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The Investigator: An Interview with Dr. Paula Goering

By Sheela Subramanian
Network, Spring 2011

Dr. Paula Goering, RN, PhD, is an experienced clinician, consultant, educator and researcher. She is a professor in the University of Toronto Department of Psychiatry with cross appointments to the Faculty of Nursing, Institute of Medical Science and Department of Health Policy, Management and Evaluation. She is also an Affiliate Scientist in the Department of Social and Epidemiology Research at the Centre for Addiction and Mental Health (CAMH) and Research Lead for At Home/Chez Soi, the Mental Health Commission of Canada’s $110 million, five-city demonstration project on mental illness and homelessness.

From 1980 to 2011 she was Section Head of the Health Systems Research and Consulting Unit (HSRCU) at CAMH. Dr. Goering held a ten-year CIHR/CHSRF Chair in Health Services Research that ended in 2010. The Chair, entitled Generating and Disseminating Best Practices in Mental Health and Addictions, created opportunities for interdisciplinary training, mentorship, research and collaboration between researchers and policy-makers. In 2008, she was the recipient of CHSRF’s Research Advancement Award in recognition of her national leadership in knowledge creation and translation. In 2010, she was granted an Honorary Doctor of Science degree by Ryerson University.

Q: Three sets of studies — the Provincial Psychiatric Hospital and Community Comprehensive Assessment Projects (CAP), Community Mental Health Evaluation Initiative (CMHEI), and Systems Enhancement Evaluation Initiative (SEEI) — have produced a wealth of information to guide future planning and decision-making. Before these studies, what sources of information were being used to guide planning and decision-making?

There was nothing of this scale before, although there were many smaller studies that may have been used. These three studies were large, and covered multiple programs at multiple sites. All of the studies were funded by the Ministry of Health and Long-Term Care, who was also an active partner in the conduct of the research process.

These studies also marked a way of doing research that was different because they used an integrated knowledge translation approach throughout. What that means essentially is that if you want research to be used to inform decision-making, you need to involve decision-makers throughout the process, especially the people who plan and manage programs, and those who make decisions about policy and funding. All three studies used this approach. They also involved participation from service providers and mental health consumer/survivors. In contrast to research where knowledge translation is done after the research is complete, this was not separate, but always done collaboratively.

Q: What made this collaborative approach work?

Several articles have been written about the approach we took. There were many important ingredients.

First, you need to have a government partner that believes in the value of evidence and is willing to participate in the process. We had that in the Ministry of Health and Long-Term Care.

Second, you need a unique group of researchers who work in a collaborative manner. Many of the key researchers involved were at the HRSCU at CAMH and had similar interests and skills. All three studies involved other researchers from across the province, and they too had a similar approach.

Finally, you need partners who are willing to put time and energy into the process. Many organizations and service providers were involved with the data collection and interpretation process.

Q: What was your role in each study?

I was the Project Lead for all three studies, meaning that I conceptualized the overall structure for the research and recruited those involved with implementation. Throughout the time of the studies, I received funding from the Canadian Health Services Research Foundation and the Canadian Institute for Health Research for a Chair in Health Services Research which facilitated my role to lead and operate in a knowledge transfer and exchange linkage model.

Q: This must have been a challenging process at times. What motivated or inspired you along the way?

People were hungry to learn more about what needs were going unmet, and it was clear that the research findings were having a real impact. It was very gratifying to be involved in such a meaningful learning process. Part of the legacy of the studies was also that they provided numerous individuals — consumers, students and others — with opportunities for employment, learning or training. The process also helped to create a culture that was supportive of and positive about evaluation. Organizations that were involved became much less distrustful of or reluctant about evaluation and really saw the value of research for creating new knowledge.

Q: What were some of the important things that we learned about the community mental health sector from the CAP and CMHEI studies?

CAP really focused on met and unmet needs. It started with a look at the provincial psychiatric hospitals, but a look at any part of the system requires you to look at other parts as well. It was an exercise to help government figure out its next steps for the hospital sector. The findings fed into the local and province-wide regional planning tables that were part of the Mental Health Implementation Task Forces.

CMHEI provided some of the best evidence we have about the value of peer support. This was a very important finding.

Q: SEEI produced a wealth of knowledge, including many important findings about the mental health system. What does the community mental health sector need to know about those findings?

I think they would be interested in the overall message that although these new investments clearly created benefits, they were still not enough. There were still needs that were unmet, which meant that further investments are still needed.

Q: From CAP to today, how has the approach to research shifted over time?

We learned that we had to invest resources in knowledge exchange and transfer. With CMHEI, we had a knowledge broker, Dale Butterill, as part of the project, which was key. By the time SEEI was done, we had Heather Bullock and two others doing that work full time and building the Ontario Mental Health and Addictions Knowledge Exchange Network. This was one of our biggest learnings. You need people on both sides of research and decision-making who are interested in working collaboratively, but you also need the glue. Knowledge exchange for mental health must be instituted in an ongoing way in Ontario.

Q: Have the studies been used in decision-making? What is their future legacy?

All of the studies have had an impact. For example, CMHEI played a role in securing the increase in funding that was evaluated through SEEI. The justice sector has been very interested in findings from Carolyn Dewa’s Matryoshka Study and Tim Aubry’s court support study about positive outcomes and relative unmet needs. The transitional case management study by Terry Krupa has served as a program model that has been taken up by others in the province. Findings from the SEEI ACT study led by Lindsey George have been of interest across Canada. The Impact Study led by Janet Durbin that looked at system-wide impacts and regional variation has been used by many LHINs to describe what is taking place in their region. All of the studies have been used at the local level in different ways.

Q: What’s next?

The Creating Together initiative had its roots in the goodwill and partnerships created by these studies. It focuses upon the same kind of health services research but includes a broader focus of population health and prevention. The conclusions from Creating Together echo some of the findings of CMHEI and SEEI that showed the need to consider income, education and employment. Creating Together shows that there is still great interest in the social determinants of health and how they come into play when it comes to mental health.

Sheela Subramanian is a planning and policy analyst at CMHA Ontario.

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