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Module objectives

The purpose of this module is to support an initial exploration of the ChYMH Suite to understand whether it meets your organization’s needs and the first steps to prepare for a successful implementation. With this module, you will:

1. Thoroughly examine the interRAI ChYMH Suite tools.
2. Identify your organization’s goals for ChYMH Suite implementation.
3. Learn how to create a compelling vision to inspire and guide change.
4. Explore the roles involved in ChYMH Suite implementation and learn how to build a successful Implementation Team.
5. Learn about the importance of implementation readiness and how to assess it for your own organization.

1.1 The interRAI ChYMH suite

It is important to understand the interRAI ChYMH Suite so that an informed decision can be made about whether these tools are right for your organization.

There are several different tools in the interRAI ChYMH Suite, each with different features and uses.

For more information on the interRAI Child and Youth Suite, visit

1. The ChYMH Screener
   A screening tool that is used to help with decision-making and triaging.
2. The ChYMH
   A comprehensive needs assessment for children and youth accessing mental health services.
3. The ChYMH-DD
   A tool built on the same framework as the ChYMH but with a focus specific to young people with developmental disabilities.
4. The Adolescent Supplement
   A supplement to the ChYMH or ChYMH-DD that focuses on adolescent needs.

Matching your organization’s needs with interRAI child/youth suite assessments

Guiding questions on the following slides will help you consider your organization’s needs within the context of what the interRAI tools provide.

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  Scope

  What client-specific clinical decisions you want to be able to make with the information you gather? Do you require a brief review of risks and needs to support triaging? Do you require a comprehensive needs assessment? Typically, agencies opt to use the ChYMH Screener for intake/initial screening, and the ChYMH (or ChYMH-DD) for comprehensive assessment to support treatment planning and outcome measurement. However, some agencies have made different choices based on their operational needs, such as using the comprehensive tools (ChYMH/ChYMH-DD) at intake, or using the ChYMH Screener at all time points. Consider what your clinicians’ informational needs are, and what trade-off you want to make between comprehensiveness vs. amount of time to complete the tool.

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  Population

  What are the characteristics of the population you serve? What is the age range of your organization’s clients? Are they receiving community-based (outpatient) or inpatient services? Do they have developmental disabilities? As you review the information on interRAI.org note that the different tools are intended for different age ranges, populations of interest, and some tools have different versions for inpatient and community-based settings.

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  Format

  Is the interRAI data collection process compatible with your staffing and system resources? Do your staff have the clinical training, experience and capacity to gather assessment information using a semi-structured interview format that covers a broad range of areas that are known to impact child and youth functioning? Do you have the capacity to obtain an electronic data collection system? Do you intend to implement more than one interRAI child/youth suite assessment, and if so, do you have a plan for integrating and aggregating the data gathered from each tool?

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  Decision supports

  Are the outcomes provided by the tools compatible with your information needs and resources? Do your clinical staff have the capacity to use standardized tools in their daily work, including embedding results into care planning and evidence-based treatment? Do you have staff with expertise in data analysis to manage aggregate data for program evaluation and reporting?

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  Relevance of focus

  Do the domains within each assessment reflect the clinical framework currently used to support your clients? Are certain assessments a better fit in this regard than others (e.g., does the comprehensive ChYMH provide information on all of the areas of focus for your organization, whereas the ChYMH Screener only provides information about some)? If there is something relevant to your organization that is missing from the assessment, can information from supplementary sources (e.g., home-grown data collection tools) make up the difference with minimal burden? For information about the domains for the interRAI child/youth suite, see CPRI’s domain framework in Appendix A or

Understanding the key features of the interRAI ChYMH suite

InterRAI refers to the ChYMH Suite “System” to reflect the multiple parts included in a fully realized interRAI assessment. These are:

• A data collection form, e.g., the assessment itself
• A user manual, which is necessary for accurately understanding the data collection form
• Embedded “triggers” for various algorithms
• Status and outcome measures^{footnote 2[2]}
• Collaborative Action Plans, or CAPs

CPRI developed additional Caregiver Collaborative Action Plans (CCAPs) ^{footnote 3[3]}For sharing directly with caregivers.

There are key features of the interRAI tools that cannot be modified without reducing the validity and usefulness of the interRAI ChYMH Suite:

1.2 Understanding your organization’s implementation goals

A strong start to an implementation initiative involves focusing activities on intended implementation outcomes. If your tool review has confirmed the ChYMH Suite meets your organization’s information needs, the next step is explicitly identifying the benefits expected from adoption into clinical practice. Below are some of the most common goals cited by organizations that have worked with CPRI to implement these tools. Which ones resonate for you, and how can you use this knowledge to guide your organization to success?

Worksheet: Get started with selecting the right tools for your organization’s needs

This section provides an opportunity to think about what you have learned so far and how you can apply it to your own interRAI ChYMH Suite implementation. As you review the prompts, make note of your answers and thoughts.

1.3 Creating a vision for interRAI implementation

A vision is integral to a change effort. A vision statement provides direction and helps motivate those impacted by the change to participate. Consider the characteristics of effective visions below in creating yours.

“�Ħa Vision Statement tells you where you are going. It paints a compelling work of a desired, future state. It can make anyone who reads it, hears it, or lives it want to support, work for, give to, or in some other way be part of your [organization]. (Christina Drouin, Centre for Strategic Planning, 2001)”

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  Imaginable

  A vision conveys a picture of what the future will look like. The vision should be clear, attainable, and realistic.

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  Desirable

  The result of the vision should appeal to the long-term interests of employees, clients, and other stakeholders.

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  Feasible

  A vision comprises of realistic, obtainable goals. Use SMART (Specific, Measurable, Assignable, Realistic, and Time-based) goals.

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  Communicable

  A vision should be clear enough to guide decision-making but succinct enough that it can be explained in under 5 minutes.

What does work:

The best way to get staff to “buy in” to the implementation of the interRAI ChYMH Suite is to both motivate them to want the change and to help reduce the anxiety they feel in anticipation of change.

To achieve this, emphasize the positive effects of the change on both the culture and success of the organization.

Creating an effective vision helps create a sense of ‘want’ among participants during the initial stages of implementation.

What doesn’t work:

Overly analytical or financially-based visions do not work, but neither do those that are vague or overly complicated.

Be careful not to assume that a linear, logical, or budget-based plan will adequately guide staff behaviour.

For example…

The ChYMH Suite of tools will provide our organization with a standardized clinical needs assessment that will help us to better understand the needs and strengths of the young people we support. These tools will allow us to monitor the impact of our services through observable, time-sensitive criteria that is evidence-based. Data from this assessment will also help us to:

• Measure improvement in the children and youth we serve
• Understand who is at our front door to better provide appropriate services
• Help us demonstrate the effectiveness of services we provide
• Ensure that we meet reporting requirements

1.4 Roles and responsibilities in ChYMH suite implementation

CPRI’s experience supporting implementations across multiple organizations has confirmed roles that consistently enhance the likelihood of implementation success. This section outlines roles that are useful. Note: Many of these areas are discussed in greater detail later in the toolkit (e.g., training requirements).

Completion of training, decision-making authority to plan and implement initiatives to improve staff engagement.

Building your best implementation team

Successful implementation relies on an effective Implementation Team. This team plans the implementation details and aids in informing, preparing and supporting all those who will be affected by the implementation of interRAI ChYMH Suite tools. The team ensures that the implementation is well-defined and the goals of each stage of implementation are met. This team should consist of individuals who have both the time and expertise to engage in the ongoing work and challenges of implementation.

Creation of an interRAI ChYMH Suite Implementation Team can occur at an organizational or regional (cross-organizational) level. Whether your organization is undertaking this change individually or with partners, it is important that the implementation strategy be grounded in principles of inclusivity, collaboration, and shared decision-making.

Read on for details about what a ChYMH Suite Implementation Team does, who should be on the team, and how to get started.

Key functions of the team:

1. Strive to align initiatives both internally (for example with the organization’s strategic plan) and externally (for example with the goals of a ministry or school board).
2. Aim to remove barriers and discontinue ineffective efforts.
3. Build on the current resources and strengths of the organization (for example, coaching supports, processes, data collection procedures that are already in place).
4. Facilitate communication with stakeholders. This includes, but is not limited to: families, community members, policy makers, and other implementation teams.

The implementation team should consist of at least 3-5 members from a variety of roles. Members should have skills (e.g., leadership) and knowledge (e.g., familiarity with implementation science, awareness of the organization’s historical implementation efforts) to deliver implementation.

When planning the composition of your implementation team, consider the following:

Optimally, an interRAI implementation team should include members with:

• Decision-making authority such as managers or discipline leads
• A current role in delivering direct care
• Expertise in related non-clinical areas such as quality assurance, information technology, privacy
• Experience with other implementation initiatives
• An understanding of the organization’s climate and nuances
• A youth and/or family representative

Consider also involving individuals who:

• Express interest in/volunteer to support interRAI implementation
• Have strong communication skills
• Have a position of trust or authority (potential champions!)
• Have experience interacting with diverse stakeholders who will be impacted by the implementation of the interRAI tools such as families or board of directors

Checklist: 3 things to think about when building your implementation team

1. Have you got the necessary skills and knowledge at the table?

• Understanding of referral paths and program goals
• Understanding of information needs at service time points (such as clinical decision making, program evaluation, reporting)
• Understanding of organization’s Information Technology needs and electronic information needs/capacity
• Understanding of stakeholders’ needs
• Understanding of training pressures such as scheduling constraints
• Understanding of training requirements and operational needs such as accreditation standards
• Understanding of organizational data requirements and data analysis expertise

2. Have team roles, responsibilities, and tasks been documented?

• Have overall membership expectations been clarified? For example, how often will the team meet? Who will chair? How long will membership last?
• Have specific tasks been identified? Examples include: training coordination, ensuring adherence with privacy legislation, integration with organizational policy, evaluation.
• Is it clear which tasks are best for the entire Implementation Team to work on and those that are suited to a “working group”?
• Has everyone’s specific role been documented and signed off on?

3. Is your plan sustainable for the duration of the implementation effort?

• Is there an awareness that implementation is a multi-year effort, and that aspects of the team may change (composition, frequency of meetings) but the overall commitment to the effort needs to be sustained?
• Have you identified supports such as backfill or reduced clinical workload to support staff who are participating in the Implementation Team or working groups? 
  Have those supports been documented?
• Is there a plan for regular re-evaluation of Implementation Team roles, responsibilities, tasks, and membership? For example, quarterly or annual review

1.5 Readiness for change

Readiness for change is an essential component of implementation success. Readiness is a term used to describe the collective preparedness to adapt to change in an organization or team context. Readiness for change reflects a shared commitment to implement change and a belief in the ability of the organization to do so.

There are three major components to readiness:

1. Motivation to adopt the new practice
2. General capacity – the organization’s overall capacity for change such as availability of expertise and responsive culture
3. Intervention-specific capacity – the human, technical, and physical conditions needed to implement the specific practice

“Failure to establish sufficient readiness accounts for one-half of all unsuccessful large-scale organizational change efforts. (Kotter, 1995)”

To-do: readiness self-assessment

An important step in the earliest stages of starting an interRAI implementation effort is completing the Readiness Self-Assessment, which can be found on the next page.

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  What is it?

  A series of questions designed to help you understand your organization’s readiness to implement one or more interRAI ChYMH Suite tools. The survey questions are aligned to the three components of organizational readiness (motivation, general capacity, and intervention-specific capacity). Note: The survey was developed by CPRI based on published research findings but has not been tested for reliability or validity.

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  Who should complete it?

  The survey can be completed by one or more members of your organization’s staff. If your organization has formed an interRAI Implementation Team, coordinating the completion of the survey would be an appropriate early effort for one or more members of this group.

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  Why is this important?

  This step will provide a foundation for the entire implementation process. It can highlight potential obstacles and areas of specific need and ensures that efforts are focused on priority areas for your organization. This will give you an opportunity to make changes that will greatly increase the chances that your ChYMH Suite implementation efforts will be successful!

Self-assessment: is your organization ready for ChYMH suite implementation?

Answer the following questions using the response options provided. Note any thoughts and ideas that come up as you go. Refer to the guide for interpreting and using these results on the next page.

Interpreting and using the readiness self-assessment results

Once the Readiness Self-Assessment has been completed this information can be used to:

1. Determine overall organizational readiness for ChYMH implementation

• Are there a significant number of “No” responses?
• For the “No” responses, are these actions that can be put in place as part of the implementation effort, or are they factors that would be difficult to change (in particular, factors from the “General Capacity” section such as high leadership turnover or staff burnout)? It is not unusual to identify areas where readiness is not present.

2. Identify areas of strength and areas of need.

• Which of the readiness factors identified as being present can be leveraged in the short term to get the implementation effort started (such as presence of champions, shared vision) and to sustain implementation efforts (such as robust training infrastructure, expertise with data analysis and evaluation)?
• Of the factors that have been identified as being “Maybe” or “Partially” in place, what can be done to bring those up to a “Yes”?
• Which factors were identified as areas of need, and how can capacity be built in these areas?

3. Set priorities and create a shared understanding of readiness.

• Of the three components of readiness, is there one where there is a greater need? If so, it may be wise to focus efforts there before moving forward with implementation efforts.
• Consider sharing an overall summary of readiness results with staff and stakeholders to engage them in problem-solving and prioritization.

Mini case scenario #1

Organization A’s senior management team (including the Executive Director and clinical program managers) gathered to discuss use of the ChYMH Suite instruments. In advance they had reviewed an implementation package that included a sample of the ChYMH Suite instruments, an outcomes report template, and samples of clinical decision-support resources that accompany the instruments. The managers had previously completed the Readiness Self-Assessment and the results were included in the pre-reading package as well. The goals for this meeting were:

• Reviewing organization readiness factors
• Discussing organizational goals and vision
• Determining other staff members appropriate for the Implementation Team
• Identifying which, if any, ChYMH Suite instruments would be the best fit

Organization A is a children’s mental health organization planning to implement the ChYMH Suite of tools. Their client base is mostly children under age 12 with mental health concerns, though they have recently also begun providing service to children diagnosed with autism. Senior management brought together a small group of program managers to begin the process of determining next steps for ChYMH Suite implementation.

Upon reviewing their Readiness Self-Assessment results, team members supported the need for this change and its priority status. From a resource point of view, some strengths and concerns were identified. The organization had several child and youth workers and social workers who were well-suited to become assessors/trainers as well as a data analyst who could provide site administration. All staff had access to required technology.

There were concerns that some of the clinical staff may be resistant to the change due to workload issues. The team agreed that identifying champions will be a key component for success.

The team collaboratively identified Organization A’s goals: standardizing client information, improving prioritizing and waitlist management, using evidence to support treatment plan development, and using a standardized assessment to provide much needed data to better understand the needs of their clients and to support reporting requirements. It was agreed that these goals would define their vision statement.

As a first step, the team focused on determining roles and responsibilities to guide who should be invited to be Implementation Team members. Several staff were identified as potential champions. Consideration was also given to whether it would be beneficial to have staff who were expected to be more resistant to the change involved in the implementation to build buy-in.

Review of the tools indicated that both the ChYMH and ChYMH-DD would be suitable given the recent changes in service focus, however the team decided to wait and have further discussion with the larger implementation group once it was established to ensure engagement from clinical staff.

Mini case scenario #1 reflection

Guiding questions

• How ready is the organization to move forward?
• How could the vision statement read?
• What is the risk of an unclear vision statement?
• Who is best suited for an Implementation Team, those who are natural champions or those whose buy-in will need more effort to achieve?
• Who is best suited to determine which tools are most appropriate for an organization?
• Has the team adequately acknowledged the need for change management strategies?

Phase 1 actions checklist

Decide which ChYMH suite assessments and programs or services will be the focus of the implementation effort

• Consider the needs of your organization – what positive changes do you hope the implementation will bring?
• Review the ChYMH Suite information in this toolkit and at
• Decide which programs or services will implement the assessments

Establish a ChYMH suite implementation team

• Recruit individuals that have the skills and knowledge needed for ChYMH Suite implementation
• Agree upon and document the roles, responsibilities, and tasks of the Implementation Team.
• Take steps to ensure that the Implementation Team can function for the duration of the implementation effort, including providing necessary resources and planning for sustainability.
• Develop initial working groups if needed.

Create a vision and select project champions

• Identify and engage champions. Select people who are influential, respected, and who believe in the value of the implementation effort.
• Develop a vision for the implementation that can inspire staff and guide change in your organization.

Understand your organization’s current capacity for ChYMH suite implementation

• Complete the readiness self-Assessment to gain insight into your organization’s current needs and strengths as you embark on this large-scale implementation effort.
• Use the results to set implementation task priorities and create plans to improve weaker areas as well as leverage areas of strength.
• Consider whether implementation should roll out in stages or all at once.