[State of practice: ministerial standards of access, quality, continuity, efficiency and effectiveness of the service d’intervention de crise dans le milieu 24/7]

Boisvert I, Gaumont C
Record ID 32018000983
Original Title: État des pratiques: standards ministériels d’accès, de qualité, de continuité, d’efficacité et d’efficience du service d’intervention de crise dans le milieu 24/7
Authors' objectives: In 2013, the Ministère de la Santé et des Services sociaux (MSSS) published the document “Orientations relatives aux standards d’accès, de continuité, de qualité, d’efficacité et d’efficience des services sociaux généraux du programme-services - Services généraux – activités cliniques et d’aide”. This document defines, among other things, the characteristics of the Service d’intervention de crise dans le milieu 24/7. It also presents the 28 ministerial standards to be achieved for ensuring service access, quality, continuity, efficiency and effectiveness. The document clarifies that the service consists of an immediate, brief and directive method of response adapted to the person’s needs and aimed at stabilizing her or his condition. The service is available 24 hours a day, 7 days a week, and requires no prior appointment. It is delivered at home or in another adequate location. It is provided by a professional resource of the integrated health and social services centre (CISSS), integrated university health and social services centre (CIUSSS) or a health care worker from a community organization pursuant to an agreement reached by virtue of the article 108 of the Act respecting health services and social services. As part of the process of prioritizing the mandates listed in the three-year plan of activities (2016-2019) of the Institut national d’excellence en santé et en services sociaux (INESSS), the MSSS Direction des services sociaux généraux et des activités communautaires (DSSGAC) asked the INESSS Direction des services sociaux (DSS) to describe the service d’intervention de crise dans le milieu 24/7 (referred below as “crisis intervention service”). More specifically, this current state of practice was meant to: 1. describe the features of the crisis intervention service (modes of organization; characteristics of the interventions, health care workers and service users) offered throughout Quebec by the CISSS and CIUSSS; 2. define the level of attainment of the ministerial standards in terms of access, quality, continuity, efficiency and effectiveness of the crisis intervention service; 3. report on factors affecting the attainment of the ministerial standards and levers for improvement mentioned by crisis intervention service managers and health care workers.
Authors' results and conclusions: RESULTS: The analysis of the data collected within the framework of this exercise brought forward a variability in organizational modes of the crisis intervention service delivered by the CISSS and CIUSSS across the province. The intraregional and interregional variability in organizational mode of the service combined with the nonuniform understanding of the ministerial definition of crisis intervention service significantly complexify the task of painting an overall picture of the manner in which this service is delivered throughout the Province of Quebec. The analysis also revealed that the capacity of the CISSS and CIUSSS in reporting on features of the crisis intervention service they offer varies depending on the organizational mode. The managers who completed the online survey and work in a CISSS or CIUSSS where the service is provided by a community organization demonstrated a poorer capacity to provide information on its organizational mode and characteristics. In terms of achievement of the ministerial standards established for the crisis intervention service, the data collected revealed that the managerial and health care workers do face significant challenges in maintaining a service that is accessible, of high quality and in continuity with other services. As regards accessibility, the information collected revealed that certain citizens are unable (at least at the time the information was collected) to receive immediate intervention service in their community depending on the time and location of the crisis, although most CISSS or CIUSSS claim that the service is provided 24/7 throughout their area of coverage. Some managers and health care workers mentioned that ensuring a full geographical and temporal coverage of service involves dealing with the vastness of their area of coverage and limited staffing resources. As for the quality standards, consulting the managers and health care workers of this service revealed the existence of various access issues to training in the CISSS and CIUSSS, in spite of the fact that practically all the health care workers receive orientation training and continuing education to develop and maintain work-related skills. Despite the efforts made and inspiring initiatives implemented to offer quality service to users in crisis, some factors make it difficult to meet the ministerial quality standards, including poor dissemination of clinical approaches and tools regarded as effective, and difficulties recruiting and maintaining qualified health care workers and offering clinical supervision in order to support them. Where service continuity is concerned, the exercise brings out the need for sectoral and cross-sectoral cooperation across the service delivery chain to meet in continuity the needs of users in crisis. In this context, it is of utmost importance to establish collaborative agreements or service arrangements with partners. If certain communities succeeded in forging strong links with partners, the information collected revealed that linking mechanisms among the various stakeholders are nonexistent or based on collaborative agreements that in many cases have not been updated recently. Furthermore, absence of formal service agreements and accountability mechanisms was reported where the crisis intervention service is provided by community organizations on behalf of the CISSS and CIUSSS. Finally, although a large majority of CISSS and CIUSSS have introduced methods and procedures for protecting and sharing personal information among partners, there does not seem to be a common understanding and application of these procedures and methods in all the establishments. The managerial and health care workers consulted reported a series of factors hindering achievement of ministerial standards of the crisis intervention service; three of them seemingly interfere transversally with achieving the standards: vastness of areas of coverage; difficulties recruiting and maintaining qualified personnel; and a perceived lack of financial resources dedicated specifically to the service. Despite the disparities between the establishments, all the participants consulted pointed to the relevance of respect regional realities by not promoting a unique organizational model of crisis intervention service. They all expressed the wish for the service to continue to develop in complementarity with other existing services, by respecting the service organization in place, community particularities and the needs specific to each region. CONCLUSION: While many projects to restructure the crisis intervention service are currently underway in various regions of Quebec, the people consulted proposed several levers for improvement; they stressed the importance of making the ministerial standards better known to people playing a role in delivering this service; fostering a common understanding of crisis intervention in the community; focusing on partnership development; and promoting skills support and development among health care workers dealing with users in distress on a daily basis. The mobilization of managers and health care workers from the crisis intervention service consulted as part of this exercise certainly provides a crucial basis for improving this essential service. This mobilization could contribute to setting priorities among levers of improvement and offering services that fulfill the needs of individuals in crisis, in an efficient and coordinated manner
Authors' methods: Four (4) methods were used to meet the aforementioned objectives. Firstly, the analysis of the clinical and administrative data originating from the provincial databank on CLSC users and services (I-CLSC) proved instrumental in drawing a portrait of the modes of organization and features of the crisis intervention service. Secondly, the managers of the crisis response service throughout Quebec (n=44), who had been identified by their respective director, answered to an online survey concerning the organization of the crisis intervention service and their views on how the ministerial standards are met. Thirdly, a qualitative analysis of 134 documents was conducted to get a deeper insight into the services offered in every CISSS and CIUSSS; the documents had been provided by the directors of general social services sitting on the Table nationale de coordination – Services sociaux généraux (TNC-SSG) and by managers of the said service. Fourthly, two focus groups – one composed of crisis intervention service managers (n=8), one formed by crisis health care workers (n=9) – were carried out to identify barriers faced by stakeholders in meeting the ministerial standards of the crisis intervention service and to receive suggestions on levers for improvement towards their attainment. Some limitations should be considered when interpreting the results of this current state of practice, including the fact that the views of community organizations providing crisis intervention service and of users were not taken into account.
Project Status: Completed
Year Published: 2018
Requestor: Minister of Health
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Crisis Intervention
  • Mental Disorders
  • Psychiatry
  • Emergency Medical Services
  • Delivery of Health Care
  • Mental Health Services
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.