AHS PDD BEST PRACTICES SYMPOSIUM CONFERENCE REPORT FEBRUARY 19 TH 20 TH, 2013

Transcription

1 AHS PDD BEST PRACTICES SYMPOSIUM CONFERENCE REPORT FEBRUARY 19 TH 20 TH, 2013 AHS/PDD Best Practices Symposium February 19 & 20, 2013

2 TABLE OF CONTENTS Title Page No. BACKGROUND... 1 KEY THEMES... 2 Theme 1: Get a Life Person-Centric Services... 2 Theme 2: Inclusive Living and Housing... 5 Theme 3: Meaningful Employment... 9 Theme 4: Collaboration and Integrated Service Delivery Theme 5: Staff Capacity Building Theme 6: Enabling Policy Framework CONCLUDING COMMENTS APPENDIX 1: PRESENTATION TOPICS AND PRESENTERS

3 BACKGROUND Adults with complex service needs are a challenging group of individuals to serve, often requiring coordinated efforts from several government ministries and community service agencies. In Alberta, this need for a coordinated approach motivated the development of the Cross-Ministry Policy Framework, Supports for Adults with Complex Service Needs in The Framework included five major policy directions, specifically: Integrated Case Management Approach; Continuum of Services; Training and Education; Effective and Efficient Systems; and Shared Accountability Across Ministries. While substantial progress has been made over the past two years to advance these five policy directions, two areas continue to present significant challenges, namely: Housing: Ensuring access to a safe and appropriate range of supportive housing options for persons with disabilities and complex service needs; and Community Capacity: Ensuring that appropriately skilled human resources and other community supports are in place to serve this unique group of clients. To discuss these challenges, and to learn from the experiences of colleagues in Ontario and British Columbia, the Alberta PDD program hosted a Best Practices Symposium on February 19 and 20, 2013 in Edmonton. Day one of the symposium was focused primarily on housing and addressed both housing policy and innovative housing approaches and models being utilized. Day two focused on staffing and employment related issues, including employment opportunities for persons with disabilities. The presentations and discussion provided a rich environment to share and learn about innovative and successful approaches being used across the country, with a view to informing future policy and practice. The presentation topics and presenters for each day are detailed in Appendix 1. 1

4 KEY THEMES Over the course of the two day symposium, a number of common best practices themes emerged from the presentations and discussions. These themes have been used to organize the Symposium Report and include the following: Get a Life: Individual choice, activities, relationships and experiences add meaning and enjoyment to life and must be fundamental considerations when planning programs and services. Inclusive Housing: Access to inclusive and appropriately supported independent living homes in the community must be a high priority. Meaningful Employment: Meaningful employment is an important vehicle to connect individuals to the community and to build confidence and a sense of self-worth. Integrated Service Delivery: Working closely with service delivery partners is required to facilitate coordinated seamless service delivery and optimize the use of available resources. Staff Capacity Building: Emphasis must be placed on attracting, developing and retaining staff and service provider partners with the knowledge, skills, expertise and attitudes necessary to provide the required supports and services. Enabling Policy Framework: A regulatory and policy framework must be in place that facilitates effective leadership and management of the program. Theme 1: Get a Life Person-Centric Services A consistent message from all presenters was the importance of developing and implementing person-centric plans for individuals to live the best quality of life they can, surrounded by friends and family in a supportive living environment. Effective programs place emphasis on building upon the strengths and interests of individuals to create opportunities and processes to support individual choice. They also ensure the supports required to sustain increasing levels of independent functioning in a community setting are in place. A range of approaches and initiatives to ensure individuals with developmental disabilities and complex service needs get a life worth living were presented at the Symposium including: 2

5 Lifestyle Development: In British Columbia, CBI Consultants Ltd. works with persons with developmental disabilities to improve the quality of their lives using a proactive and positive approach called Positive Behaviour Support. CBI utilizes a well defined process to help individuals plan their lifestyles, manage their behaviors and move toward increasing levels of independence. To develop the individual plan, CBI starts with a strength based profile for each individual; they then focus on understanding the individual by looking at the events happening in the individual s life, identifying the triggers and antecedents for behavior, identifying behaviours or concerns that need to be managed, and analyzing the current responses to the behaviours. An individualized plan is then constructed for each individual designed to help them get a life worth living. CBI believes it is imperative to think about the client s multiple layers, identify the hot spots and the allies, and then build the skills service providers require to deal effectively with these specific situations. CBI actively advocates moving clients out of group homes and bringing individuals back to their home communities. Developmental Services Transformation: The Province of Ontario is engaged in a transformation of its developmental services system based upon a more comprehensive understanding of the needs and responses of individuals with dual diagnosis and developmental disabilities. The transformation reflects a strong commitment to social inclusion and has resulted in the closure of all institutional facilities as of March 2009, a move to individualized planning and community support, and a holistic approach to service and support provision. Community Living Services for Sexual Offenders: People with disabilities who sexually offend have historically had very limited treatment options available to them. Vita Community Living Services in Ontario gives these individuals a quality home where they receive treatment that is informed by best practices, decisions are made on data, and risk reduction is practiced with vigilance. The organization gradually increases independence and access to real life situations to transition the individual to a community living setting. Post treatment follow up is focused on providing the most independence possible, while ensuring risk is minimized. After a client has transitioned, Vita maintains a level of invisible supervision staff may be asked to observe the individual, collect data and look at how the individual identifies and manages risk. In consultation with the therapist, they discuss when the invisible supervision should be removed from the individual s plan. At every stage of the individual s transition, a therapist continues to work with them to determine if there are any risks that need to be addressed and develop tactics to mitigate these risks while maintaining quality of life. 3

6 AHS/PDD Joint Transition Plan: Alberta PDD, Alberta Health Services and the Office of the Public Guardian have been working in partnership to plan and facilitate the transfer of approximately 60 individuals with complex service needs from AHS institutional settings to appropriate supportive living options in the community. The process focuses on developing service plans for each individual that are responsive to their unique needs and circumstances. More than two thirds of the individuals will have been successfully transitioned to community living settings to date. Support Based Service Approach: Consistent with best practice and evidence in the design of support services, Alberta PDD is moving from diagnosis based programs to a needs and strengths based model to inform the development of individual service plans. Supports and Services Across the Lifespan: Dr. Suzette Bremault-Phillips presentation emphasized the importance of providing services and supports for persons with developmental disabilities across their lifespans. She noted that it will become increasingly difficult to serve Canadians with complex needs in the future due to a number of demographic trends which will manifest over the next two decades. These trends include: A smaller and older workforce will make it more difficult to maintain an individualized client centred approach. A significant increase in the number of seniors who need care and support will increase the pressure on the system. Dramatic increases in the incidence of dementia, anxiety in seniors, cognitive decline and Alzheimer s disease will impact the ability for seniors to live independently. The increase in the number of people with multiple health challenges will make system navigation more difficult. Within this context, the importance of early life planning was stressed, since research demonstrates that what happens early in the client s life journey has a significant impact on their rate of cognitive decline in later years. 4

7 Theme 2: Inclusive Living and Housing There is compelling evidence that persons with developmental disabilities and complex service needs achieve better outcomes and higher quality of life when they reside in appropriately supported independent living homes in the community. These living arrangements generally produce better outcomes in terms of choice, social networks, access to mainstream facilities, participation in community life, opportunities to acquire new skills, and satisfaction with living arrangements. While the goal, where possible, is to transition individuals to appropriate inclusive living arrangements in the community, it is recognized that some individuals needs are best met in facility settings with access to tertiary services. In addition, individuals needs are not static and they may require varying levels of support and service at different stages of their lives. Many creative ideas and approaches to ensuring individuals with developmental disabilities and complex service needs have access to a range of appropriate housing options and supports were presented at the Symposium. Housing and Support Services Continuum: In Alberta, work is progressing on the development of a housing and supports services continuum designed to ensure that persons with developmental disabilities and complex service needs have access to the housing, health services and community supports they need. In addition to supported community living options, the continuum: Includes the development of a tertiary care framework for clients whose needs are best met in a facility rather than in supported housing and living environments Recognizes the need for temporary emergency housing Provides for step up and step down services to manage transitions from tertiary to community settings This work will be supported by targeted development of required housing options and community supports across the continuum. Complex Needs Housing Project (Edmonton): A collaborative cross-ministry, crossindustry initiative involving PDD Edmonton, Alberta Health Services, Homeward Trust, Catholic Social Services and Neighborhood Bridges has been initiated to pioneer a new approach to house and support people with complex needs in the Edmonton Region. The project is designed to facilitate individuals with complex needs living in the community 5

8 over their lifetime. The intent is to define a new approach to supporting the complex needs population that will increase quality of life and break the negative cycle of crisis and institutionalization. The project will: Focus on serving this population in a community setting and is founded on the philosophy of individual choice and stable, secure housing as keys to improving quality of life Invest appropriate resources aimed at proactively supporting individuals with complex needs the right supports in the right amount at the right time for each individual Use PDD funds to develop home living environments i.e. ensure individualized secure homes Demonstrate improved quality of life and decreased cost to the system over time through the application of appropriate performance metrics Build meaningful partnerships that leverage the broader networks and infrastructures of each Community Asset Mapping Tool: The Edmonton PDD group has also developed a community asset tool that maps out communities based on services, social supports, infrastructure, personal and human resources, activities, employers, libraries, landlords, faith communities, hiring practices, renting practices, walkability, and blended income. CRCB PDD-CHF Partnership (Calgary): The Calgary Region PDD Community Board (CRCB PDD) and Calgary Homeless Foundation (CHF) have formed a partnership to increase the supply of appropriately designed homes for persons with developmental disabilities and complex needs. Under the arrangement, CHF purchases, renovates and owns the homes, and CHF leases homes to CRCB PDD approved service providers for a 30 year term. CHF acts as the landlord, ensuring that they understand tenants needs, provide affordable rent for individuals, and provide maintenance free properties for service providers. The process involves: CRCB PDD consulting with service providers to identify important features to consider when buying a home CRCB PDD working with CHF to identify properties to purchase which include the desired features 6

9 CRCB PDD consultation with service providers to identify required renovations including an appropriate focus on safety and security of individuals, staff and the community and the application of smart home technology. Inclusion through Innovation: The Burnaby Association for Community Inclusion (BACI) is focused on changing the way we think about and interact with persons with developmental disabilities. The shift they encourage would have us focus on assets versus deficits, prosperity versus charity, collaboration versus isolation, partners versus recipients, and investing versus spending. Guided by these directional shifts, BACI has developed a range of innovative housing models including cohousing projects, accessible low income housing with community facilities, development of housing options for persons with developmental disabilities in mixed housing units, P3 partnerships with the city and developers to include a fixed percentage of housing units for persons with developmental disabilities in apartment developments, and repurposing older housing stock to support life sharing arrangements (see page 8) or transition to personal ownership. Specific examples of housing developments include: Creekside Commons, Courtenay Cohousing project where a community of households share common spaces, activities and equipment; works cooperatively to manage houses and land; and enjoys co-operative and friendly relationships with neighbours. Creekside Commons was created to provide housing that supports greater social interconnectedness while using resources efficiently. Stride Place 45 mixed housing units 1/3 low income, 1/3 affordable, 1/3 market, 3 fully accessible units, 5 to 10% of the tenants have a disability. The project was developed in partnership with VanCity Credit Union and the City of Burnaby. BACI hired a social worker to be the property manager and an in-house caregiver who has a high level of skill serving people with disabilities. Rosser Apartments 4 fully accessible low income units in this large apartment tower, part of a P3 partnership with the City of Burnaby, fully subsidized for persons with disabilities. Developers were offered a density bonus from the City of Burnaby if they provided free apartments for persons with disabilities. BACI owns the space and houses those that need to use it. The developer, in return, gets more penthouse level floors to make up for the units given to BACI. 7

10 Filby Court 9 accessible low income housing units with a common room/kitchen for community use, community gardens and a child care centre to help build connections to the community. Orchard Heights Re-developed a group home to create 5 units of low income housing, 2 fully accessible units, one staff supported home. Madison 9 affordable units, 2 fully accessible units, staff supported home, P3 partnership with the City of Burnaby Life Sharing: BACI has also developed life sharing as an approach to inclusive living. Life sharing involves developing a 3-way relationship between the person with disabilities/their family, the life share partner and BACI. Each party has a role to play and their own set of hopes, dreams and expectations; i.e., the hope of a good life, lived with purpose and an expectation to be treated and supported with respect. Making the right match is the key to a successful life sharing relationship. BACI s Life Sharing Network Team is the relationship matchmaker and utilizes a detailed home study/assessment process to determine the suitability of prospective individuals. Following successful assessment, a Life Sharing Agreement is executed. This is a legal document between the life share partner and BACI describing the terms, conditions and key deliverables of the relationship. Ongoing support is provided through BACI s Life Sharing Network Team, personal networks, monitoring and web-based resources. Currently BACI has 120 life share arrangements in place. Virtual/Mobile Beds vs. Structure: In addition to a range of supported community living options, the Ontario government has funded 90 accommodation spaces for adults with disabilities. They have urgent crisis response beds focused on stabilization and getting clients back to their original homes. These spaces are more like virtual beds and can move around where required. Another unique solution that Ontario has introduced is having a credit card available when a client needs to be removed from a stressful situation to have a break. The government has given service providers the flexibility to do this with flexible funding options built in at the policy level. Vita Community Living Services (Ontario): At Vita, their members are active in the development of the centre. They have developed a Rights Group of Members who speaks to Vita about issues that they are facing and what they need. Vita is also very aware of their responsibility to the surrounding neighbourhoods and actively engages with the 8

11 community at large on a regular basis. In addition, the family is involved in the member s transition plan to help determine the best possible housing solution for the member. Theme 3: Meaningful Employment Presenters consistently identified having meaningful employment as fundamental to a person s happiness, sense of fulfillment and quality of life. It was noted that persons with developmental disabilities can develop the skills, knowledge and attitudes necessary to do important and meaningful work, and that this group represents an untapped economic resource for the country. Among the creative approaches and strategies shared by presenters at the symposium were the following: Prospect Human Services: Prospect Human Services in Calgary has experienced considerable success helping adults with developmental disabilities experience an enhanced quality of life through increased workforce and community participation. They offer work experiences, career exploration, job search design, employment placement, on-the-job support and consultation with the employers. Their approach to workforce engagement includes: Respecting the choices and preferences of individuals Establishing collaborative partnerships with employers Communicating, planning and collaborating with an individual s support network parents, guardians, PDD Ensuring supports are integrated with additional program, clinical and overall supports Prospect serves over 10,000 people annually and strives to enhance individual and employer capacity by focusing on partnerships, experiential learning and multi-disciplinary teams. Prospect found that the major barriers to employment for persons with disabilities were that there were few opportunities for individuals to apply the skills that they were learning and that attitudinal barriers existed on the employer side, primarily due to lack of experience and fear of the unknown. As a result, Prospect introduced experiential learning with their clients. Individuals directly practice the skills that they are learning in the work environment rather than having to apply them later. They also spend a significant amount of time fostering relationships with employers and identify existing support networks that their clients may have (clinical, personal or community). For Prospect, employer engagement is the key, and they have adopted an industry intensive focus. They also hold Effective Practice Forums to bring employers together to learn about employees with 9

12 disabilities. Here, they provide concrete solutions that employers can bring into their workplace and, as a result, help to shift attitudes and perceptions. Employment First Focus: Alberta PDD is developing a plan designed to position employment as a fundamental vehicle to facilitate community connectivity for people with developmental disabilities. This will include collaboration with other government ministries and the business community to develop the key elements of the plan; i.e., project purpose, key results and employment targets, strategies and tactics, public and private sector partners, program monitoring and performance metrics, etc. Employment Supports: In British Columbia, BACI operates on their belief that most people can get a job, and the organization actively helps people with disabilities to access the necessary resources to prepare them for meaningful employment. Switzerland Study Results: Jacques Pelletier, Co-Lead for the Community Networks for Specialized Care (Eastern region) described his experiences working with the complex needs population in Switzerland. A study conducted there demonstrated that the most stable individuals with disabilities were those that had meaningful employment. Theme 4: Collaboration and Integrated Service Delivery Many presenters emphasized the importance of focusing the limited resources and energy of various government ministries, community agencies and service providers on the achievement of common goals. Working closely with service delivery partners is required to facilitate coordinated seamless service delivery and optimize the use of available resources. This is particularly the case when providing services for individuals with developmental disabilities and complex needs, many of whom require services from multiple government ministries and community agencies. A number of initiatives are focused on supporting collaboration and integrated service delivery. These include: Collaborative Partnerships: In Alberta a Cross-Ministry Policy Framework, Supports for Adults with Complex Needs has been developed and work is progressing on its implementation. The implementation work focuses on four strategic priorities/pillars, namely: integrated case management, staff training and development, community based supports/capacity development and access to appropriate housing options. Significant progress is being made in a number of these policy areas including: 10

13 The establishment of cross-ministry issue resolution tables to quickly resolve issues that cut across government ministries The creation of multidisciplinary community support teams to facilitate the integrated case management approach and provide hands on support to service providers The development of a strong collaborative partnership between Alberta PDD and Alberta Health Services to ensure individuals with disabilities and complex service needs have access to required health care services Initiatives to strengthen the relationships between Alberta PDD and the service provider community Establishing an integrated housing and supports framework working group to help identify service gaps and set housing capacity development priorities. Creating Connections: Alberta has recently adopted (2011), and is now implementing, a strategy designed to transform the addiction and mental health system in Alberta by developing a comprehensive and coordinated system that provides people with the range of addiction and mental health services and supports that they need. The strategy will also enable enhanced health promotion and prevention activities, provide timely access to high quality assessment, treatment and supportive services when needed. It includes a strong focus on meeting the needs of persons with developmental disabilities and complex service needs in an integrated seamless manner across the entire lifespan. Calgary Complex Needs Collaborative: In Calgary, a group of four service providers have come together to form the Calgary Complex Needs Collaborative (CCNC). The CCNC was formed to create a vehicle to help members work together to benefit individuals with complex needs. The CCNC seeks opportunities to jointly collaborate with other government departments and NGOs and share information and best practices among service providers. The three main features of this collaboration are lightweight governance (in the form of a MOU), action focused teams and third party coordination. The joint group is owned by the four organizations and they openly share information amongst each other and approach the government collectively rather than as separate organizations. This group has developed a common voice so they can provide clear advice to government on policy issues. Behaviour Supports Alberta Advisory Committee: The Behaviour Supports Alberta Advisory Committee has been established to pool resources to bring people together to build provincial networks. Behaviour Supports Alberta currently links with a number of provincial initiatives and is planning to integrate into the PDD system in a more structured 11

14 way. Behaviour Supports national entity has a research arm, and provides education and support for front line staff including webinars available on their website. Developmental Disabilities Primary Care Initiative: In Ontario, the Ministries of Health and Long Term Care and Community and Social Services fund the Developmental Disabilities Primary Care Initiative. Youth to Adult Transition Planning: The Ontario Ministry of Community and Social Services has collaborated with the Ministry of Education, and Youth and Children s Services to develop transition protocols for clients as they move from youth to adulthood. The ministries support timely, proactive collaborative planning to ensure that individuals with disabilities move seamlessly from youth to adult services and supports. Specialized Dual Diagnosis Services: the Ontario Ministries of the Attorney General, Community Safety and Correctional Services, Health and Long Term Care, and Community and Social Service work with the Provincial Human Services and Justice Coordinating Committee to address diversion from the justice system for adults with a dual diagnosis. Individuals with dual diagnosis can access specialized services funded by the Ministry of Community and Social Services. These services, which are provided by qualified agencies and health professionals, are designed to address a person s physical and mental health and include: Psychological/psychiatric/behavioral assessment, psychiatric and counselling services, speech and language therapy, behavior management, and specialized case management Specialized accommodations where individuals receive transitional or ongoing clinical supports from specialized professionals Specialized training for professionals who work with individuals who have a developmental disability Community Networks of Specialized Care: In 2006, the Ontario Ministry of Community and Social Services established four Community Networks of Specialized Care to coordinate specialized services for people with a dual diagnosis. The networks partner with specialized service providers and professionals across the development services and mental health in the north, east and central regions of the province. Their mandate is to coordinate the specialized services system, improve service delivery, and educate and train. 12

15 Collaborative Partnerships: In British Columbia, BACI has cultivated strong relationships with families, local neighbourhoods, the municipality, the business community, the healthcare system and government ministries. They have engaged their partners in helping them establish their vision setting and strategic plan for the organization. They partner with The city and private developers to encourage and support investment in inclusive housing infrastructure. BACI focuses on asset development, building community capacity and ensuring members are surrounded by friends, family and the community as well as BACI staff. They anchor the community at large into the homes they develop through mechanisms such as community kitchens, community gardening plots and child care centres. At BACI, inclusion is fundamental to their service strategy and homes/facilities are designed to include a mix of families. They also focus on being great neighbours and members of the community. Theme 5: Staff Capacity Building The ability to attract, develop and retain staff and service provider partners with the knowledge, skills, expertise and attitudes necessary to provide the required supports and services is critical to success. Presenters shared their issues relating to staffing and their creative approaches to building staff and service provider capacity. In Alberta, 25,000 people contract with Alberta Human Services, 17,000 of these provide services for people with disabilities. Attracting and retaining qualified staff is a challenge with the staff turnover being in the 50-70% range. High turnover rates often have negative repercussions on the quality of services due to the lack of consistency in care givers, and the need to be constantly orienting and training new staff. The situation is exacerbated by Alberta s growing economy, where employees often leave to take higher paying jobs. In addition, employees with the unique skills and attitudes required to work successfully with persons with disabilities are in short supply. To address these human resource capacity challenges Alberta has been doing the following: Attractive Career Option: Efforts are being made to attract young people to careers in the field using tactics such as high school volunteer programs so that young people see the field as a viable, rewarding and interesting career choice, partnerships with community colleges to better develop defined careers and training programs in the field, and recruiting employees whose value systems are aligned with the value orientations required to work successfully with persons with disabilities. 13

16 Training Opportunities: Since January 2012, the Alberta governments has invested just under half a million dollars to provide free training opportunities for staff in the field. Training has focused on areas such as: Positive behavior supports Challenging behavior workshops Crisis and trauma resource institute courses Joint PDD and vendor/agency workshops AHS/PDD coordinator information sharing Utilization of assistive technology such as web conferencing sessions has proved to be very valuable. This option has saved time and resources for all involved and proved to be an excellent medium for training and collaboration. This training appears to be well-received as evidenced from the following quote from a symposium attendee: As a front line person experiencing this training, I can t tell you how valuable this training is. Being told what to do and what not to do is great: the training is efficient and effective. It is working and we want more. Community Support Teams: Community Support Teams (CTS) are being developed in the community to support integrated case management. Base level support incudes behavior management expertise and access to health care related supports. Enhanced teams include the base level supports referenced above plus a broader range of professional treatment services and mobile crisis-response capacity supported by multiple disciplines. Vendor/Agency Development: Efforts are being made to work more closely with vendors and community agencies to support staff attraction and recruitment and provide joint staff training and development initiatives. Common Practice Standards: Work has begun to establish common practice/service standards to improve quality and consistency of services across vendors and service provider agencies. In Ontario, the Ministry s focus for the first two years of their new PDD policy implementation has been to educate, train and support individuals in the field. According to the Ontario representatives, this has been the most important thing they ve done to position the policy framework for success. To facilitate this training and ensure open communication channels, webinars and technology have been utilized as much as possible. There are 49 dedicated video conferencing units across Northern Ontario. In addition, 476 people have completed a course on dual diagnosis in which they collaborated amongst 14

17 themselves to develop a series of online training materials. Other approaches to staff capacity building in Ontario included: Competitive Salaries: There has been a movement in Ontario to make wages higher and consistent across the province to ensure equity across service providers and geography. First Responders Course: The Ontario government offered an extremely successful course for first responders. As a part of the course, they brought in clients who could be the specific individuals that the police and EMTs are interacting with on a regular basis. Court Case Manager: Part of the implementation of specialized care in Ontario included the introduction of 12 court worker case managers. These case managers advocate on behalf of the accused individual and explain the situation to the crown and defense lawyers to ensure people know who is before them and what unique challenges they may be facing. This new practice has proved extremely successful at ensuring persons with disabilities receive a fair trial. Engaged Staff: Vita Community Living Services maximizes the role of the direct support staff and encourages them to teach programs and take on more responsibility. They also encourage open and honest communication from their front line staff and believe that trust is an important aspect of the support worker s relationship with the members. At Vita, training is essential and employees are trained to understand the complex needs of their members. Vita is well known for how well their members are treated and people feel passionate about working for the organization. Employees receive intrinsic value in being a part of the organization. However, Vita does admit that they are not as competitive as they need to be in wages and in benefits and turnover remains higher in the homes than in the rest of the organization. They currently operate in a unionized environment and there is a general understanding that there is not much room to negotiate regarding salaries. As a result of their solid human resource strategies and open communication processes, they do not have difficulty recruiting staff. In British Columbia, wage rates are not mandated by the government; however, rates have largely standardized across the province. At BACI, employees are paid $18-25 an hour and work in a unionized environment with four wage levels. BACI usually pays at the top level of the grid because they experience difficulty recruiting qualified applicants at the lower levels. In addition to an hourly salary, BACI provides a pension plan, benefits, and sick days. Staff turnover at BACI is around 25-35%; however, those that stay past five years generally stay a long time. Recruitment is an area of concern for the organization and they 15

18 do their best to fill every position within a month s time period to ensure that service is not negatively impacted. CBI Consultants provide ongoing training and support for staff with online training materials augmented by face-to-face coaching. CBI also assists service providers to develop individualized service plans for clients; staff members can review materials and individualized service plans online in advance of treatment. For follow up, both face to face coaching and online training are available from CBI to support the staff. Theme 6: Enabling Policy Framework Several presenters noted that the ability to effectively serve persons with developmental disabilities and complex needs was positively impacted by an enabling legislative and policy framework. A number of supporting government policy initiatives were highlighted during the presentations including: Alberta s Social Policy Framework: Alberta is finalizing a social policy framework which will provide overall policy direction and guidance for supporting persons with developmental disabilities and complex needs. The policy framework is centered on principles of dignity, respect, inclusiveness and mutual responsibility. In addition to the policy framework, the role and mandate of the Human Services Ministry in Alberta has been expanded to include a much more comprehensive range of human services (disability services, children and youth services, financial supports, guardian and trusteeship, homelessness, family and community services, foster care, working in Alberta, newcomer supports, etc.) This will enable more effective service planning for persons with disabilities and across-the-lifespan services for people with complex needs, and help remove barriers to effective and timely decision-making. Ontario s Transformation Agenda: Ontario is transforming how developmental services are delivered in the province. The government has committed to social inclusion, individualized planning, and a holistic approach to service delivery through a $1.72 billion investment. The transformation agenda started as a conversation with families over a two year period. Families helped drive the vision, mission and principles. The transformation agenda is moving the province to a single point of access to services rather than having multiple points of entry. Access to developmental services has been branded in a consistent way across the province and the functions of the application entities have been clearly spelt out. This new system has addressed the issue of fairness and equity in how people gain access to the system. It has also put into place a system that provides the province with an 16

19 unduplicated count of people receiving services and those waiting for services. Quality assurance measures have also been put in place for transfer agencies. The agencies are taking these measures very seriously. The networks of specialized care located in four quadrants across Ontario are actively investing in capacity building and cross sectorial relationship building to improve how persons with disabilities and their families access the system. British Columbia s Focus: In January, 2012, the province of British Columbia released a comprehensive report: Improving Services to People with Development Disabilities. This included a 12-point plan that began a shift from a complex system of supports and services to an integrated system of support that will better meet the needs of individuals with developmental disabilities and families. Since the release of the 12-point plan last January, progress has been made towards improving services to people with developmental disabilities and their families. Changes have been made to improve transition planning for youth, the overall delivery of services and collaboration across government, and work continues on the development of an integrated service delivery model. 17

20 CONCLUDING COMMENTS Feedback from session participants on the symposium was very positive. Very high levels of satisfaction with the quality of the presentations and relevance of the material presented were noted and participants appreciated the opportunity to share innovative approaches and ideas during the discussions and question periods. Table 1 summarizes participant evaluative feedback on the session. The top three changes that participants indicated they planned to make to their practice as a result of attending the Best Practice Symposium were to review and explore a wider range of housing options for individuals with complex needs, increase their focus on using a team approach to planning and delivering services, and to do a more effective job of connecting clients to services. Table 1: Summary of Participant Feedback Evaluation Criteria* SA/A D/SD Neutral The symposium was well organized 95% 3% 2% The presenters were effective in this medium 91% 2% 7% There was enough opportunity for questions and discussions 91% 0% 9% The symposium was presented in a credible and unbiased manner 88% 2% 10% The learning objectives were clearly defined 78% 5% 17% I increased my level of understanding on the topics presented 81% 10% 9% within the symposium The material was relevant or applicable to my practice 76% 10% 14% Knowledge or ideas gained from this symposium will improve my ability to support adults with complex needs 74% 9% 17% * SA Strongly Agree; A Agree; D Disagree; SD Strongly Disagree Session participants were energized by the unique practices being implemented across the country and came away armed with new techniques and ideas. While significant work remains to be done in the areas of housing, human resource development and community capacity building, the examples and unique approaches shared in the Best Practice Symposium are an excellent starting point for the future success of Alberta in these areas. 18

21 APPENDIX 1 PRESENTATION TOPICS AND PRESENTERS 19

22 DAY 1: HOUSING Presentation Topics Presenters Alberta Health Services and PDD Alberta Dr. Tim Weinkauf, Director, Program Development Experience (Housing) and Innovation, Alberta PDD Doug Vincent, Director, Tertiary Care and Strategy Alberta Health Services Vita Community Living Services The Will, Kim Lenahan, CEO, Vita Community Living Services The Way, and What We ve Done: Serving Jordan Hoath, Vita Community Living Services People with Challenging and Complex Needs Desmond Bailey, Vita Community Living Services through Innovation and Collaboration Burnaby Association for Community Inclusion (BACI) Inclusive and Innovative Housing Options PDD Edmonton and Calgary Community Boards Richard Faucher, Executive Director Burnaby Association for Community Inclusion Liz Peterson, PDD Edmonton Heather Mazur, PDD Calgary DAY 2: STAFFING/COMMUNITY CAPACITY Presentation Topics Presenters Alberta Health Services and PDD Alberta Experience (Staffing) The Complex Client Experience & Resources for Help over the Lifespan CBI Consultants Ltd. Get a Life : A Powerful Intervention in Positive Behavioral Support Overview of Developmental Services, Complex Needs and Dual Diagnosis: The Ontario Approach Prospect Human Services: Inclusions through Collaboration Dr. Tim Weinkauf, Director, Program Development and Innovation, Alberta PDD Doug Vincent, Director, Tertiary Care and Strategy Alberta Health Services Dr. Suzette Bremault-Phillips, Assistant Professor University of Alberta, Occupational Therapy, Rehabilitation Medicine Dr. Paul Malette, Clinical Director, CBI Consultants Ltd. Nicole True, Regional Program Manager, Community Developmental Services, Government of Ontario Jacques Pelletier, BCJP Consulting Alexi Davis, Manager Disability Services, Prospect Human Services Tarina Dueck, Manager Disability Services, Prospect Human Services