Transcript Development Update - Addictions and Mental Health Ontario

Optimizing Transitions from
Forensic Alternate Level of
Care to Supportive Housing
Addictions Mental Health
Ontario Conference 2016
Presentation Objectives
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Help to create co-design processes across sectors
by using appreciative inquiry method as a way of
being innovative and collaborative
Expand community providers’ knowledge of those
in ALC in hospital and how community providers
can respond to their needs
Design collaboratively a multi-sector program
Leverage the expertise of people with lived
experience in program design and delivery
LOFT Community Services
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Provides supportive housing, case management
and outreach to youth, adult and seniors in
Toronto and York region
Over 1200 supportive housing units with
specialty high support sites including forensic,
seniors, complex physical health challenges
Since 2012, 320 people transitioned from ALC to
supportive housing
Our most recent programs designed exclusively
where hospital is the only other option
Working Across Sectors: The Essentials
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Essential #1: Align community practices to best
practice/research
Essential #2: Learn the language and roles
Essential #3: Know common client and common
need
Essential #4: Make friends
Essential #5: Formal MOU
Essential #6: lead the summit
CAMH
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Canada’s largest mental health and addiction
teaching hospital
ALC at CAMH
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Historically the highest rate of ALC in the Toronto
Central (TC) LHIN
Approximately 20% of inpatient beds are occupied
by ALC patients (varies between 80-100 people)
Risk Factors for ALC at CAMH
What is ALC?
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ALC = Alternate Level of Care
Provincial definition:
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“when a patient is occupying a bed in a hospital and does not
require the intensity of resources/services provided in this
care setting (acute, complex continuing care, mental health
or rehabilitation)” (CCO, 2009)
ALC patients require a different, higher level of
care. In order to transition to the community,
these patients require specialized supports,
which are often cited as a barrier to discharge.
(OHA, 2013)
ALC High Support Housing Initiative
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ALC High Support Housing Initiative is a system
response to the ALC problem
Funded elements include:
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High Support Housing (including LOFT/O’Connor
Project)
Step-Up Housing
Senior Housing
Interdisciplinary Transition Team
Flex Fund
New Practices in the ALC
High Support Housing Initiative
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Steering Committee
Matching process
Step-Up Housing
Community Support Planning
Flex Funds
Interdisciplinary Transition Team
Partners of the ALC High Support
Housing Initiative
CAMH
CMHA Toronto
Cota
Eden Community Homes
Good Shepherd Non-Profit Inc.
Habitat Services
House of Compassion
LOFT Community Services
Madison Community Services
Mainstay Housing
Margaret’s Housing and
Community Support Services
Pilot Place Society
Regeneration Community
Services
The Access Point
Toronto Central - CCAC
Mental Health and Justice Program
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Established over 10 years ago
Supportive housing and case management for
people with MH issues involved with justice
system
High support “hub” that spokes out to 96
scattered rent supplement units
Larger membership with the MH and Justice
Network and the Human Services Justice
Coordination Network
O’Connor Project History
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Gap identified by profiling CAMH ALC clients, a
high support housing consortium: meals,
expertise in forensic ALC and support with
medications and complex health challenges
CAMH had some rent supplement funding to
dedicate to a project and invited proposals
LOFT submitted to CAMH, was approved then
did a joint application to the TCLHIN
Our Collaboration in Design
Working with the Individual Client
Client demographics, needs, and strengths
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Average age of ALC residents: 46
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Most prevalent primary diagnoses include schizophrenia and
schizoaffective disorder
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Some residents diagnosed with dual diagnosis, personality disorder
and previous concurrent disorders
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Needs include medication assistance, meal programming, room
cleaning, accompaniment to appointments, and support with daytime
activities that facilitate structure
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Two residents encounter mobility issues and three residents have
visual impairment
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Some residents engage in ESL classes and facilitate social activities in
building
Client Demographics
Client Primary Diagnoses
Client Secondary Diagnoses
Paraphilia
NOS
10%
Personality
disorder NOS
10%
Anti-social
personality
traits
40%
Schizoaffactive
disorder
Schizophrenia
Psychosis (NOS)
Sample Size = 15
residents
Developmental
Disorder
30%
Depression
10%
Client Demographics con’t
Client Ethnocultural
Representation/Groups
Client Age Ranges
65+
6%
African
Canadian 3
Caucasian 6
55-64
20%
Middle
Eastern 4
Tamil 2
45-54
27%
25-34
20%
35-44
27%
Our Team (a year ago)!
Transition Process from Hospital to
Community
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Matching meetings with the Circle of Care
Integrated support plans
Transitions have been approximately 4 months
in duration
Launching Health Links Coordinated Care
platform
Uniqueness of clients from forensic ALC–
involves lots of support long term
Shared Care Model
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Clients’ circle of care team varies based on
individual needs
LOFT
CCAC
East End
Community
Health
Centre
ALC
Transition
Team
EFOPs
CAMH & LOFT Roles – What Does it
Look Like Now?
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CAMH
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Psychiatrist
Social Workers
Nurses
Occupational Therapists
Behavioural Therapist
Peer Support Worker
LOFT
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Personal Support Workers
Peer Support Worker
Community Support Worker – Addictions Specialist
Overnight Workers
O’Connor Program Elements
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On-site multi-disciplinary team
Integrated Support Planning/Coordinated Care Plans
24 hour staff: 2 staff available at all times
On Site Coordinator
Personal Support workers on site
Peer support worker & an on-site community support worker
Interprofessional team of LOFT and CAMH staff : Social workers, behavioural
therapist, psychiatrist, nurses, and doctors
Scheduled and unscheduled PSW support and alert buttons
Assistance with medication
Support with psychosocial needs related to life skills and social recreation
including a meal program
Structured program including group activities, social opportunities & Family
Night
Drug and alcohol free program
Personal Support Workers (PSWs)
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Have already been part of various LOFT program
teams
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PSWs bring another dimension and strength to
client care & enable staff to support clients with
more complex needs & medication administration/
monitoring
Role of LOFT Personal Support
Workers
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PSWs on site at O’Connor Site
Mental Health expertise
Medication assistance & monitoring
Meal preparation
Diabetes management
Delegated acts of care
Support with Activities of Daily Living (ADL’s) &
personal care
Supportive counselling & crisis response
Peer Support
Why Peer Support?
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Peer support is based on the belief that
people who have faced, endured, and
overcome adversity can offer useful
support, encouragement, hope, and perhaps
mentorship to others facing similar
situations.
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https://schizophreniabulletin.oxfordjournals.org/content/32/3/443.full
Why Peer Support?
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“Traditional therapeutic relationships are
different from peer relationships. Peer
Relationships have more of a mutual,
reciprocal nature and include friendship and
an equal power base.”
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(Forchuk, Jewell, Schofield, Sircelj, & Valledor, 1998, p.202)
Why Peer Support?
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“Mammoth potential” (Mental health Commission , 2010)
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“Peer participation is recognized at
national, provincial and local levels as a key
component to a recovery-oriented model of
care”(Campbell, 2005)
Why Peer Support?
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Two randomized, controlled studies found that
peers serving in health services resulted in
increased service engagement, level of social
participation, and quality of life among consumers
served.
(Craig, Doherty, Jamieson-Craig, Boocock and Attafua, 2004)
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Pickett et al (2012): not only improved outcomes
but sustained them past 6 months
Role of Peer Support
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To use lived experience to assist clients with
change and transition within the scope of PSR
Establish and maintain a more equal power
relationship with the client
Creating an environment of recovery
Role of Peer Support
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Creating and fostering a sense of home & community
Use of active listening, empathy, non-judgment and
appropriate use of personal disclosure
First hand knowledge of social stigma, discrimination
& mental health system resources
Outcomes
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As of March 31st, 2016 – 15 clients in process or
transitioning to the O’Connor Site
Only 1 client returned to CAMH as a result of
violation of ORB conditions (as of March 31st,
2016)
Group social activities, Family Nights and
community meals are well attended
Outcomes
ALC Resident Survey
I can join social groups and activities
My opinion and ideas matter
very satisfied
I would recommened program
satisfied
neutral
I know who to speak to
dissatisfied
very dissatisfied
Services offered are relevant to my
needs
I am satisfied with support
0
2
4
6
8
Lessons Learned/Recommendations/Moving
Forward
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Controlled entry essential due to requirement of
a drug and alcohol free space
The support level required is very high: Lot of
physical challenges (implemented emergency
button alert system)
The “rub” between PSR and ORB
Given the structure, really only a fit for clients
with ORB requirements in future
Any Further Questions…
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Theresa Hirschberg, Program Coordinator
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Tony Gordinho, Community Support Worker
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[email protected]
[email protected]
Katelynd Litt, Behavioural Therapist
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[email protected]