Brant Community Protocols and Processes

1. Brant Community Protocols and Processes Welcome to the Brant community electronic orientation package on community Protocols and processes. Revised April 2013

2. Background • The Children’s Services Committee, represented by numerous sectors, has approved these community protocols • This electronic orientation was developed by the Children’s Services Committee

3. Communication, Coordination, Collaboration The Brant community Protocols guide our daily practice in serving people - Communication, coordination & collaboration help us: • Best meet the needs of the people we serve • Address services for ‘Most in Need’ • Avoid duplication and contradiction

4. Guiding Community Principles • Person/Family-centered service • Work collaboratively • Address ‘Most in Need’ • Least intrusive services • Utilize best practice • Confidentiality • Maximizing available resources

5. Service Collaboration Protocol Ensures staff are working together when multiple agencies involved: • Supports a single plan of care • Supports coordinated & complementary services • Avoids duplication and contradiction Every staff has a role in establishing and maintaining communication with other service providers

6. Collaboration Protocol cont’d Staff aware of more than 1 agency involved will communicate(with Consent):All staff are responsible to initiate communication within 2 weeks with other providers • Document* the coordinated planningIdentify clients that are ‘stressing’ services as “Emergent” or “Urgent”

7. Most in Need Tool Tool describes: • Priority, Situation, & Timing of Request • Action required for those prioritized as Emergent or Urgent • Emergent = Stressing service system; support needs not easily met • Urgent = At risk; services exhausted

8. CASE CONFERENCES Meeting together ensures: • Seamless system for families • Planning for individual’s outcomes • Communication between services • Coordination & collaboration of supports

9. Case Conference Agenda Prepare: • Have a clear purpose for the meeting • Briefly review currentsituation • Identify strengths, as well as needs & barriers • *Explore support options & coordination of services • Set an action plan - define who is doing what and when

10. CASE CONFERENCE ROLES “Case Manager” Role: • Identify and invite participants • Identify prior who will Chair meeting • Identify prior who will take Minutes • Prepare/present brief summary • Follow-up on your role after meeting

11. CASE RESOLUTION Protocol A community response to children/youth at risk: • Urgent and complexneeds • Community services exhausted • Barriers include resources • Preceded by acase conference Facilitated by Contact Brant

12. CASE RESOLUTION AGENDA (At Risk) • Has a clear plan based on clinical goals • Case Manager preparesa Case Resolution Summary Report prior to meeting • Case Res. Team, family & case manager discusstheplan, barriers, options • Case Resolution Teamonly meets to address resources and how the support plan will be implemented

13. CASE RES AGENDA Transitional Aged Youth • At age 16: Identify the developing plan & supports for a youth with a developmental disability; inform adult DS services • At age 17: Identify the discharge plan atage 18 from children’s services for supports and activities • Case Manager submits the Transition Plan • Case Res. Team discusstheplan, barriers, options; ensures a realistic plan is in place

14. CASE RESOLUTION ROLES ‘Case Manager’: • Requests Case Resolution • Invites family & staff • Submits Case Res. package 4 days priorto meeting • Clarifiesany questions • Supports individual/family • Follows-up • UpdatesContact Brant re outcomesof the plan Contact Brant: • Confirms eligibility/date • AssistsCase Manager • Invites Case Res. Team • Sends packageto Team to review prior to meeting • Chairsmeeting • Follows-up • PreparesCase Res. Reportfor MCYS & Team • Reports updates to Team • Identifies gaps & pressures for system planning

15. Transition Planning Protocol (DS) Provincially mandated Regional Protocol for youth with a developmental disability: • Start planningatage 14 by referring to Contact Brant • Develop awritten transition plan; it should be realistic, evolving, and updated annually • Identify personal goals and community services, as well as desired adult service supports • Plan with: youth & family, school, children’s and adult community services What will really happen at age 18?

16. TAY Planning Checklist Use the Checklist template! Transition Planning should identify: • what the youth wants • what they need now and in the future • how they want to do things • who they want to help them • Involve youth, family, service providers & school; ensure transition plans are meaningful and seamless at age 18 The plan is about community involvement and quality of life - not just about services

17. Brant Community Crisis Protocol • Crisis Plan template: Complete for individuals likely to have police or ER involvement • Coordinated response for children and adults with special needs in crisis • Cross-sectoral protocol & response

18. Crisis Protocol - cont’d • Crisis Planning • Use the Crisis Plan form • Crisis Response– follow plan • Post Crisis Follow-up – improve response

19. Transitioning from Children’s Mental Health Services Protocol Transitioning Youth from Children’s Mental Health to Adult Mental Health and Addictions Services Community Protocol • Ensures a coordinated transition plan for youth with acute mental health needs/longer-term service usersat highest risk and require on-going mental health and addictions supports

20. Transitioning from Children’s Mental Health cont’d • Provides definitions to understand the differences between children’s mental health services and adult mental health & addictions services • Start at age 14 to identify these youth • By age 16, provide information about services, expectations once 18, andsupport connections to adult mental health & addictions services Assist youth/families to develop a proactive, coordinated, and seamless transition plan

21. Transitioning from CMH Protocol cont’d • Collaboration between Children’s Mental Health Services and Adult Mental Health and Addictions Services is key • Support the need for increased independence • Provide choices and involve youth in the transition process to promote and support self-advocacy By age 18, the youth has a coordinated transition plan between children's mental health services and adult mental health & addictions services

22. Telepsychiatry Protocol • Access to child psychiatrists with various expertise through Woodview Children’s Mental Health and Autism Services’ videoconferencing equipment • One-time Psychiatric consultation, available in our community

23. Telepsychiatry Protocol cont’d Must have a ‘case manager’ for follow-up: • Completesreferral form and mental health assessment specific to the consultation requested – send to Woodview • Participates in meeting (60 – 90 minutes) with child and family • Follows-up on recommendations Note: Other child psychiatry services are available through CPRI, McMaster, and St. Leonard’s Clinic

24. Residential Placement Advisory Committee Child and Family Services Act legislates an RPAC review: • For children/youth placed in a residential facility of 10+ beds, and will be staying over 90 days • To advise, inform, assist re the residential service and alternatives; recommend appropriateness • Within 45 daysof placement & every 9 months after RPAC Team includes: An Informed Citizen, a Children’s Service provider, an Aboriginal representative (when appropriate) Contact Brantcoordinates for Brant

25. RPAC Agenda Case Manager: • Prepares a summary report and submits 48 hours priorto Contact Brant • Makes a brief presentation; child/family & residence may also present RPAC Teamreviews the reason for residential placement, the goals of placement, and appropriatenessof the residential placement RPAC is chaired by Contact Brant

26. RPAC ROLES Case Manager: • Notifies Contact Brant within 7 daysof residential placement • Preparespackage 48 hours priorto RPAC • Invites participants • Supports child/family • Presentsbriefly • Follows-up with residential provider and community services • Notifies Contact Brant when discharged Contact Brant: • AssistsCase Manager • Sets date of RPAC meeting • Invites RPAC Team • Ensures packagecopied for RPAC Team • Chairs meeting • SubmitsRPACReportto MCYS • Identifies future review dates when needed

27. . • A community publication of free workshops, courses, groups,and events provided by local organizations for families, children & teens • Watch for publications 3 times per year • Available at your agency, or electronically at: www. contactbrant.net/yourguide

28. Community Information Database A web-based Community Services Database: • Make sure your programs are listed and updated! Check it out – www.info-bhn.ca • Thisdatabase is used by 211 Ontario to provide their information for Brant, Haldimand & Norfolk: call 211 24/7 or visit 211ontario.ca Managed locally by Contact Brant

29. Community Collaboration around supporting people… CommunicateCoordinate Collaborate Together we can make things happen!

30. For information & help with Community Protocols/Processes: Call: (519) 758-8228