Forensics at Pathstone Mental Health

Transcription

1 Forensics at Pathstone Mental Health Presentation to the Audit, Communicate, and Educate Advisory Committee (ACES) March 22, 2016

2 Forensics Programs High Risk (Suicide/Homicide) The Arson Prevention Program for Children (TAPP-C) The Sexual Treatment Outpatient Program (STOP) Youth Justice Early Intervention Program (EIP) Youth Justice Court Social Worker (YJCSW) Youth Justice Court Counsellor (YJCC) Extrajudicial Sanctions (EJS) Probation

3 High Risk A program for youth that have been identified as being at elevated risk to harm themselves and/or others. Often these youth are identified and referred to Pathstone by community partners including police, schools, hospitals, or child welfare. These youth are provided intensive individualized service designed to reduce the imminent risk they pose to themselves and/ or others. Once risk has been reduced, the youth is referred to a more appropriate and less intense service or program. Therapists conduct weekly sessions with clients Reports from weekly sessions are discussed with the Clinical Manager

4 High Risk Admissions/Discharges Sept. 1, 2011 to Sept. 30, 2012 Admissions: 10 Discharges: 10 Sept. 1, 2012 to Sept. 30, 2013 Admissions: 23 Discharges: 22 Apr. 1, 2013 to Mar. 31, 2014 Admissions: 20 Discharges: 19 Apr. 1, 2014 to Mar. 31, 2015 Admissions: 38 Discharges: 16 Apr. 1, 2015 to February 29, 2016 (1 st 11months) Admissions: 33 Discharges: 32 Note: Program was begun only in September, 2011

5 High Risk (Homicidal-Suicidal Services) CAFAS DATA April 1, 2013 to March 31, 2014 Pre-test Average: 150 Post-test Average: 170 Total change: -20 April 1, 2014 to March 31, 2015 Pre-test Average: 97 Post-test Average: 71 Total change: 26 April 1, 2015 to February 29, 2016 (1 st 11 months) Pre-test Average: 72 Post-test Average: 38 Total change: 34 Notes : (1): CAFAS clinically significant change is defined as 20 point change in total CAFAS score; (2) positive change has occurred significantly in each time period noted above.

6 High Risk (Homicidal-Suicidal Services) CAFAS DATA 170* 150 Avera ge 97 71* 72 38* Pre (04/13) Post (03/14) Pre (04/14) Post (03/15) Pre (04/15) Post (02/16) *Sig. Change when 20 Dates (by Fiscal Year)

7 The Arson Prevention Program for Children (TAPP-C) The Fire Involved Program is the mental health portion of The Arson Prevention Program for Children (TAPP-C), as developed by the Centre for Addictions and Mental Health in Toronto. This program has been highly successful in preventing further incidents in young people with fire-setting behaviours. The program is available for children and youth prior to their 18th birthday. Fire-setting behaviours need to be treated very seriously as these behaviours can lead to severe property damage, injury, and even death. The Fire Involved Program primarily addresses these behaviours but also looks at other co-existing concerns as well.

8 TAPP-C Admissions/Discharges Fiscal Year 2013 to 2014 Admissions: 25 Discharges: 16 Fiscal Year 2014 to 2015 Admissions: 29 Discharges: 23 Fiscal Year 2015 to 2016 (1 st 11 months) Admissions: 28 Discharges: 23

9 TAPP-C: CAFAS Scores Between April, 1, 2013 and March 31, 2014 Pre-test average scores: 83 Post-test average scores: 66 Difference: 17 Between April, 1, 2014 and March 31, 2015 Pre-test average scores: 100 Post-test average scores: 57 Difference: 43 Between April, 1, 2015 and February 29, 2016 Pre-test average scores: 96 Post-test average scores: 40 Difference: 56 Note: Clinically significant is defined as 20 point difference

10 TAPP-C: CAFAS Scores * Avera ge 57* 40* Pre (04/13) Post (03/14) Pre (04/14) Post (03/15) Pre (04/15) Post (02/16) *Sig. Change when 20 Dates (by Fiscal Year)

11 TAPP-C Effectiveness Is it effective? How do we know it is effective? CAFAS scores Feedback, based on telephone interviews with 11 clients (February/March, 2016) regarding treatment, revealed: 0 parents have experienced further fire setting behaviour by their child/children parents concern over fire-setting behaviour has decreased completely (5 on a scale of 1-5) Greater fire safety awareness by parent and child has increased (4.8 on a scale of 1-5) Belief expressed by parent that therapist was responsive to child s needs (5 on a scale of 1-5) Several comments by parents of these same 11 youth were volunteered consistently reflecting complete satisfaction with both treatment and therapist providing same In addition, worthy of note is that: Pathstone staff was asked to present at the Ontario Fire College to teach fire personnel across the Province about working with juvenile fire setters Also, staff has been asked two consecutive years to present about TAPP-C at the Ontario Municipal Fire Prevention Officers Association as well as to present to a number of municipalities across the Province

12 The Sexual Outpatient Program (STOP) The Sexual Treatment Outpatient Program (S.T.O.P.) is a mental health treatment based program for children/youth ages 4 to 18 who are exhibiting sexual behaviour problems or have been charged with a sexual offence.

13 STOP Admissions/Discharges Fiscal Year 2013 to 2014 Admissions: 32 Discharges: 33 Fiscal Year 2014 to 2015 Admissions: 32 Discharges: 24 Fiscal Year 2015 to 2016 (1 st 11 months) Admissions: 56 Discharges: 35

14 STOP CAFAS Scores: Fiscal April 1, 2013 March 31, 2014 Pre-test Average: 88 Post-test Average: 33 Change: 55 April 1, 2014 March 31, 2015 Pre-test Average: 81 Post-test Average: 34 Change: 47 April 1, 2015 February 29, 2016 (1 st 11 months) Pre-test Average: 73 Post-test Average: 46 Change: 27 (Note: Clinically significant change is defined as a 20 point change)

15 STOP CAFAS Scores: Avera ge 33* 34* 46* Pre (04/13) Post (03/14) Pre (04/14) Post (03/15) Pre (04/15) Post (02/16) *Sig. Change when 20 Dates (by Fiscal Year)

16 Sex Offender Treatment % of high risk offenders scored two standard deviations below high risk at discharge, using a multi-protocol assessment that includes CAFAS CAFAS Scores April 1, 2013 March 31, 2014 Pre-test Average: 87 Post-test Average: 33 Change: 55 April 1, 2014 March 31, 2015 Pre-test Average: 81 Post-test Average: 34 Change: 47 April 1, 2015 February 29, 2016 (1 st 11 months) Pre-test Average: 73 Post-test Average: 46 Change: 27 (Note: Clinically significant change is defined as a 20 point change)

17 87 Sex Offender Treatment: Avera ge 33* 34* 46* Pre (04/13) Post (03/14) Pre (04/14) Post (03/15) Pre (04/15) Post (02/16) *Sig. Change when 20 Dates (by Fiscal Year)

18 STOP Effectiveness Is STOP effective? How do we know it is effective? Child and Adolescent Functioning Assessment Scale (CAFAS) data have consistently revealed clinically significant change over time. International Recognition Pathstone has been invited to and has presented at International Conferences on Sexual Offending most recently in 2014, in Marlborough, Massachusetts.

19 Youth Justice Court Social Work Early Intervention Program (EIP) The goal of the EIP is to provide an early intervention plan for youth in the context of the criminal justice system. This initiative is supported by an enhanced community response across multiple service sectors. There is one full-time staff and one part-time staff in Pathstone s EIP.

20 EIP Social Worker The Social Worker provides supports to the Youth Justice Court for youth with mental health needs and other related concerns. The Social Worker informs the disposition of the court and compresses the number of adjournments. The Social Worker uses a variety of tools to triage mental health and other needs to ensure youth are appropriately supported. In collaboration with youth, caregivers, service providers, school officials, and other key individuals, the Social Worker will identify, inform, and facilitate the development of a plan to address the mental health and related needs of a young person.

21 The EIP Court Counsellor The EIP Counsellor assists the EIP Social worker by liaising with various community partners (including defense counsel, duty counsel, crown counsel, schools, FACS, police, CASON, Youth Resources Niagara, and the hospital (among others) for the purpose of developing and executing a well rounded community treatment plan. The EIP Counsellor is an active member of the Niagara Court Screening Initiative (NYCSI), which meets at Youth Court bio-weekly.

22 Youth Served by the EIP February, 2015 to February, 2016: 44 youth completed, with the following outcomes: 18 had charges withdrawn 3 had charges stayed 3 received a peace bond 3 received a reprimand 1 received an absolute discharge 8 received a conditional discharge 8 received probation In addition 10 youth did not complete the program, for various reasons opting out (e.g., deciding to plead) Fiscal year (first 11 months): 96 youth served

23 Is the EIP effective? How do we know it is effective? 71 youth were served from April 1, 2014 to March 31, youth were served from April 1, 2015 to February 29, 2016 Notes: (1) Ministry annual fiscal-year target is 220 youth. Numbers for fiscal year fell below target due to staffing changes during the year, as well as fewer referrals than anticipated. (2) Numbers for fiscal year (data for 1 st 11 months) also were below target due to fewer than anticipated referrals. (3) Numbers for fiscal year are expected to increase considerably as the Youth Court, supported by the NYCSI is fully operational.

24 EIP Effectiveness (cont d) Worthy of note is that in the few years since its inception at Pathstone, this program (below-target numbers notwithstanding) is now widely regarded across Ontario as cutting edge with both the Social Worker and the Counsellor asked to present at various venues. On October 28, 2015, the Youth Justice Services Division, West Region, of MCYS informed Pathstone of its results of the Youth Mental Health Court Worker Program Implementation Evaluation in summary, noting that the program has been designed and implemented with the program objectives and performance measures listed in the program description.

25 EXTRA JUDICIAL SANCTIONS (EJS) POST CHARGE Partnering with the Crown s Office, Police, and Probation, we assist the young person through an alternative to a formal court procedure. We contract with the young person and provide them with sanctions to complete, that enable them to payback the community for any wrong doings in which they may have participated. Assisting the young person in coming to terms with having made a wrong decision, we encourage them to make a positive change in their future.

26 EJS Is it effective? How do we know it is effective? Some data: 36 active cases between April 1, 2015 and February 29, % successful completion rate The EJS counsellor (along with the Pathstone EIP court counsellor and other Niagara community screening members ) is an active member of the Niagara Youth Court Screening Initiative see immediately below.

27 The Niagara Youth Court Screening Initiative (NYCSI) Story So far 18 youth courts held 76 First Appearance (FA) youth scheduled 68 referred to NYCSI 51 screened (75% of youth referred, i.e., 67% of possible FA youth Youth can decline screening; some already connected with other services Data for 43 youth available for analysis Youth profile by age: average age is 17 Youth profile by gender: 79% boys

28 Probation The Community Service Program assists the young person in finding a suitable Community Placement in which they can fulfill their obligation to the Court and complete their Community Service Hours. With the Probation Officer, we monitor the young person s performance, report any issues that might arise, and terminate the file at the completion of the Community Placement. Referrals to this program are made through Probation Services.

29 Probation (continued) 32 clients served between April 1, 2015 and February 29, 2016 Is the program effective? How do we know it is effective? Feedback solicited and received (February, 2016) by Manager of Forensics from Frank Casale, Acting Director of Probation Services, revealed highest possible level of satisfaction provided by Pathstone staff CAFAS data (see below)

30 Probation Counselling CAFAS DATA October 1, 2014 to March 31, 2015 Pre-test Average: 90 Post-test 20 Total change: 70 Note: Clinically significant is defined as a 20 difference between scores.

31 AREAS OF STRENGTHS Staff: all are experienced, trained, competent, and highly committed often going beyond the scope required of them in their job descriptions. To date, there has been no occurrence of suicide by a Pathstone client or homicide by any Pathstone client with whom Forensics staff have worked since the establishment of Forensics as a comprehensive program. Two programs (TAPP-C and Youth Mental Health Court) have been recognized inside and beyond the Niagara Region as cutting edge and are regularly invited by other agencies and service providers across the Province to present at workshops and/or lead conferences. Assessment and treatment policies/procedures are largely well established and observed in practice (as per Forensics Program Manual and fidelity checks).

32 Challenges 1. Quality Assurance within the individual Forensics programs to be further enhanced PLAN Existing/additional fidelity and outcome measures to be carried out more frequently Additional outcome measures to be identified and operationalized as appropriate/feasible (e.g., comparing year-over-year average length of time of clients in treatment, by specific program Obtaining more frequently client satisfaction feedback Tracking number of clients not returning or in need of referral to other programs within the Agency BY WHEN Fully carried out/implemented by the end of fiscal year (progress to be evaluated and reported on quarterly to the Director of Mental Health)

33 Challenges (cont d) 2. Additional financial and staff resources to be pursued in order to sustain/augment meeting of current and expected future demands in all Forensics programs PLAN Prepare and present written rationale to Director of Mental Health BY WHEN By March 31, 2017

34 Challenges (cont d) 3. Strengthening of staff competence PLAN Identification and agency support of further program-related staff training opportunities Encouragement of staff in taking greater personal (i.e., non-agency funded) responsibility for their own professional development Cross-training of Forensics staff to cover off each other for absences (e.g. vacation, extended illness) BY WHEN Fully carried out/implemented by the end of fiscal year (progress toward to be evaluated and reported on quarterly to the Director of Mental Health)

35 Questions?