Capital Health

1. Capital Health Presenters: Linda Brennan & Joan Smith

2. Part 1 • Admission to East Coast Forensic Psychiatric Hospital- January 2004 • Index offence: prostitution & assault (high risk) • Karen’s story- a brief overview • Becoming mentally stable. Role recovery & rehab groups; AWOL’s & ‘crack’ use

3. Classification Process- November 2005 • Conditional Discharge- May 2006 • Internal and External supports explored • Discharge to Small Options Home

4. Life after Kingston (Sept. ‘06) • Meetings with Community Supports & Small Options Home • What went wrong? • “I want a place of my own”.

5. Work placement at Lakecity Employment Services • Work is “repetitious, boring, not challenging enough”. • Returns to New Beginnings Clubhouse • AWOL’s and drug abuse continue

6. Part 2

7. Forensic Group Home Placement • Offered increased supports • Opportunity to learn more skills • Karen remains unhappy & not engaging • What went wrong?

8. Part 3 • Possible place at Victoria Road Group home • Intensive staff in-servicing • Work placement: Salvation Army Thrift Store • More supports on Board- ICM

9. Absolute Discharge Denied • Article about Karen in newspaper- work placement terminated! • Unexpected meeting with father • Good things still happening despite setbacks

10. AWOL’s continue, but urine drug screens negative • Accepted at Victoria Rd. Group Home • Passes continue with ICM worker being a positive influence • Happy at Victoria Rd.

11. The AWOL’s from Group Home are stressful for both staff & clients. Karen tells Carole that she wants her own apartment. • “I don’t think I fit in here. I don’t want to lose my family”. • Exploring strategies for impulse control and increased daily structure

12. Attendance at new Beginnings more consistent; has more interaction with staff. Organizing a Fashion Show • Karen not comfortable with Group Home. “Living with men is a problem”. • Placement at Group home discontinued • May use Daily Living suites for assessment purposes

13. Part 4

14. Conditional Discharged Maintained • Carole can offer independent living with supports. Karen wants ECFP to continue supports. • “They know me and I trust them”. • Calvin continues to be a problem • Urine drug screens remain negative

15. Daily Living suites assessing for independent living skills • Karen in agreement with budget & cigarette program • Karen views Lakefront Apartment • Karen signs lease on apartment

16. Preparation for Independent Living • Karen has difficulty sustaining attention but is able to complete tasks • Karen continues appointments with Addiction Services • Karen starts overnights in Daily Living Suites • Karen starts working with OTA to develop skills in menu planning, grocery shopping, meal preparation & budgeting

17. AWOL’s continue but urine screens remain negative • Karen sets up apartment • Continuous need for supports • Karen worries about discharge

18. Karen starts to work with OTA in apartment- skill building • Transition to her own apartment will be slow • Team meeting with supports. Cigarettes & budget remain a big issue • Karen remains stressed about leaving ‘family’

19. Karen continues appointments with Addiction Services • Graduation from cooking program • Karen meets with Forest Hills Pharmacy • Possible placement at Mort’s, but doesn’t like working with old people

20. Karen receives Absolute Discharge • Karen wants ECFPH supports to stay in place • Negative urine drug screens continue while in apartment • Karen has passes to Halifax, but returns for medication & appointments

21. Interview with Karen at her apartment

22. Post Discharge • Karen has no control over her life? • Structured activities- who is monitoring them? • Urine drug screens felt unnecessary • Karen’s a chronic client- if others don’t get this level of support, should she?