Speakers
Description
Background/Rationale
The Registered Nurses’ Association of Ontario Transitions in Care and Services (TICAS) Best Practice Guideline (BPG) provides evidence-informed recommendations to strengthen continuity, intersectoral coordination, and person-centred care across with service delivery. While TICAS is primarily implemented in clinical settings, public health organizations are increasingly exploring how TICAS principles can be adapted to support integrated, equitable transitions within community-based services. Public health implementation presents unique opportunities and challenges related to diverse programs, varied client interactions, population health approaches, and cross-sector partnerships.
Aim/Purpose
This session will share implementation experiences from 3 public health units, examining how TICAS is being adapted and applied in meaningful ways to guide practice. It highlights practical implementation approaches, key challenges, local adaptations, and early learnings to support improved client transitions.
Methods/Implementation Approach
Three public health units used the Social Movement Action framework to engage and build capacity of TICAS BPG Champion leads, to co-create program-specific implementation activities. Guided by the Knowledge-to-Action, Population Health framework, and Health Promotion model, Champions adapted TICAS by clarifying public health services and populations served; identifying multiple levels of client interaction; translating transitions in care concepts into language familiar to public health settings; and supporting cross-site collaboration to identify barriers, enablers, and opportunities for uptake.
Results/Outcomes
Participating health units showed variability in readiness, capacity, and partnership structures as they integrated TICAS recommendations. Adaptation enabled gap analyses and prioritization of key actions. Identified transitions included referrals, assessments, health teaching, navigation to community supports, and “warm handoffs.” Capacity building supported shared learning and collective action across participating health units.
Lessons Learned & Implications for Practice
Findings highlight the importance of collaborative barrier assessment, local adaptation, and tailored strategies when applying clinical BPGs in population health settings. This work supports broader efforts to advance equitable, accessible, person-centred transitions across the health system.
Author(s) Credentials and Title
Janet Kwansah, RN, BScN, MPH, Chief Nursing Officer
Lisa Alguire, RN, BScN, Public Health Nurse
May Tao, RN, BScN, MSN, CCHN (C), Health Promotion Specialist, BPSO Lead
Andrew Falco, RN, BScN MN, Health Promotion Specialist
Lucia Taggart, RN, BNSc, MPH, nursing practice coordinator & BPSO Lead
Danielle Vieira, RN, BNSc, IBCLC, Clinical Nurse Facilitator
Cynthia Stone, RN, MSc, Public Health Nurse
What RNAO BPG or tool/toolkit is your abstract related to?
RNAO Best Practice Guideline: Transitions in Care and Services (TICAS)
| Organization Name | Grey Bruce Health Unit, Toronto Public Health, Southeast Public Health |
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