. So we used the funds budgeted for a project manager to hire a consultant instead — to help us re-work a better implementation plan. Part of the resources came for Department of Justice Canada.
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QUESTION: What about needs assessment? Did you do that?
ANSWER: (Kaufman) – We had the advantage of information from earlier work. Having a needs assessment is not the whole story through. Saying “there’s a need” only gets you half way there. What brings the government funders on-board is answers to — “what’s the value proposition?” You need to demonstrate the value — that kids who have CAC help will use less court time, because problems are solved earlier. That is very compelling evidence. Governments pay attention to that.
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QUESTION: How important is it to do a pilot project?
ANSWER: (Kaufman) – Very important. But realize that pilots absorb a lot of time and human resources. Also… it turned out, in our case, that some of the players doing the pilot will not be in the initial roll-out. They may come back in at a later phase.
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QUESTION: How does the accountability work?
ANSWER: (Kaufman) – Accountability lines are clear. The job description of the Executive Director of BOOST makes the scope of accountability very clear. The process for disputes and conflict resolution is laid out, and that will be adapted — with learnings, over time. The liabilities between the CYAC and the service partners are described in the protocol. The service agreements with every partner lay out in detail who does what. We will review the structures and agreements after 3 years of operation through a formal review process.
There are detailed communications processes on how to deal with complaints. It’s important to realize that a “command and control” type person will not work well as an ED, in this structure.
COMMENT: (Kennedy) – I decide who to hire as a direct BOOST employee. But we have no options about the people who come to work there from other agencies. So that’s a challenge. The police will send people who have expressed interest in the CAC model. Children’s Aid Societies will send people based on their seniority lists. There will be a big need to train the people who come from other agencies in the multi-disciplinary team model at a CYAC.
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QUESTION: How have you addressed concerns about the fiduciary responsibilities of Board members, possible conflicts of interest, and other obligations of Board members?
ANSWER: (Kennedy) – Most large law firms have a pro bono policy. We accessed those services to write up our legal protocols and agreements. The challenges started when all the partners wanted to bring THEIR lawyers to the table.
ANSWER: (Kaufman) – We under-estimated the time and effort of the legal involvement. The cultures of lawyers in different sectors — are very different.
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QUESTION: But Board members sign on as invididuals….
ANSWER: (Kaufman) – That’s true …. and an important point…. and another reason why we set up our Advisory Structure as we did.
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QUESTION: What is the buy-in from the Aboriginal community in Toronto?
ANSWER: (Kennedy) – We have narrowed BOOST’s focus to sexual abuse and physical abuse. Aboriginal services thought that most of their investigations are more about neglect.
ANSWER: (Kaufman) – There will be a designated Aboriginal position on the BOOST Board. Toronto’s Native CAS decided they would not provide services at the BOOST building. But they will contract with the CYAC for services. They want to ensure there is special support in an environment that is competent to deal with aboriginal children.
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