The Hamilton Acquired Brain Injury Corrections Working Group: - - PowerPoint PPT Presentation

The Hamilton Acquired Brain Injury Corrections Working Group: Integrating Multiple Sectors for Better Complex Case Management

August 23rd, 2016

@HSJCC

Moderator: Trevor Tymchuk , P-HSJCC CKE Chair

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Presenters

Veronica Pepper LHIN 4 Acquired Brain Injury Systems Navigator; HNHB ABI Network Terry McGurk COAST / LHIN 4 Lead for Mobile Crisis Rapid Response Teams, St. Joseph’s Healthcare Hamilton

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@HSJCC

Veronica Pepper

LHIN 4 Acquired Brain Injury Systems Navigator HNHB ABI Network

Terry McGurk

COAST / LHIN 4 Lead for Mobile Crisis Rapid Response Teams

• St. Joseph’s Healthcare Hamilton

August 23, 2016 Webinar

• At the Hamilton Local HSJCC one of the

target populations frequently identified were ABI individuals at the Hamilton Wentworth Detention Center (HWDC)

• The Local committee was concerned that the

incarcerated ABI client was not well served leaving the Detention Center resulting in high rates of recidivism

• Committee was formed and began meeting

monthly in October 2013

 TOR established: A committee

tee that t wi will address dress the ongo going ing concern erns s and d impro rove ve and d enhance hance servi rvice ce deliver very y for adults lts and d trans nsiti tional

• nal youth

th wh who are e suspected spected of havin ving g a brain ain inju jury ry and d may also

• have

ve a mental tal heal alth th or addi diction ction issue, ue, and are consi sider dered ed high gh risk sk wi within n the e comm mmunity nity and/or d/or wh who have ve frequent quent contact act wi with the crimina nal ju justi tice e syst stem. em.

 All members signed a confidentiality agreement  Individuals discussed with consent of the client  Individuals cons

nside idere red d by the e mem ember ers to have ve iden entif tifie ied d risk factor tors s that pres esen ent as immin inent ent harm rm to sel elf or other ers in th the com

• mmun

unit ity super ersedes es th the priva vacy cy leg egisla lati tion and the case is discusse sed without

• ut conse

sent

 Because

se of th these precondi

• nditions

ions planning ning for the prevent ention ion

• f re-offense

fenses and red educ ucing ing the e inev evitab itable le likel elihood ihood of socie ietal l victim imiza ization tion perpetra rated d by these client ents s it see eems th this may fall with thin in th the param amete eters rs for reason

• nab

able le disclosu losure re of confid ident entia ial l client ent inform

• rmation.
• tion. (pg

pg 54 4 PHIPA PA)

• Encouraged to use the Threshold Assessment Grid (TAG)

to determine level of risk



Other necessary stakeholders were identified and offered membership



The Working Group now has a dedicated membership from the Hamilton area brain injury, mental health/addictions, correctional services and housing sectors including:

• Hamilton Health Sciences ABI Program
• Brain Injury Services
• HNHB ABI System Navigator
• CMHA Hamilton Wentworth Court Support
• St. Joseph’s Healthcare Centre Psychiatric Emergency Service
• St. Joseph’s Healthcare Crisis Outreach and Support Team (COAST)
• St. Joseph’s Discharge planner
• Hamilton Wentworth Detention Centre
• Hamilton Wentworth Probation and Parole
• Hamilton Police Services
• Hamilton Residential Care Facilities and Hamilton Housing
• Indwell Housing Services
• T.A Patterson Addiction Services
• *Members

bers must st be able le to repre rese sent nt their eir organ aniza zati tion

• n in decis

cision

• n

makin ing

Headache> Irritability+Impaired thought+Reduced anger control>Behavioural outbursts Fatigue Agitation organization Disinhibition Physical aggression Impulsivity Verbal aggression

• Also co

consi sider der co co-occ

• ccuring

uring disor

• rders

ders i.e. menta tal l illness ess, , addictions, ctions, Inte telle llectua ctual delay y etc. c.

 Conditions that work for the client on the inside –

structure, routine, consistency – are lost upon release to the outside

 Most clients, due to their cognitive difficulties, are

reliant on highly structured environments – predictable mealtimes, worktimes, exercise times, clear rules and behaviors, probation orders etc.

 Shifting from predictable/structured to

unstructured/unpredictable days is often highly disruptive, confusing, anxiety provoking and is poorly self managed often leading to re-incarceration

 Cognitive deficits cause the inability to “make the

link” between their ABI and offending or reoffending.

Initial Steps with the HWDC

• Agreement that inmates could be screened

(with consent) for the purpose of discharge/release planning only

• Nurse and Social Worker on Special Needs

Unit would be trained and would apply the HELPS Screening Tool

1.

HELPS Screening Tool implemented to ‘flag’ possible ABI

2.

If positive flag and consent given, a ‘Client Case Review’ referral form completed and submitted to the ABI System Navigator (with initials

• nly)

3.

The Navigator screens the case to ensure it meets the criteria for review

4.

The Navigator calls the Social Worker to obtain the name of the client

5.

The Navigator then calls all members of the working group and identifies the name of the client for review

6.

All members review records/charts/files to see if they have been involved and bring all pertinent information to the case review for sharing

7.

All members review, discuss, problem solve and develop an individualized support plan with necessary stakeholders. This sometimes involves contacting ad hoc service providers when necessary

8.

Support plans are implemented and cases are reviewed at subsequent meetings with necessary changes

• The HWDC Social Workers have administered

53 HELPS screenings

 24 (45%) flagged positive for potential ABI

• There has been 14 Complex Case Reviews

(10 or 71% declined offer of services and supports)



37 year old male presented for Complex Case Review June 2015



ABI at 3 years of age when struck with a baseball bat and also suffered multiple concussions from multiple physical altercations over the years resulting in cognitive and behavioural problems



Co-occurring mental health and addictions, using crystal meth and cocaine



No current involvement with ABI supports - admitted to HHS ABI Inpatient Program in 2003 but discharged himself because not allowed to use cocaine while admitted



Involved with COAST since 2014 and Mobile Rapid Response Team



Multiple trips to EPT by police but never admitted, mostly substance induced psychosis



Incarcerated multiple times at the HWDC – multiple property offences, possession and many, many breaches of probation



Had been residing at a residential care facility for 3 weeks however it was not going well as he was finding it ‘hard to follow all the rules’ and he didn’t like it there



Was experiencing explosive outbursts putting other residents at risk but was also considered a risk to himself



Had attempted substance abuse rehabilitation one month ago but discharged himself from the program after 2 weeks



Family Dr. prescribed Olanzapine but refuses to take it as he feels there is nothing wrong with him



Presents with paranoia, hard to gain trust, does not like rules



PLAN: BIS & Court support worker to meet with client to make referral to BIS, discuss goals and build rapport & trust

Update Meeting Augus ust t 12, 2015



BIS & Court Support Worker met with client and completed BIS referral



BIS staff met 2 other times to maintain contact and monitor behaviours



Client agreed to have the Working Group meet to do further planning for a move from the RCF to his own apartment, to re-apply to detox/rehab program and identify involvement with BIS PLAN: Men’s detox

• x worker to see if client can return to the detox program



COAST to develop crisis response plan taking into account cognitive and behavioural deficits



Waysi side de manager to see if client can attend the program with ABI support worker



Director from Indwell ll to determine if placement is possible



CMHA HA Court t supp pport

• rt worker will remain involved despite mandate that she end

involvement once court involvement is complete



Proba batio tion n Offi fice cer to be educated on ABI sequelae and how to make compliance with conditions of probation order more successful



Manager of curren ent t RCF CF to meet with BIS Worker to see how BIS can support facility staff and maintain current placement



HHS Comm mmunit nity Interv rvent ntio ion n Coordi dina nato tor to assess for possibility of HHS ABI Outpatient Clinic appointment regarding anger management medications



ABI System m Navigat gator to continue to coordinate and move forward with plan



Brain in Injury ry Servi vice ces s to continue to meet with client to maintain a relationship and follow in the community while plans move forward

Update meeting January uary 13, 2016

 Client was once again in custody for theft and breach of

probation

 Was not consistently attending probation appointments  Referral to Indwell completed and Intake person to

interview/assess client while incarcerated

 BIS still attempted involvement while in the community however

hard to contact him as he has no cell phone because he either loses it or it gets stolen and does not remember meeting dates

 Reported not actively seeking crystal meth but will use when

• ffered

 Client still agreed to move forward with Plan developed at last

meeting PLAN: Indwell, Probation Officer, BIS worker and Court Support Worker to work together to get the Indwell Intake Coordinator into the HWDC to interview/assess client for appropriateness for potential placement at Indwell

Update meeting March ch 1,2016



March 13, 2015 client is being released from custody



Accepted to Indwell however no housing available there until September 2016 so applying to Transitions to Home, Housing First, and Mission Services for temporary placement



Indwell stipulated that he cannot be using substances while at Indwell and because client was excited about living there he agreed to abstain from substance use and continue to move forward with detox/rehab



Probation reported that he will be off probation March 9, 2016 but the PO will make herself available to him if/when he needs her as she had built a trusting relationship with him



The CMHA Court Support Worker is also going to maintain involvement despite mandate and provide

• n-going support where needed



BIS will continue involvement and assist with move to next living environment providing education and training to staff and ongoing support to the client including a visit to the BIS Day Program PLAN: N: HWDC C Social al Worker will continue as point/contact person while release planning coordinated



HWDC C SW and BIS S staff ff will contact Transitions to Home, Housing First and Mission Services to see if

• ne is able to accept him on a temporary basis with support from BIS staff



CMHA Court rt Suppo port rt Work rker to remain involved and provide any support needed



Applications will be made to addiction services once released – client stating not ready yet



COAST ST & MCRRT T will also remain involved as crises plans

Update Meeting June 7, 2 2016



March 13, 2016 was released to Transitions to Home Program through the Welsley Centre



Didn’t like Transitions to Home so staff there assisted with finding him an apartment downtown in April



May 2, 2016 moved into Indwell



Since then he has been to the dentist, has had a rapid psychiatric consult at St. Joe’s Community Psychiatric Services, attended a family physician visit where his meds are now being consistently administered daily, although probation order is completed, he continues to ‘visit’ with probation officer and tells PO he’s very appreciative of all the help he is receiving from everyone



Indwell has a substance abuse counsellor on staff however client has not participated in sessions offered but figure there is a need to establish rapport and trust first



Salvation Army arranged as Trustee for finances



Has identified a goal of obtaining some form of employment, decreasing substance use and attending day/social rec programs at BIS



He has had no contact with Police, COAST, MCRRT to date



Getting his health card next week



Indwell has crisis plan in place with COAST & MCRRT and are going to meet with BIS staff for ABI training and education



Indwell reported some initial transition problems however appears to be settling, no risk of losing placement at this time



Mom re-involved and has taken him to her home for a couple of days visits which have gone well PLAN: Indwell SA Counsellor to continue to offer and encourage drug counselling and support



BIS staff to provide ABI training and education to Indwell Staff and offer Day Program involvement



Probation Officer agreed to maintain ‘visits’ and support

• A reduction in recidivism rates with the HWDC
• A reduction in re-offences with/calls to the

Hamilton Police Services

• A reduction in the frequency of calls to

COAST

• A reduction in ED/EPT visits
• An increase in compliance with Probation &

Parole orders

• Improvement in overall quality of life
• Address all social determinants of health

 Same complex case process being considered

for duplication at other areas of the HNHB LHIN area

 HELPS screening tool being considered at

member agencies in the community (e.g., CMHA, Probation & Parole) and individuals being referred to appropriate ABI resources

Questions?

For more information about the Provincial HSJCC and to join the mailing list, visit: www.hsjcc.on.ca

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