Background
Service Resolution is an important feature in the delivery of Developmental Services in the Toronto Region. In Toronto, this function is carried out by a Service Resolution Committee which operates both as part of the Developmental Service structure and the Toronto Network for Specialized Care. Service or case resolution was mandated through Making Services Work for People (1997). In Toronto, the committee became known as Service Review and later became Service Resolution, with the Toronto Network of Specialized Care (TNSC) having the lead.
Initially, when Service Resolution began, complex situations were heard and recommendations were provided. This process was cumbersome and took a great deal of time – few situations were able to be covered in the allotted time. At this period in time, Toronto had developed treatment programs under the Specialized Accommodation initiative and there was a need to identify people in a timely way to be supported in the programs. This led to the establishment of the Clinical Conferences, a feature unique to Toronto.
Discussions at the TNSC indicated that there needed to be a clearer pathway to the discussions of individuals as well as systemic needs and issues. With this in mind, dedicated time on the TNSC agenda was proposed.
All agencies which provide services and supports to adults with a development disability in Toronto and which receive operating funds from the Ministry of Community and Social Services are required to support the Service Resolution process.
All of the activities carried out will be based on the guiding principles of the Toronto Developmental Services Model: person‐centred approach, equity, shared responsibility/
accountability.
Service Resolution is for client and service situations that require broad, cross‐sector groups of decision makers for the development of coordinated solutions to clinical and community support needs. Presentations must occur at the Clinical Conference prior to discussion at Service Resolution.
Service Resolution is not intended for situations in which there is a capacity/resource issue due to waitlists.
This includes situations:
When system need exceeds the capacity of families and individual providers, therefore requiring creative collaboration between various providers in the Toronto region.
Which require referral to specialized transitional residential resources.
Which are so complex that needs cannot be met by existing specialized clinical service providers in conjunction with community service providers from the developmental and mental health service sectors.
When the necessary specialized service does not exist in Toronto.
Which may require ministerial awareness and support of solutions.
When all existing specialized clinical and core community service options have been tried and it is not possible to implement an integrated service plan fully.
The steps to access Service Resolution are referral to the TNSC Coordinator or the CAIR (Collaborative And Individualized Resources) Facilitator, followed by a presentation to the Clinical Conference.
Situations which are identified at Clinical Conference as needing to be presented at Service Resolution will be brought forward by the Chair of Clinical Conference or designate.
There is an expectation for full communication of any concerns, information, or
perspectives which are relevant to responding to the needs of the individual under Service Resolution discussion.
When consensus about a recommended strategy is not reached, but the majority of participants are in support of the strategy, everyone at the table will agree to support the implementation of the decision. ‘Off‐line’ conversations with the TNSC Chairs are not acceptable unless content is shared with the TNSC committee at the time of the meeting.
A situation can be brought back to the table if the situation, circumstances and/or information changes appreciably.
In cases in which issues are related to a particular agency’s delivery approaches,
participants need to identify concerns as they relate to the client need. It is understood
In cases in which issues exist in regard to individual or family acceptance of the lead agency role, discussion should be presented at Service Resolution by focusing on client need and the match of agency approaches to need.
If the Chair is privy to information about the delivery approach of a current or past provider
and the provider’s ‘fit’ with a client, they may opt to contact the Executive Director of the provider organization to share this information. This will be at the Chair’s discretion.
Meetings
Service Resolution is imbedded in the TNSC committee meeting structure. Should decisions be required between meeting times, the TNSC membership will be polled via e‐mail. Each Service Resolution meeting will be structured to include the following:
1. Identification of obstacles to effective service/support provision: Identification by all participants of any real or perceived obstacles to resolution for a person getting what they need (list of potential areas of challenge, barriers, issues regarding family, service providers, diagnostic challenges, behavioural issues/risks, access to clinical services/variables, program fit, availability of appropriate programs, barriers to accessing supports upon completion of treatment).
2. Presentation of the new individual situations from Clinical Conference for problem solving or access to specialized resources by the Chair of Clinical Conference or designate.
3. Review of situations previously presented if required for problem resolution, access to specialized resources, review of outcomes, or evaluation of the progress of the plan.
4. Update on vacancies, progress of residents, and waiting lists for specialized resources.
5. Ongoing evaluations of the Service Resolution process.
Membership
Agencies in DSTO share a joint responsibility for this process, as each has a mandate to service the target population. Similarly, Network partners in the Toronto Network of Specialized Care, as part of their membership and partnership within the Network, will be required to support the Service Resolution process and to participate as required/indicated as core or associate members.
More specifically:
Representatives will have the authority to commit or recommend resources, services and staff time for planning, so they will need to be decision makers and to offer a high level of clinically sophisticated analysis and problem solving/solution finding.
Participants will be creative, flexible thinkers, willing to support community endeavours to allow challenging situations to be addressed in new ways, making use of resources
available.
Approval:
The Service Resolution Process was approved on December 23, 20
Toronto Network of Specialized Care (TNSC)
1. Develop and implement the Network partnerships.
Maintain and update the Memorandums of Understanding to enhance and reflect the continuum of specialized services and supports.
2. Establish, facilitate and support coordinated access to the range of specialized services and supports available in the TNSC and collaborative service response, service resolution, including: (see Appendix 1: Service Resolution Process)
Monitoring the Collaborative And Individualized Resource (CAIR) flex fund as initiated in the 2011 funding allocation.