Policy Implications

Implementation of the P4C Service Model

The Partnering for Change Model was implemented successfully in this study, in three diverse school boards and two health regions; success was due in large part to the partnerships that were forged at many levels and to the commitment to ensuring that the P4C service was delivered in the way it was intended. Barriers identified along the way were: “medical model” tracking; the need for time to transition over to a new model; differences in roles and expectations across health care and education systems; the need for change in administrative processes and billing procedures; the importance of maintaining the principles of P4C during expansion of the model; and the time required for such a significant transformation. Efficiencies were identified that, could reduce costs and provide more “value added” interactions for families.

  • Implementation of a different model of service delivery, to replace a long-standing model, requires time to transform thinking, address barriers, build partnerships, change system processes, and develop common language for collaborative communication.
  • A transition period in the first year of implementation would enable systems and people to make the necessary transformations for successful implementation of this new model.

Transforming Thinking

Partnerships and effective communication are required prior to implementation of the P4C model.

Partnerships and effective communication are required prior to implementation of the P4C model.

Exceptional partnerships were developed between the research team, the Central West and HNHB CCACs, the administration at all of the school boards, the occupational therapists and the Ministry representatives. Despite excellent support from the Toronto Central (TC) CCAC, particularly at the Chief Executive Officer level, it was not possible to introduce the P4C model of service within the Toronto District School Board.

Consideration needs to be given to the type of rehabilitation services, and current model of service delivery used in each school board, prior to recommending any change. Discussion and partnerships need to be established to understand both differences and similarities in order to effectively implement new models of service delivery.

Time is required to effectively implement such a significant change in service delivery.

Time is required to effectively implement such a significant change in service delivery.

During this study, the Central West (CW) and Hamilton, Niagara, Haldimand and Brant (HNHB) CCACs met with each participating school board to discuss how the P4C service would be introduced and supported within their board. Time was required for this, to ensure discussion and support for local needs and context. System challenges needed to be discussed and solutions determined for issues such as access to internal board wide intranet communication, storage of files, access to photocopying etc. Any board-wide decisions regarding access need to be communicated to the individual schools and approved by the principals. During the P4C project, the TC CCAC also approached many of the private schools with whom they partner to discuss implementation of the P4C model of service delivery. Time is required to partner with each private school, one at a time. Educators within each type of school, and families, need to become familiar with the new model of service delivery.

A common language needs to be established that meets the needs of the education, health care and rehabilitation systems.

A common language needs to be established that meets the needs of the education, health care and rehabilitation systems.

During the project, the Peel District School Board (PDSB) identified a need for a common language as a result of discussions between the In School Support Teacher (ISST) and the P4C OT working in her school. Members of the research team met with two ISSTs and a consultant with Special Education Support Services to share information and develop a common language that could be used at In School Review Committee meetings, or generally at the school, when an OT is involved with a child. It was agreed this would enable improved documentation of the child’s needs and would enable “a more accurate paper trail” or audit, especially when a student moves to another school.

Change is needed within administration and system-level processes to identify potential efficiencies and to ensure sustainability of the model.

Change is needed within administration and system-level processes to identify potential efficiencies and to ensure sustainability of the model.

As the process maps demonstrated, the referral and tracking system in Partnering for Change requires the involvement of far fewer individuals and is more coherent and seamless for families. Even fewer steps could be achieved. The OTs provide more direct service to children, educators and families in this model; however, changes needed to be made to the method of documenting the strategies and supports that were found to be successful. Changes could also be made to the way in which OTs are hired, trained and supervised, which might address the concerns identified in Lessons Learned about reimbursement. Given the large waitlists, a transition period is needed which is focused on “waitlist management”, prior to the OT being able to deliver the P4C services according to the principles of the model.