Service teams and home visit

Saint John, New Brunswick, March 12 & 13, 2015

Murielle Doucet, Housing First Trainer (Moncton)Nancy Keays, clinical nurse, Housing First Trainer (Montreal)

Topics today

Act team in a Housing first model

ICM team in a Housing first model

Training

Video « the visit » Pathways

Home visit (principles and chalenges)

At Home / ACT Team

• Intensive treatment and support in community

• Model where almost all services are provided by

team clinicians

• Client/staff ratio of 10:1 or less if higher needs

• 24 hour coverage 7 days a week

• 90% visits in the community

• Medication delivery program/injections

• Program staff are closely involved in hospital

admissions and discharges

At Home / Act Team Peer engagement specialists Psychiatrist & Physician Nursing (medical and mental health) Social worker Substance abuse counselors Supported employment specialist Counsellors, Home Economist, other outreach workers Housing specialist

All staff trained in client choice as a model of care

MHCC decided on adding evidence based interventions to the Housing First ACT teams standards.

• Minimum one peer worker as full team member

• Motivational interviewing

• Integrated Dual Diagnosis Treatment - harm reduction

• “IPS” Employment specialist

• “Illness Management and Recovery” programs

• Family psycho-education and support

Doing ACT

• Morning meeting

• Weekly clinical/planning meeting/complex cases

• Scheduling

• Flexibility all around to meet participant needs

• Challenges of trans-disciplinary care and staff burnout are

very big issues

• Team leader needs to keep eye on workload and team

cohesion

How to “do ACT” and Housing First

Follow Housing First Fidelity measures with your Team rather than standard ACT fidelity measures Yearly fidelity review Always maintain a Housing first philosophy Ask advice, talk to other folks doing Housing First Be Innovative and daring Try new things Avoid too many rules

Think outside the box

ICM teams (At home )

15-20:1 ratio of Staff

Services for people with moderate needs

7 days a week/ 12 hours a day

Outreach/ home visits primarily

Weekly team meetings

Non clinical staff, services brokered out

Challenges are developing linkages to health and mental health

and addiction services

Building a good team

Great team leader with skills, experience

Provide basic and ongoing trainings

Hire Peer Workers in fully integrated roles !!!

Staff need to be eternally Hopeful, Empathic and Flexible

Ability to work with challenging personalities and

behaviours

Innovative strategies are needed

Training - Team Skills

Recovery oriented Strengths based approach Harm reduction Motivational interviewing Trauma-informed practice Cultural competency Crisis Management/Suicide intervention & Assessment Self Medication Management Anger Management

Video « The visit » Pathways

https://www.youtube.com/watch?v=JOb8tX1MFGk

Home Visit

5 principles of Housing First

① Immediate access to housing with no readiness conditions② Personal choice and self –determination③ Recovery orientation④ Individualized person-driven supports⑤ Social and community integration

2 Conditions : 1) Visit once a week2) Pay 30 percent of income for rent

Choice based Goals

work towards the persons goals

Recovery/Care plans should be focused.

Doing a Recovery plan - way to get to know people - their

hopes and dreams

Use motivational interviewing techniques to make goals more

specific and focused

Strength-based approach

• Recovery is based on strengths

• Focus on the healthy part of the person and believe in the potential of recovery

• Recovery is a personal journey of healing and transformation

• An on-going process, takes time and is multi-dimensional

Recovery is the main focus

The person in recovery « owns » his or her recovery process. The person searches for…

• Hope for the future• A more positive sense of self• Positive social roles• A sense of belonging within the community• A sense of purpose• The sense that what he or she does and decides matters

How Housing First differs…From what’s wrong to what’s STRONGRather than focusing primarily on what is “wrong” with the person • symptoms• substance use concerns• skill and resource deficits

HF focuses foremost on what is “right” with people • Goals• Skills• Knowledge• Interests• Resources and supports• Motivation• What they are already doing that helps them manage their condition

Home Visit Philosophy

Respectful of the person’s : • Boundaries• Culture• Space and time• Their tolerance for degree of

contact (length and # of visits)

• Ongoing active engagement• Focus on Person’s Choices not

the programs goals

Opportunity for Engagement

Opportunity to develop a trusting relationship

Clues about tastes, interests and hopes

Learn who they are

Targeted Intervention

Purposeful and goal directed

Focus on person’s chosen goals (recovery plans)

Provides continuity of support and treatment

Opportunity for continuous engagement

Interventions extends from home to community settings

Assess Well-being

How is the person today?• Their greeting

• Clothing

• State of alertness

• Mood

• Changes from usual patterns

Why Home visits: “Achieving goals”

• Learning new skills best done in “real” environments• Budgeting and ADL’s• Recovery happens in the community, not the office• Friends, work and social inclusion happen in the community• Community Integration

Team operations/home visits

• Minimum once a week• Schedule in advance/avoid surprise

visits• Reminders, calendars, notes on fridges • Varies over time• Non-linear process• Need to be flexible and accommodate

the needs of the individual• Effi ciency is important• Distribute workload by specialty and

geographically

To look at the condition of the apartment

Organized to disorganized?

Do you look in every room?

Careful observation

Are there repairs that need

to be made?

Liaising with property

manager?

Looks like we have a guest! Who’s the guest?

Do you intervene?

What if you see this in a tenant’s fridge?

Are there dreams and hopes that you would not support?

What ever path the person chooses, just be there to listen and support. Walk beside them.

Thank you

Contact us: info@mentalhealthcommission.ca

Visit: www.mentalhealthcommission.ca

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