With Dr. Joanna Henderson from the Centre for Addiction and Mental Health (CAMH) as the lead, YWHO is comprised of expertise from the Provincial System Support Program at CAMH and the Ontario Centre of Excellence for Child and Youth Mental Health of CHEO. YWHO reflects a partnership between the Ministry of Health and Long-Term Care and the Ministry of Child and Youth Services, with support from the Graham Boeckh Foundation. The YWHO team is working closely with stakeholders from across the province, including youth and their families, to inform every aspect of the initiative at the provincial and hub-specific level. This includes engaging specific equity-seeking groups of youth, such as First Nations, Inuit, and Métis, LGBTQ+, Francophone, immigrant, refugee, ethno-cultural, and racialized youth, and youth with disabilities.

• In response to longstanding and persistent calls to address system issues related to service access, quality and transitions from youth, family members, service providers and other Ontarians,  YWHO hubs are designed to provide adolescents and transition-age youth and their families with rapid access to high quality mental health and substance use services through easily identifiable, low-barrier, youth-friendly locations. These hubs will provide evidence-based mental health and substance use interventions matched to an individuals’ level of need, with clear pathways and seamless transitions to specialized care services when the severity of need is evident.
• Hub services will be integrated with primary care, education, employment, housing and other support services, reducing transitions and supporting youth in achieving goals across multiple life domains. By co-creating hubs with youth and family members, hubs will be more engaging, youth-centred and developmentally-appropriate than current services. Rigourous evaluation within and across hubs will allow individual and system outcomes to be monitored, and additional system improvements to be made.
• YWHO is also committed to improved quality of service and increased access to an integrated service approach for equity seeking groups of youth, such as First Nation, Inuit and Métis youth, LGBTQ+ youth, Francophone youth, immigrant, refugee, ethno-cultural and racialized youth, and youth with disabilities.

YWHO builds on what is already in place at multiple levels.

Provincial Level

At a Provincial level, YWHO brings into action Ontario’s Comprehensive Mental Health and Addictions Strategy: Open Minds, Healthy Minds. It operationalizes system transformation through:

• focusing on improving the mental health and overall well-being of youth. Not only do hubs bring together mental health and addictions services into an integrated approach to care, these services are embedded within a holistic approach to promoting well-being that includes attending to youth’s other health, educational, vocational, social and community needs; and
• through co-creation, cross-sectoral collaboration, and strategic community engagement efforts, Ontario hubs can become the focal point of community strengthening, and redefine the public’s perception of mental health and addiction services as they have BC.

Currently, youth often have to wait unacceptably long periods of time for treatment. The current system emphasizes assessment, and treatment is harder to access. For many youth, this translates into escalating difficulties due to long wait times, divergence from healthy developmental trajectories, disconnection from important aspects of social, educational and community life, and increasing severity of distress leading to ED visits for primary mental health care.

• Hubs involve services offered through no/low barrier platforms such as walk-in clinics, facilitate early intervention, and emphasize developmentally-appropriate evidence-based intervention in every session.

• In short, hubs are designed to provide ready access to high quality, integrated services that focus on keeping youth and their families at the centre of care.

YWHO puts into action recommendations from the Leadership Council, including hubs specifically, but also needs-based planning, outcome monitoring, developmentally-appropriate care – better meeting the needs of transition aged youth, and optimizing transitions.

YWHO exemplifies the objectives of Patients First: Action Plan for Health Care through:

• improving access to services matched to the individual needs of young people (“stepped care”);
• requiring and designing hubs to provide integrated services across sectors, through highly accessible community-based physical locations;
• offering a readily identifiable ‘one-stop-shop’ for youth wellbeing – from information provision to specialist service delivery; and
• reflecting a co-design model that engages the youth and families who use the system, and emphasizing evidence-based care and systematic outcome monitoring.

Hubs provide the tangible evidence to the public of commitment to Moving on Mental Health through providing operational exemplars of a coordinated, responsive system that provides easy-to-access, timely, individually tailored help. Hubs involve creating and implementing clear pathways to care, implementing core services (as defined by MCYS/MOHLTC), and leveraging investments in Lead Agencies by providing a tangible opportunity to organize community services around youth needs.

Consistent with Moving on Mental Health’s commitment to youth, family and stakeholder engagement, YWHO places youth and families at the centre of service delivery and at the decision-making table for community hub planning. YWHO also aligns with recommendations from the Auditor General regarding the need to shorten wait-times and improve the responsiveness of the mental health and addictions system.

YWHO also builds on Youth Collective Impact (Youth CI), an Ontario government-supported program designed to improve outcomes for youth in communities by enabling groups of organizations to address major challenges, i.e. poverty, youth unemployment, and low graduation rates.

Local level

At a local level, YWHO supports communities to understand their assets, bring them together into a collaborative process to better understand the needs and strengths of their youth, and customize implementation of YWHO values, standards and services to optimize youth outcomes.

YWHO team members and other system leaders have been working with youth and family members for several years to identify the necessary ingredients for a “youth-friendly” mental health and addiction system. There appears to be almost universal agreement that access to community-based integrated service models co-created by youth themselves, offered in a youth-friendly location is critical for Ontario youth mental health and addiction system transformation. This approach is consistent with common principles across international initiatives (e.g., Ireland’s Jigsaw and Australia’s headspace) and associated with positive findings in the emerging research base examining hub-based models of service delivery for youth.¹

Accordingly, the Youth Wellness Hubs Ontario model incorporates evidence-based interventions together with these principles and guidance received through current youth, family and other stakeholder engagement activities to form the essential elements that will be common across the development of Ontario’s youth wellness hubs. In addition, each hub will be developed with local youth, family and stakeholder involvement, and be provided with YWHO support to respond to localized needs and contexts.

¹ O’Keeffe, L., O’Reilly, A., O’Brien, G., Buckley, R., & Illback, R. (2015). Description and outcome evaluation of Jigsaw: an emergent Irish mental health early intervention programme for young people. Irish Journal of Psychological Medicine, 32(1), 71-77.

Rickwood, D. J., Mazzer, K. R., Telford, N. R., Parker, A. G., Tanti, C. J., & McGorry, P. D. (2015). Changes in psychological distress and psychosocial functioning in young people visiting headspace centres for mental health problems. The Medical Journal of Australia, 202(10), 537-542.

Hilferty, F., Cassells, R., Muir, K., Duncan, A., Christensen, D., Mitrou, F., … & Nguyen, H. (2015). Is headspace making a difference to young people’s lives? Final Report of the independent evaluation of the headspace program.

Integral to the YWHO integrated model of youth care is a commitment to youth and family engagement, and their involvement in key decisions – from planning to implementation and program evaluation. By actively involving youth and families, YWHO will better understand what works, what doesn’t, and why – leading to improved outcomes, enhanced youth ownership, and responsiveness to the changing needs of youth.

Youth and family members are encouraged to participate in the YWHO initiative in many ways, including attending/participating in community events or webinars; in identifying key service gaps and needs; by conducting ongoing local outreach and consultation; by serving as program staff; and assisting with surveys and evaluation. Youth and family members are also encouraged to participate in governance and decision-making at local and provincial levels by serving on various youth and family working groups and on advisory committees.

To learn more about participating in the YWHO initiative, please contact the Ontario Centre of Excellence for Child and Youth Mental Health at ywho@cheo.on.ca.

YWHO is committed to supporting sites with a range of resources and levels of readiness. Several criteria are being used to assess applications and guide selection of sites. These include, but are not limited to:

System Collaboration

• Community partnerships across youth services and sectors (e.g. mental health (required), substance use (required), primary care and one or more of education, employment, community and other social support services) to provide services that span the target age range (12 to 25 years);
• The Lead Agency of the catchment area of the hub must be a network member, and the network must include a health service provider (HSP);
• Collaboratively submit a network or team proposal across organizations, with network leadership clearly identified, and with the expressed support of youth and an Indigenous organization or stakeholder from the community;

Youth and family engagement

• Specify how local youth and families will be meaningfully included on the community team and in decision-making processes, and how the team will work together to develop and safeguard a youth-friendly space;
• Demonstrate authentic commitment to engagement through structure and resourcing in different elements of the hub’s planning, operation and evaluation processes;

Commitment to integrated services and supports for youth

• Demonstrate integration exemplified through planning for co-location, integrated clinical processes, and integrated governance;Include low/no barrier access (e.g., walk-in delivery platform), with convenient hours of service for youth and families;
• Demonstrated ability to apply principles of access, equity, and inclusion
• Demonstrate an ability to include and use non-traditional supports such as online platforms, mobile platforms, etc.;
• Articulate an approach for ensuring equitable access to culturally appropriate services for diverse youth (e.g. First Nations, Inuit and Métis, Francophone, LGBTQ, racialized youth) that includes an emphasis on engagement from the planning stages;

Demonstrated community value and impact

• Articulate a significant level of positive impact a hub would have for the local region with a focus on addressing specific currently existing gaps, barriers and/or breakdowns in the experiences of youth and their families in accessing services;
• Articulate the specific and unique complexities of the local system that can make service delivery, access and treatment challenging;

Capacity and competence

• Demonstrate capacity for implementing evidence-informed mental health and substance use services. (Note: Evidence informed means having a foundation based in evidence. Innovative approaches are also accepted as long as a clear plan for evaluation is provided);
• Show a clear motivation and presence of leaders or champions to provide sustained support during the development and implementation of the hub;
• Must have sufficient resources and physical space to support a youth hub;

Implementation and evaluation

• Commit to adhering to common evaluation framework, standardized measures, data management, data submission processes and continuous quality improvement;
• Commit to implementing processes, projects or tools to ensure adequate support at all levels of the organization to operationalize the change;
• Commit to participation in the development and implementation of a common branding strategy across sites;
• Express a willingness to work as part of a province-wide initiative; and
• Applicants must be representatives of organizations that are legally constituted under the provincial, territorial or federal laws of Canada.

In addition to requesting $50-$300,000 per year for up to three years to be used for implementing hubs, networks can request up to $100,000 (one time) for physical space, renovations, capital investment, to be funded through support that has been made available through philanthropy.

Congratulations to the following new hubs:

• Eastern Champlain
• Haliburton
• Kenora
• Malton
• North Simcoe
• Niagara Region

They are joining the following existing hubs:

• Chatham-Kent
• Central Toronto
• Scarborough
• Toronto East

An announcement was made in October 2017 inviting networks of agencies, youth and family members to submit proposals for funding and support to get a youth wellness hub up and running in their area. Proposals were carefully reviewed in a multi-step process that included scoring by three panels based on the demonstration of pre-established selection criteria and several full days of discussion. Following a vote, top-ranked applicants were interviewed to further discuss the merits of their proposals, and to clarify any questions the review panelists had. In addition, the needs of the province and system as a whole were taken into consideration, particularly in terms of equity, geographic distribution, need and readiness, leading to the development of YWHO recommendations. Recommendations were then submitted by the YWHO Executive to the YWHO Governance Table for review and then moved on to the Ministry of Health and Long Term Care and the Ministry of Children and Youth Services for final approval.

There were three panels involved in reviewing and scoring funding proposals: a youth panel, a family member panel, and a general panel. The general panel was comprised of system leaders from across sectors that work with youth. All panels, included representatives from across Ontario’s geographically diverse communities and from various equity seeking populations, including First Nations, Inuit, Metis Francophone and LGBTQ. YWHO staff from the Ontario Centre of Excellence for Child and Youth Mental Health, the McCain Centre for Child, Youth & Family Mental Health, and the Provincial System Support Program of the Centre for Addiction and Mental Health (CAMH) worked closely with each panel to facilitate the review process. Based on all of these review processes, the YWHO Executive (Executive Director, leadership from the Ontario Centre of Excellence for Child and Youth Mental Health; and leadership from CAMH’s Provincial System Support Program) made recommendations to the Ministry of Health and Long-Term Care and the Ministry of Children and Youth Services. The entire review process was guided and facilitated by an independent moderator.

Applicants not selected for funding through this process are encouraged to remain engaged in co-learning about integrated services for youth by participating in ongoing knowledge exchange opportunities. We will be reaching out frequently through our newsletter and on our website with information about these opportunities so please continue to keep an eye open for updates and reach out to us with ideas or recommendations for connections.

Please direct your questions and/or interest in staying connected to info@youthhubs.ca.

Shareable information and resources will be made available through youthhubs.ca and we will be updating content on an ongoing basis. Please consider all information on our website shareable and usable with appropriate acknowledgements to YWHO given. Thank you!