Improving Ontario’s mental health and addiction services for youth and young adults is the critical step for Youth Wellness Hubs Ontario to bring the right services to youth and their families at the right time and place. It is a network of 22 hubs aiming to provide the right service for youth and their families when they need it the most. In this episode, Dr. Jo Henderson, Executive Director of YWHO, discusses how the organization balances program fidelity and community customization. She also shares advice on dealing with fake efficiency arguments that come up in this sector. As an Executive Director, Dr. Henderson ensures she stays on the helm to guide the YWHO in supporting the youth of our future. Tune in and learn more!
Listen to the podcast here
Youth Wellness Hubs Ontario With Dr. Jo Henderson, Executive Director
I am thrilled to share my conversation with Dr. Jo Henderson. She is the Director of the Margaret and Wallace McCain Center for Child, Youth, and Family Mental Health at the Center for Addiction and Mental Health and the Executive Director of the Youth Wellness Hubs Ontario. She is also a Senior Scientist at CAMH and a professor in the Department of Psychiatry at the University of Toronto. Their work aims to improve access to high-quality integrated services for youth and substance use and or mental health concerns and their families.
Dr. Henderson goes deep and shares their commitment to growing with purpose and principle, what it takes to grow in integrated service rapidly across Ontario. There are many lessons for leaders across our social profit sector, and it’s a great conversation to boot. Please enjoy my conversation with Dr. Jo Henderson.
Welcome, Jo. We’re glad to have you on the show, and we’re looking forward to diving into the incredible breadth and depth of the work that you do in your professional life, but first, can you tell our audience about Youth Wellness Hubs Ontario, what its mission is and who you’re serving?
Youth Wellness Hubs Ontario is a system transformation initiative that serves young people aged 12 to 25. It was co-created and co-designed and continues to be co-designed by youth aged 12 to 25 and older. It’s an initiative that intends to bring a whole wide range of services to young people in their communities, in context spaces that resonate for them, that they’ve co-designed. Those services include mental health, substance use, health, primary care, employment, education, housing, a wide range of social communities, and health support.
You mean bringing all the services that youth might need into a single point of entry.
It’s under one roof, you might say. We heard loud and clear from young people as we were developing this model that they wanted to be able to walk in a door and say, “My life is crappy. Can someone help me?” Everything they would need would be right there, and the people would work in ways that led them to have a seamless experience that thought about them in a holistic way. We’re able to offer services that address their needs across multiple different aspects of their lives without forcing them to figure out, is it this or is it that? What about this? Allowing them to receive service without having to tell and retell their story.
We made a little fun at the idea of how simple it is to have that one door to offer these services, but it’s not funny because these services are typically historically spread out. That’s the system change part of the work to bring all of these things together. I’m fascinated by the idea of co-creating, particularly when it comes to the delivery of mental health services and services for youth. As someone who is an expert in the field, were you surprised by any of the suggestions or requests that you heard through that co-creation process?
I’ll start first at a high level. Across Canada, at this point in time, the majority of provinces have indicated that they are doing a similar provincial initiative that focuses on integrated youth services. One of the provinces is still exploring this idea, but across many jurisdictions and different kinds of communities, this idea has resonated. The reason it has resonated is because you co-designed this model. That’s why it resonates. My biggest learning is that it is not only the right thing to do but also an approach that will lead to better implementation, uptake, and outcomes.Integrating youth service is an approach that will lead to better career implementation, better uptake, and better outcomes. Click To Tweet
What are some of the details? What are some of the interesting nitty-gritty of the model? It is about the details. It’s about things like not walking into a space intending to deliver services that start with a desk or we’re still a desk, a wall, and a lock. That is not how we create the kinds of spaces young people want. It’s about being able to walk into a space.
There’s also a place and a welcome to bring your pets if that’s what you want to do. This is different than how healthcare is typically delivered. This is about having lockers so that you can lock your phone and have it safely secured while you’re doing something else and not have to worry about your stuff. It’s about having peer support workers who are right close to that entry point. When you walk into a hub, you encounter someone who resonates with whom you can identify much more readily than the typical clinician who might be older or of a different gender. It’s all across different aspects of the hub model.
It sounds intuitive, but you started this with a system change. One of the things I’ve learned in a lifetime of work in the social profit sector is sometimes systems don’t want to change. Tell us a little bit about how you and your colleagues were able to generate that momentum for change.
Most people working in the youth-serving sectors are there because they want to help young people. We have a shared vision. Most people across those sectors work hard, often for pay that doesn’t reflect the value of their work, often in challenging circumstances where you’re dealing with people who are distressed, and you’re trying to support them in the context of a system that may not have adequate resources. They do the work because they have an idea about offering something that can be helpful. It’s been important for us to come together around that common vision.
The other thing is we started with people who wanted to do this, organizations in communities who came together and said, “We want to deliver better outcomes with young people, for young people. We’re prepared to work together differently in order to achieve that. We’re even prepared to give up our brand and offer our services under a common brand, Youth Wellness Hubs Ontario, so that young people can go anywhere in the province and find the services they need.”
They don’t need to know the names of 400 different organizations. They need to know one name, and they can find the services they need.” Those communities who put up their hands and said, “We want to do this,” they were already in a state of readiness. They were already committed to partnering with young people and thinking about this challenging problem differently. That was critical.
I had conversations with a few leaders in the youth mental health space. One of the unifying themes seems to be that no one doing it on a day-to-day basis thinks that the system is working as it was or as it is. Nobody thinks, “We’ve got this nailed. We need to increase it by 5% more, and we figured it out.” There’s this question shared journey around finding that new model.
As Youth Wellness Hubs Ontario was getting started, tell us a little bit about how the idea came together and what the initial funding looked like because you’re in an environment competing for scarce resources. You’re describing a new way of doing it. What was the tipping point that brought those dollars to the table that will allow the work to get started?
It’s interesting that you asked the question in that way because one of the things that differentiates Youth Wellness Hubs Ontario and maybe more broadly integrated youth services across Canada is this mixed funding model. We’re trying to work together differently, not only in terms of service delivery but operating as a learning health system. That means we’re focused on generating new evidence in addition to using evidence-based practices. As a result, research funding has been important in the development of integrated youth services and philanthropic dollars.
Youth Wellness Hubs Ontario first started with some funding that was received by the Federal government for us to support communities and build cross-sectoral networks of youth-serving agencies across the country. We did that for a few years. As part of that, we identified gaps and solutions. We did that together with young people.
There was a research funding call that created an opportunity to propose a new model of care, which we co-designed with young people. We successfully received research funding to do what’s called a randomized control trial of that new model of care of the integrated youth services model compared to hospital-based treatment as usual in outpatient psychiatry settings.
This was for teenagers, not for the full 12 to 25. It was for 14 to 17-year-olds. We weren’t able to do that trial completely without additional support. That’s where philanthropy came in. Philanthropy supported the additional components that we needed to develop in order to develop not only the test prototype for the research but a whole community-based initiative.
That’s got us started for our first three hubs. After that, it was about the Ministry of Health in Ontario and the system as a whole, becoming interested in the model and supporting us in doing a demonstration initiative that expanded our prototypes across ten sites across Ontario. They are allowing us to examine the model in other kinds of contexts and bringing in more philanthropy to help us grow and support components that aren’t quite yet ready for government support.
You mentioned the ten sites across Ontario. How did you choose?
I’m privileged to be able to talk to you about all of this work, but this is not my work and ideas. This is a huge team of people. More than 1,000 young people contributed ideas to the creation of the model, and hundreds of family members and service providers to say that. This is one of these things that was created by many people.
We did an open call for proposals. Forty-five communities across the province applied in that initial round of funding in 2017 to be one of the communities selected to do a demonstration initiative of the Youth Wellness Hubs Ontario model. We had to select ten out of all of those. We had youth panels, family member panels, and system leader panels.
We examined the applications that came in from perspectives of equity, community engagement, commitment to youth and family engagements, and commitment to measurement-based care. Measurement-based care is a relatively new idea that helps us ensure that young people have and experience services committed to achieving better outcomes.Measurement-based care is a relatively new idea that helps us ensure that young people are experiencing services committed to achieving better outcomes. Click To Tweet
For the call for proposals and the selection process, we did all of these different things. There were written submissions and interviews. There were young people, family members, service providers, and system leaders involved. Collectively, we arrived at a set of recommendations that were made to the government, and the government is the decision maker. Since that time, we’re up to 22 funded networks, with five more announced. Some of those networks operate more than one hub. We have hubs operating in more than 30 communities across the province.
That’s incredible, and it has been such a short period of time to see that. Does that speak to the need, the novelty of the model, or both?
It speaks to the need. I think it speaks to the existing child and youth mental health sectors, willingness, and interest in embracing a new model of service delivery in order to achieve better outcomes. It reflects a broader interest on the part of communities to come together to support young people differently. There’s the pandemic that has had significant disproportionate impacts on young people, especially young people who were moving through those developmental stages during the pandemic. We’ve seen a lot of momentum.
One of the challenges in our work here at the Discovery Group with organizations that operate as hubs or as networks is the balance between program fidelity. We know what works, and here’s the model that needs to work. As you expand to different communities, it may need to be tweaked here and there and changed a little bit. As executive director, how do you manage that balance between program fidelity and community customization?
The history from a research perspective has been that this idea that fidelity to a model that was tested in a research context is essential for achieving the outcomes. When you make modifications or adaptations in order to support implementation in real-world settings, somehow, that’s a failure, or you’re compromising the model. If you look at the research literature, you’ll see it’s filled with language like that.
We come at it from a different perspective. We start from the premise that we don’t have all the answers we need. We certainly don’t have interventions that demonstrate equitable outcomes for young people. We have a long way to go. We’re not going to throw out everything that’s already been learned.
We take the best available evidence where we can. We position that evidence as an opportunity to generate new evidence and learn about the essential components that are required to achieve enhanced outcomes and what are all the adaptations that are required to make implementation possible and might also enhance outcomes.
It all comes back to measurement. We can’t know whether something is effective or improving unless we measure it. Measurement is built into everything that we do. Based on the measurement, we can get a better understanding of whether we’re achieving the outcomes we want to achieve or not. We can wrestle with that tension around fidelity, adaptation, and outcome.
We often see organizations struggling with fidelity adaptation and tension. One of the things that can be missing in the adaptation is what are deemed to be essential elements of the initial program or the intervention. We see organizations that are struggling to find that. How do we connect all of these? We understand we need to customize and adapt it. They see that as a value and a strength.
How do we make sure it’s the same, or we’re giving the best to each client that comes through the door? I like the way you phrased that, which is that guiding principle. It sounds like, in your organization, there is that commitment to measurement. We’re going to adapt and measure. If this doesn’t work, we’re not going to do it again, and we’re going to change it.
The other thing is that we have focused on core components that are about ways of working as opposed to specific services. I think of them as service widgets. We’re not in the business of producing a set of service widgets. We’re in this because we want to change how young people experience services and how services are delivered and achieve those outcomes.
Thinking about things like, “How are we exemplifying our commitment to youth co-creation all throughout the services? Is every hub ensuring that young people are on the hiring committee to make sure that the people who are hired to deliver the service widget are the kinds of people who exemplify the values we want to be woven into the system, people who like young people, people who will listen to young people who will support them and empower them to be active in their own care.”
That gives you a sense of how we work more than the specific services that are offered. We monitor that. We have a whole set of criteria to describe the different core components. We monitor the extent to which people are implementing in alliance or following those core components. It helps us to get a better sense of the extent to which the hubs are bringing the values to life and their day-to-day work.
What you’re underscoring there is the value of service delivery that has its roots in research that commitment and discipline to paying attention to what’s happening and ensuring that as the evolutions and adaptations are taking place. The core principles and the best elements are held onto. There are a few ideas that have passed by that didn’t quite work.
Jo, this may not work as a question, but I have been impressed by how consistently you keep coming back to that concept of youth co-creation. In our sector, there is the common adage of nothing about us without us, and when it comes to service delivery and advocacy across a whole range of causes and issues. We see in some boards and some funders that this concept of co-creation takes too long at times.
We know the answer. We’re wasting time. It’s not efficient. Instead of having 30 hubs, maybe we could have 50 or 60 by next March if we do what we know works and we pass by this co-creation. I’m guessing you would push back against that. I’m curious. What advice would you have for leaders who are facing those kinds of fake efficiency arguments that can sometimes come up in our sector?
We have faced that challenge in terms of relaxing our commitment to our values in order to move more quickly or keep particular stakeholders happy. It’s essential. One thing that I would say to myself and to all of the teams with whom we collectively work together is, “What are we prioritizing?” Sometimes, those kinds of decisions happen unintentionally or without any consideration. We make them quietly. We make them by which emails we prioritize when we’re checking our email. We make them subtly in nuanced ways.
Always bringing to every significant decision, what are we prioritizing? What are we missing? It can help us to see how we are straying from our values or how we’re staying connected to our values. Nevertheless, we still feel the pressure to go quickly, and engagement does take time. If you’re building something as significant as what we’re building, we need to take that time. We need to ensure that the foundation is a foundation that will sustain what we’re building over time.
We have amazing treatments and interventions that have been created through research and medical model frameworks that have changed people’s lives. Have they solved the whole problem? Not. That’s the evidence that shows we need to think more broadly. We need to be thinking about the social determinants of health. We need to be thinking about how mental health, well-being, mental illness, and the social determinants of mental health, identity, and intersectionality, how all of these things fit together to translate into youth outcomes.
If we think we can get a fast solution to a problem that’s existed for so long and is becoming worse, we’re going in the wrong direction. This is going to take thoughtfulness, meaningful engagement, and commitment for the long term that will carry you through the many challenges we will face along the way. It has to be about persistence and commitment to coming back to those core values, especially co-creation, when things get difficult.
I appreciate that answer, Jo. There are two things I want to underline in what you said to pull out as specific advice for leaders who may be reading. In the face of conversations with funders, board members, or other essential partners, I’m starting with a question, what are we prioritizing? I’m reframing the conversation out of urgency to one of importance and one of values. What are we prioritizing?
It can’t be as basic as email in your example, but that commitment to co-creation that you keep returning to is a valuable one. The other one is a simple reminder. It’s good for all of us. The things that are significant and sustainable take time. That’s a feature of these qualities we want in our organizations and our services. It’s not a flaw. You can go fast, but it’s likely not going to be significant, and it’s almost certainly not going to be sustainable. If you stick to values and take that time, you can realize that significance and that sustainability.
That brings me to another question I have for you. Organizations have the opportunity, through their success and partnerships, to expand as quickly as the Youth Wellness Hubs are. How do you think about growth as an organizational leader? You’re able to serve more people, clients, and young people. I would imagine the number of growing pains that cross your desk in a weak number in the hundreds, not the dozens.
Yes, that is correct. It’s challenging. It does come down to people. From my perspective, the only way Youth Wellness Hubs Ontario has been possible is through the commitment and the engagement of people and ensuring that the people who are engaged share the vision and the values. That’s been a big worry for me.The only way Youth Wellness Hubs Ontario has been possible is through the commitment of people, the engagement of people, and ensuring that the people who are engaged share the vision and the values. Click To Tweet
When this started, I was never a traditional researcher, but I was a clinical psychologist doing psychology work and doing research. You are puttering away at your own little projects. All of a sudden, it was like this big endeavor. I worry, like, “How do I know that the most hired person in a hub and our provincial office understands the value, shares the vision, and knows the nuance of talking about youth as youth and not calling them kids? How do we ensure that commitment to amplifying and supporting the voices of young people is throughout the organization?”
I don’t have a fantastic answer for that other than ensuring that, as people come on board, we’re taking the time to spend time with people around those pieces. We’re connecting with people as they’re becoming part of Youth Wellness Hubs Ontario to both share our vision and learn about what attracted them to Youth Wellness Hubs Ontario.
This is a time for health human resources. It is difficult. When people want to work with Youth Wellness Hubs Ontario, we want to know about that. We want to know why and what attracted them. We want to harness that enthusiasm. At the same time, we’re ensuring the commitments to the values and the ways of working are exemplified and understood.
Can you give us an example of how you make sure those values are exemplified?
We have high expectations of all of the teams in terms of treating one another with respect. This may seem a basic approach, but you’d be surprised at how many places it’s missing. Especially for people who are in leadership positions within Youth Wellness Hubs Ontario, it’s clear that we want to be a flat organization, and we haven’t achieved that because there’s so much pressure to not be flat. We want to operate like we’re a flat organization, and we want a person who may be in a much more junior role to feel uncomfortable speaking up and saying, “What about this? I’m concerned about this. Could I talk to Jo about this?”
The answer is always yes, and there is always room to hear from everyone across all the parts of the organization about their ideas and, most importantly, about their concerns and the times they feel things haven’t gone well. Communicating that at the outset, and this is about all of us collectively working together towards a shared vision, helps exemplify the values and create the kinds of spaces and organizations where people are not afraid to speak up. At least that’s what I hope we’re doing and people experience
It is challenging. There’s such a powerful selection bias of people who want to work in youth mental health. You’re people are electing to do that are committed and certainly likely values aligned at the outset. As you’re growing, there’s a lot of pressure on a lot of people in the organization. Sometimes, that pressure doesn’t bring out the best in us.
It’s how to correct an individual or a whole hub. I’m not going to ask you to name one. That may go a little slightly off-center to bring those individuals or that site back. As executive director, how do you think about making space for people to come back if they may have gotten a little top-down or done something slightly askew from the values?
We can think about it at the personal level. This is all about humans, human behavior, humans supporting other humans, and humans trying to create and build new ideas and do novel things in pursuit of a particular vision. Taking the time to appreciate that people are, most of the time, trying their best. We all face challenges. We all make mistakes. We all go off astray over there and come back. At a personal level, it’s about modeling.
Hopefully, the folks that I work with experience me as modeling a lot of reflection about my own work, thinking about how I could do things differently, bringing that spirit, and encouraging others to do the same. It doesn’t necessarily need to be my communication to someone else about something, but that they can do that themselves.
At a hub level, we do similar things. We have people who are experts in delivering implementation support and see that hubs are evolving over time. They have to have the freedom to try different things, learn from those experiences, and bring that back. We focus on embracing a culture of learning, which means we will fail sometimes. There will be times when we will try something that doesn’t work, and that’s okay because A, it didn’t work because we measured, and B, we’re going to make it better by doing that.
We make some strategic structural expectations. For example, to bring in different voices and have conventionally held all of the power in healthcare and service delivery, we incentivize hubs to flow some of their funds and resources to organizations that may be culturally based, youth-led, or organizations that are not typically funded through core sustainable funding. We’re pushing hubs to share the power and resources to bring those other voices in. When we have a greater diversity of voices, we also have greater accountability for working in ways that are respectful and values-based. Those are a few things like a crash from people to organizations.When we have a greater diversity of voices, we also have greater accountability for working in ways that are respectful and values-based. Click To Tweet
I’d love to hear a little bit more about the incentives around funding organizations that wouldn’t otherwise have access. You’ve mentioned a commitment to equity in a couple of your answers. I certainly know it’s an important part of the hubs. Is that funding non-traditional or organizations that wouldn’t have access to funds? Is that part of that commitment to equity? What does that look like in a real-world example?
Early into our work with Youth Wellness Hubs Ontario, we used social network analysis to understand hubs and their interconnections within each community and all of the network partners. I have done this in other kinds of work. I wanted to understand how hubs might change over time in terms of their network and the strength of their connections.
One of the things that was interesting when we did that first round of social network analysis was that we could see that there were these little organizations that were quite separate from the core of all of this network activity but to whom and from whom, many young people were moving in this system. This told us that these particular organizations likely were highly attractive and engaging for young people, but they lacked the resources to deliver the services themselves.
We wanted our networks to reach out to those organizations and draw them into the Youth Wellness Hubs Ontario network because our model is the network that’s funded. We’re not in the business of continuing these funding sole organizations across the province and have their own boards and brands. We don’t want that. We want communities to come together, use a community approach, and fund a network to deliver better outcomes.
We worked with the existing members of a steering committee or integrate, we call them integrated governance committee for the network, to reach out to those organizations and draw them in to have them be part of the governance of the hub to ideally build capacity amongst all of the service providers within the hub and deliver services in the hub and to do that, not in ways that are extractive. It enhances their organization by flowing funds to the organization so that they build greater capacity. We’re trying to move towards a model that addresses inequity in those ways. We have other strategies that we use.
What an elegant solution, and what you’re describing there is a muscle that’s not often used or underused muscles in our social profit sector of identifying organizations that can, in a sense, be brought into that network by providing the resources to bring them in rather than giving them an opportunity to spend their own money to participate in the existing network. It is quite a different model. How has that worked? How do you get organizations through that integrated governance model? How do you get people excited about bringing those groups in? The advantage and challenge seems obvious. It’s the in-between part where I think a lot, in our sector, we fall down.
As long as we don’t have parity with physical health in our mental health funding, we will always have this challenge around temptation and a push towards competing for resources. Overall, the sector is under-resourced. It’s hard. If you move outside of mental health into addictions or other aspects of social determinants of health and pieces that are required for well-being, the resource challenges are huge. That makes it challenging to have people share resources.
How have we navigated that? We’ve made it imperative. It’s part of the model. We have to do it. It almost circles back to something we were talking about in the beginning, which is why it’s critical to have youth as co-creators because youth, as co-creators, there are lots of good reasons to do that. One of the reasons is that youth are in a position to make compelling cases for why we need to engage these organizations that have historically been excluded.
The unique value proposition, not in those words necessarily, but sometimes in those words, the unique value proposition that those organizations offer, the ways in which those organizations provide a counterpoint to our conventional ways of delivering mental health care that has been shown to be notably uninspired and ineffective for young people. It’s about the why, approach, and applying pressure on organizations to be willing to share power. Notably, we have started with the organization’s most willing. That makes it a little bit easier.
I want to pivot slightly in our conversation to talk about you for a little bit because you seem to be the embodiment of the adage. If you want something done, you give it to a very busy person. In addition to your role with Youth Wellness Hubs Ontario, you are a professor in the Department of Psychiatry at the University of Toronto and Scientific Director of the Margaret and Wallace McCain Center for Child, Youth, and Family Mental Health, and you’ve talked about being a practicing psychologist and doing your own research. When you have a question related to any one of those jobs, but particularly related to the Youth Wellness Hubs Ontario, who do you go to for advice?
There are some phenomenal system leaders and thinkers that I am privileged to have in my world. Some of those people are young people. Some of those people are people with much longer and broader experiences in conventional system leadership roles. One of the cool things about integrated youth services is that it does have momentum across Canada.
There are a number of people across the country who are engaged in trying to support system transformation in similar ways. We’re not all the same. We might come at it from different perspectives. Our models might be slightly different, but the idea is that values have to be central to the work and that we need to redefine how we think about mental health and mental health service delivery or youth service delivery is shared and common across many of my colleagues. We connect with one another. I always say, “I would connect with different people depending on what I need.” Sometimes, I need moral support. It might even be the people I’m closest to who can say, “It’ll be better tomorrow.”
One of my favorite questions to ask, especially as we’re here in the new year when we bring guests on, is to conclude our conversation. Jo, what are you looking forward to?
We are at a moment in the history of youth service delivery in this country that we’ve never been at before. We have alignment, not perfect alignment, but an adequate amount of alignment across a wide range of people and organizations. We’ve not seen this before. I’ve been here at the Center for Addiction Mental Health, its predecessor organization, since 1994. I have not seen in all of my time the alignment of municipal, provincial, Federal, territorial, and government alignment with research and philanthropic funders. This shared vision crosses young people from a multiplicity of cultures and identities, family members advocating, service clubs advocating, researchers and clinicians. This has not happened before.
We all are saying, “The way it is is not adequate, and we need to work together to do something differently.” That gives me a lot of hope, momentum, and enthusiasm to go into the new year, thinking about what can be. We’re going to face challenges, but having a collective approach and knowing that there are many others who have a shared vision leaves me feeling like, “What a privilege it is for me to have this role, be in this place, and be able to contribute in this way.”
We’ll leave it there as everybody gets over the goosebumps from reading your inspiring answer there. Jo, thank you so much for taking the time to be on the Discovery Pod.
It’s my pleasure. Thank you for having me.