Needs Identification and Development of Specialized Services for Persons with a Dual Diagnosis within the Province of Ontario

Transcription

1 Needs Identification and Development of Specialized Services for Persons with a Dual Diagnosis within the Province of Ontario Tony Vipond Marnie McDermott

2 Canadian Statistics There are more than 300,000 individuals with an intellectual disability in Canada Ontario has the largest percentage of the population (34%) Services for individuals with intellectual disabilities are provincially based There is no national requirement on how best to meet the needs of individuals with developmental disabilities Intellectual disability is not a recognized subspecialty in family medicine or psychiatry Mental Health Services for Individuals with Intellectual Disabilities in Canada: findings from a national survey (Lunsky, Garcin, Morin, Cobigo and Bradley 2007)

3 Prevalence Intellectual Disabilities affect 1 3% of the population Individuals with intellectual disabilities are at higher risk than non-disabled (Tasse & Morin 2003) individuals for developing a psychiatric disorder (Brothwick Duffy 1994) 10 40% of individuals with a developmental disability will develop a psychiatric disorder (Reiss 1990) Mental Health Services for Individuals with Intellectual Disabilities in Canada: findings from a national survey (Lunsky, Garcin, Morin, Cobigo and Bradley 2007)

4 Statistical Comparisons Total prevalence / Total population Canada 650,000 / 32m (2 %) Ontario 275,000 / 12.4m (2.2%) Central East 47,000 / 1.9m (2.5 %) Mental Health Prevalence Total prevalence Canada 247,000 Ontario 104,500 Central East 17,860

5 History of the Community Network of Specialized Care The lead ministry that provides funding for supports and services for adults with developmental disabilities is the Ministry of Community and Social Service There were voluntary guidelines outlining how the ministries should work together

6 The generic healthcare model, combined with a lack of national guidelines and provincially determined services has translated into poorly coordinated care for individuals with a dual diagnosis The definition of dual diagnosis refers to persons with a developmental disability who also have a mental health diagnosis and/or challenging behaviour Mental Health Services for Individuals with Intellectual Disabilities in Canada: findings from a national survey (Lunsky, Garcin, Morin, Cobigo and Bradley 2007)

7 History of Community Networks of Specialized Care On May 18, 2005, as part of the transformation of developmental services, the Ministry of Community and Social Services announced that four networks of specialized care would be established across the province.

8 Central East Network of Specialized Care HKPR SIMCOE DURHAM YORK

9 Central East Region The Central East Region consists of: -- Durham Region, -- Haliburton/Kawartha Lakes/Peterborough Region (HKPR) -- Simcoe County -- York Region Combined population of 1,884,000 Central East Region is comprised of both rural and urban settings Significant Francophone and Aboriginal populations Up to 141 languages or dialects have been identified in Central East Region

10 Most Challenging Populations Sexual offenders / inappropriate behaviours Serious / significant aggressive / assaulting behaviour Autism with severe aggressive behaviour Fire setters Individuals with difficult to stabilize mental health needs Deaf blind individuals who have challenging behaviour also diagnosed with a developmental disability Transient youths Individuals with developmental disabilities who are in crisis. Individuals with developmental disabilities housed in forensic settings

11 Key Service Gaps Knowledgeable, skilled, experienced clinicians Clinical services Coordinated multi-disciplinary teams High intensity case management Crisis intervention Timely, flexible, individualized supports Navigation of the service sectors

12 Central East Network of Specialized Care Response to Regional Needs Designed a network to support persons with a developmental disability who also have a mental health diagnosis and/or challenging behaviour

13 Crisis Response Network Mobile Resource Team Mobile Outreach Team Regional Case Resolution Residential Treatment Beds Mobile Treatment Team Sociomedical Clinic

14 Memorandums of Understanding Specialized Transition Case Management Health Care Facilitation MRT Behaviour Technician Support Intensive Long Term Support Residence (5 beds) Best Practice Model for Specialized Accommodations Manual Clinical and Responsiveness Training Manuals

15 Central East Network ~ Who Are We? ~ We are a partnership of community based organizations that work together to provide professional services, consultations, teaching, education, training, and research-related activities for the target population of adults with a dual diagnosis.

16 Developing a Community Network of Specialized Care which is... Accessible... so that people and their caregivers/families can access the clinical services they need, when and where they need them Coordinated and Integrated... so that the services and supports from a number of programs, organizations and sectors are working together with people and their families to make a difference Accountable... so that we know the Networks are actually making a difference

17 Philosophy Behind the Central East Network of Specialized Care: BioPsychoSocial Model Each of the areas is assessed in order to develop a comprehensive diagnosis: FACTORS Bio (Medical) Psycho Social AREA OF ASSESSMENT Medical, Medication Reactions, Psychiatric, Neurological state Syndrome Current psychological features (emotional, cognitive, behavioural issues) Physical, social and program environment

18 Process to Access the Central East Network of Specialized Care Crisis Response Network Agency / Family / Case Manager (1) Developmental Services Ontario (2) Local Case Resolution (3) Local Case Resolution could go straight to Regional Case Resolution if the individual does not have mental health diagnosis and/or challenging behaviours, but may need timely access to effective clinical services. Specialized Resources Mobile Resource Team, Mobile Outreach Team, Behaviour Technician Videoconferencing, Clinical Services Central East Network of Specialized Care (4) Access to Specialized Resources through Tri-Regional (Central Region) Network of Specialized Care Regional Case Resolution (5) Central East Region Specialized Treatment Beds, Mobile Treatment Team, Clinical Services through Videoconferencing. Out-of-Region Specialized Treatment Bed

19 Central East Region MOBILE RESOURCE TEAM

20 Mobile Resource Team The Mobile Resource Team consists of a multidisciplinary team of professionals working in the fields of developmental disability, behaviour management, autism, mental health, medical, crisis response, as well as advocacy and case management. The Mobile Resource Team is a team of professionals from different disciplines working in partnership. They assess individuals needs based on the BioPsychoSocial model and the person directed planning philosophy

21 Mobile Resource Team (continued) The Team is made up of many professionals with a wide range of expertise, who are able to access resources that may not be otherwise accessible at the local or agency levels. The Mobile Resource Team makes recommendations and/or offer support to agencies, case managers, families and funders to better support individuals with a dual diagnosis to stay in their home community if possible.

22 The Mobile Outreach Team is comprised of a smaller team of professionals that go into the person s home environment for a one day observation of the person. A report is developed making recommendations on how to best support the person in his/her home environment based on the BioPsychoSocial model.

23 Central East Regional Case Resolution Committee The Central East Regional Case Resolution Committee is comprised of the Chairperson, the four (4) Local Case Resolution Chairpersons, Clinical Service Representatives, Ministry of Community and Social Services, the Central East Network of Specialized Care Coordinator, the Mobile Resource Team Coordinator, the Central East Network of Specialized Care Specialized Transition Case Manager and the Central East Network of Specialized Care Executive Assistant. This committee has the final approval for admissions to the Central East Region treatment beds and accessing the Mobile Treatment Team

24 Community Living Huronia staff who have received enhanced specialized training. Range in staffing components from Direct Support Professionals to Managers. Self directed and develops an individualized treatment plan. The goal of the model is to support the person in their home environment utilizing the current staff supports with the assistance of the Mobile Treatment Team. The Treatment Team will liaise and mentor with community based staff/caregivers in the person s home environment.

25 Central East Region RESIDENTIAL TREATMENT BEDS

26 Criteria for Specialized Treatment Beds Criteria for Individuals 18 years of age or older Confirmed eligible through Developmental Services Ontario Individual has developmental disabilities and mental health needs and/or challenging behaviours Psychiatrically stable (recent psychiatric assessment) Medically stable (recent medical assessment) All community resources have been exhausted (treatment home is seen as a last resort) Consent required for treatment homes Individual has a residence to return to or to move on to, after the treatment period has been completed (preferably within his/her own community)

27 Central East Specialized Treatment Homes As per the regional process, the Specialized Treatment Beds (20 in Central East Region) traditionally are accessed after review by the Regional Case Resolution Committee. The CENSC has taken a very strong stand that individuals who have been in Mental Health Centres (and other hospitals), on a long-term basis, and who no longer need to be there, have to become a priority to move back to their communities. The CENSC made a commitment that at least 4 of the specialized treatment beds be designated for individuals leaving hospital psychiatric beds.

28 Specialized Treatment Homes 1 Year Treatment - Maximum For adults with developmental disabilities and mental health problems and/or challenging behaviours that requires either transition from a secured institution setting (i.e. jail, mental health facility), prior to being placed in the community; or requires stabilization and treatment in order to access and/or maintain existing community supports and resources. SIMCOE YORK HKPR DURHAM PINEVIEW FOREST VIEW

29 Specialized Treatment Homes Long-Term Treatment VITA For adults with a history of significant sexual offending behaviour (may also have other criminal/inappropriate social and/or aggressive behaviour). ACCESS For adults with significant behavioural needs that require long-term clinical supports and interventions.

30 Provincial Residential Forensic Treatment BEACON HOUSE For adults with forensics involvement that require long-term clinical supports and interventions. Three treatment beds and three day program spots.

31 CENSC Health Care Facilitator Working to improve access to primary care for individuals with a developmental disability, and to build capacity with health care professionals through training, education and support. Working collaboratively with the Developmental Disability Primary Care Initiative, CNSC is using the new Primary Care Guidelines and accompanying tools to assist health care professionals, caregivers and families in enhancing the primary care experience for individuals with developmental disabilities. Consistent with the provincial mandate, the Health Care Facilitators continue to partner with community agencies, service providers, caregivers and provincial Ministries to ensure current best practices in providing health care to individuals with developmental disabilities are available, and integrated into care.

32 Central East Region COMMUNITY CRISIS RESPONSE NETWORK

33 Crisis Response Intervention Crisis response is a quadrant based active process that aims to provide relief from the immediate problem / crisis / symptoms as perceived by the individual or the individual s family, as well as to prevent the condition from worsening. Memorandums of Understanding outline the roles of the and responsibilities of the host agencies and the Central East Network of Specialized Care. Crisis intervention is timely and flexible. Prevention is the best form of crisis intervention and can be used at any time to prevent further escalation of the crisis.

34 Durham Crisis Response Referral Process Referrals can be made by the individual, their family, caregiver or service providers who have obtained consent. Community Living Ajax, Pickering, Whitby /Durham Mental Health Services Haliburton Kawartha Lakes Pine Ridge Canadian Mental Health Association, Peterborough Branch Simcoe York Catulpa Community Support Services York Support Services Network

35 Crisis Response Coordinator ~ Role ~ To establish collaborative contacts, with community based services. To develop a strong linkage with Developmental Services Ontario and the Urgent Response Process. To support the development of a shared Individual Support Plan, responding to the individual s assessed needs based on the principles of Person Directed Planning, self determination, and choice that will identify, inform, and facilitate interventions at key points in the judicial process in collaboration with cross sector services. Be transitional in nature up to 4 months.

36 Central Region VIDEOCONFERENCING & CLINICAL SERVICES

37 Background To support the delivery of specialized clinical services, The Ministry of Community and Social Services sponsored two successful pilot projects in The Ministry of Community and Social Services decided to further invest in this initiative by expanding the project. In 2011, the Ministry of Community and Social Services centralized VC service and supports giving the Central East Network of Specialized Care the responsibility for the development and maintenance of the province wide system. Presently, the Central East Network of Specialized Care directly manages 196 systems in 135 sites provincially.

38 Provincial Videoconferencing Merger of three successful provincially-funded networks

39 What is Videoconferencing? Health care, education, court appearance, professional development, clinical consults, administrative meetings and family visits are just some of the uses of this exciting technology. Connecting with a specialist or clinician who also has videoconferencing means that individuals can be assessed or receive follow-up treatment just as if they were in the health professional s office. The benefits of telemedicine are many. It reduces time, cost and risk of travel while accessing specialized clinical services.

40 Videoconference within Central Region There are two Regional Videoconferencing Coordinators within Central Region. Life cycle management on the hardware, which includes but is not limited to: o Managing warrantees on all equipment, refreshing hardware and monitoring firmware upgrades.

41 Videoconference within Central Region Education / Training/ Clinical Develop specific training materials to provide training to our member sites as required Recruit presenters and clinicians, develop their profile, identify objectives and target population

42 Central East Region RESOURCES The object of all work is production or accomplishment and to either of these ends there must be forethought, system, planning, intelligence and honest purpose, as well as perspiration. ~ Thomas Edison

43 The Best Practice Model for Specialized Accommodations Manual was published in February Implemented in all of the treatment homes in central east region. Focus: -Person Directed Planning -Access and Process -Discharge and Evaluation -Staffing and Operations

44 Training for Managers, Supervisors and Direct Support Professionals. Topics covered in the training: Positive Supports for People Understanding Behaviour Positive Support Environments Changing Consequences Teaching Skills Behaviour Support Plans

45 Central East Region PROVINCIAL PROJECTS COLLABORATION AND RESEARCH Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending. ~ Author Unknown

46 The Ministry of Community and Social Services engaged consultants to complete a Dual Diagnosis Evaluation report in The consultants recommended a Framework to implement the Dual Diagnosis Guidelines in Ontario The Central East Network of Specialized was engaged to bring together the Ministries of Ministry and Community of Social Services and the Ministry of Health and Long Term Care to develop a joint process to better support this challenging population. Outcome: To provide the common standards upon which services that support people with a dual diagnosis can be implemented, delivered and measured across Ontario.

47 Provincial project lead by the CNSC s to develop the Care and Treatment Guidelines for Adults with Developmental Disabilities and Concurrent Mental Health Issues and/or Challenging Behaviours. An Expert panel from across the province of Ontario reviewed literature and provided recommendations to develop the Care and Treatment Guidelines. A symposium and planning session was held to inform the process of developing parameters and the framework of the future care and treatment guidelines for the province.

48 Outcome: To provide common guidelines upon which care and treatment for persons with a dual diagnosis is delivered across Ontario. Broader consultations for both provincial projects will be conducted across the province to inform the process of the implementations.

49 Central East Network of Specialized Care Individually Strong, Collectively Greater.

50 Tony Vipond Marnie McDermott