Accelerating implementation of First Link® Gale – you could open by explaining a bit about Ontario as a federation of 10 provinces etc and than Alzheimer Society mirrors this but within Ontario – largest province there are 38 chapters, estimated 200,000 people with dementia – Gale Carey, CEO Alzheimer Society of Ontario Alzheimer’s Disease International March 2012

Outline Why First Link®? What is First Link and where is the magic? Who guides implementation and who delivers the service? What are the tools to guide implementation and monitor adherence? What have we learned? Presentation will cover these areas – questions afterwards and colleague David Harvey is here to help with questions.

First Link® Why? – People diagnosed with dementia benefit from early intervention and access to supports, but there are barriers to accessing these supports What? – First Link reduces these barriers to access through direct referral by health-care providers and follow-up by local Alzheimer Societies The basis of all our services is that the earlier we reach people the more able we are to provide effective service and the more able people are to benefit from them But we know that too often people never contact us or often wait until there is a crisis So we wanted to reach people earlier and we tried to do this by asking health care providers to seek their patient or client’s permission to directly refer the person rather than by simply suggesting that they contact us. This simple change has made all the difference! This is the magic. But we need to convince health care providers to make referrals and we need to make it easy for them. On referral, the Alzheimer Society calls the person and offers service and continues to do this periodically

Reduce gap between diagnosis and access to support and services So what difference has First Link made? Most importantly we reach people earlier. Referred clients contact us 11 months earlier on average than direct contact clients. First Link® Demonstration Project Evaluation, McAiney et al. 2009

Increase in partnerships Our First Link referral numbers are growing and now exceed direct contact numbers. Our partnerships have expanded significantly

Delivery challenge Service and support are delivered through 38 local Alzheimer Societies Challenge – how to accelerate adoption of First Link and keep “faithful” to the model Understand the intervention and how to repeat it Spread the ‘know how’ to other sites Monitor for results This is a map of Canada with Ontario inserted. As I mentioned, we have 38 chapters so our challenge is to accelerate our introduction of First Link but keep true to the model; provide consistency for optimum benefit. The key to First Link success was the referral partnership and the client experience. Adherence to the intervention is key to success

Tools for implementation process Core implementation components Service Agreements Skill Exchanges Staff Training/Tools Common Data Collection Service Standards Client Satisfaction Tool Our process to replicate First link and to monitor it involves these 6 activities Service agreements with each participating society to set out core activities and reporting requirements Skills exchanges among key staff annually to share ideas and learnings; First Link Coordinators Focused training in key areas such as client education; conference, webinars, workshops Common data collection to capture clients served, referrals, etc Service standards related to service agreement and core activities Client satisfaction tool administered to a sample of clients and referral partners

First Link® standard implementation Principals – First Link Why? Content –First Link What? Format-First Link How? Process – First Link Who? Where? When? al E Early diagnosis and linking people with dementia & care partners to Alzheimer Societies (AS) Collaboration among AS and service providers to reduce barriers to early access as Direct referral system Outreach strategies & rapport building with referral source Direct client contact to supports in timely manner Local Alzheimer Societies implement Collect/use data Service Delivery Model Tool Satisfaction survey Staff Skills Exchange as Direct referral to First Link at early stage AS follow-up and contact through the continuum of the disease This is another representation of the First Link Implementation process using a Logic Model - Implementation maintains sufficient fidelity to the model to achieve successful delivery. It is not intended to curtail creativity. We should always be striving for continuous improvement

Lessons learned Understand and “lock in” key components of the intervention Create tools that describe, communicate and replicate the intervention before further adoption Ensure adherence to model and/or control change – “standardize before you customize” Manage change and resistance to change So what have we learned? Know what the magic is and focus on it – understand why referral agents agree to work with us? Repeat your success and create tools to help others do it successfully Discourage customization until the proven model is fully implemented and understood Manage change – how does this change existing work and partnerships- understand why some may resist change and create messages to respond to them and explain benefits of new approach

Questions? Gale Carey gcarey@alzheimeront.org www.alzheimer.ca/on