Regional Research on Intellectual Disability, Crisis Response and Justice System Involvement

Susan Braedley , Assistant Professor School of Social Work, Carleton University with support from Aaron Howes, Analyst

This research was funded by: CIHR/CHSRF Chair in Health Services

and Nursing Research at York University

Carleton University Faculty Research Fund

Today’s Outline:

1. What is the research about? 2. What did we find so far? 3. What other questions do our

findings suggest? 4. Where to from here ?

What is the research about?

I am investigating the growth and expansion of crisis/emergency services that serve vulnerable populations to ascertain the degree to which crisis services are used regularly .

Some people are living in constant “crisis”.

Sub-study: Community Crisis Response Quantitative study of

service data from Central East Network of Specialized Care, serving adults with ID and mental health or behavioural conditions

Established in 2007 across Ontario as part of policy shift to community care

Community Crisis Response for those 16+ who have an ID Available 24/7 Time-limited

intervention Active process –

relief for the immediate crisis

Can be used to prevent escalation of difficulties

What did we want to know? Who uses crisis response for people with

intellectual disabilities? What problems or issues does this

service address? How often do people use this crisis

response? What factors are most associated with

multiple crisis response use? How does crisis response use compare to

intensive case management services use for people with intellectual disabilities?

Why should HSJCs care?

Our findings show a relation between crisis response use and justice system involvement that may offer opportunities for early intervention.

Our findings show that some regions are doing better than others at keeping people out of the justice system... Further research will tell us how and why.

What did we do?

Quantitative analysis of service statistics from the crisis response and intensive case management services using SPSS.

Aggregation of data by individual, rather than by incident.

Analysis of correlations with justice system involvement, among other factors

Comparison of service data from individual areas of the Central East region to see if “local” matters.

 .

Parameters:

Central East Network of Specialized Care Data ( HKPR, Simcoe County, York Region, Durham Region) from inception of service in Aug 2007 to June 2009.

This is 18 months of data.

An update is currently being prepared.

Population:

Our analysis identified: 320 unique individuals in the data set. 65 had used only intensive case

management (20%). 255 had used the crisis response service

(80%). 60 individuals had used at least one incident

of crisis response and case management services.

 

Factors for Analysis

Living Arrangements Reasons for Referral Involvement with the Justice System Referral Agent Diagnosis or Condition Age/Sex Number of crisis response service

uses.

General Profile

53% of clients have used crisis services more than once

Overall, males receive service more often than women (59/41).

The average age of clients is 31 years. Half of clients are described as dual

diagnosis. Just over half of clients have

involvement with the justice system.

Living Arrangements

Living Arrangement

Total Unique Clients (n= 320)

Intensive Case Management (n=65)

Crisis Response(n=255)

Independent 21% 29% 19%

Family 46% 39% 48%

Supportive Housing

8% 8% 8%

Group Home 8% 6% 9%Shelter 11% 9% 11%IRMHospital 6% 5% 7%

Reason for Referral

Reason for Referral

Overall (n= 320)

Crisis Response ( n=255)

Intensive CaseManagement(n=65)

Homelessness or risk of

45% 48% 34%

Lack of Community supports

68% 66% 77%

Mental Health 55% 54% 57%

Behavioural Issues 58% 53% 75%

Family Sit Change 27% 28% 25%

Safety Concerns 48% 44% 60%

Indicates significant at 95% confidenceIndicates significant at 99% confidence Indicates significant at 95% confidenceIndicates significant at 99% confidence

Indicates significance at 99% confidence

Indicates significant at 95% confidenceIndicates significant at 99% confidence

Indicates significance at 95% confidence

Crisis Response Level Comparison ICM (n=65)

One Crisis (n=85)

Two+ Crisis

(n=170)

CrisisNone - - -One - - -Two+ - - -

Gender Male 75% 54% 55%Female 25% 46% 45%

Age Mean 27.7 yrs 31.1 yrs 32.6 yrs

Diagnosis Code

Developmental Delay 49% 46% 54%

Dual Diagnosis 63% 57% 52%Mental Health only 11% 7% 8%Autism 15% 18% 13%

Justice Concerns 99% 25% 48%

Living Arrangement

Independent 29% 20% 18%

Family 39% 44% 50%Support House 8% 8% 8%Group Home 6% 4% 12%Shelter 9% 13% 11%IRM 0% 0% 1%Hospital 5% 5% 8%

Reason for Referral

Homeless (or at risk of) 34% 42% 51%

Lack of Community Supports 77% 66% 65%

Mental Health 57% 53% 55%Behavioural Issues 75% 41% 59%Family Situation Change 25% 18% 33%

Safety Concerns 60% 31% 51%

HKPR: What does the data say? Size of sample : ICM = 14 individuals 1 Crisis = 69

individuals 2+ Crises = 45

individuals For those who had 1 crisis, justice

involvement was a factor for 33% . For those who had 2+ crises, justice

involvement was a factor in 41% of the cases.

HKPR Data

The client average age for crisis response is 30.5 years – older than the 25.9 years of ICM clients.

The ratio of men to women is 62%/38%

Those who have 2+ incidents are much more likely to live with families, and behaviour issues are significantly higher than for those who have only 1 incident.

HKPR Data compared to other areas Ratio of 1 instance to 2+ instances is

consistent across regions – about 66 % of individuals use service more than once.

HKPR Crisis serves more men than other regions

At one incident, justice concerns are a factor for 58% of clients. At 2+incidents they are a factor for 71% of clients. This is by far the highest incidence of justice involvement in the region, with York region at 50% for 2 + incidents, and Simcoe the lowest at 18%

HKPR Data

HKPR crisis clients also seem to have fewer behavioural issues, fewer safety concerns and much less risk of family situation change.

Is this an actual difference or are people’s situations being interpreted differently by workers in HKPR?

To summarize so far:

Repeat crisis response use appears to be related to justice system involvement

In Central East, those who use crisis response tend to be older than what is sometimes expected.

More than half of clients use crisis response more than once ( up to nine times) in an 18 mo. period

So what?

We can follow up with qualitative research that will identify why some regions have different rates.

This can assist us to identify promising practices, or advocate for resources.

Critical Questions

  1. The goal is to provide this service. But is there a

goal behind the goal? Is this a service designed for frequent use?

  2. Is the service really seeing situational crises or is

it seeing structural crisis in multiple service users?  3. What other services are these clients and their

care providers and/or supporters using?   4. When we talk about linkages and coordination,

what is the outcome we expect? 

Where to from here?

Update the data set and have a trend analysis completed in order to assess change over time

Qualitative study conducted to assess reliability of quantitative data and to get better data on interventions.

Propose that some provincial comparisons could be useful to inform policy.

Closer look at those factors that show most significance in order to identify promising practices and plan effective services.

An invitation to research A CIHR application has been made for a

planning meeting for those interested in partnering in a research project that will extend this research across Ontario.

All Networks of Specialized Care have signed on, along with many other agencies. We expect to be funded within the next year.

If you are interested, please contact me! (susan_braedley@carleton.ca)