LOCAL TOOLS The tools are presented in alphabetical order and do not indicate any order of priority. Tool 1 Central East Network of Specialized Care: Memorandum of Understanding for the Crisis Response Network The Memorandum was developed in August 2012 and approved by members of the Network on November 1, 2012. The working group that developed the document was a sub‐committee of the Central East Community Network of Specialized Care and included representation from the four quadrants in the region and the four lead agencies that host the Community Crisis Response Network positions. This included Durham Mental Health, Catulpa, Community Living Ajax, Pickering, Whitby, York Support Services Network, CMHA Peterborough and Community Living Huronia. The Central East Network wanted to create greater clarity and consistency at a regional level for the crisis response service which is delivered through positions in four different agencies – two from the mental health sector and two from the developmental services sector. Participating agencies identified the MOU as a way to clarify roles and responsibilities and to define an agreed‐upon purpose for the Crisis Response Network. The development of the MOU was the result of a highly collaborative process and all participants feel that significant progress has been made in achieving clarity of expectations. For further information contact: Marnie McDermott, Regional Coordinator, Central East Network of Specialized Care Community Living Huronia, 705.526.0311 ext 321 [email protected] Tool 2 Central East Network of Specialized Care: Best Practice Model for Specialized Accommodation This manual, printed in February 2012, was the result of five years of work by a sub‐ committee of members from the Central East Network. The committee included representatives from developmental service and mental health agencies, MCSS and the DSO Central East. The content of the manual is based on ONTABA standards (i.e. Ontario Association for Behaviour Analysis), reflects the expectations of the Services and
LOCAL TOOLS Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, MCSS 2008 and represents the culmination of promising practices in providing specialized accommodations to persons with a dual diagnosis. The material in the manual is used to assist sectors and agencies in developing programs for individuals with a dual diagnosis for specialized accommodations. It provides templates that can be adapted to the policies and procedures within the agency providing specialized accommodations for persons with a dual diagnosis. While the manual was developed for Central East region it can be applied to settings across the province. The members of the CE Network of Specialized Care endorse this manual as a best practice. The manual is the property of Community Living Huronia and Behaviour Management Services of York and Simcoe and is available in hard copy only. For further information contact: Marnie McDermott, Regional Coordinator, Central East Network of Specialized Care Community Living Huronia, 705.526.0311 ext 321 [email protected] Tool 3 Huron Perth System Pathway to: Services and Supports for People with a Dual Diagnosis The project to create this document began in November 2008 with the final product being launched in June 2011. This was the result of a work plan goal identified by the Huron Perth Dual Diagnosis Committee, to become a resource to those in need of assistance in supporting individuals with a Dual Diagnosis in Huron Perth. The members of this sub‐committee consisted of staff from developmental services and both community and hospital‐based mental health services. The information included in this system pathway covers all of Huron and Perth counties. There are some key urban areas included such as Stratford, Goderich, Exeter and some smaller towns and rural areas. The material was launched at a one‐day conference on Dual Diagnosis sponsored by the committee. One of the committee co‐chairs introduced the System Pathway document explaining how it came to be and how it could be a helpful resource to the cross sector professionals who were in attendance. The Protocol
LOCAL TOOLS for Linkages developed by the Dual Diagnosis and the Huron Perth Mental Health and Addictions committees identifies the process that will happen when someone with a Dual Diagnosis enters a Schedule One hospital. Committee members identify this document as an effective practice as it provides comprehensive information in one place that can help professionals, families and advocates. The process of working together on the creation of this document has helped professionals to be more aware of the needs of people with Dual Diagnosis and has contributed to stronger relationships between mental health and developmental service providers where partners are more likely to contact each other with questions when difficult situations arise. This makes working together on new collaborations/projects easier. For further information contact: Lynda Legge, Facilitator Southern Network of Specialized Care Woodstock General Hospital 519.881.0922 ext 2405 [email protected] Tool 4 Lanark County: L.E.A.D. Team Protocol This protocol, developed in 2005, was initiated by Dave MacDonald (OPP) and Diana McDonnell of Lanark Mental Health utilizing an example of a police/mental health protocol from the Chatham‐Kent region. To secure the collaboration, they met individually with local chiefs of police and OPP, managers of ER departments and ambulance services, Royal Ottawa Hospital (mental health) and community hospitals. The Chatham‐Kent protocol was based on police and mental health collaboration, but the interest was to expand beyond police to include the entire “emergency responder” network. It now includes children and youth services, addiction services, distress centre and most recently, Brockville General Hospital as it has taken over acute mental health services from Royal Ottawa Hospital. The protocol agreement is reviewed and revised (if necessary) annually. To ensure awareness and adherence to the protocol, front‐line staff attend a two‐day training conference. Training, including awareness of mental health issues (including dual diagnosis) and response protocols is offered to all protocol partners as well as all front‐
LOCAL TOOLS line responders (i.e. ER nurses, ambulance attendants), probation and parole, developmental services, court, crown attorney. Core participants (i.e. emergency, addictions and mental health) are still the signatories of the protocol. Local partners indicate that the protocol has been extremely effective because: police are spending less time waiting in the emergency department; a mental health referral form for police is available in the ER so they can include their observations as part of the individual's mental health assessment; there are improved relationships between frontline responders as a result of having better awareness of each other and their roles, and if issues arise, the protocol identifies the lead individuals to sort issues out. The initial protocol included all of Lanark County, however, the LEAD protocol has been adopted by Human Services and Justice Coordinating Committees and adapted to meet the needs of communities across the South East, as well as parts of Champlain including Prescott‐Russell, Stormont, Dundas and Glengarry and Ottawa. For further information contact: Diana McDonnell, RN, BScN, CPMHN Director, Lanark County Mental Health 613. 283.2170 ext 222 [email protected] Tool 5 Niagara Region – Southern Network of Specialized Care: Crisis Response: Pathway and Guideline The Flow Chart of Crisis Services in Niagara was developed and revised during the period of late 2011 to the summer of 2012 and applies to all of Niagara Region. This pathway was the work of the Niagara Crisis Steering Committee which was a small working group evolving out of the Niagara Service Delivery Network. The Crisis Steering Committee came as a result of years of promoting the benefit of an integrated cross sectoral approach to problem solving. This group took on broader partners including Mental Health (community and hospital based), Addictions, Developmental Services, Crisis Response Services, Justice, Police and Health to accomplish the goal. This group also drafted a community crisis protocol between partners and a template for crisis planning. Its work has resulted in a multi‐sectoral collaborative approach to implementation, review and revision.
LOCAL TOOLS The Crisis Flow Chart is used to explain the process for responding to crisis in Niagara and to help all partners and sectors see their role within the larger community plan. It will also be used as an educational tool as the committee provides information to front line staff about the guideline and crisis planning tools. The Flow Chart has been an effective tool in that it has enabled the group to talk through the approach including redirecting the process from hospital and has allowed them to see individual sector roles within the larger plan. It has served as a great visual learning aid. For further information contact: Nancy Hall, Facilitator for Niagara, Haldimand and Norfolk The Southern Network of Specialized Care (905)‐684‐6918 X312 [email protected] . Tool 6 North Bay Regional Health Centre Developmental Disabilities Service – Continuum of Care The continuum of care map is a draft service pathway developed in‐house by the North Bay Regional Health Centre to aid the staff of the program in understanding the various sectors and multiple agencies involved in the provision of services. For further information contact: Patti Turcotte, Manager Developmental Disabilities Service, Birch Lodge, Maple Lodge Psychiatric Rehabilitation Program North Bay Regional Health Centre 705.474.1200 ext3506 [email protected]
Tool 7 North Community Network for Specialized Care Risk Spectrum Analysis The Risk Spectrum Response group was a subgroup of the Supporting Individuals in High‐Risk Service Situations Working Group. It met from September 2010 to November
LOCAL TOOLS 2011 and was comprised of members from the DS sector and the MOHTLTC from the Muskoka and Nipissing areas. The Risk Spectrum document is used as a means of identifying where an individual falls on the risk spectrum continuum. The Clinical Supports document outlines the corresponding responses to be made by the appropriate service provider. The Scenarios document provides examples of how someone in each of the six scenarios might present in each of the areas of the Risk Spectrum continuum. While no research has been completed in order to identify this as an “effective practice” both the members of the subgroup and of the working group believe that the documents provide an effective way of coordinating service delivery in order to support and respond to individuals in crisis situations. It also provides a framework for preventing crisis situations. For further information contact: Angie Nethercott, M.A. Senior Behaviour Consultant North Community Network of Specialized Care Hands TheFamilyHelpNetwork.ca 705.645.7478 ext 3245 [email protected]
Tool 8 Toronto Network of Specialized Care: Service Resolution Pathway The Service Resolution Pathway in its current form has evolved from earlier process diagrams. As the Toronto Network of Specialized Care (TNSC) has evolved over the last six years and new services have been added, the Network has modified the details of the pathway. The pathway is a guide for accessing the supports of the Toronto Network of Specialized Care. It is an effective illustration of the process that an individual goes through and the details of what is offered as they move through the system. The Pathway leads to the Clinical Conference where individual situations are discussed with those supporting people with complex needs and have the benefit of a larger community providing ideas and recommendations. For example anyone wishing to access the Specialized Accommodation – treatment beds ‐ follows the pathway through Clinical Conference where recommendations are made including being put on a waitlist for a treatment bed. There are also recommendations generated that span the specialized continuum and beyond to other developmental and
LOCAL TOOLS mental health services, along with supports to families and caregivers as well as health care supports. It is through the Clinical Conference where gaps/barriers and trends get identified and brought to the TNSC – Service Resolution. The TNSC –Service Resolution looks at systemic as well as individual issues. MCSS is a member of this group, and thus becomes aware of the broader system issues. Recently, the Toronto LHIN has joined the TNSC, and so partners are in the beginning stages of determining an ongoing relationship. For further information contact: Sandra Bricker Coordinator, Toronto Network of Specialized Care Surrey Place Centre 416.925.5141 ext3115 [email protected]
Tool 9 Toronto Network of Specialized Care: Memorandum of Understanding MOUs have been in use at the TNSC since the early days of the networks and were the result of a consultation process. In 2007, the Network began implementing the use of MOU specifically to increase the utilization of the offerings through the Clinical Conference table. The MOU reflects the commitment of the partners at the Network to working in collaboration and MOUs are currently held with both developmental and mental health service providers. In 2012, the TNSC revamped the format of its MOU to the more streamlined document shared in this report. The supports contained in the MOUs are primarily from the specialized continuum; however there are additional services that agencies have made available such as education and training. The supports offered in the MOUs are based on an agency’s ability to deliver certain services and generally relate to assessments and connections to services. For further information contact: Sandra Bricker Coordinator, Toronto Network of Specialized Care
LOCAL TOOLS Tool 10 Toronto Network of Specialized Care: Special Project: Alternative Level of Care (ALC) Alternate Level of Care (ALC) is a term used to describe hospital patients who face barriers to discharge although the level of care provided is no longer appropriate. Patients may be designated as ALC for a few days until, for example, home supports are put in place, or they may remain ALC for weeks and months, as the level of care they require is simply not available. Patients waiting in ALC for longer than 30 days (“long‐stay”) account for 13% of ALC discharges in the Toronto Central LHIN, and yet represent over 50% of ALC days, signaling that a small proportion of people are using a large proportion of ALC days. In early 2011, the Toronto Central (TC) LHIN asked CAMH to assume a leadership role, with support from a cross‐sectoral Advisory Committee to develop a framework and comprehensive plan for the ongoing care and maintenance of individuals with severe behavioural issues including dual diagnosis in the TC LHIN. CAMH recently completed their report “Smoothing the Path: Addressing Alternate Level of Care Issues for People with Severe Behaviour Issues including Dual Diagnosis” outlining 11 final recommendations. This ALC initiative builds on the recommendations outlined in that report. In support of its priority of reducing emergency room wait times and alternate level of care days, this project will focus on implementing and pilot testing initiatives focused on effective transitions, enhanced community supports and reducing gaps throughout the continuum of care. The project is aimed at individuals with mental health and addictions and behavioural issues including individuals with dual diagnosis, as recommended in the “Smoothing the Path: Addressing Alternate Level of Care Issues for People with Severe Behaviour Issues including Dual Diagnosis”. One of the selected initiatives was ALC Transition Service for Dual Diagnosis with the following objectives: To reduce the number of ALC days for those with a dual diagnosis who are ALC in TC LHIN hospitals by supporting them to move to an appropriate community setting with the appropriate clinical supports (community setting may include any combination of family home, supported housing or housing supports and community participation support in the developmental or mental health systems).
LOCAL TOOLS To build the capacity of the broader MH and DS community sectors to effectively serve ALC clients from hospital and community transitional treatment beds (I.e. those with high support needs whose discharges are blocked for similar reasons as those who are ALC in hospitals). To improve system utilization and flow for clients with high support needs. In this strategy, 4‐5 new clients will be served annually by one Behaviour Therapist (BT) who will provide mobile, individualized clinical supports to transitioning ALC clients in Toronto Central LHIN hospitals and Toronto Network of Specialized Care community‐ based transitional treatment beds. Further, team‐level training and support to strengthen the receiving team’s knowledge, skills and effectiveness to implement the required protocols will be provided. The BT will support implementation of the individualized transition plan by providing individual functional assessment and behavior treatment strategies within the context of the new environment. Flex Fund resources will augment and support the BT role by providing experienced and trained frontline staff 24/7 to work alongside the receiving agency staff to implement the individual’s treatment and support plan. This is a model that has been in place for over a decade through the Griffin Centre, which also allocates flex funds on behalf of the Griffin Community Support Network and Collaborative and Individualized Resource (CAIR). Together the BT and Flex Fund resources provide additional clinical supports for up to 1 ‐2 years, thus enhancing long‐term community tenure and preventing emergency department use and a return to higher, more expensive levels of care. This ALC service will be integrated with the existing Collaborative and Individualized Resource (CAIR) service funded by MCSS. Together, and with the support of the Toronto Network of Specialized Care, Griffin Centre and CAMH provide the CAIR service. Griffin’s role includes recruitment, orientation and training of one‐to‐one staffing (flex fund model) to implement programming that will enhance stabilization and successful community integration, and program management. CAMH Dual Diagnosis Program provides one Facilitator (MSW prepared, performing functions similar to an intensive case manager). CAIR services are limited to 6 months duration. The goal of CAIR is to prevent the need for more intensive and costly services and to enhance system capacity to address complex clinical issues that require more flexible and intensive responses than are currently available. Integrating the ALC BT and Flex Funds with CAIR will extend the current resources beyond 6 months. The ALC BT and Flex Funds will also expand CAIR by providing more intensive supports specifically to ALC clients in hospitals and
LOCAL TOOLS time limited community treatment beds so that clients can move through the continuum of services into longer term permanent community environments. For further information contact: Sandra Bricker, Coordinator, Toronto Network of Specialized Care 416.925.5141 ext3115 [email protected]
LOCAL TOOLS
Local Tools
LOCAL TOOLS TABLE OF CONTENTS TOOL 1 MEMORANDUM OF UNDERSTANDING (SEPTEMBER 2012)... 14 TOOL 3A SYSTEM PATHWAY TO SERVICES AND... 20 TOOL 3B SYSTEM PATHWAY TO SERVICES FOR PEOPLE WITH A DUAL DIAGNOSIS IN HURON PERTH... 43 TOOL 4 LANARK COUNTY L.E.A.D. TEAM PROTOCOL ... 44 TOOL 5 NIAGARA CRISIS PATHWAY ... 53 TOOL 6 NORTH BAY REGIONAL HEALTH CENTRE CONTINUUM OF CARE REFERENCE SHEET... 65 TOOL 7 HIGH RISK SPECTRUM DOCUMENTS ... 67 TOOL 8 TORONTO SERVICE RESOLUTION PATHWAY... 73 TOOL 9 TORONTO MOU TEMPLATE ... 74 TOOL 10A TORONTO ALC BROCHURE... 84 TOOL 10B TORONTO CLINICAL RESOURCE PLAN ... 85 TOOL 10C TORONTO FINAL REVICES CAIR COMUNIQUE... 90
TOOL 1 – MEMORANDUM OF UNDERSTANDING (SEPTEMBER 2012)
MEMORANDUM OF UNDERSTANDING
Lead Agencies and
Central East Network of Specialized Care (Community Living Huronia)
Lead Agencies:
Canadian Mental Health Association – Peterborough; Catulpa Community Support Services;
Community Living Ajax, Pickering and Whitby York Support Services Network.
Service Provider:
Durham Mental Health Services for Community Living Ajax, Pickering and Whitby
General
The purpose of this Memorandum of Understanding (“MOU”) is to describe the nature and terms of the relationship between the Lead Agencies and Central East Network of Specialized Care (Community Living Huronia) hereinafter called “the Partners”. This agreement governs the provision of a community crisis response service for adults with a developmental disability, mental health needs and/or challenging behaviours; residing in;
York Durham Simcoe Haliburton, Kawartha, Pine Ridge
The Partners are committed to the principle that collaborative service delivery promotes accountability and quality improvement for individuals, their families and service providers.
JOINT RESPONSIBILITIES OF LEAD AGENCIES AND CENTRAL EAST NETWORK OF SPECIALIZED CARE (COMMUNITY LIVING HURONIA) PARTNERSHIP:
The Crisis Response Network Coordinators (CRNC) will work collaboratively with each other, the (LEAD AGENCIES) and the Central East Network of Specialized Care (Community Living Huronia) to do the following:
Coordinate and monitor the crisis service response for individuals with a developmental disability and mental health needs and/or challenging behaviours and/or involved or at risk of involvement with the criminal justice system provided by all participating agencies (including hospitals) in the quadrant. The Central East Network of Specialized Care (Community Living Huronia) will play a key role in developing, formalizing, supporting and maintaining linkages between various services and sectors to support an integrated, client-centred response for persons in crisis served by the Network.
Work closely with the existing MOHLTC funded community mental health crisis response service and local service resolution structures and personnel to develop and maintain effective pathways to specialized services (when appropriate).
Identify and develop education and training that will consolidate and expand the expertise of the Network agencies, generic providers, and families / caregivers.
Ensure a timely and appropriate crisis response is accessible to individuals requiring crisis supports.
Respond to enquiries, conduct risk assessment, offer consultation (including community visits and short-term follow-up) as required on an individual basis to facilitate crisis resolution.
Conduct intakes for Crisis Response Services.
Coordinate/match individual needs to Network service providers to develop assessment, intervention and support strategies.
Work with Central East Network of Specialized Care (Community Living Huronia), Regional Coordinator and the other three quadrant Coordinators to manage, allocate and assign regional flex crisis funds according to agreed upon established guidelines.
Ensure adequate supports are in place and monitor the crisis service response provided by the Network through regular contact and support to service providers and caregivers/family.
Refer to the Developmental Services Ontario as appropriate.
Develop and implement processes and procedures to work collaboratively with all lead agencies, coordinators and the Central East Network of Specialized Care (Community Living Huronia) Regional Coordinator.
Values
1. Partnership - work closely with the Lead Agency (Canadian Mental Health Association – Peterborough, Catulpa Community Support Services, Community Living Ajax, Pickering and Whitby and York Support Services Network), Service Provider, Durham Mental Health Services and Central East
Network of Specialized Care (Community Living Huronia), Regional Coordinator and Network partners.
2. Person directed care – offering access to support services that are individualized, holistic, respectful, strength-based, and responsive, while respecting natural support.
3. Respecting diversity – delivering competent service regardless of race, culture, faith, language, gender, sexual orientation, class, diagnosis or special needs, honouring individuals’ and families’ service preferences with respect to these factors whenever possible and to endeavour such service does not create barriers to accessing appropriate individual support services.
4. All partner agencies are committed to accountability, transparency, and continuous improvement.
Purpose
The purpose of the Program:
(a) Respond to requests for crisis service in a timely manner (within 2-3 business days).
(b) Provide services to eligible individuals from Central East region for up to thirty days.
(c) Maintain all required documentation (including flex fund expenses). (d) Provide orientation and training on services to Network partners. (e) Participate in Network evaluation processes.
Central East Network of Specialized Care (Community Living
Huronia)
Is responsible for:
(a) Regional Planning
(b) Advocating for Crisis Response Network. (c) Administer Flex Funding.
(d) Supporting Lead Agencies (Canadian Mental Health Association – Peterborough, Catulpa Community Support Services, Community Living Ajax, Pickering and Whitby and York Support Services Network) and Service Provider, Durham Mental Health Services
(e) Collect, analyze and provide key statistical data and analysis to the Central East Network of Specialized Care Advisory Committee, Participating Agencies, Ministry and other stakeholders.
(f) Coordinate, monitor and support access to the resources of the Central East Network of Specialized Care (Community Living Huronia) including clinical consultation.
(g) Represent the Crisis Response Network Coordinators at the appropriate Ministry level committees.
(h) Initial and ongoing training for the Crisis Response Network Program Standards.
Role and Responsibilities of Lead Agencies - (Canadian Mental Health Association – Peterborough; Catulpa Community Support Services; Community Living Ajax, Pickering and Whitby; York Support Services Network):
*Community Living Ajax, Pickering and Whitby purchases services from Durham Mental Health Services.
(a) Provide leadership to the Crisis Response Network Coordinators in the local quadrants, involving key agencies and local stakeholders.
(b) Respond to all enquiries / act as spokesperson for the Crisis Response Network Coordinators.
(c) Provide the contact and entry point to the Crisis Response Network Coordinators; provide response, consultation, and support to individuals, families, and agencies.
(d) Coordinate crisis response and provide direct support in facilitating consents and the development of individual service plans (up to 30 days) including discharge planning.
(e) Maintain an inventory of resource information and local Network capacity (vacancies) daily.
(f) Track agreed upon data elements.
(g) Manage local flex fund budget and allocations.
(h) Ensure Memorandum of Understanding are established and updated as needed with partnering agencies.
(i) Liaise with the appropriate inter-ministerial resources.
(j) Participate in developing linkages with Central East Network of Specialized Care (Community Living Huronia), Regional Coordinator
and engage in regular dialogue regarding service needs and Network development.
(k) Participate with other Region Coordinators to provide support and resource sharing.
(l) Participate in Local Case Resolution Committees.
(m) Support the established policies, procedures, protocols and program standards to ensure they are available to members, to the community and updated as needed to reflect the evolution of roles and functioning. (n) Provide supervision for the Crisis Response Network Coordinators in
the local quadrants as per Lead Agency expectations.
Accountability Framework Chart:
↨
↨
↨
Ministry of Community Support Services
Central East Network of Specialized Care
Community Living Huronia
Canadian Mental Health Association – Peterborough
Catulpa Community Support Services
Community Living Ajax, Pickering and Whitby
Durham Mental Health Services
York Support Services Network
Crisis Response Network Coordinators
CONS
ULTATION
General Consultation: approval of flex funds and access to regional resources
Clinical Consultation: provide access to behavioural, psychiatric and psychological services via regional resources and videoconferencing
Termination of Agreement
This Memorandum of Understanding will be maintained unless revoked or altered in writing, by any of the parties to the Central East Network of Specialized Care
(Community Living Huronia). Either partner may terminate this agreement by providing 90 days written notice to the other partners. This agreement will be reviewed every two years.
___________________ ________________
Signature Date
Tony Vipond, Chief Executive Officer, Community Living Huronia
___________________ __________________
Signature Date
Mark Graham, Executive Director,
Canadian Mental Health Association – Peterborough
___________________ __________________
Signature Date
Margaret Gallow, Executive Director, Catulpa Community Support Services
___________________ __________________
Signature Date
Barb Andrews, Executive Director,
Community Living Ajax, Pickering and Whitby
___________________ __________________
Signature Date
Marie Lauzier, Executive Director, York Support Services Network
TOOL 3A – SYSTEM PATHWAY TO SERVICES AND
SUPPORTS FOR PEOPLE WITH A DUAL DIAGNOSIS
Huron Perth
ystem Pathway to Services and Supports for
eople with a Dual Diagnosis
S
P
September 22, 2010
June 8, 2011 Revised
Huron Perth Dual Diagnosis Committee
Community Mapping/Crisis Subcommittee
TABLE OF CONTENTS
What is a Dual Diagnosis?... Page 3 What is a Developmental Disability? ... Page 3 What is a Mental Health Illness? ... Page 4 How is a Dual Diagnosis Confirmed? ... Page 5 System Pathway to Services for People with Dual Diagnosis ... Page 6 Risks of Crisis Reasons ... Page 7 Preventing Crisis ... Page 7 Evaluating Risk... Page 7 Questions to Ask... Page 8 Re‐Assessing Risk... Page 9 In A Crisis ... Page 9 Resources in the Community... Page 11 Developmental Services Pg 11 Community Living Agencies Pg 11 Specialized Services Pg 12 Mental Health Services Pg 13 Community Based Mental Health Services Pg 14 Alzheimer Societies Pg 16 Addictions Pg 16 Financial Resources Pg 16 On‐Line Resources Pg 17 Appendix A ... Page 18 “Protocol for Linkages Between Schedule I Hospital (Huron Perth) Community Based Hospital and Development Service Providers & Community Mental Health” Appendix B ... Page 21 “Recognizing a Developmental Disability” Appendix C ... Page 22 “Recognizing Mental Health Problems”Huron Perth
System Pathway
For People with a Dual Diagnosis
What is a Dual Diagnosis?The Ontario Ministry of Health and Long‐Term Care (which funds mental health services and supports) and the Ministry of Community and Social Services (which funds developmental disability services and supports) agree that “Adults with a Dual Diagnosis” are those persons 18 years of age and older with both a developmental disability and mental health needs.” Reference: Joint Policy Guidelines for the Provision of community Mental Health and Developmental Services for Adults with a Dual Diagnosis December 2008. The term dual diagnosis is a term applied to a person who has a developmental disability and mental health need and/or challenging behaviours. The term “challenging behaviour” is used to describe behaviour that interferes with a person’s daily life. What is a Developmental Disability?
On July 1, 2010 The Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 became law. The Act identifies a person with a developmental disability as a person with “significant limitations in cognitive functioning and adaptive functioning and those limitations, (a) originated before the person reached 18 years of age; (b) are likely to be life‐long in nature; and A person with a Dual Diagnosis has a developmental disability and a co‐existing mental illness and/or challenging behaviours.
(c) affect areas of major life activity, such as personal care, language skills, learning abilities, the capacity to live independently as an adult or any other prescribed activity. 2008, c. 14, s. 3 (1).” “Adaptive functioning” means a person’s capacity to gain personal independence, based on the person’s ability to learn and apply conceptual, social and practical skills in his or her everyday life; “Cognitive functioning” means a person’s intellectual capacity, including the capacity to reason, organize, plan, make judgments and identify consequences. 2008, c. 14, s. 3 (2). Reference: Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2010 What is a Mental Health Illness? Mental illness is a severe disturbance in thoughts, feelings, and perceptions that can impact a person’s daily routine and ability to perform at their usual level. It can happen any time in a person’s life. Mental illness includes diagnoses such as depression, bi‐polar disorder, mood disorders, and schizophrenia. Mental illness can cause challenging behaviour that is not recognized as being caused by mental illness. Common mental illnesses include; The serious mental illnesses are: o Schizophrenia o Bi‐Polar Disorder o Depression Other Mental Illnesses: o Mood disorders – including “serious” mood disorders o Anxiety disorders o Depression o Personality disorders o Obsessive Compulsive disorders It can be complex to understand how a person’s developmental disability relates to their mental health needs.
If a person has a confirmed developmental disability, some common signs that they may also have a mental health issue/behavioural issue and, therefore, a dual diagnosis are: Hyper‐vigilance: extreme worry, nervousness, may be compelled to complete repetitive behaviours, anxiety. Psychosis: loss of contact with reality, hallucinations such as hearing voices. (Staff must be cautious not to confuse self‐talk with psychosis).
Hyper‐arousal: increased muscle tension, emotional tension, periods of excitable behaviour with insomnia (rapid speech, pacing, repeating phrases or words), irritability, for prolonged periods. Rapid mood swings. Noteworthy changes in sleep patterns (sleeping during the day and up in the evening). Unexplained decrease in skills of daily living: hygiene, self‐care, or communication skills. Frequent complaints of not feeling well with no medical reason (pains and aches). Substance abuse or inappropriate self‐medication. Lack of regret related to behaviour. Increase in self‐injurious or harmful behaviour. Changes in appetite (not eating as much as or eating more than normal for the person). Notable changes inability to complete tasks that previously could complete. Periods of sadness longer than normal for that person. Memory problems/changes in ability to remember. Etc. How is a Dual Diagnosis Confirmed? Determination of a dual diagnosis must be done through formalized assessment of a person’s developmental level and their mental health. This process involves: Consultation with and assessment by a Psychologist or Psychological Associate qualified to complete psychometric or psychological assessments to determine development level.
Consultation and assessment by a Psychiatrist or Psychologist/Psychological Associate who is qualified to assess and diagnose mental health issues.
CRISIS Any serious deterioration of a person’s ability to cope with everyday ife. l It does not necessarily involve danger of serious physical harm to oneself or others. System Pathway to Services for People with Dual Diagnosis in Huron Perth PREVENTING CRISIS Persons With Dual Diagnosis Risk Factors *MH Diagnosis *Genetics *Medical *Expectations too High *Changes in Life Circumstances *Not Enough Support IMPLEMENT EXISTING CRISIS PLAN PREVENTATIVE FACTORS Family & Friends Meaningful activities/ Relationships Medical Resources Family physician Psychiatrist DD nurse Medication Pharmacist Family Health Teams Community Resources Community Living APSW Church Employer (etc) Police Crisis ODSP Specialized services Regional Support Associates (RSA) Enhanced Specialized Services (ESS) Community ental Health Services Dual Diagnosis Program (DDP) Dual Diagnosis Justice Case Management (DDJCM) Hospital Based Services EMERGENCY A situation in which there is an immediate danger that the person will harm either themselves or someone else. ACCESS CRISIS SERVICES *Crisis Line *Police *Local Hospital *Schedule I Hospitals Stratford Goderich FOLLOWING CRISIS Link with pital Staf review/revise crisis plan or to create a crisis plan Hos f to Dual Diagnosis Program, Regional Mental Health Care London CRISIS
People with a Dual Diagnosis are at risk of crisis for many reasons including: □ Medication or medical complications □ Changing life circumstances □ Inappropriate or inadequate supports □ Flare up of their illness □ Substance abuse problems Preventing Crisis
When someone has a Dual Diagnosis it is imperative that they work together with an interdisciplinary team which could include a Family Physician, a Psychiatrist, Developmental Service providers who can advocate, coordinate and provide services and supports as well as other services such as Regional Support Associates (RSA), Community Mental Health programs who can provide specialized services and supports. A coordinated team of
family/friends and professionals working together with the person may reduce the risk of
crisis. Together a supportive team can increase the ability of individuals to have improved quality of life with supportive living environments, meaningful relationships, activities, and improved ongoing health. Evaluating Risk of Crisis Evaluating risk is a vital part of a good person‐centered support to people with Dual Diagnosis. Ideally, issues of risk are discussed and a plan to address them is developed before a crisis occurs (see Crisis Care Plans). Being able to identify when the person you support is escalating is critical to support the person well. When those around the person realize there is an escalation it is time to regroup and put plans in action to assist the person to deescalate. There are three primary areas to consider: damage or harm to self, to staff and/or to others around, and to goods and/or property. Questions to ask when behaviour is escalating What danger exists? Is it possible that the person would: Yell at someone? Threaten someone? Harm themselves, someone else, or damage property? A Crisis is any serious deterioration of a person’s ability to cope with everyday life. It does not necessarily involve danger of serious physical harm to himself / herself or others.
How great is that danger? How likely is the behaviour? If we provide more support, is the behaviour less likely to occur? How often has it occurred? When and where does it occur? What factors may be causing the situation? What can be done to minimize the risk? What supports can we add? What steps can we take to keep the person and others safe? How can we prepare to manage the risk? Call relevant specialized providers to see if there is something that can be done to deescalate the situation. For Example
call the Crisis Line (1‐888‐829‐7484 or Stratford 519.274.8000, Seaforth 519.527.0155) at the hospital to problem solve about other resources that may help stabilize the person without going to hospital e.g. how can we support your team, may have a consult with the Psychiatrist call the person’s Psychiatrist’s office to let them know what is occurring call RSA for Behavioural support and/or consideration of In home/Safe Space/Treatment Space call the Social Worker or Out‐patient Nurse at Regional Mental Health Care – London, Dual Diagnosis Program for consultation Re‐assessing risk Risks will change as the person's situation changes. For example, the likelihood of someone self‐harming is much less if the person is supervised in a supported setting, than if the person is on his or her own in the community. You will need to regularly re‐assess risk to reflect the person's current state, environment and level of support. In a Crisis Follow Crisis Care Plan if there is one. Consult with team members to confirm situation when behaviour starts to increase.
Call the Crisis Line 1‐888‐829‐7484 (Crisis) 24 hour Telephone support Crisis Face to Face consultation can be arranged by calling the crisis line number. If this is an emergency and the person needs to go to hospital go to your local emergency room. A crisis worker may be dispatched to your location to help determine the next steps. If the police need to be called ‐ make the 911 call providing as much information as possible about the individual and the situation. If the person has a crisis care plan let the dispatcher know so the protocol can be followed. After any emergency situation – trip to the emergency room or inpatient stay – the crisis care plan (CPP) needs to be reviewed to see if any changes are necessary. The case manager/primary support person will be responsible to review and revise the CCP. The team supporting the person, including all clinical providers and other professionals involved, need to participate in the review. If someone does not have a Crisis Care Plan it may be helpful to have one developed. The key is to develop rapport and relationship with all of the professionals involved so you can work together to provide critical information to inform decision‐making and to develop the best treatment plan for the person. Working together helps to ensure the person with Dual Diagnosis has a supportive living situation with a positive support plan, good medical care, meaningful relationships and activities, in order to reduce the chance of ER visits and hospital stays and for improved overall physical and mental health. Resources in the Community that can assist in supporting people with a Dual Diagnosis: Developmental Services Adult Protective Service Worker Support adults and their families to coordinate and advocate for necessary services and supports – call Family Services Perth Huron – or 1.800.268.0903 or 519.273.1020 Stratford or 519.482.5833 Clinton.
An emergency is a situation in which there is an immediate danger that the person will harm either himself or herself or someone else. Examples of emergencies include threats of suicide, threats of physical violence or extreme
Community Services Coordination Network (CSCN)
As of July 1, 2011 Community Services Coordination Network will be the Application Entity for the South West region and will be called Developmental Services Ontario South West Region ‐ DSO SWR
Please go to www.dsontario.ca , www.healthline.ca or www.mcss.gov.on.ca for more information. Developmental Service Ontario The key function of Developmental Service Ontario is to coordinate access to various services and supports for adults with a developmental disability. Developmental Service Ontario is the single point of access to services for adults with a developmental disability living in Huron Perth. 171 Queens Avenue, Suite 750, London, On N6A 5J7 call 519.438.4783 or toll free at 1.877.480.2726 Website – www.dsontario.ca L’Arche Stratford 400 Huron St. P.O. Box 522 Stn Main, Stratford, On N5A 6T7 Telephone: 519.271.9751 Fax: 519.271.1861 Email: [email protected] Website: www.larch.ca Anago Resources Inc. 364 Huron St. East, Exeter, On N0M 1S2 Telephone: 519.235.2963/519.235.4275 Fax: 519.235.1250 Website: www.anago.on.ca Family Home Program 820 Main St., Listowel, On N4W 3H2 Telephone: 519.291.5401 Fax: 519.291.5726 Community Living Agencies Provide and advocate for a full range of community‐based services for individuals with intellectual disabilities including accommodation, employment, social, recreation, planning and family supports. Community Living North Perth 820 Main St. East, P.O. Box 220, Listowel On, N4W 3H4 Telephone: 519.291.1350, Fax: 519.291.2747 Email: [email protected]
Community Living St. Mary’s and Area 300 Elgin St. East, P.O. Box 1618, St. Mary’s On N4X 1B9 Telephone: 519.284.1400 Fax: 519.284.3120 Email: [email protected] Website: www.communitylivingstmarys.com Community Living Stratford and Area 112 Frederick Street, Stratford, On N5A 3V7 Telephone: 519.273.1000
Email: [email protected] Website: www.clsa.ca
Wingham and District Community Living Association 153 John St., P.O. Box 818, Wingham, On N0G 2W0 Telephone: 519.357.3562 Fax: 519.357.4283 Website: www.wdcla.org Community Living Central Huron 267 Suncoast Dr., P.O. Box 527, Goderich, On N7A 4C7 Telephone: 519.524.7362 Fax: 519.524.1511 Email: [email protected] Website: www.clch.ca Community Living South Huron 146 Main St. P.O. Box 29, Dashwood, On N0M 1N0 Telephone: 519.237.3637 Fax: 519.237.3190 Website: www.clsh.ca Specialized Services Regional Support Associates Services provided are: assessments; psychiatric, psychology, behavioural, cognitive, sexuality, vocational, geriatric, speech and language, swallowing and offers clinical support in the areas of social work, nursing, speech/language pathology, and behavioural intervention and Justice Dual Diagnosis Case Management. Contact Jane Joyes at 519.433.7238 or 1.800.640.4108. Visit the website at www.regionalsupport.on.ca Enhanced Specialized Services Has been developed to provide intensive clinical support, assessment and short term treatment, for individuals who are experiencing significant challenging behaviours and/or mental health concerns. Specially trained support staff will work with the individual’s support group under the clinical supervision of Regional Support Associates, will assist in implementing behavioural strategies, gather data, model intervention techniques for caregivers and reinforce a holistic team approach to support. This is not a crisis service, but part of a continuum of preventative community service that can provide support on an urgent basis. “Urgent service” means when the situation is stable but the person and their
supports need clinical assistance as soon as possible to prevent the person and situation from becoming a crisis state. Contact Regional Support Associates; Jayne Joyes at 1‐800‐640‐4108. Dual Diagnosis Program, UWO ‐ St. Joseph’s Regional Mental Health Care‐London The DDP Unit is an 18‐bed inpatient unit serving dually diagnosed people ages 18‐64. They provide a short‐term, specialized psychiatric assessment and treatment program. Priority is given to people currently hospitalized (for example, in Stratford General Hospital or Alexander General and Marine Hospital in Goderich). They will not accept crisis admissions or people with no residential options. There must be evidence that local resources have been considered and/or accessed first. They serve adults, 18‐64 years, with both a developmental disability and mental health issue(s) (a psychiatric disorder or severe behavioural problem). Admission typically is from a hospital. The Southern Network of Specialized Care The SNSC works to enhance services to adults with a developmental disability who need specialized care for co‐existing mental health and/or behavioural issues. They provide opportunities to access additional training and resources, grants for research, education and training; promoting evidence based best practices, creates awareness of employment opportunities in the field. They work with cross sectoral service providers to discuss ways to improve service delivery by identifying service gaps, assisting to find ways to meet these gaps and by providing a unified community voice at the provincial and senior government levels. Contact Lynda Legge, Facilitator, Huron, Perth, Grey, Bruce at 1.800.640.4108 or 519.881.0922 ext. 2405 Visit the website at www.community‐networks.ca Mental Health Services Hospital Based Services To find a psychiatrist: Family physicians may fax referrals to the Psychiatry department, for non‐ emergency referrals. If you do not have a family physician consult with a local Family Health Team or ask a Nurse Practitioner. In Huron Phone: 1.877.695.2524 or 1.519.524.8316 Fax: 519.524.9349 In Huron your initial appointment with the Psychiatrist will be at the Hospital. Other appointments will be at the closest Community Psychiatric Clinic. The Clinics are located at: Clinton, Exeter, Goderich, Seaforth, Wingham To reach Dr. Conlon, Dr. McAuley or Dr. Hudson call the Alexandra Marine and General Hospital at 519.524.8323
In Perth Phone: 519.272.8210 Fax: 519.272.8226 In Perth your initial appointment will be at the Special Services Building of the Stratford General Hospital or at Mental Health Outpatient Services building at the Listowel Hospital. The referring Doctor or Nurse Practitioner please note on the referral form that the person has or is suspected of having a Dual Diagnosis. Other appointments will be at the same locations. The psychiatrist will make referrals to other community services as necessary. To Refer to Other Mental Health Services contact 519.482.3961 Intensive Case Management Program provides time‐limited support by a multidisciplinary team with goal‐specific community treatment, and medication monitoring 7 days a week in the client’s home. (for this program call (519.524.8316) Assertive Community Treatment Team provides long‐term treatment 7 day a week in the client’s home and community focusing on relapse prevention, medication monitoring, psychiatric consultation and goal‐specific treatment by a multidisciplinary team. Community Treatment Order Services provides advocacy, coordination, case management and education to clients, psychiatrists and community resources. Huron Perth Seniors Mental Health Program provides assessment and treatment provided for older adults experiencing depression, anxiety, confusion, cognitive impairment and changes in behaviour. Services are time limited and include community treatment, assessment, consultation, counseling, advocacy and education. In‐service training provided to Long Term Care Homes, community groups and residential care homes. They offer psycho‐geriatric clinics, psycho‐educational groups for caregivers and psychiatric resource consultation. Community Based Mental Health Services Canadian Mental Health Association (CMHA) Huron Perth Branch Locations: 540 Huron St., Stratford, On N5A 5T9 92 Goderich St. W, Box 1139, Seaforth, On N0K 1W0 Telephone: 519.273.1391 or 1.888.875.2944 Fax: 519.273.0505 Website: www.cmha‐hp.on.ca CMHA serves individuals with a serious mental illness by providing programs and they will provide information to the general public.
Programs include: Community Support Program ‐ offers individualized community‐based support for people, 16 years of age or over with a serious mental illness, aimed at improved quality of life through community integration. Case Managers assist with housing, financial planning, development of supportive network of family and friends, life skills, involvement in meaningful activities and linking with other professionals and community agencies. Court Support & Diversion ‐ Mental Health Court Support Services are available for persons with a mental illness who come into conflict with the law. This service provides court diversion, pre‐charge diversion, case management, support and consultation through the criminal justice system. The Release Planner component provides planning for release from incarceration and serves individuals 16 years and over. Concurrent Disorders ‐ provides linkages to assessment, treatment and psychosocial rehabilitation for service recipients who have a serious mental illness and addiction disorders. Housing Initiative/Rent‐Geared‐to‐Income/Enhancement/750 ‐ sublets units to eligible participants with serious mental illnesses at a reduced rent equal to an individual/family’s maximum shelter allowance under the Ontario Works or Ontario Disability Support Programs. Rent‐geared‐to income (RGI) units house up to 26 individuals (4 units are used as transitional housing up to 3 months for individuals looking for permanent housing) and 3 market rent units in Seaforth. Consumer Peer Support Initiative ‐ provides meaningful programs and activities which are planned and operated by consumer/survivors. Groups offer members: involvement in community activities; information on services and supports; hope, reassurance and support to prevent set‐backs. Family Support Group ‐ offered to family and friends of people/clients with a serious mental illness Education Program ‐ organizes workshops and educational presentations, information displays, public awareness and mental health week promotion. Resource centres are in Seaforth and Stratford with books, videos and brochures on mental health topics. WOTCH Mental Health Services Exeter Office: 149B Thames Rd W, Exeter, ON N0M 1S3 Goderich Office: 274 Huron Rd, Goderich Website: www.wotch.org Provides psychosocial rehabilitation programs to adults who have disabling or chronic psychiatric conditions. Social Recreational Life Skills Program ‐ life skills such as cleaning, shopping, meal preparation, personal hygiene, budgeting, etc. Provides social and recreation events including book/writing club, discussion groups, physical exercise, card tournaments, trips to various locations and events. Housing ‐ supportive services can range from daily supervision if required, to weekly support. Clients pay their share of rent, food and other expenses and housing case managers assist and teach clients to
budget, cook, clean, menu plan and shop. The homes are shared and are located in Exeter (congregate living) and individual apartments are located in Goderich (homelessness apartments). Employment Services ‐ focuses on maintaining established simple assembly piecework contracts with local plants, while working with employers and other community service providers to support individuals in finding appropriate jobs in factories and small businesses. Phoenix Survivors of Perth County 95 Frederick St., Stratford, On N5A 3V6 Telephone: 519.273.7780 Fax: 519.273.0807 Peer support network for people coping with mental illness. They are an employer of people who have/had a mental illness. Clubhouse ‐ drop‐in centre offers leisure activities, workshops and outings. To find out about evening activities and workshops contact the office at 519‐273‐7780 or 1‐877‐425‐9498 Weekly Peer Support Meetings Listowel ‐ 6:30‐8:30pm Mondays at Trinity United Church, 230 Barber Ave N Mitchell ‐ 7‐9pm Tuesdays ‐ call 519‐273‐7780 for location and information St Mary’s ‐ 6:30‐8:30pm, Wednesdays at James Purdue Centre,300 Elgin E Alzheimer’s Society Alzheimer Society of Huron P.O. Box 639, Clinton, On N0M 1L0, Phone: 519.482.1482 Fax: 519.482.8692 Email: [email protected] Website: www.alzheimerhuron.on.ca Alzheimer Society of Perth 1020 Ontario St., Unit 5, Stratford, On N5A 6Z3 Phone: 519.271.1910 Fax: 519.271.1231 Email: [email protected] Website: www.alzheimerperthcounty.com Addictions Choices for Change: Alcohol, Drug & Gambling Counseling Centre In Huron Seaforth Community Medical Clinic, 28 Centennial Dr. Seaforth, N0K 1W0 Phone: 1.877.218.0077
In Perth 10 Downie St. 3rd Floor, Stratford, On N5A 7K4 Phone: 1.877.218.0077 or 519.271.6730 Fax: 519.271.2746 Website: www.choicesforchange.ca Provides assessment, referral and out‐patient counseling to individuals affected by their own or someone else's substance use or gambling behaviour for Huron and Perth. Community Withdrawal Management Program Supports people to withdraw from substances within the community. Call 519‐271‐6730, 519.482.7820 or 1‐877‐218‐0077 Located at the Festival Square Building, 10 Downie St, 3rd Fl, Stratford, ON N5A 7K4 Financial Resources Ontario Disability Support Program Provides income and employment supports for adults with a disability. 581 Huron St., Stratford, On N5A 5T8 Phone: 519.271.1530 or 1.800565.5762 TTY: 519.271.0124 Website: www.mcss.gov.on.ca Ontario Works Provides income and employment assistance for people who are in temporary financial need. You must be a resident of Ontario, in immediate financial need and willing to participate in employment assistance activities. 82 Erie St., Stratford, On N5A 2M4 Phone: 519.271.3773 ext. 254 or 1.800.669.2948 Website: www.mcss.gov.on.ca Online Resources The Health Line
Go to www.thehealthline.ca for a listing of mental health services and developmental services in Huron and Perth. It has program descriptions and contact information.
ConnexOntario
Go to www.connexontario.ca for Health Services information for help with substance abuse, problem gambling or mental health issues.
Regional Support Associates www.regionalsupport.on.ca
Southern Network of Specialized Care www.community‐networks.ca Arch Disability Law Centre (formerly ARCH) www.archdisabilitylaw.ca
National Association on Dual Diagnosis www.thenadd.org Ontario Association on Developmental Disabilities www.oadd.org National Coalition on Dual Diagnosis www.care‐id.com Surrey Place Centre www.surreyplace.on.ca Canadian Mental Health Association www.cmha.ca Community Living Ontario www.communitylivingontario.on.ca Healthy Ontario www.healthyontario.ca Ministry of Community and Social Services www.mcss.gov.on.ca Fetal Alcohol Spectrum Disorder Ontario Network of Expertise www.fasdontario.ca Fetal Alcohol Spectrum Disorder and Justice www.fasdjustice.on.ca University of Western Ontario Developmental Disabilities Division www.psychiatry.med.uwo.ca/ddp Great website with lots of links! Great website for young people and emerging adults to access information, resources and tools during tough times www.mindyourmind.ca
The purpose of this document is to outline how crisis response between the mental health and development service providers will coordinate their services for the care of people with a dual diagnosis. Definition of Target Client Population:
The target population will be defined as “persons who have a intellectual disability and a co‐ existing mental health issue or symptoms consistent with a mental health issue.” (Dual Diagnosis) Guiding Principles: Build on existing strength in the system Share consistent information between providers Protocol for Linkages Between Schedule I Hospital (Huron Perth) Community Based Hospital and Development Service Provider & Community Mental Health
