From Innovation to Impact: The Recent Evolution of Strongest Families Institute

Strongest Families Institute (SFI) is an award-winning, Canadian charity delivering bilingual, evidence-based e-mental health (eMH) services to children, youth, adults, and families.

Grounded in over two decades of social science research and an unwavering commitment to co-design, access, quality, and innovation. Clinical trials showed that SFI’s cognitive behavioural (CB) informed programs delivered by paraprofessional telephone coaches overcame diagnosable pediatric mental health disorders. SFI has become a trusted solution for mental health and well-being across the lifespan. Through a unique blend of human connection and technology, SFI bridges the gap in access to care by offering timely, stigma-free, culturally relevant interventions that reach individuals in the comfort of their homes—no waitlists, no travel, no judgment. SFI is a pioneer in distance pediatric and family-centred care delivered by paraprofessional coaches and technology.

This case study explores SFI’s evolution over the past two years, including strategic responses to emerging challenges, lessons learned, impacts, and future directions for sustainable growth and system-wide mental health transformation.

A Time of Change and Transformation

Over the years, millions of Canadian Institutes of Health research funding has been invested into SFI (formerly Family Help) to design and scale a new system of care to help solve the access gap for pediatric and family mental health supports. SFI aimed to ‘get it right by design’ by using an integrated knowledge translation strategy , enlisting opinions from various key interest groups (e.g., people of lived experience from diverse backgrounds; health professionals, government, scientific experts) to inform all aspects of SFI’s system from programs to processes to technology. SFI’s system is an example of implementation science – from the development and conduct of multiple rigorous randomized trials that included SFI’s proprietary platform ‘IRIS’, to transforming from research to service delivery in 2011, launching SFI as a non-profit, to successfully scaling to reach more than 10,000 Canadians annually. 

SFI’s service programs include: positive parenting, addressing behavioural challenges at home, school and daycare and includes an enhanced program for parents caring for neurodivergent children (i.e., Parents Empowering Kids/Parents Empowering Neurodiverse Kids Ages 3 to 14); anxiety, depression and stress (i.e., Chase Worries Away/Defeat Anxiety/ICAN for ages 6 to 18+); and nighttime bedwetting (Dry Nights Ahead Ages 5-12). SFI provides easy access to all programs via the SFI App, but also bridges the digital divide by mailing handbooks, skill-demonstration videos and other program materials if preferred by the client. 

Key SFI advancements in the past two years

During the COVID-19 pandemic, SFI received funding from the Public Health Agency of Canada (PHAC) to support the transformation of SFI’s high intensity programs into a stepped care model. The past two years have focused on finalizing program enhancements creating a universal system of mental health care that is now being disseminated across Canada. With three levels of program intensity, SFI offers services that promote good mental health (level 1: four weeks with brief coach support), prevents early signs of mental health issues from becoming worse (Level 2: 6 weeks with weekly 1-hour coaching for mild conditions with minimal impairment), and intervention (Level 3: 4.5 months with weekly 1-hour coaching). Clients can be levelled up or down, supporting them across the continuum. 

Several provinces and territories have embraced SFI’s universal stepped care model, funding open access through self-referral and other referral pathways such as health professionals, education, justice, community services and others. This open model eliminates barriers, providing immediate access to SFI’s services, adopted by the governments of Newfoundland and Labrador (NL), Prince Edward Island, New Brunswick, Manitoba, Northwest Territories (NWT), Yukon, and Military Family Services Ottawa. SFI has also helped to reduce waitlists of hundreds of children in various jurisdictions. 

Most recently, SFI has received SFI App/IRIS certification from the Mental Health Commission of Canada and ORCHA after completing a very comprehensive app assessment framework. This recognition demonstrates SFI’s commitment to culturally appropriate care, security and safety, and effective service offerings that align with the national standards. 

Although SFI has the evidence backing and was co-designed with people for people, has the experience to scale, is low cost and high impact, and demonstrates commitment to continued innovation, SFI’s services are not yet equitable to all Canadians. SFI continues efforts to scale equitably by working closely with provincial, territorial and federal governments. 

Challenges and Lessons Learned

With the emergence of new eMH services since COVID-19 pandemic, SFI has faced challenges with increased competition. Additionally, this past year, SFI has experienced unprecedented low referral rates, despite the increased need for mental health supports and evidence that our young people are at risk. Anecdotal information from SFI’s referring sources suggest a new phenomenon called ‘virtual fatigue’ has led to lower utilization of eMH services – people would rather wait for face-to-face services. It is unknown whether virtual fatigue is related to video appointments or online demand fatigue. SFI pivoted by changing promotional activities to highlight SFI’s value proposition, setting SFI apart from others. Moreover, SFI focused resources on organic outreach to provide regular education and updates through webinars. By increasing awareness and education, SFI has seen a rise in referral rates.

Navigating funding uncertainty is an ongoing challenge, especially in light of inflation, competitiveness, and Canada’s economy with the tariff threats. Unpredictable government funding cycles pose challenges, especially for Canadian non-profit organizations (NPO). As the competition grows, so do the challenges for non-profits, particularly when it comes to Request for Funding (RFP) calls. The process is arduous requiring resources that NPOs often do not have. Moreover, most NP can not compete with large corporation competitors during such a bidding process. To protect evidence-based NPOs there must be a shift in process requirements.  

An additional challenge is securing funding to support IRIS technology, particularly advancement. Often, funding calls exclude NP and there is a scarcity of government funding specifically for advancing a NP technology.

SFI has accelerated efforts to diversify its revenue by executing a more robust fundraising strategy as well as advancing innovation through new program services. 

Key Insights for Successful Implementation

SFI’s success lies in its ability to blend science, compassion, and technology. Several foundational insights continue to guide the organization’s implementation model:

• Co-Design and Cultural Safety to ‘Get it Right by Design’: Program development is driven by partnerships with those the programs are meant to serve. This includes working with people of all ages and backgrounds (i.e., Indigenous peoples; military, Veterans and their families; newcomers; 2SLGBTQIA+; BIPOC) and other key interest groups. 

• Data-driven focus: SFI leverages IRIS real-time data to identify trends to inform process change, improve efficiencies, and enhance program enhancements. 

• A culture of diversity, equity, inclusion, and accessibility is a fundamental tenant of SFI and is embedded in all that we do from our internal SFI family – our people and our Board – to our external clients and their families. 

• Continued innovation: SFI is committed to continued improvement including modernizing our program materials and terminology, improved accessibility, advancing service offerings  and new programs through continued research and development.

• Measurement-Based Care: SFI uses validated tools and custom tracking forms to monitor quality and provide regular reports to government partners. 

Outcomes and Impact

SFI’s services consistently demonstrate strong outcomes such as 89% outcome success rate (Pediatric 90%; Adult 86%), low attrition rate (7%) and high satisfaction (87% of users rated SFI’s services as “very good” or “excellent”). SFI results show improved school attendance, improved peer, family and social relationships, reduction in substance use and improved quality of life. SFI outcomes are consistent across age groups, populations, and regions, underscoring SFI’s ability to deliver scalable, high-quality care regardless of geography or demographic profile.