Strongest Families Institute: Our COVID-19 Response as an eMental Health System of Care

Strongest Families Institute (strongestfamilies.com), is an award-winning (e.g., 2017 Governor General of Canada Innovation Award; 2012 Mental Health Commission of Canada Award), bilingual charity.  Grounded in over 20 years of social science research[1][2][3][4][5][6][7], SFI leverages technology, best science, and highly skilled staff to deliver evidence-based, educational skill-based programs to children, youth, families and adults dealing with mild to moderate mental health issues. SFI’s proven innovative distance delivery system, using para-professional telephone support coaches, was designed as a cost-effective waitlist and access solution as part of primary mental health care reform. SFI has been shown to scale quickly to remove barriers to care.  SFI’s programs and system of care has been co-designed since inception[8] and continues to engage those with lived experience to inform change through SFI Advisory Committees. SFI’s proprietary e-platform IRIS (Intelligent Research and Intervention Software) is based on smart technology so intervention content is customized to meet the client needs[9]. Our aim has, and continues to be, to ensure our services meet the needs of our users and the mental health care system. SFI is an educational emental health (eMH) system of care with programs informed by a cognitive behavioural approach.

SFI delivers services to individuals and families when and where they need it, in the comfort and privacy of home at convenient times. The distance delivery model means geography nor time are barriers when accessing SFI services and promotes client autonomy, bridging the gap for marginalized populations (e.g., low income families, Indigenous, rural/remote families). SFI’s objectives are to provide timely and rapid access to high quality care regardless of location; commit to outcome measurement collection and reporting; customize care to meet the client/families’ needs with a family-centred and culturally competent approach. This distance delivery model virtually eliminates stigma and reduces access barriers, providing equitable access to quality programming across the population, significantly reducing health access inequities.

Strongest Families exists to provide clients and families timely access to quality services, there is no wait for services, so clients begin intervention quickly. Services (e.g., Anxiety Programs: 6-18+ year olds “Chase Worries Away (ages 6-12)”, “Defeat Anxiety (ages 13-17)”, “ICAN (I Can Conquer Anxiety and Nervousness: an adult program for anxiety and depression- ages 18+)”; Disruptive Behaviour Program: “Parents Empowering Kids (ages 3-12)”; and Bedwetting: “Dry Nights Ahead (ages 5-12)” are convenient and non-stigmatizing. For example, coaching telephone calls are held at times convenient to the clients’ schedule (days, evenings, nights) which means no missed time from work or school; there is no need to travel; there is no financial burden; and care at home is private. The average duration of our 17 weekly telephone appointments is about 4.5-5 months for our intensive coaching services.

SFI is dedicated to consistently measuring and reporting outcomes using validated measures. The Anxiety program is highly effective with a better than 85% outcome success rate in overcoming presenting anxiety issues. Additionally, results show strong impacts on: a) youth /emerging adult co-morbid depression issues; b) youth/emerging adult academic progress; c) youth/emerging adult socialization and reduced screen time. Clients also report high satisfaction with services and SFI consistently shows a less than 10% attrition rate, demonstrating that this system of care is accepted, and most clients complete the program. 

SFI’s COVID-19 Response

The COVID-19 pandemic has had severe impacts on the mental health of children, youth, adults and families, world-wide.  When the Canadian Government declared a State of Emergency, it forced many Canadian mental health services to temporarily close clinics and intake agencies, as they worked on virtual solutions. SFI quickly pivoted to provide the supports needed for clients and assist our traditional mental health care system. As a pioneer in eMH, SFI was poised to adjust quickly. As such, SFI’s telephone support coaches and administrative staff were able to continue to provide clients services with no disruption and stepped in to offset the work of other traditional face-to-face mental health services. SFI was able to operationally scale to hire more staff to meet the increased referral demands.

In addition to SFI’s response , the team effectively modified our program skills and customization to address COVID-19 impacts. We updated our training programs to equip our active coaching team to adapt skills, based on each family’s/client’s unique situation with school, childcare, employment, health concerns, and social isolation issues related to imposed restrictions. With SFI’s distance delivery system designed to bridge the geographical divide, we continued to reach families in remote, under serviced and resourced regions. SFI’s COVID-19 imbedded response included providing online resources for parents, providing strategies for self-care, encouraging the group-based coaching option for social/peer support (especially important for those impacted by COVID-19 restrictions and in need of peer support).  The coaches actively problem-solved around our new norms of wearing masks and social distancing expectations. Since SFI services span Canada, our team was attentive and up to date on the COVID-19 pandemic status and applicable restrictions in each province and territory so that our staff could relate and respond to our clients’ needs.

With COVID-related anxieties and behavioural responses on the rise related to school closures and social isolation that increase parental stress/depression, more families are in need of SFI’s programs that are customized to deal with their specific COVID impacts. Equipping children, youth, and adults with life-skills now, to address such mental health impacts, builds resilience and will lead to a healthier more productive future.

Vulnerable populations have been a focus during the pandemic

In Canada, parents and families are often overwhelmed with the challenges of supporting their children with neurodevelopmental disorders (NDD)[1]. This coupled with the current COVID-19 pandemic impacts, left many families struggling to find help, especially those with NDD children. The temporary closures created additional barriers for parents with NDD children. These barriers, together with the heightened COVID-19 related anxiety and behavioural challenges has resulted in an increased demand for effective eMH services for parents with NDD children. We know that parents of NDD children are more affected by COVID impacts, underserved, and they can benefit from evidence-based services, therefore, SFI was a convenient and effective solution[2]. SFI’s skilled-based programs provide strategies to cope with COVID restrictions and impacts that support the families’ environment and routines, leading to improved mental well-being for the child and family.

Other vulnerable populations that SFI have been able to help through the pandemic include but not limited to seniors and those isolated or living in rural/remote regions, military and Veteran families, BIPOC and LGBTQ2S+.

Pandemic Outcome and Client Quotes

In March of 2020, as SFI adapted its programs, supported its staff, and continued to scale to meet demand by hiring and implementing a virtual training program, the expectation was that intervention effects may not be as strong, given the on-going challenges of this more than a year long pandemic. SFI experienced record numbers of referrals reaching 13,000 Canadians in 2020-2021. Additionally, our outcome reports remained strong with 90% outcome success, 4% attrition and high client satisfaction. 

Client Quotes

Parent Chase Worries Away (5-year-old child): “Loving the program. It is making life easier. I Would recommend…. life is getting easier especially during Covid19. This program came at a great time.”

ICAN Adult Client “we all started our calls at our worst and ended the calls at our best. I used Muscle relaxation, Deep Breathing and made a SOLVER plan for a family trip. The skills decreased my anxiety in my first trip to COSTCO since the beginning of the pandemic”

ICAN Client (65 year old): “I feel like a new person…The only thing that I tried in the last seven years that actually worked for me.  I still have a way to go but I will get there. I have hope and happiness back and something to look forward to.  I am a different person, thank you to my coach.”

SFI continues to Innovate and Celebrate our 10th Year Anniversary

Despite the challenges the SFI team faced during the pandemic,  the team worked diligently on new research projects in the randomized control trial phase (Parents Empowering Neurodiverse Kids; Caregiver Problem-solving Program), new program enhancements (SFI’s Stepped Care model adaptations to our intensive programs providing three additional lower intensity service levels including self-mediated services with minimal coaching contact) and IRIS innovation including an etriaging algorithm for the stepped care model and a fully integrated, innovative App connection with the IRIS platform providing users with a motivational and direct connection to all of their program needs available when working offline.

During the coming year SFI’s will be celebrating its 10th Anniversary as a non-profit organization! As part of this exciting milestone, SFI will be launching a website redesign and updated branding. SFI’s goal is to leverage its 10th Anniversary year, post-COVID, to plan to unite staff, partners and supporters alike though a number of initiatives highlighting appreciation, recognition, achievement, and celebration. SFI will celebrate its history and plans for the future. In the year 2012 when SFI moved from a research organization (established in 2000 and embedded in the provincial Pediatric IWK Health Centre in Halifax, Nova Scotia) to an independent non-profit the organization had approximately 19 staff helping about 700 Canadians and at the end of its 9th year SFI is more than 100 staff strong and has reached more than 13,000 Canadians. Enduring the pandemic challenges and increased demands for eMH services, SFI is embracing the opportunity to celebrate key milestones and accomplishments this year.

SFI COVID-19 Recovery Plan

We can expect that COVID-19 impacts on mental health for people of all ages will continue for years to come. SFI’s COVID-19 recovery plan is to continue to increase timely access to evidence-based services, equitably for Canadians. As the pandemic becomes under control with vaccination campaigns, SFI will begin to explore and define its ‘new normal’. Because the SFI non-profit is rooted in empirical research with over 20 years of experience in distance coaching services, their continues to be a commitment to: data collection and reporting; engaging client’s opinions and satisfaction data to inform change through diversity and inclusion; innovate digital solutions and add new program options; research and development; and continued support of staff and clients as we all recover from the pandemic.

About Strongest Families

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www.strongestfamilies.com  |  www.famillessolides.com |www.irisplatform.com

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