Acquired Brain Injury in Residential Addiction Treatment. Wayside House of Hamilton

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1 Acquired Brain Injury in Residential Addiction Treatment Wayside House of Hamilton

2 Who we are: Residential addiction treatment and supportive housing Established residential beds + 1 crisis bed 29 supportive housing beds 24/7 clinical and crisis support weeks with flexible length of stay for residents Funded by the Ministry of Health and Long Term Care through the HNHB Local Health Integration Network Governed by a volunteer board of directors Primary addiction with support and program for those with a concurrent disorder and/or ABI. Specialty Hepatitis C team

3 Program Design Assessment Orientation Core Recovery Continuing Care Supportive Housing

4 Assessment Objective Determine whether referral is appropriate Identify potential crisis Connect with and support client Identify any concurrent disorders or ABI in order to link with mental health partner agency Determine next steps Process Review ADAT tools Screen for concurrent disorders Provide phone support, direction and additional information In-person and phone interviews Refer clients to other, more appropriate treatment options if necessary Schedule intake date Outcomes Decrease number of inappropriate admissions Decrease wait times Client is prepared to enter residential program Admission date established

5 Orientation Objective Introduce client to program, facility, staff & services Direct client to community supports Establish individualized treatment plans Begin discharge planning Process Engage client in individual and group sessions Assign peer mentor to new clients Administer additional assessments and questionnaires Assign primary counsellor Outcomes Client prepared to begin core program Comprehensive treatment plan established Post-treatment referrals initiated

6 Core Program Objective Inform, educate and support client in maintaining their recovery goals Enhancement and development of life, recreation and social skills Process Provide psychoeducational groups Structured 1:1 counselling In-house community support sessions Introduce clients to self-help options Adhere to best practice guidelines in all educational content and delivery of service Involve partner agencies in delivery of care Outcomes Demonstrated understanding of content material Archive core program goals Improvement in self-esteem, and social support

7 Recovery Phase Objectives Minimize potential relapse Secure safe and appropriate housing Return to work or school where appropriate Finalize and implement discharge plan Process Complete structured relapse prevention program Explore new housing opportunities or assure existing housing is safe Make contact with employer or school Review discharge plan and put action plans in place Outcomes Relapse plan in place Housing secured Returned to work or school Know how to minimize relapse and decrease risk

8 Continuing Care Objective Support client following completion of residential program Maintain adherence to established recovery goals Continued peer support Process Provide aftercare groups facilitated by staff Phone support 1:1 follow-up sessions Volunteer opportunities with agency Alumni support Social & recreational Activities Outcomes Client recovery goals maintained Relapse episodes decreased Early intervention of crisis situations Linkage with community supports maintained

9 Supportive Housing Objective Provide safe and supported abstinence based housing Restore independence Maintain dignity Minimize relapse Employ life skills training Reintegration to greater community Process Secure and support private residences in the community Provide onsite and remote support with designated staff Support clients in maintaining independence Provide conflict resolution Assure support in the event of crisis or relapse Outcomes Return to independence Recovery goals maintained Secure housing Maintained Decrease dependence on alternative systems and services

10 How ABI Presents Diagnosed Complete medical and psychiatric history Informed referral provider Directions; precautions Missed or undiagnosed Delayed connection Missed appointments Agitated, demanding or vague as to expectations (from unknown source)

11 Barriers Pre treatment Access presenting symptoms physical, stroke or communication skills Referred from non-abi service provider Interviews difficulty following through, attention to process, become angry, agitated, appearing not to pay attention Follow-through not keeping appointments, late or attend on different day then scheduled Engaging appear to have little interest or motivation, distant, agitated or aloof

12 Barriers - Core Program and Recovery Phase Difficulty following schedule, late for appointments Confrontational, appear easily agitated Poor retention of information Easily frustrated Group setting appear to be burdensome; become fidgety, drift off, forget Difficulty with focused conversations Others become frustrated and annoyed

13 Barriers Continuing Care Difficulty following through with goals and treatment plans Missed appointments Difficulty with maintaining or follow-through with outside referrals Poor engagement Drop out Return to use

14 Solutions Pre treatment Improved assessment and referral that includes history Direct contact with referral source that includes in person session with client Ask the right questions in order to make an informed decision one that is mutual Use of standardized assessment tool for ABI Develop training on ABI for addiction treatment providers

15 Solutions Core Program Improved appreciation of client with an ABI Understanding barriers what is the client experiencing? Develop collaboration with ABI providers Improve informed integration - share resources and expertise Bring in existing supports prior to admit Where possible involve family or other collaterals

16 Solutions Core Program Continued Program needs to accommodate behaviours in an informed and respectful manner Be creative in how services are providers Develop treatment plans that are easy to understand and follow Allow for shorter groups sessions, breaks and time outs Improved presentation of materials; more hand outs, notes and review tools Direct clinical support before, during and after any session

17 Solutions Continuing Care Develop improved collaboration and share cared approach Improved partnerships Training in ABI Improved training for clients Develop ABI-Addiction peer support Identify leads Minimize confusion for client Improved engagement and follow through Minimize assumptions

18 Discussion Points Identify opportunities to link client, while in treatment, with appropriate community agencies and supports Encourage collaboration how? Realize that a brain injury is not always obvious to the uninformed Not always obvious to the client ABI may have a direct effect on immediate, short and long-term engagement Client may view return to use as a failure

19 Contact Information 15 Charlton Avenue, West

20

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