Steele Street Treatment and Rehabilitation Residence

Transcription

1 Steele Street Referral Package 1 Program overview Steele Street Treatment and Rehabilitation Residence The Steele Street Treatment and Rehabilitation residence is one of the services offered by St. Joseph s Regional Mental Health Care, Psychosis Program. The Steele Street residence is staffed 24 hours a day by a multidisciplinary team of professionals including a psychiatrist, occupational therapist, occupational therapy assistant, social worker, recreation therapist, and nursing staff. The program emphasizes a home-like environment in which therapeutic relationships are developed, and individual choice is encouraged. The program operates with the values and principles of psychosocial rehabilitation as a guiding philosophy. The Steele Street program is not just a place to live but rather a community-based treatment and rehabilitation program providing specialized services to people with highly complex needs. Admission criteria To be considered for the Steele Street Residential Treatment and Rehabilitation Program, an individual must: - have a serious mental illness that is manageable in a residential setting - be 18 years of age or older - agree to the conditions of co-operative living Cooperative living and behavioural expectations Note: On referral to Steele Street, clients do not have to have all the skills necessary to engage in the following activities but must express/demonstrate initiative and desire to develop the necessary skills - Participate in chores on a twice weekly basis - Assist in menu planning once weekly - Complete grocery shopping with staff approximately once every two months - Assist in meal preparation, clean-up, table-setting on an alternating basis with other residents - Share a room with one other resident - Maintain care of own bedroom area - Participate in regular residents meetings - Participate in their own rehabilitation plan aimed at developing the skills needed to reach their overall rehab goal - Observe guidelines set out in lease (no smoking in home, refrain from disturbing other residents, neighbours, etc.) - Live cooperatively with up to nine other residents and to show respect for others rights, privacy, etc. - Residents can live at the home for a maximum of two years

2 Steele Street Referral Package 2 Services provided by Steele Street Rehabilitation and Treatment Residence include: - Goal setting and assistance in attaining goals as required - Activities of daily living skill training and development - Medication education and information - Group education including wellness group, relaxation group, and illness management and recovery group - Advocacy support Information/documents required to process the referral include: (Please include completed copy of this checklist with referral forms) Authorization for release of information Completed Steele Street referral forms Medications list/kardex Recent treatment plans Psychosocial assessment, current admission record Psychological tests Nursing/medical summaries Recent physical, routine blood work and investigations Family contacts Time lines Recent assessments (OT, SW, TR) Community Risk Assessment Prior to transfer to Steele Street: Arrange to have file transferred to ODSP St. Thomas Office if appropriate Apply for Community Start Up Benefit or partial CSUB if eligible Set up bank account / contact OPGT re: finances and budget Documents due on day of discharge or LOA Script for medications and blood work to be sent to Steele Street Valid health card ODSP drug benefit card Social Insurance Number Birth Certificate/citizenship papers Current copy of kardex (including PRN meds) Rent and grocery money for the first month (or deposits arranged with OPGT) Nursing transfer summary Notice of continuance, i.e. OPGT if appropriate

3 Steele Street Referral Package 3 37 STEELE STREET RESIDENTIAL TREATMENT AND REHABILITATION PROGRAM AND OUTREACH SERVICE T: F: REFERRAL FORM Date: Name: Casebook #: DOB: Source of Income: OHIP # and expiry: Social worker: Telephone: Other primary worker: Telephone: Referral source: Attending physician: ODSP/OW #(if applicable): Is the card in the client s possession? Yes / No if not, explain: Does client wish referral? Yes / No HISTORY Diagnosis: Axis I: Axis II: Date of client s first admission to hospital: Date of current admission: Number of previous admissions: Where? (If not RMHC St. Thomas): Why is Steele Street being considered for this client?

4 Steele Street Referral Package 4 Description of client s community/treatment/personal experiences in past two years: Current medications: attach list/kardex Allergies: Level of knowledge of and/or independence in taking medications: Client s strengths (please include at least two identified by the client): Client s rehab needs (if possible please include areas identified by the client): Support people in the client s life and contact numbers: Recreational interests:

5 Steele Street Referral Package 5 Current involvement with other programs (i.e. ACE, Elgin House, CMHA, Talbot House) Financial status capable / incapable If incapable, identify trustee/opgt and contact information Treatment status capable / incapable If incapable identify substitute decision maker and contact information Names of any additional support workers and contact numbers: Religious / spiritual supports:

6 Steele Street Referral Package 6 Risk factors Presence of current suicidal ideation History of severe self-harm within three months History of severe self-harm within twelve months Presence of severe current violence to others History of severe violence to others within three months History of severe violence to others within twelve months History of abuse of weapons History of arson Frequent police involvement History of alcohol abuse History of abstinence syndromes Non-compliance with prescribed medication History of continued oral misuse of drugs within the last three months History of continued oral misuse of drugs within the last twelve months History of continued oral misuse of drugs within the last five years History of prolonged use of CNS hallucinogens within the last three months History of prolonged use of CNS hallucinogens within the last twelve months History of prolonged use of CNS hallucinogens within the last five years History of use of I.V. drugs over the last three months History of use of I.V. drugs over the last twelve months History of use of I.V. drugs over the last five years Allergies: Medical alerts: Language barrier History of seizures Impaired mobility Sensory deficit Incontinence Please attach most recent progress notes/relevant history Completed by: Date completed: Signature of client: I have explained the Steele Street Program to the applicant and I feel that he/she is an appropriate candidate. It is understood that should the applicant be accepted in the Steele Street Program that I will be expected to continue to be involved in a consultative role. Signature: Date: