Innovative Approach to Housing Based on Psychosocial Rehabilitation Principles in 2010 and the Future

1. Innovative Approach to Housing Based on Psychosocial Rehabilitation Principles in 2010 and the Future

2. Who is Leeds & Grenville Rehabilitation & Counselling Services (LGRCS)? • Adult Community Mental Health Agency(80% MOHLTC funded, 20% funding from MAG & United Way) • Target population: SMI • Main office: Brockville + 4 Satellite offices(Delta, Gananoque, Kemptville, Prescott) • Population base: 100,000(The City of Brockville has been home to a larger mental health institution for over 125 years) Research shows that 25% of the population will likely experience mental health problems

3. Organization Philosophy We are a Recovery-Basedorganization where services are tailored to meet the consumers needs. • Goal: Promote an increased Quality of Life for the Consumer of the Service. • Mission Statement: In partnership with our communities, staff and volunteers, LGRCS provides quality comprehensive services that encourage integrity and respect by supporting personal growth toward mental wellness.

4. Programs Offered by LGRCS

5. Case Workers(Short/Long Term & Acute) • Coordinate multi-disciplinary teams consisting of internal & external resources • Provide individualized assessment for goal planning with clients. Utilize the OCAN (previously QOL) • Work in partnership with clients focusing on client strengths • Support, guide and advocate on behalf of clients to address system barriers • Assist client with ADL’s like budgeting and grocery shopping, focus on promoting independence • Utilize tools to provide client feedback (QA) ensuring client goals are being addressed • KEY FOCUS: Client Housing (safe & secure) and adequate income

6. Counselling (Masters Level Counsellors) • Focus is on individuals with SMI who want to address their emotional recovery • Also facilitate groups(Anxiety & Stress Management, Anger Management, STEPPS program) Well researched that nearly 80% of persons with SMI have suffered trauma in their life time.

7. Vocational & Educational • A key element of recovery is a return to a meaningful and productive life experience. This includes a vocational or educational experience. • We define ourselves often by the work we do. • LGRCS offers the BUILT program (online and available in rural areas), a Job Club, a basic literacy course, and customer service job preparation courses. • Partnerships with local employers to hire clients of the agency. • Programs are designed to promote client independence.

8. Wellness • Focus is on the whole person, including physical aspects that are under-serviced in the mental health field. • High rate of physical illnesses such as diabetes, obesity, high blood pressure, heart & liver problems. • Many new anti-psychotics can cause increased weight gain (on average 70 lbs within the 1st 3 months) • This program utilizes a personal training approach + group fitness and educational/preventative clinics (flu shots, foot care, STD clinics & diabetes clinics). • Focus on healthy eating, i.e. portion size, assistance with grocery shopping for healthy foods, preparing low budget healthy meals. On average a person with SMI has a lifespan almost 20 years shorter than someone not diagnosed with SMI

9. Therapeutic Social Recreation • Based on the philosophy that individuals with SMI have poor social interpersonal skills and are extremely socially isolated. • Very active Drop-in Centre component. • Recreational activities, social skill development, arts & craft groups, music group, bowling, YMCA/YWCA programs, camping, movie nights, car races, bus trips to zoos, plowing matches, sugar bushes, hockey & baseball games). • Loaves & Fishes (community partner) provide low cost lunches and dinners for clients on a limited budget-located in our building. • Clients participate in community fundraising events such as the United Way Amazing Race, bake sales, garage sales etc.

10. Supported and Supportive Housing • A range of housing options are available to persons living on fixed income, 16 years of age or older, who are severely mentally ill, and are prepared to work with the clinical team on a recovery plan • Total Beds: 161

11. LGRCS Housing Program Support Tailored to Client Need

12. High Support Low Support Phased Housing

13. Davison HouseAssessment & Rehabilitation (SMI, CD) Acute Short Term 24 hr staff Church HouseAssertive Rehabilitation (SMI, CD) 8 hr staff Murray HouseAssertive Rehabilitation Forensic 8 hr staff Edward House (Dual Diagnosis) 24 hr staff Pine St ResidenceIndependent Step Down (forensic, SMI, CD, DD) Case Management Cooperative Living (forensic, SMI, CD, DD) Case Management Independent Living (forensic, SMI, CD, DD) Case Management LGRCS Housing Program

14. Davison Avenue • Program • Acute and short term support • Crisis and Respite support • Assessment (initial part of recovery or relapse) • Rehabilitation and Recovery • High support will be provided • 24 hr staffing • Does not mean doing everything for the clients

15. Davison Avenue Cont’d • Focus on Rehabilitation & Recovery • Psycho-Education and Psychosocial Rehabilitation • mental disorders (symptom and medication management) • Process of change, motivational enhancement • Stress management • Self Esteem and self worth • Goal setting and problems solving • Lifestyle balance • Practical skill building with ADL, cooking and budgeting • Diversional leisure

16. Davison Avenue Cont’d • Social Recreation • Vital role in recovery • Initial need for high support • Leisure assessment • Fixed schedule • Focus • Diversional activities • Structured (planned) activities • Solitary activities • Group • Fitness

17. Edward Street • Dual Diagnosis clients • Nature of disability and limited resources equals limited progression • People will come to the home and probably remain for a very long time • Challenges • Create a program that is effective at managing behavioural challenges and provide a good quality of life on a limited budget • Prevent staff burnout

18. Edward Street Cont’d • 24 hr staffing support • Caseworker • Rehabilitation worker • Personal Support Worker • External agency supports • Structured in-house program has been developed • House very active with brief interventions

19. Church St & Murray St • Both homes offer similar programs • Church Street also includes concurrent disorders programming • Murray Street is for Forensic clients • Program • Assertive rehabilitation • Program similar to Davison with a shift in level of support • Moderate level of support

20. Church & Murray Cont’d • Continued motivational enhancement, more coaching and prompting to foster greater independence • Skill Building and education • mental disorders (symptom and medication management) • Process of change, motivational enhancement • Stress management • Self Esteem and self worth • Goal setting and problem solving • Lifestyle balance • Practical skill building with ADL, cooking and budgeting • Evaluation and planning for the next level of independence

21. Church & Murray Cont’d • Greater emphasis on leisure and social recreation • Leisure education and independence • Vocational assessment and planning • Individual structured recovery plan • Consistent program delivery is a must

22. Pine Street • Transitional Independent • Clients transition from group homes or cooperative (co-op) housing • Moderate Support • Variable On-site Casework, Rehab 1 and PSW • Off-site social recreation and vocational • Structured recovery – residents expected to have a weekly schedule and follow it • Social Recreation, vocational and Wellness will be primary focus

23. Pine St Cont’d • Continued motivational enhancement, coaching and prompting to foster greater independence • Evaluation and planning for the next level of independence • Demonstration and evaluation of acquired skills • Apartment furnishings provided by LGRCS will be basic essentials (single bed, dining room set) • Lower rent will allow budgeting for purchase of non essential furniture “creature comforts” such as end tables, TV., gaming console, etc. • Future Start up for purchase of essential items such as bed, dressers and dining room set.

24. Pine St Cont’d • High evaluation of strengths and needs • If someone does well in group home but not independent ...why? • Was it social? • Was it stress? • Would a co-op be better?

25. Coalition Housing • Independent living accommodations that include apartment and town houses owned by LGRCS • Intended for clients that wish to live independently, but because of their mental health symptoms have been unsuccessful in rental units with a community based landlord • Philosophy is that as mental health providers we recognize the symptoms of mental illness and provide intervention at onset and sensitive to client issues. • Lower rental costs as mandated by the MOHLTC • Little movement due to low rental costs

26. Independent Apts. (Community Landlords) • Part of the Homelessness Initiative • Involves a 3 way agreement with the client, landlord and LGRCS • Client pay the maximum allotment for their shelter allowance subsidy on ODSP and LGRCS “tops up” the rent to market value • Disposable income does not change • Client must agree to work with a case management service

27. Cooperative Living Accommodations (Co-op) • Shared accommodations that are either 2-bedroom apartments or 3 bedroom homes • Rehabilitation staff visit daily, as required to assist with ADL and house routines • Can involve medication monitoring • Currently 15 – 2 bedroom apartments and 2 – 3 bedroom homes • Co-op Team= • 2 rehab workers • 2 case workers • 1 personal support worker (half-time) • 1 part-time social recreational worker in the evenings.

28. Cooperative Living A Case Worker’s Perspective

29. A Case Worker’s Perspective Matching Clients: • Case Workers try to match people by their age, gender, personality type, & interests • Sometimes clients find their own roommates or initiate their own relationships in the group home

30. A Case Worker’s Perspective Case Management: • Coordinate initial conference meeting • Plan move & arrange all details • Set up budget with client for monthly expenses • Liaise with psychiatrists, family physicians, counsellors, etc. • Complete an OCAN assessment & make appropriate referrals • Coordinate needs assessment & schedule support

31. A Case Worker’s Perspective • Meet with co-op team on a weekly basis • Liaise with landlords to ensure good communication with tenants & address any concerns • Encourage social recreation involvement, community integration, vocational or educational participation & make appropriate referrals • Maintain supportive relationships with client as #1 priority to continue visits at office, in community and at client home to see client from all perspectives.

32. Cooperative Living A Rehabilitation Worker’s Perspective

33. A Rehabilitation Worker’s Perspective • Ranges from high to low level of care • Require assistance with activities of daily living • Client have various levels of functioning

34. A Rehabilitation Worker’s Perspective Work with: • Social recreation • Vocational programs • Family physicians • Outreach nurses • Other service providers Goal: Teach skills & promote independence for client recovery.

35. A Rehabilitation Worker’s Perspective Daily Tasks: • A.M. Visit: Med compliance, glucometer, personal hygiene • Discuss plans for the day • Encourage participation in activities • Chore plan • Meal plan • Occasional p.m. visits for med compliance or more lengthy activities (teaching skills).

36. A Rehabilitation Worker’s Perspective • Shopping • Laundry • Cooking and meals • Health and wellness • Cleaning

37. Building Blocks of LGRCS Housing Program founded on PSR Principles Foundations for Recovery-Based Housing

38. 1. Psychosocial rehabilitation practitioners convey hope and respect, and believe that all individuals have the capacity for learning and growth. 1. Employ the “Yes” Philosophy 2. Ultimate goal of Housing Program = Cooperative Living or Independent Living 3. Hold HOPE for the client! 4. Use of motivational interviewing techniques – Attitude Factor: interviewing must be respectful and positive. (See Making it Happen, from MOHLTC where the least restrictive and most independent setting is recommended for individuals). Individuals who have been in mental health facilities for a long period of time have often lost hope, dreams and aspirations.

39. 2. Psychosocial rehabilitation practitioners recognize that culture and diversity are central to recovery, and strive to ensure that all services and supports are culturally relevant to individuals receiving the services and supports. 5. Provide staff training on sensitivity and knowledge of cultural differences 6. Offer an entire spectrum of housing focusing on client participation (offering choices and options). 7. Inclusion of entire SMI population base: persons with concurrent issues, intellectual challenges, complex medical issues and forensic clients

40. 3. Psychosocial rehabilitation practitioners engage in the process of informed and shared decision-making and facilitate partnershipswith other persons identified by the individual receiving services and supports. 8. Selecting appropriate housing is based on extensive discussion between the case worker and the client. Discussions include the individuals’ finances, expectations, chores, individual responsibilities, and what services will be provided by other agencies. 9. Relationships between co-op residents are fostered prior to moving in together: best results are with persons who have existing friendships/relationships 10. Detailed recovery care plans are created with client input.

41. 4. Psychosocial rehabilitation practices build on strengths and capacities of individuals receiving services and supports. 11. Client movement into either co-op or independent housing is based on strength-based assessments, not pathology 12. Use client strengths when building relationships for cooperative living environments (i.e. match clients that have complimentary skill sets)

42. 5.Psychosocial rehabilitation practices are person-centered; they are designed to address the distinct needs of individuals, consistent with their values, hopes and aspirations. 13. Staff only provides the support the client needs, always building on an individual’s current skills to promote independence. 14. Clients don’t necessarily possess all independent living skills but the support provided address deficits and focuses on individual skill development. 15. Rehab workers, personal support workers and case workers all focus on client specific needs 16. Community resources are also utilized to meet client needs (i.e. YMCA, Loaves & Fishes)

43. 6. Psychosocial rehabilitation practices support full integration of people in recovery into their communities, where they can exercise their rights of citizenship, accept the responsibilities and explore the opportunities that come with being a member of a community and a larger society. 17. The housing program’s ultimate goal is independent / cooperative living so that clients become part of the neighborhood. 18. Clients are engaged with a larger community via activities in vocational, educational and social recreation program involvement. 19. Cooperative and independent living units are not clustered, providing individuals anonymity against SMI stigma.

44. 7. Psychosocial rehabilitation practices promote self-determination and empowerment. All individuals have the right to make their own decisions, including decisions about the types of services and supports they receive. 20. Work with all clients and respect their decisions even when we as clinicians may disagree. 21. Maintain consistent client contact in home to ensure the housing and supports in place are meeting their needs. Clients who want to live independently but who have active symptoms are offered Coalition apartments (agency-owned)..

45. 8. Psychosocial rehabilitation practices facilitate the development of personal support networks by utilizing natural supports within communities, family members as defined by the individual, peer support initiatives, and self-and mutual-help groups. 22. Utilize all available resources within mental health and external to mental health. We have wonderful partnerships with: • YMCA/YWCA • Rideau Valley Diabetic Association • Brockville Pharmasave • Family Physicians • Loaves & Fishes • Community Employers • Income support programs Mental Health Resources • ACTT, ACTT DDx, Forensic • CMHA Leeds Grenville (transportation services) • Crisis Services • All LGRCS services 23. Engage with families both prior to client move and beyond, with client consent. Family involvement both positively & negatively can have a great impact on the recovery process of a client. It takes an entire community to ensure success”

46. 9. Psychosocial rehabilitation practices strive to help individuals improve the qualityof all aspects of their lives, including social, occupational, educational, residential, intellectual, spiritual and financial. 24. Include a strong emphasis on structured and meaningful activities • LGRCS has a strong social recreational program, a recreation worker embedded in the co-op team, as well as numerous vocational and educational opportunities • Contracts with community employers for LGRCS properties in return for full time employment opportunities • Basic Literacy Tutor 25. Maximize client financial resources • Cooperative living, coalition and independent apartments all provide client with maximum financial resources 26. Provide clients with assistance (if required) in managing finances.

47. 10. Psychosocial rehabilitation practices promote health and wellness, encouraging individuals to develop and use individualized wellness plans. 27. Utilize a holistic approach to client’s wellness including physical, emotional and psychological well-being. 28. Ensure clients have access to counsellors to deal with trauma treatment and to develop a wellness plan in the event of decompensation in their mental health.

48. 11. Psychosocial rehabilitation services and supports emphasize evidence-based, promising and emerging best practices that produce outcomes congruent with personal recovery. Psychosocial rehabilitation programs include program evaluation and continuous quality improvement that actively involve persons receiving services and supports. 29. Create individual Recovery Plans of Care. 30. Develop a client-friendly evaluation process that is continual and maintains a client-centered approach. 31. Hold regular treatment conferences where all service providers meet to discuss individual needs and progress. 32. Gather client feedback on a daily basis.

49. 12. Psychosocial rehabilitation services and support must be readily accessible to all individuals whenever they need them; these services and supports should be well coordinated and integrated as needed with other psychiatric, medical and holistic treatments and practices. 33. Develop strong partnerships with other mental health service providers to ensure any system gaps are addressed and that no client need, as identified through the Recovery Plan of Care, is missed. • We have no on-call services, so we rely on programs like ACTT, Crisis Outreach to respond to crisis scenarios. • Our relationship with Brockville Pharmasave allows clients to have their dosettes scrutinized by a pharmacist to ensure no med errors 34. Identify lead staff liaisons within the organization to coordinate with other service providers, ensuring no client falls through the cracks. • We have a forensic liaison person, acute care case workers, ACTT liaison and crisis worker. All of these relationships have developed enormously with our housing service model • Client benefits from coordinated and integrated service provision.

50. Video