1. 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

2. 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.

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. Questions?
Gale Carey