Facilitated Discussion on Voluntary Integration The ECC Board Meeting May 2018

Purpose – What do we hope to achieve? What do we want to get out of this conversation? Consider the spectrum of options Determine areas where the Board needs more information to determine its position How are we going to get there?

Guiding Principles for Integration “The potential of integration is in its ability to address both sides of the value equation – improving health outcomes and the experience of care for those using the health system, while at the same time reducing duplication or lack of coordination that can lead to unnecessary costs.” Toronto Central LHIN ‘Voluntary Integration Roadmap’ page 2

Context for Integration “Before considering potential transactions, it is critical that Board members and executives take stock of their own organization’s progress in achieving its vision and mission, effectiveness (e.g. client outcomes, service quality), internal strengths and challenges, as well as emerging client and community trends and other external factors affecting the future.” Woodgreen ‘From Strategy to Implementation’ page 6

The ECC Mission and Vision Mission The ECC improves infant, child, youth and family well-being by providing effective community based mental health and autism services. Vision Children, youth and their families succeeding in their daily lives.

The ECC – A Brief History Ewa to provide

Integration Is More Than Just Mergers Additional Considerations for Integration Degree of Integration Linkage (ad hoc) Coordination Structured Collaboration Program/Service Transfer Full Integration Limited or informal connections, network One time / ad hoc working arrangement Ongoing formal partnership/coordination agreements within a system Program/service level No structural changes Ongoing formal collaboration agreements within a system Standardization along care pathway, shared services Brands remain separate Formal transfer, merge or amalgamation of program services May include back office services/functions as well as clinical Creation of single system of care Based on Kodner’s model

Domains to Consider Access Quality Property Infrastructure Toronto region Woodgreen pages 6-9

The Political Landscape Scenario 1: Increasing pressure Scenario 2: Decreasing pressure In this scenario, the next government continues to push for integration Pressure to integrate grows as funding is maintained at current levels in the short term Funding seems likely to be cut in the medium term In this scenario, the next government pauses or reverses direction on integration Recently announced autism funding is delivered as promised Increased funding for children’s mental health seems likely in the medium term In either scenario, The ECC must be able to clearly articulate its position and demonstrate that the Board has done its due diligence in considering integration. Is our position ‘integration if necessary, but not necessarily integration’? Or something different? The Board should also consider how and when to make its initial approach to newly elected (or re-elected) MPPs.

Scenario 1: Coordination Ongoing formal partnership/coordination agreements within a system Program/service level No structural changes How would this scenario affect The ECC’s: Sustainability? Quality of care? (access; wait times) Alignment with vision/mission?

Scenario 2: Structured Collaboration Ongoing formal collaboration agreements within a system Standardization along care pathway, shared services Brands remain separate How would this scenario affect The ECC’s: Sustainability? Quality of care? (access; wait times) Alignment with vision/mission?

Scenario 3: Full Integration Creation of single system of care Could involve The ECC becoming part of a larger entity; The ECC absorbing a smaller entity; a merger of two like-sized entities to form a new entity How would this scenario affect The ECC’s: Sustainability? Quality of care? (access; wait times) Alignment with vision/mission?

Next Steps What are the Board’s thoughts on the ideas we’ve discussed? What else do we need to know or consider to go deeper into this conversation? What are the next steps we need to take?