The Hamilton Acquired Brain Injury Corrections Working Group: Integrating Multiple Sectors for Better Complex Case Management August 23 rd , 2016 Moderator: Trevor Tymchuk , P-HSJCC CKE Chair @HSJCC
HSJCC Webinar • We will have a Q&A period at the end of our webinar. To ask a question, please type your question in the chat box. • Power-point presentation will be emailed to you following the webinar. • Please complete the brief evaluation survey following the webinar. @HSJCC 2
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 @HSJCC 3
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 onal youth th wh who are e suspected spected of havin ving g a brain ain inju jury ry and d may also o 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 ommun unit ity super ersedes es th the priva vacy cy leg egisla lati tion and the case is discusse sed without out conse sent Because se of th these precondi onditions ions planning ning for the prevent ention ion of 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 onab able le disclosu losure re of confid ident entia ial l client ent inform ormation. 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 on in decis cision on ◦ 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 occuring uring disor orders 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
HELPS Screening Tool implemented to ‘flag’ possible ABI 1. If positive flag and consent given, a ‘Client Case Review’ referral form 2. completed and submitted to the ABI System Navigator (with initials only) The Navigator screens the case to ensure it meets the criteria for 3. review The Navigator calls the Social Worker to obtain the name of the client 4. The Navigator then calls all members of the working group and 5. identifies the name of the client for review All members review records/charts/files to see if they have been 6. involved and bring all pertinent information to the case review for sharing All members review, discuss, problem solve and develop an 7. individualized support plan with necessary stakeholders. This sometimes involves contacting ad hoc service providers when necessary Support plans are implemented and cases are reviewed at subsequent 8. 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 ox 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 ort 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
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