Final Report

Early Youth Interventions Project Report

March 31, 2009

Transitional Age Youth and Health Promotion

Summary

The Early youth interventions project charter identified the need to establish best practice guidelines for health promotion and to establish a task force for transitional age youth in order to assist in the transitioning of youth into the adult mental health and addiction network.

The project team reviewed mental health and addiction promotion by identifying best practice guidelines (10 best practice guidelines, Centre for Addiction and Mental Health) and compared them to existing youth mental health and addiction services. The findings revealed a range of health promotion and prevention services in the children and adult mental health and addiction services network. Gaps in services included opportunities for organizational change and policy development.

Also, the project team investigated 5 areas for transitional age youth: psycho-social rehabilitation services, housing, referrals and assessments, a best practice service for youth, and a service delivery model for transitioning youth into the adult network. The project team saw this as a means of creating the journey for transitioning youth into the adult mental health and addiction network and to support the work of the Task Force which met on 25 March, 2009.

Process and Methodology- Literature Review

A number of best, leading and promising practices were identified in the literature, government reports and field practices. The information would suggest that a best practice for early youth interventions was not associated with any one approach to service provision, but rather a multi-intervention approach, where risk factors are managed and protective factors are enhanced.

Government reports support an integrated, collaborative, seamless approach involving service providers, consumers and families in all aspects of treatment.

Current services and practices in the community reveals that the management of risk and enhancement of protective factors approach is in place and there were indications that integration of services and programs have been successful in health promotion, education and mental health and addiction interventions.

Process, Methodology and Summary of Findings - Health Promotion:

A health promotion environmental scan was completed in order to identify youth mental health and addiction promotion and education services. The scan involved site visits, telephone interviews with children and adult community mental health and addiction agencies , (69 service providers), meetings with consumers, families and community groups (70 persons), and completion of a literature review regarding best practices in the area of mental health and addiction promotion. Also, a survey was forwarded to

2 service providers in November, 2008 in order to confirm findings from site visits and telephone interviews.

The environmental scan revealed a number of best practices and approaches. The Centre for Addiction and Mental Health has developed a best practice guideline(s) for mental health promotion promotions interventions for children and youth. The guidelines include evidence based approaches in the application of mental health promotion concepts and principles for children and youth and are based upon mental health principles that have been identified through critical analysis of literature reviews. The guidelines are based upon ideal mental health promotion interventions.

A comparison of current services to best practices in the literature was completed and a leading practice in the field of mental health and addiction promotion was identified.

Findings reveal that there are many youth mental health and addiction health promotion and education services are available to youth and provided in a variety of setting (schools and community based service settings). Most mental health and addiction health promotion services address risk and protective factors.

All service providers were client centered in their approach to mental health and addiction education services to youth, with a goal of educating and empowering the consumer. Curriculum associated with the programs varied in research, quantity, quality and evaluation processes. Available information through agency websites supported principles of cultural appropriateness, sensitivity and accessibility to the public.

Youth mental health and addiction services focused on peer relationships, resiliency, and effects of bullying and stigma related to mental illness and addiction. A gap in services may be identified in the area of education information to families and youth which are linguistically appropriate and in most cases, ongoing training for health promotion services.

Process, Methodology and Summary of Findings – Transitional Age Youth

The Transitional Age Youth project team was comprised of 13 members (consumers, family and service providers in the children and adult mental health and addiction network) and met on 5 occasions. The project team supported a terms of reference which included a multi intervention approach to transitioning youth into the adult mental health and addiction network. Literature and data supports the need to provide mental health and addiction treatment for youth.

The project team researched and investigated the following areas:

Service delivery model: A summary of evidence demonstrates that Assertive Community Treatment (ACT) programs improve clinical status and reduce hospitalizations;

3 Psycho-social rehabilitation programs and services: While there are many best practices programs and services identified, education, employment and family support services for transitional age youth were identified as most important for transitional age youth.

Housing was identified as fundamental for successful transitions into the adult mental health and addiction network. Some gaps in mental health and addiction supportive housing, use of emergency shelters by youth and a lack of available data were some of the findings and a need to initiate further research in the area of youth housing.

Referrals, assessments and communication issues were also reviewed by the project team members. Referral forms were developed and standardized tools of assessment for youth over and under the age of 18 years were investigated. Communication between and amongst service providers and ensuring that privacy of individuals is protected is highlighted as central to success transition for youth.

Best Practice principles for service delivery identified 3 main areas: orientation to client, approach to practice and appreciating the context. The team supported these guidelines for use by children, youth and mental health and addiction practitioners, noting that it was of particularly importance for clinicians and practitioners who may be delivering services to youth in the adult system. The issues for youth who will not transition into the adult system may be understood by potential waiting lists in the adult system at the time of transitioning; situations where youth choose not to access mental health and addiction services; family breakdown and youth leaving parental home and experiencing homelessness; those who choose to leave care.

Systems Map Logic Model – Findings

A Youth Service Matrix Model was developed which outlined youth mental health and addiction services and service providers from both the children and adult systems.

Services include a wide range of providers and services from mental health and outlines common areas for the network. The map is also a useful tool for agencies, consumers and families in order to identify who provides what services for children and a means of navigating through the children and adult mental health and addiction network. (See appendix # 1).

Recommendations of the Transitional Aged Youth Project Team based on the Findings

1. Youth are best supported when using a model of Best Practice

• That a recovery model of practice is incorporated into treatment approaches (wellness philosophy). Best practices support a recovery model approach involving a number of interventions and treatments for youth. The Project team recognizes the importance of client centred care, respect, choices, potential for change in children and youth. , The project team supports the need to avoid labels which can stigmatize and emphasize illness rather than wellness. 4 • That youth are supported in their home communities. The project team recognizes the importance of family, peers and community in wellness of children. • All Services should be planned, implemented and evaluated using evidence- based Best Practice Guidelines.

2. Youth are best served when Agencies have the capacity to provide the highest quality of service.

• Both the Youth and Adult Mental Health and Addictions System require capacity building in order to address the needs of Transitional Aged Youth. Part of this capacity building involves funding for Infrastructure development which will permit the implementation and maintenance of a connected system of service. • That agency needs are recognized in the provision of transitional age youth services. When changing, expanding and creating new services for transitional aged youth, adequate funds and resources must be in place. Such resources should be seen as a social investment and not a cost. • The project team recognizes that Agencies require enhanced funding which is specifically targeted to serving Transitional Aged Youth. • The project team also recognizes the importance of communications in the creation of networks, collaborative partnerships and case coordination. • That a network of care is established to address the needs of transitional age youth and specialized populations. The team notes that while there are specialized services in the children and adult network; a similar service needs to be implemented to serve Transitional Aged Youth. • The project team recognizes the importance of networks and partnerships in the process of transferring youth into the adult mental health and addiction network Partnerships should also include Service Providers and Educators. • This Network must function on the basis of Referral Protocols that are compliant with relevant legislation, but must also provide for a system of care that is as seamless as possible. Service Providers should initiate the transition process early for those Youth who will be entering the Adult Mental Health and Addictions System within a pre-determined window of time. • That a standardized referral system be established between the Youth and Adult Systems for Transitional Aged Youth.

3. Funding Bodies must work together to establish and coordinated and accessible system which will best serve the needs of Transitional Aged Youth.

• That an integrated and consistent relationship is established between Provincial Ministries which will result in a coordinated and accessible service to clients. The project team recognises the systemic challenges associated with transitioning youth into the adult mental health and addiction network and supports the strategic directions of the following

5 Ontario Government reports: “Making it Happen; “Making Services Work for People”; “Setting the Course, A Framework for Integrating Addiction Treatment Services in Ontario”; “A Shared Responsibility: Ontario Policy Framework for Child and Youth Mental Health”. Ministries must endorse a plan for resource allocation for transitional age youth. The project team recognizes that where there are limited resources for youth in some communities, services must take a collaborative approach to planning, transitioning and sharing resources in the area of mental health and addiction education and treatment. • The project team recognizes that resource allocations for services to schools are a shared responsibility, and provision of services to these settings will require greater social investments and resources. This will require an integrated, collaborative and creative approach to social investments, sharing existing resources and expertise that will be led by funding bodies.

4. Criteria related to accessibility to educational and vocational services serving Transitional Aged Youth need to be reviewed and revised in order to reflect a Recovery-Based perspective. 5. Services offered to Transitional Aged Youth and their families need to be accessible in terms of cultural, linguistic and gender diversity. Interpreters who possess an understanding of Mental Health and Addictions issues need to be made available to Transitional Aged Youth and their Families. 6. That an Assessment of Need for Transitional Aged Youth is conducted throughout the CELHIN that will address the diverse needs of the population. 7. Designated housing for Transitional Aged Youth should be made available through the Mental Health and Addictions System that will allow Youth to remain in their home communities. 8. An adequate system of Respite Care is made available to those families who require it. 9. Youth who access Shelter Services must have access to Mental Health and Addictions Supports through Service Agreements between the Shelter and the Mental Health and Addictions Service System. 10. That a coordinated system of Mental Health and Addiction Health Promotion is established and maintained throughout the CELHIN. This should include Providers, Educators, Families and Consumers. The purpose of this system would be to plan, implement and evaluate a comprehensive Program of Health Promotion related to Mental Health and Addictions throughout the CELHIN.

6

Literature Review and Best Practices: Youth Mental Health and Addiction

Literature identifies risk and protective models in achieving positive treatment outcomes. Risk factors should be understood to be conditions or elements which contribute to mental health and addiction, while protective factors are supports for prevention and reduction of risks for mental illness and addiction. Recovery models utilize selective interventions, preventive measures and promote positive conditions for treatment (Preventions Research Quarterly, November, 2007). A mental health strategy should include an approach where promotion, prevention, treatment and monitoring should be coordinated in order to best utilize primary care and schools. (Canadian Journal of Psychiatry, March, 2007).

Treatment approaches and methods should also address health problems, personal issues of mental health, self esteem, developmental change, family and peer relations, relapse management, family therapy, skills training and cognitive behaviour therapy, noting the importance of providing such services in a youth program structure , independent of adult treatment settings ( Health Canada. Best Practices, 2001).

10 guidelines for mental health promotion programs: children and youth were published by the Centre for Addiction and Mental Health. The guidelines are based upon mental health principles that have been identified as a best practice and include: address and modify risk and protective factors that indicate a possible mental health concern; intervene in multi-settings, with a focus on schools; focus on skills building, empowerment, self efficacy, individual resilience and respect; train non-professionals to establish caring and trusting relationships, involving multiple stakeholders; provision of comprehensive support systems that focus on peer and parent-child relations, and academic performance; adopt multiple interventions; address opportunities for organizational change, policy development and advocacy; demonstrate a long term commitment to program planning, development and evaluation and ensure that information and services are provided in a culturally appropriate, equitable and holistic manner (Center for Addiction and Mental Health, 2008).

Development of resiliency is another practice identified in the literature. Resiliency is the ability to cope with mental health and addiction challenges. Promoting competence, minimizing risks and stressors, facilitating protective mechanisms and processes, treating illness and reducing harmful practices are some of the methods to enhance resiliency ( Centre for Addiction and Mental Health, 2002).

Other best practice characteristics of successful mental health promotion interventions include clearly stated outcomes, intervention in multiple settings, provision of screening and early interventions for mental health problems at all stages of the lifespan, involvement of the social network, intervention over an extended period of time, long term investment in program planning, development and evaluation (Center for Addiction and Mental Health, 2003).

7 Best practices programs in the area of substance abuse (school settings) should include involvement of students, talking about why people use drugs, use of honest facts, use of non-scare tactics, realistic information about drug use, opportunities for active learning, use of students as leaders, reinforcement of messages in the community, involvement of families in the prevention efforts, use of a variety of health promotion strategies, involvement of students in the selection of the program(s), inclusion of information which outlines health and social consequences, a focus on teaching and building skills, messages about health risks, promotion of partnerships between schools and the community, advocacy for social change and evaluation (Centre for Addiction and Mental Health).

Other practices include a cognitive behaviour approach, where students learn about the true nature of addiction and address accepted attitudes associated with substance use; involvement of students in debates associated with substance abuse through the use of psycho-educational approaches. The focus is on covering a number of risk and protective factors with an emphasis on accurate information, training programs for leaders and preventing substance abuse problems among young people (Health Canada, 2001).

The literature also references mental health anti-stigma programs for youth as a leading practice and how this is an important means of changing attitudes towards mental illness and addiction. An evaluation of the Durham T.A.M.I. Project in 2007 revealed changes in student’s attitudes after completing the high school based anti-stigma education program. Similar results were found in a 2004 evaluation in Hamilton, Ont. (Watters, C et al., 2007 & Ross, M., 2004).

Reports completed by the Governments of Canada and Ontario support a number of recommendations and best practices for youth mental health and addiction interventions. The Standing Committee on Social Affairs, Science and Technology Report (May, 2006) identified the importance of housing, elimination of legislative silos that inhibit youth who are transitioning into adult mental health and addiction services, inclusion of family and caregivers in the treatment process, the importance of early intervention, a focus on community development, creation of baskets of community services, training for teachers in the area of mental health and addiction, development of schools as sites for effective delivery of services, promotion of collaborative care which includes a variety of mental health providers, consumers and family members in the partnerships ( Government of Canada, 2006).

The province of Ontario produced a number of reports (Making it Happen, Implementation Plan for Mental Health Reform; A Shared Responsibility: Ontario’s Framework for Child and Youth Mental Health; Setting the Course: A Framework for Integrating Addiction Treatment Services in Ontario, and Making Services Work for People: A New Framework for Children and for people with developmental Disabilities. The reports support the need to integrate and coordinate services, that all government and community partners must work together to achieve a community health sector that is coordinated, collaborative, and that support for collaborative planning should include

8 integrated service plans -involvement of mental health and addiction services, consumers, addiction services, families, self help organizations and community mental health agencies (Government of Ontario, 1999, 2006, 1999 and 1997).

Best, leading and promising practices in the area of early youth interventions, health promotion and education have been identified where services range from coalitions and partnerships in the area of mental health, anti-stigma education, Early Psychosis Intervention programs and partnerships in the area of addiction. Community Health Centres, Canadian Mental Health Associations, children and adult mental health and addiction service providers, Schedule 1 and 3 Health Centres, housing programs and services provide a range of specialized and generic services to youth. Health Promotion Findings

Existing youth mental health and addiction services indicates that a variety of mental health and addiction educational programs are offered to youth, primarily within school settings. Highlighted are 1) a best practice and 2) a review of programs. Best Practice

The Centre for Addiction and Mental Health has developed a best practice guideline for mental health promotion for children and youth. The guidelines include evidence based approaches in the application of mental health promotion concepts and principles for children and youth and are based upon mental health principles that have been identified through critical analysis of literature reviews. The guidelines are based upon ideal mental health promotion interventions and include: 1) Address and modify risk and protective factors that indicate possible mental health concerns; 2) Intervene in multiple settings, with a focus on schools; 3) Focus on skill building, empowerment, self efficacy and individual resilience, and respect; 4) Train non-professionals to establish caring and trusting relationships; 5) Involve multiple stakeholders; 6) Provide comprehensive support systems that focus on peer and parent-child relations, and academic performance; 7) Adopt multiple interventions; 8) Address opportunities for organizational change, policy development and advocacy; 9) Demonstrate a long term commitment to program planning, development and evaluation; 10) Ensure that information and services provided are culturally appropriate, equitable and holistic (Center for Addiction and Mental Health, 2008). 9 Programs

Early Psychosis Intervention Programs

The Early Psychosis Intervention programs within the CELHIN (Durham Amaze Program in Durham, the LYNX Program in Peterborough and the Toronto Early Intervention in Psychosis Network in Scarborough) offer a mental health and addiction educational component. The educational service is provided in school settings and relationships between the schools and the programs appear to have been developed on an individual basis between the program and the schools. Curriculum from established programs; i.e. CAMH - Talking About Mental Illness Program- has been adapted in one case, while another program offered has developed their own curriculum. Evaluation components are in place - pre and post test questionnaires. Addiction Service Providers

Addiction services also provide health and educational promotion to youth, either in the form of inpatient and clinical interventions or services to school. Educational opportunities are provided to schools, individuals, families and community groups, with a focus on addiction and concurrent disorders. Service appears to be provided on an as requested basis from the schools. The Centre for Addiction and Mental Health services, located in Peterborough and Durham Region also provides education and consultation services to youth and schools; a Drug Awareness Coalition in the city of Peterborough and the County of Peterborough provides health promotion and education; the Chinese Family Services of Ontario offers educational workshops on parenting, marriage enrichment, stress management and addiction education. Pinewood Addiction Support Services and Four Counties Addiction Services (Fourcast) also provide health promotion and education services. The Community Health Centres

The CHC’s offer a variety of mental health and addiction health promotion services to youth. The Oshawa CHC for example offers a new anti-bullying project, while the Youth Centre offers mental health and addiction educational services to youth and schools; the Brock CHC has developed collaborative relationships with a local school in health promotion. The Westhill CHC has mental health promotion initiatives.

Public Health Departments

Public Health Services also have an educational component for provision of mental health and addiction education, yet the environmental scan revealed that there appeared to be a focus on the anti-tobacco initiative; addiction education is reported in a Substance Abuse Initiative which provides information about alcohol and other drug issues and supports prevention projects in the community.

10 The Central East CCAC

Available information obtained during the environmental scan reveals that the CCAC provides children/school health support services and medical rehabilitation needs.

Schedule 1 Health Centres (Hospitals)

A number of community mental health and addiction services are offered by the Schedule 1 Hospitals; i.e., Northumberland Hills Hospital, Campbellford Hospital, Haliburton Highlands Health Centre, Ross Memorial Hospital, Lakeridge Health Oshawa. In some cases, these Schedule 1 Hospitals support the Early Psychosis Intervention Programs and addiction services (Campbellford Hospital, Ross Memorial Hospital, Haliburton Highlands Health Centre, Northumberland Hills Hospital, Lakeridge Health Corporation). The Scarborough General Hospital supports an addiction service, provided by the Centre for Addiction and Mental Health, with some education services for addiction and problem gambling. Rouge Valley Health Services supports adolescent inpatient and outpatient services, where mental health education is available to parents to assist with their children.

(Schedule 1 Health Centre) Whitby Mental Health Centre

The Whitby Mental Health Centre provides a range of inpatient and outpatient mental health services to youth, in addition to health promotion programs and services. The centre supports the Talking about Mental Illness Program (T.A.M.I. project). The project includes the T.A.M.I. Coalition of Durham Region, which is an integrated service comprised of mental health and addiction service providers, educators and consumers/survivors. The coalition’s terms of reference is centered on mental health stigma reduction, educational events for youth, particularly students.

The stigma reduction curriculum has been researched and evaluated and is delivered by trained speakers. Conferences (summits) are coordinated and implemented by the Durham T.A.M.I. Coalition on a yearly basis. The summits are directed towards engaging the broader community towards the goal of mental health and addiction stigma reduction.

Curriculum focuses on skills building, coping strategies, respect, community development and training volunteer speakers. Coalitions involve a number of service providers and consumers and supports the principle that stigma reduction education is essential to student well being and success in other areas of learning. The project also incorporates a number of methods in the stigma reduction education process utilizing a non discriminatory approach. The T.A.M.I. project has been the recipient of a number of awards in recognition of their mental health and addiction health promotion strategies.

Other Children and Adult MH&A Promotion Programs

The children and adult mental health and addiction service network within the CELHIN also provides health promotion services.

11 Frontenac Youth Services, Kinark Youth Services, CHIMO Youth Services, East Metro Youth Services, Youthlink, Tropicana Youth Services and Peterborough Youth Services also offer a variety of health promotion service to youth up to the age of 18 years. Some involve collaboration with area schools, families and youth on an individual basis. Alternative learning opportunities have been supported through collaborations between local boards of education. Other programs include violence prevention initiatives such as peer led training and workshops on issues such as bullying, dating violence, gang violence, conflict resolution and anti bullying training for first nation community workers in Northern Ontario. An award winning anti-violence program has been developed.

The Canadian Mental Health Associations (Durham, Kawartha Lakes, Toronto and Peterborough Branches) offer mental health and addiction education in their services. Curriculum has been established in order to educate students on issues pertaining to mental health (Peterborough CMHA, through the LYNX program – Open Your Mind Program, Inter-link and Kids on the Block). Durham Branch offers public education regarding mental health issues, training to other professionals and workshops on stigma reduction. Kawartha Lakes Branch offers public education to enhance mental health well-being and stigma reduction (curriculum was not available at the time of this report). The United Survivors Group in Oshawa provides mental health education in the form of self help groups.

Hong Fook Mental Health Association offers health promotion through a newly formed group “Mind Matters” consisting of volunteers from the community.

Youth Link offers a variety of prevention and early youth intervention programs directed towards self esteem, leadership development and violence prevention.

Point in Time Centre for Children, Youth and Parents offers a parenting and public education program.

Discussion - Gaps in Service

Many youth mental health and addiction health promotion and education services are available to youth and provided in a variety of setting (schools and community programs). Most mental health and addiction health promotion services address risk and protective factors and some excel in this area. Notably, addiction services teach and support recovery models through inpatient and outpatient services and education services to schools. Also, the T.A.M.I. project utilizes speakers to assist youth identify risk and supportive situations in their curriculum as does some of the health promotion service through the Early Psychosis Intervention programs, CMHA Services, Hong Fook Mental Health Association and the CHC’s. Some services address risk and protective factors, skills building, training to speakers, involvement of the community, are culturally appropriate and some education is provided to individuals in a clinical context – i.e., group and individual counselling and case management. Most mental health and addiction services are directed towards students.

12 Many of the youth mental health and addiction health promotion services are directed toward the school settings; an example is the work of the community health centres, the T.A.M.I. project, the work of the Early Psychosis interventions programs. Some children’s services for example, Point in Time, Kinark, Frontenac, East Metro Youth Services, Pinewood, Fourcast, CAMH Addiction Services and the CMHA services provide training and education for youth in individual and group work situations.

All service providers in the scan were genuine and client centered in their approach to mental health and addiction education services to youth, with a goal of educating and empowering the consumer. Curriculum associated with the programs varied in research, quantity, quality and evaluation processes. The T.A.M.I. project for example has been identified as a well researched and evaluated program with numerous awards for quality and quantity of stigma reduction information. Other programs did not appear to have the same degree of research, evaluations and recognition attached to their programs.

There was a gap identified in the area of health promotion training for service providers. Few services indicated a training component for non-professionals, other than the Durham T.A.M.I. Project/Coalition which has one of two provincially mandated trainers as a member. This person provides training to speakers/volunteers in the implementation of the program. Other programs have utilized health promotion educators and clinicians in stigma reduction presentations (the CHC’s, the CMHA services, Addiction services) and it was not clear to what degree clinicians had been trained in the stigma reduction presentations or if volunteers were utilized in presentations.

Most services involved a number of stakeholders, but with the exception of the Durham T.A.M.I. coalition, utilized personnel from home agencies. The T.A.M.I. coalition involves a number of mental health and addiction service agencies, schools and consumers within the Durham Region in their health promotion initiatives; Hong Fook Mental Health Association appears to involve the community supports in their new program, while the anti bullying program through the Oshawa CHC did not provide information regarding other stakeholders or who was involved in the delivery of their service. The Brock CHC involves a school in a health initiative.

Many youth mental health and addiction services focused on peer relationships, resiliency, and effects of bullying and stigma related to mental illness and addiction. Psycho-social rehabilitations programs are provided to family members through the Family Outreach Recovery Program, family support groups offered through the LYNX program, counselling services offered through CHC services and CMHA services. Children’s mental health services (Frontenac, East Metro Youth Services, CHIMO Youth and Family Services and Youthlink et al also offer support focusing on family-child relationships). The Durham T.A.M.I. project/coalition also supported development of peer relationships.

The CHC’s and addiction services offer a number of interventions in mental health promotion. The Durham T.A.M.I. project supports community engagement with the

13 school boards and broader community and provides skills building workshops and conferences/summits which support school policies directed at stigma reduction.

There did not appear to be many opportunities for service providers to engage in the organizational change, policy development and advocacy in this aspect of service delivery. Some programs provide advocacy through the educational services and this may be interpreted as a form of empowerment and change. (The United Survivors of Oshawa, S.P.A.N., Provincial Patient Advocacy Programs, CMHA programs).

Some services have been in operation for a brief period only while others have recently started providing mental health and addiction education programs. Other programs such as the CHC’s are well established in their services and yet one new CHC is beginning to develop services. The Durham T.A.M.I. coalition and project has been in operation since 2002 and prior to this, had been supported by the Centre for Addiction and Mental Health since 1994. There has been ongoing planning, development and evaluation associated with this program over the years.

All services identified within the environmental scan should be seen as culturally appropriate, sensitive and available to the public, however, a gap in services may be identified in the area of education information to families and youth which is linguistically appropriate.

The project team noted that while there are a number of effective anti-stigma education and prevention programs and services, there was a need for coordination, research, evaluation, partnerships between schools and community services, training for volunteers, peer support and inclusion of youth in the anti-stigma educational process. The project team would support creation of coalitions, similar to the Durham T.A.M.I. Coalition, for Scarborough, Peterborough and the 4 Counties.

As well, responsibility for health promotion and education should be seen as a shared responsibility between the school boards and the community mental health and addiction service providers. Provision of services will require social investments, but also recommends creative and collaborative approaches which involve partnerships amongst school boards, service providers and benefactors (volunteers).

Transitional Age Youth

Findings

The Early Youth Intervention Charter referenced the need to address the issue of transitioning and supporting youth who require mental health and addiction services in the adult system, noting that this population is a growing part of the population within the CELHIN.

In addition, literature and studies support the need to address treatment for youth. It is estimated that one in five children has a serious mental health problem; similarly, alcohol and drug abuse data for youth indicates that approximately 8% of youth between the ages of 15 and 24 years report being affected by an alcohol or illicit drug 14 dependency; one in ten Canadians, aged 15 and over, (approximately 2.6 million people) reported symptoms consistent with alcohol or illicit drug dependence. Other information reveals that youth, between the ages of 15 and 24 years, are the least likely to use any resources for problems associated with their mental health and use of alcohol or illicit drugs ( Health Canada, Statistics Canada: CCHS 2003).

The project team reviewed the definition question associated with transitional age youth. Definitions include “an early period of development; the time between childhood and maturity; or a young person in adolescence”. The project charter identified the age range of 14 to 21 years. In addition, the project team reviewed service age for youth, noting that there is a cross-over of responsibilities between ministry mandates, where adult mental health services assist beginning at age of 16 years while children’s mental health services are mandated to provide service to youth up to, and including, the age of 18 years ( Government of Ontario, 2008). It was highlighted that this cross sectional responsibilities can create challenges and confusion for consumers, families and service providers.

The project team also reviewed available data pertaining to youth. Age distribution data was available for the Haliburton, Kawartha and Pineridge District for 2006 (data for other areas have been requested and not available at the time of this report). The age group between the ages of 5 and 19 years is the largest group, with distribution between males and females remaining the relatively the same. Projections for population growth in this district for this age group is noted to be in decline, where trends for the age group is projected to be declining by 2011 and 2016 (see appendix # 7)

Finally, Mental Health and Addiction service utilization for the youth population in 2006 for this district reveals high utilization in Haliburton for counselling services and high service utilization for counselling and family services in Northumberland County. (See appendix # 4).

5 areas were investigated by the project team: psycho-social rehabilitation programs and services, best practice guidelines for service delivery, assessments, referrals and communications, housing and a service delivery model.

Psycho-Social Rehabilitation Programs

Definitions of Psychosocial rehabilitation is varied: referred to as “non bedded” services, where mental health services are delivered to individuals and can be provided in the client’s environment (home, workplace) and that do not require an overnight stay for medical care. This definition does not include clinical interventions that are required for outpatient services (Government of Ontario, 2002).

Other definitions include “The process of facilitating an individual’s restoration to an optimal level of independent functioning in the community... while the nature of the process and methods used differ in different settings, psychological rehabilitation invariably encourages a person to participate actively with others in the attainment of 15 mental health and social competence goals. The process emphasizes the wholeness and wellness of the individual and seeks a comprehensive approach to the provision of vocational, residential, social recreational, educational and personal adjustment services” (International association of Psychosocial Rehabilitation Services, 1985).

A number of programs and services available to youth should be considered best practice and following a review by the project team, education, employment and family support services were considered a priority.

Data for youth employment in 2006 in Haliburton, Kawartha and Pineridge District reveals an unemployment rate of 16.6% for the age range between 15-24 years (see appendix # 6). In addition the project team cited the ability to read, write and problem solve as important consideration in order to cope with a mental illness or addiction. Further, the project team emphasizes that successful educational outcomes are related to mental health wellness.

The project team also recognized the sensitive and vulnerable issues for youth who come from diverse cultural back grounds, as well as gender identity issues. Notably, it should be highlighted that youth who are new Canadians are, in many situations, “the bridge” between their families and the larger culture and assume many roles: interpreter, advocate, care-giver and in some cases a source of income for families. The project team also highlighted the need for culturally appropriate interpreting services that have an understanding of mental health and addiction issues and support the need for training interpreters in the area of mental health and addiction services. This also applies to specialized medical conditions, i.e., hearing impaired. Because of the lack of knowledge and vulnerability of youth, gender identity issues can crate and lead to illness and addiction. The project team supports creation and expansion of existing sexuality counselling and educational services for youth.

The project team also reviewed existing programs and services in the adult service system and note that while there are a number of services for youth in the adult system, that the distinction between adult and youth needs must be understood and programmed for by the adult service providers. Other recommendations for service provision includes community based services, highlighting the need to support youth in their own community, close to family and peers; that access to programs should not depend upon a youth’s disability but ability, where it is noted that many rehabilitation programs have an accessibility criteria that is based upon disability, not ability.

Housing

The project team recognizes that transitional age youth must have access to safe, affordable and supportive housing and that youth, who have a mental illness and addiction, cannot be adequately supported while living on the “streets” or in adult emergency shelters.

A best practice in the provision of housing for youth varies, but some practices focus on: meeting basic needs first; scattered site apartments; convertible leases; target services

16 to the unique needs of sub-populations and an integrated approach to services and housing where partnerships are developed between and amongst existing service providers (integrated housing with employment and training, case management and mentoring) (Vancouver Housing Options Study, 2007).

Research supports a link between homelessness and mental illness. There where higher levels of diagnosed mental illness among people who were homeless than among the population as a whole. Rates of substance abuse are higher among homeless individuals and homeless individuals with both a substance abuse disorder and a mental illness are likely to remain homeless longer than others (Canadian Institute for Health information, 2007-2008).

The project team researched available data and literature pertaining to homelessness amongst youth. Estimates indicate that in Toronto, youth homelessness is over 12,000 persons (Cameron et al., 2004); that youth make up about 6.1% of the population using shelters ,that mental disorders account for more than half of hospital stays among the homeless in Canada; that mental disorders accounted for 52% of acute care hospitalizations amongst the homeless in 2005-2006 (outside Quebec) ; that 35% of visits to selected emergency departments (Emergency Departments) – mostly in Ontario – by homeless persons were related to mental and behavioural disorders, a proportion that is higher than that for other patients (3%); that mental disorders account for more than half of the hospital stays among homeless in Canada ( Canadian Institute for Health information, 2007-2008).

Exact numbers of youth homelessness within the CELHIN was difficult to determine. Information obtained from the Region of Durham regarding hostel use for the year 2008, for example, revealed that more than 300 youth between the age of 16 and 24 years utilized a shelter in Oshawa, Ont. (Cornerstone Men’s Hostel) ( Region of Durham, December, 2008); that a Toronto Shelter for Youth (Second Base Youth Shelter, Scarborough) reported occupancy of 900 in 2008 ( Second Base Youth Shelter, 2009); The Durham Youth Housing & Support Services, Ajax, Ont. reported more than 100 utilized their service between April, 2008 and December 31, 2008 (a total of 2425 bed nights) (Durham Youth & Housing Support Services, February, 2009).

The reported reasons for shelter use amongst varied: family breakdown, discharge from a correctional centers, lack of housing, hospital discharge, street involvement, addiction, transient lifestyle, family abuse, refugees, escaping violence, far away from home (stranded in the area), financial, coming from treatment and unsafe housing ( Second Base Youth Shelter, 2009 and Durham Youth Housing & Support Services, 2009).

Referral sources for hostel use include schools (guidance counsellors), police, street helpline, word of mouth, Toronto Bail Program, shopping malls and community mental health services (Second Base Youth Shelter, 2009 and Durham Youth Housing & Support Services, 2009).

17 The project team recognized the importance of housing for transitional age youth and recommendations are focus upon family support services (counselling and respite services for families), integrating existing mental health and addiction services with emergency shelters to assist youth; designating a certain number of beds in the existing adult supportive housing system for transitional age youth (independent of adult beds); initiate a more detailed investigation into housing supports in the northern section of the CELHIN. The project team members note that in this part of the LHIN, many transitional age youth are in competition with others who have housing needs; that there are no existing rental units, emergency shelters, transitional housing units or long terms residential settings available for youth, and that the need for a place to live can remove a vulnerable youth from a community.

Finally, the project team was in support of further research into the homelessness and housing challenges experienced by youth. Exact data regarding numbers and needs were difficult to obtain (homelessness, living at family home, “couch surfing”, living in institutions and unable to leave due to housing availability, incarcerated). This was seen as a major barrier and gap in transitioning youth into the adult mental health and addiction network.

Best Practice Service Delivery

The Ontario Youth Strategy Project (2008), with the support of the MOHLTC summarized ways of utilizing the best practice information. The result was a work book that transcribed directions into guidelines to assist organizations.

The best practices focused on 3 main areas:

1) Orientation to Client, where an orientation of client centred and client directed care is recommended; trust and respect of the youth’s motivation for treatment; involvement of the family, as defined by the youth; seeing the youth within their “system “ of relationships, which includes peer, family, community and others.

2) Approach to practice highlights that a practice must have an explicit framework that directs and leads to measureable outcomes; utilizes a holistic, bio psycho-social approach; incorporates a harm reduction approach and one that is strength based, experiential and focused on skill building. The guideline highlights the need for social service organizations, provide services to youth to ensure that treatment services have an intended “impact” and client experiences reflect the client centered, strength based, and holistic approach.

3) Appreciating the context must include a safe and respectful service which involves in a manner that is meaningful, which develops, delivers and evaluates services; recognition that youth are not a “homogeneous” group and that tensions are managed in a manner that includes client’s needs, choices and resources.

18 The guidelines recommend provision of a safe and respectful service for youth who are seeking service where they can be supported with guidance, recognition and respect. A safe environment for service provision is cited as a critical component for treatment, where harassment, abuse, discrimination or oppression is not tolerated. The guideline highlights that effective treatment occurs within a culture of respect, where clinical staff treat each other with dignity and respect (Government of Ontario, 2008).

The project team identified the need to have a standard of practice for clinicians and practitioners who deliver services to transitional age youth in the adult system. The project team viewed transitional age youth as unique: not adults in a cognitive and behavioural sense, and legally not defined as children. Challenges with respect to consents to treatment, right to make choices, engagement in the treatment process, supporting a harm reduction approach to substance use, creating a treatment environment which is sensitive to youth needs, involving family as much as possible are important issues for adult clinicians and mental health practitioners.

The project team recommends that these guidelines are utilized by clinicians and practitioners in the adult system whose practice involves working with youth.

A Service Delivery Model

A challenge for the project team was addressing the issue of a safe treatment approach to creating the journey for a youth moving into the adult system. The case management model of service delivery was investigated by the team and after discussion and review, identified this approach as a best practice to assist transitional age youth access services and programs in the adult system.

Case management services assign the administration of care for a client to a single person (or team) and can include coordinating all necessary medical and mental health care, along with support services. The purpose of case management is to enhance access to care and improve the continuity and efficacy of service. Services can range from linking clients to services, provision of clinical or rehabilitative services, outreach services to engage clients, assessing individual needs, arranging support services such as housing, financial benefits and job training, monitoring medication and advocacy for clients.

Models of case management include: Assertive Community Treatment (ACT), intensive case management and clinical case management (Encyclopaedia of Mental Disorders, 2009).

A range of clinical trials have accumulated evidence to demonstrate that Assertive Community Treatment (ACT) programs are superior for improving clinical status and reducing hospitalizations in Canada. Studies generally support that ACT is a cost effective alternative to hospitalizations with standard aftercare for person at risk for repeated hospitalization; produces high rates of client and family satisfaction and no increased burden on families. A smaller body of controlled and uncontrolled studies

19 show that rehabilitation and personal strengths models are effective in improving social and vocational functioning and promoting residential stability and independence (Public Health of Canada, 2002).

The Ministry of Health and Long Term Care published case management standards in May, 2005 and the document highlights the need to “achieve a consumer oriented system that provides access to effective, quality health services through accountability and performance management”, supporting the need for consistency of case management services throughout the many mental health and addiction settings, ensure that a system wide goal of mental health reform is achieved and finally standards of service delivery will permit the development of performance measures and data collection requirements for monitoring purposes ( Government of Ontario, ).

Treating youth who do not transition into the adult system, dealing with waiting lists in the adult system, youth who leave care at a designated age, provision of family supports while waiting for services in the adult system, and advocacy were reviewed by members of the project team. It was felt that case managers (youth and adult allies) who assist consumers, families and service providers during the transition period would ensure that the necessary supports are in place until a link is established with the adult system.

It was also recommended that a case managers work with youth, families and service providers in both the children and adult mental health and addiction system and provide programs and services, advocacy, family, educational and vocational counselling during the transition process. The project team highlighted the need for an integrated and consistent relationship between ministries when reviewing case management services for transitional age youth as well as the need for ministries, children and adult service providers to work collaboratively in sharing resources and responsibility for transitional age youth.

The project team acknowledged that creating a new service for transitional age youth will require resources but suggests that opportunities may come about as a result of shared responsibilities between ministries and service providers where pilot projects are initiated by service providers with a view to providing transitional age youth case management services.

Finally, the project team recognizes the importance of networks and case coordination in implementing a case management approach to transitioning youth. Case coordination activities have proven to be successful, and with the support of case management services, would ensure that youth are not “lost” in the journey between the children and adult mental health systems.

TAY Assessments, Referrals, and Communication

The Project team also reviewed and investigated the issue of assessments, referrals and communication of information for youth who are transitioning into the adult mental health and addiction services network. Communication between and amongst service

20 providers was seen as critical, yet at the same time, it is important to ensure that privacy of youth is respected and in line with existing regulations.

Team members reviewed the standardized tools of assessment for youth over and under the age of 18 years ; i.e., the CAFAS, BCFPI, RAI-MH and the Common Assessment (Camberwell) as well as clinical and discharge summary documents. The project team recommends that referral must contain demographic information, the referring agency, a summary of contacts, medications and who prescribes them, relevant medical history and any medical conditions, summary of involvement, treatment plans/goals and other agency involvement. Consent to release forms and documentation must accompany any referrals. The referral process must begin as early as possible or when it is reasonable to believe that a child may require mental health and addiction services in the adult system. The project team notes that signed consent forms must be used when any communications between children and adult service providers takes place.

The Personal Health Information Protection Act, 2004 (PHIPA) was also reviewed by the project team. The act makes provision for communicating health care information between and amongst services providers as well as providing for protection of privacy.

Highlights of the act includes rights and responsibilities for consumers, families and agencies as well as roles and responsibilities: a health custodian may disclose personal health information for the purpose of determining or verifying the eligibility of the individual to receive health care or related services, goods or benefits, contracts and agreements regarding the exchange of information between health care custodians may occur and a health care custodian may disclose personal health information if the potential successor first enters into an agreement with the custodian to keep information confidential and secure and not to retain any of the information longer than is necessary for the purpose of assessment or evaluation (34).

Consents which are required under PHIPA may be given verbally, in writing or by electronic means, and implied consent permits a health care custodian to infer from the surrounding circumstances that an individual would reasonably agree to the collection, use or disclosure of his/her personal information (35).

The circle of care definitions, implied consents, verbal consents, signed and witnessed documents are important considerations for clinician and practitioners.

The project team recommends that protocols for information exchange between children and adult mental health and addiction services must adhere to privacy laws and regulations, as set out under the PHIPA, 2004. Any clinical files or documentation (electronic and paper) must be stored safely.

Also, the team recognized the need for communications, and information exchange in the transitioning process and the need, once again to begin transitions at an early stage.

21 Next Steps

1) Youth who will not transition into adult mental health and addiction network (need a profile of this group, CMHS?) 2) Committee to review systems map for accuracy, gaps and mandate drift 3) Committee to set up and execute a consultation process for youth and to incorporate outcomes into final report.

22

References

Bains, N. Et al. CELHIN, Population Health Profile. Cameron, K., Y. Racine, D. Offord, J. Cairney. Youth at Risk of Homelessness in an Affluent Toronto Suburb. Toronto: Oct. 2004

Canadian Health Information Institute. Improving the Health of Canadians 2007- 2008- Mental Health and Homelessness. Ottawa: 2008

Canadian Mental Health Association& Centre for Addiction and Mental Health (2001). Talking About Mental Illness – Community Guide. Toronto: Centre for Addiction and Mental Health.

Canadian Mental Health Association, Peterborough, Open Your Mind: Mental Illness Needs Demystifying. Peterborough: Canadian Mental Health Association, LYNX Program, United Way and the Schizophrenia Society of Ontario.

Canadian Mental Health Association& Centre for Addiction and Mental Health (2001). Talking About Mental Illness – Community Guide. Toronto: Centre for Addiction and Mental Health.

Centre for Addiction and Mental Health (2008) Best Practice Guidelines for mental health promotion programs: children and youth. Toronto: Centre for Addiction and Mental Health.

Centre for Addiction and Mental Health: Theory, definitions and context for mental health promotion; Adolescent mental health, Resilience and Ontario data; Adolescent Concurrent Disorders, Youth & drugs and mental health: A Resource for Professionals; The Relationships between substance use and mental health problems; Adolescent substance use; The most common concurrent mental health problems; Alcohol & Drug Prevention Programs for Youth: What Works? Programs That Work with Youth. Toronto: Mental Health and Addiction Statistics. 2003.

Cameron, Kelly N., Yvonne Racine, David Offord and John Cairney. Youth at Risk of Homelessness in an Affluent Toronto Suburb (2004). Canadian Journal of Public, 95, 352-356.

City of Toronto Planning Department (2006). Perspectives on Housing Affordability. Toronto.

CMHA, Peterborough (2004): Lynx early Psychosis Intervention Multi-Agency Network Model.

Cnaan et al. Psycho-Social Rehabilitation Journal; Vol. 11, No. 1: April, 1998.

23 Concurrent Disorder Network of Durham Region (2007). Integrated System Development for Children, Youth, Families, and Caregivers with Concurrent Mental Health and Substance Use Issues: Consensus Document and Charter.

CMHA, Peterborough: Lynx Early Psychosis Intervention Multi-Agency Network Model (2004).

Durham T.A.M.I. Coalition (2006). Teacher’s Facilitation Guide, Student Learning Guide. Whitby: Durham T.A.M.I. Coalition.

Durham Youth Housing & Support Services (2009). Project Utilization. Ajax.

Central East (Whitby) Mental Health Implementation Task Force (2002). Seizing the Opportunity. Whitby.

Family Outreach & Response Program. Talking to Youth Lately (TTYL) (2008). Scarborough.

Gerstein Idea. A Shelter When it is Dark, Toronto, Vol. 1, Issue 1, Spring/Summer, (2008).

Goren, N. & Jane Mallick (2007). Prevention and early intervention of coexisting mental health and substance use issues. Prevention Research Quarterly: No. 3. Melbourne, Australia.

Government of Canada (2001). Best Practices. Treatment and Rehabilitation for Youth with Substance Use Problems. Minister of Public Works and Government Services Canada.

Government of Canada Preventing Substance Use Problems among Young People – A Compendium of Best Practices (2008). Minister of Public Works and Government Services Canada.

Government of Canada (2006). Out of the Shadows at Last, Transforming Mental Health, Mental Illness and Addiction Services in Canada. Minister of Public Works and Government Services.

Government of Canada (2008): Intraspec.

Government of Canada: Review of Best Practices in Mental Health Reform (2002). Ottawa.

Government of Ontario (2002). Best Practices in Treating Youth with Substance Use Problems. A Workbook for Organizations that service youth. Toronto.

24 Government of Ontario. A Shared Responsibility (2006). Ontario’s Policy Framework for Child and Youth Mental Health, Ontario Ministry of Children and Youth Services.

Government of Ontario (2005). Intensive Case Management Service Standards.

Government of Ontario (1999). Making it Happen. Plan for Mental Health Reform, Ontario Ministry of Health and Long Term Care.

Government of Ontario (1997). Making Services Work for People. A New Framework for Children and for People with Developmental Disabilities, Ontario Ministry of Community and Social Services.

Government of Ontario (2002). Tier 3 Provincial Working Group. Definition of non – bedded services. Toronto.

Heeney, B (2008). Mental Health and Schools Symposium “Stomping Out Stigma Summits for Youth. Whitby: Durham TA.M.I. Coalition.

Hussain, A. A Discussion on the Role of Case Management within Community Mental Health.

John Howard Society of Durham (2008). Housing Programs. Whitby.

Kraus, D and J. Woodward (2007). Vancouver Youth Housing Options Study. Vancouver.

Leavey, J. “Building Better Health Care Models for Youth with Emerging Mental Health Problems”; 5th National Conference on Shared Mental Health Care. Vancouver (2004)

McGrath, Y., Sumnall, H., McVeigh, J., Bellis, M (2006). Drug use prevention among young people: a review of reviews. Evidence briefing update. UK: National Institute for Health and Clinical Excellence.

National Child Traumatic Stress Network Engaging Adolescents in Treatment.

Ontario Substance Abuse Bureau. (1999) Setting the Course. A Framework for Integrating Addiction Treatment Services in Ontario.

Ontario Federation of Community Mental Health and Addiction Programs (2009). Core Principles of Psycho-social rehabilitation (PSR Toolkit).

Psycho-social Rehabilitation Canada. Core Principle of Psycho-social rehabilitation principles.

25 Region of Durham (2008). Cornerstone Men’s Hostel: Utilization Report. Oshawa.

Ross, M.Talking About Mental Illness (2004). An Evaluation of An Anti-Stigma and Educational Program in Hamilton Ontario. Hamilton: The T.A.M.I. Steering Committee.

Scott, Dr. H., Dr. Wendy Stanyon, Dr. Shadid Alvi (2006) Durham region Homelessness Initiative, Youth Report. UOIT.

Statistics Canada (2006). Age Distribution in HKPR, (2006).

Statistics Canada. Community Profiles.

Statistics Canada Study (2008): Leaving a post secondary education without graduation. Ottawa.

Stevens, A. et al. (1996). A Pilot Study of Tele-video Psychiatric Assessments in an Underserviced Community. Toronto, Clarke Institute of Psychiatry.

Waddell, C., McEwan, K., Shepard, Offord, D.R., Hua, J.M. (2005) A Public Health Strategy to Improve the Mental Health of Canadian Children, Canadian Journal of Psychiatry 2005;50:226-233

Watters, C, Megan Lummiss, Marjory Hogan & Lisa Kitchen (2007) Durham Talking About Mental Illness Coalition: Evaluation of a School-Based Mental Health Education and Anti-stigma Program. Whitby, Ont. Wraparound Durham (2005). Connecting People to Caring Communities. Oshawa.

26

Appendices

1) Systems Logic Map

TAY Service Matrix - Draft Level of Need/Care

Primary Health Information Centralized Intake Community Crisis Services (Incl. Consumer & Promotion & Development Crisis Safe Beds and Family Supports Education Pychiatric Emergency) Mental Health

• Four Counties Crisis • DRAP – Durham •CHC’s • TAMI Coalition •Schedule I 1Hospitals • CMHAs – Peterborough , Services, Peterborough KL, Toronto and Durham Region , •Concurrent •WMHC and Four Counties •CMHA’s Disorders Network of •PYS •MCYS •Four County Crisis •Crisis Response – •Durham TAMI Durham Region

Functional Definitions •DMHS,HHMHS,CMHS, Durham Region Coalition (WMHC) •DMHS Lakeshore CMHS, Child (CHIMO,DMHS, •CHC’s Development Centre

(Core Mandates Only) Frontenac , Kinark •Public Health Units •CMHS (Kinark, •United Survivors Frontenac, CHIMO, •CHC’s: •Scarborough Mobile •CE –CCAC Support Centre Crisis Network EMYS) •Schedule I Hospitals /Program •Schedule 1 •CMHS (Frontenac, •Scarborough Mobile •EPI Programs (Durham Hospitals Kinark, Chimo, •Northumberland Crisis Amaze, TEIPN, Lynx) Distress EMYS, Youthlink, •Shoniker Clinic •CAS (Durham, Toronto, Peterborough YS) •Northumberland •Lifeline Telecare- Toronto Catholic, Distress Centre Lindsay •Hong Fook, Peterborough, KL, NH) Mental Health Services Services Health Mental

™ •Telecare- •Distress Centres- •DMHS, •United Survivors of Durham; (Peterborough Oshawa, SPAN •Telecare-Durham, •Peterborough Drug Lindsay, Durham) •WMHC (Adol. Program, Peterborough, Coalition) STEP), •CMHA’s

Entry Public Integration & Detox / Initial Assessment Education, Coordination of Withdrawal Community Treatment Prevention & Services Management Treatment Planning Health Promotion Services Addictions •Lakeridge •Pinewood, •TAMI Coalition •Pinewood •FOURCAST (Pinewood), •FOURCAST •Concurrent •Methadone Clinics •Pinewood (Destiny •FOURCAST Disorders Network of (Lindsay, Manor) •TAMI Coalition Durham Peterborough) •Chinese Family •SG (CAMH), Public Services of Ontario •Peterborough Drug Health, Awareness Coalition •Harbour Lights,EMYS,CAMH •CAMH •Regent HS, Destiny Addictions Services •Partners in Manor,Renascent Addiction Services

27

Functional Definitions Level of Addictions Need/Care Addictions Services ™ Mental Health Services(Core Mandates Only) Mental Health Inpatient Services •Shoniker Clinic •Shoniker Lakeridge Health R.V./CENT.,SG, RMH, PRHC, • Psychiatric Schedule 1 •CMH HMHS), •HHHC (Haliburton CMHS), •NHH (Lakeshore •RMH, •RV/AP, CENT., •SG, • Medical/Psychiatric • • PRHC, PRHC, SG (CAMH) Pinewood Ambulatory Ambulatory Outpatient 1 Schedule Community Treatment Services Case Management Case Case Management Case •Lakeshore CMHS HHMHS, •DMHS, Chimo, EMYS) Frontenac, •CMHS (Kinark, Fook •Hong TEIPN) Amaze, Durham (Lynx, Programs •EPI •WMHC Toronto) Durham, KL, (Peterborough, •CMHA’s •FOURCAST ?? •FOURCAST Services A evc arx-Draft - Matrix Service TAY Development Cent. Development Child Response, •Family Outreach & Tropicana,CAS) Youthlink, Chimo, EMYS, Frontenac, (Kinark, •DMHS,CMHS Programs •EPI &3 •Schedule1 HC Fook,Court Diversion Survivors, Hong JHS, EFS,United CMHA’s, CHC’s, • (Recovery) Rehab Development Psychosocial Psychosocial & Skills Frontenac, EMYS) Frontenac, •CMHSKinark, (CHIMO, •R.V./CENT. (Gateway) •Hong Fook •NHHC •WMHC/HSC’s •CMHA’s •DMHS • Dedicated Housing Housing Dedicated • • • Destiny Manor Renascent Harbour Lights Four County Crisis County Four Residential Supportive Treatment for SMI for • Psychologists Psychiatrists, Social Workers, Physicians, •Community T.E.I.P.N.) Durham Amaze, Programs(Lynx, •EPI andCentre Resource Counselling •Community Response Program and Outreach •Family •DMHS •Schedule1&3 HC Fook Hong •CMHA’s, CAS) Centre, Development Child Youthlink, Frontenac, Chimo, EMYS, CMHS(Kinark, CMHS(Kinark, •Renascent •Harbour Lights Services of Ontario Family •Chinese •FOURCAST Manor) •Pinewood(Destiny Day/Evening Day/Evening Community Treatment Therapy •COTA Worker Program Justice •Community Centre Resource & Counseling •Community •CMHC KL Toronto, Crisis), Counties (Four Peterborough •CMHA’s – •DMHS Diversion & Court Court Diversion & 28 Support

Functional Definitions Level of NeedCare Addictions Mental Health Addictions Services ™Mental Health Services(Core Mandates Only) • • • • ™ • • ™ • • • • • • • ™ RMH, SG, R.V./CENT., • STEP) • Inpatient Services PRHC, Lakeridge, Lakeridge, PRHC, WMHC (Adol. & & (Adol. WMHC n 416-847-4101 Ont Scarborough, Centre, Health Community Hill West 723-0036 905 Ont Oshawa, Centre, Health Community Oshawa 705-432-3322 Ont Centre, Cannington, Health Community Brock 905-428-1212 – The Ajax,Centre, Youth Ont Community Health Centres CHC’s – 1-877-669-6658 – Services Youth and Children of Ministry MCYS – DRAP 1-888-454-6275 Centralized Intake 705-745-2273 – Telecare-Peterborough 1-800-452-0688 Region) (Durham 905-433-1121 (Local) Durham Centre Distress - 705878-4411 - Lifeline Telecare-Lindsay 905-372-5919 – Distress Northumberland 416-289-2434 – CrisisNetwork Mobile Scarborough 1-888-337-0481 &YouthChild RegionServices Durham Response Crisis 1-866-995-9933 - Services Crisis Counties Four Services Crisis Specialized Specialized Pinewood • Scarborough Hospital CHS) • • Residential Medical WMHC NHHC (Lakeshore Treatment Teams CMHA –Toronto, Assertiveness Community Community Psychiatric Psychiatric Treatment Specialized Sub- Specialized (District-Wide) Population Population Services A evc arx-Draft TAY- Matrix Service • • • • ™ • • • • ™ 905-668-7711 Toll:1-800-841-2729 - Ont Whitby Department, Health RegionDurham 416-392-7401 Toronto Unit - Health Public 4577 905-885-9100 Toll : 1-866-888- - Unit, PortOnt Hope, Health PineKawartha, District Haliburton, Ridge 705-743-1000 Unit - Health Public Peterborough Units Public Health 705-328-2704 - Ont Lindsay, Branch, Lakes Kawartha – CMHA -905-436-8760 Ont Oshawa, Branch, Durham CMHA – 705-748-6711 - Ont Branch, Peterborough, Peterborough CMHA – 416-289-6285 - Ont Scarborough, Branch, Toronto – CMHA Canadian Mental Health Association CMHA’s – •RMH •Lakeridge Health •PRHC •WMHC Outpatient Services Ambulatory / Specialized Practitioners Nurse and Clinicians , Psychologists Physicians , Community • Other Specialized Community Community Services Residential Services Residential Renascent Centre Renascent Manor Destiny Housing Peterborough Youth Centre, Resource Counseling & • Services & Support Housing • • • thlink) Kinark,Chimo,CAS,You • • Community Community Youth Durham DMHS CMHA’s CMHS (Frontenac, WMHC (HSC’s) Residential Treatment

29

™ Addictions • Pinewood Centre, Oshawa, Ont - 905-723-8195 • FOURCAST – Four Counties Addictions Services Team, Peterborough, Ont - 705-876-1292 • Peterborough Drug Awareness Coalition, Peterborough, Ont - 705-743-1000 • Chinese Family Services of Ontario, Scarborough, Ont - 416-979-8299 • Salvation Army - Harbour Lights, Toronto, Ont - 416- 363-5496 • JHS – John Howard Society • Peterborough Branch, Peterborough, Ont - 705-743-8331 • Durham Branch, Oshawa, Ont - 905-579-8482 • EFS – Elizabeth Fry Society, Peterborough, Ont - 705- 749-6809 • Family Outreach and Response Program, Scarborough, Ont - 416-439-2253

™ Schedule 1 Hospitals • United Survivors Support Centre, Oshawa, Ont - 905- • PRHC - Peterborough Regional Health Centre, 436-8772 Peterborough, Ont - 705-876-5114 • Peterborough Youth Shelter , Peterborough, Ont - • RMH - Ross Memorial Hospital, Lindsay, Ont - 705- 705-748-3851 324-6111 • Hong Fook Mental Health Association, Scarborough, • RV/AP -Rouge Valley Health System (Ajax/Pickering ), Ont - 416-493-4242 Ajax, Ont - 905-683-2320 • DMHS – Durham Mental Health Services, Whitby, Ont - • RV/Cent. - Rouge Valley Health System (Centenary), 905-666-0831 Scarborough, Ont – 416-284-8131 • WMHC - Whitby Mental Health Centre, Whitby, Ont - • Lakeridge Health, Oshawa, Ont 905-576-8711 905-668-5881 • SG - Scarborough General Hospital, Scarborough, Ont • HHMHS – Haliburton Highlands Mental Health - 416-438-2911 Services, Minden, Ont - 705-286-4575 • Lakeshore Community Mental Health, Cobourg, Ont - ™ CMHS – Children’s Mental Health Services 905-377-9891 • CHIMO, Lindsay, Ont - 1-888-454-6275 • SPAN?? • EMYS – East Metro Youth Services, Scarborough, Ont - • CE CCAC - Central East Community Care Access 416-438-3697 Centre, Whitby, Ont - 905-430-3308 • Frontenac, Oshawa, Ont - 905-579-1551 • Kinark Child and Family Services, Whitby, Ont - 905- ™ EPI Programs – Early Psychosis Intervention programs 433-0241, Toll: 1-866-929-0061 • Durham Amaze • Youthlink, Scarborough, Ont - 416-967-1773 • TEIPN - Toronto Early Intervention in Psychosis • Shoniker Clinic, Scarborough, Ont – 416-284-8131 Network ext. 7301 • Lynx Program • Tropicana Community Services, Scarborough, Ont – 416-439-9009

30 2) Best practice guidelines for mental health promotion programs: Children & Youth

This web resource provides the health and social service provider (“practitioner”) with current evidence-based approaches in the application of mental health promotion concepts and principles for children and youth. It is envisioned that these guidelines will support both the inclusion and the sustainability of mental health promotion concepts. This resource is intended to support practitioners in incorporating best practice approaches to mental health promotion interventions directed toward children (7–12 years of age) and youth (13–19 years of age).

This resource includes:

• Guidelines: Identifies the 10 best practice guidelines for mental health promotion interventions with children and youth. • Theory: Provides practitioners with the context for mental health promotion through definitions and underlying concepts, with a focus on promoting resilience. • Resources: Provides a worksheet (MS Word doc) that can be used by practitioners to plan and implement mental health promotion initiatives, a sample worksheet (PDF) showing how it has been used in a mental health promotion initiative and a glossary of words commonly used in mental health promotion. • References and Acknowledgements: Lists references used to develop these guidelines, and provides author information and acknowledges those who helped develop this web resource.

In Best practice guidelines for directing interventions for children and youth Guidelines The(se) 10 guidelines define best practices for mental health promotion interventions. They are based on mental health promotion principles that have been identified through critical analysis of literature reviews. The guidelines are not intended to be used as an evaluation tool, but rather to improve existing interventions or develop new interventions. Not all components will apply in all contexts, because the guidelines are based on ideal mental health promotion interventions. Health and social service providers will have to take into consideration their own level of resources and restrictions, given the overall mandate of their organization. They should apply what is relevant for their programming needs.

1. Address and modify risk and protective factors that indicate possible mental health concerns. 2. Intervene in multiple settings, with a focus on schools. 3. Focus on skill building, empowerment, self-efficacy and individual resilience, and respect. 4. Train non-professionals to establish caring and trusting relationships. 5. Involve multiple stakeholders. 6. Provide comprehensive support systems that focus on peer and parent-child relations, and academic performance. 7. Adopt multiple interventions. 8. Address opportunities for organizational change, policy development and advocacy. 9. Demonstrate a long-term commitment to program planning, development and evaluation. 31 10. Ensure that information and services provided are culturally appropriate, equitable and holistic.

• Theory o How is mental health promotion related to health promotion? o What makes mental health promotion different from health promotion? o What are the goals of mental health promotion? o What are the characteristics of successful mental health promotion interventions? o • Resources o Blank worksheet for planning mental health promotion interventions (MS Word) o Sample completed worksheet (PDF) o Glossary of commonly used terms o • References used to develop these guidelines • Authorship and acknowledgements

3) Age Distribution in HKPR District, 2006

Population 2006

County Haliburton Kawartha Northumberland Peterborough Lakes

Total – All 16,145 74,565 80,963 133,080 Persons

Age 0-4 520 3,085 3,555 5,690

Age 5-14 1,510 8,800 9,415 14,865

Age 15-19 1,025 5,060 5.650 9,375

Age 20-24 650 3,900 4,075 9,420

Age 25-44 2,930 16,270 18,030 30,075

Source: 2006 Data: 2006 Census – Statistics Canada

32 4) Local Service Profiles: MCYS Community Profile: Children’s Services, 2006

Agency Program Description Age # clients Haliburton

Point in Time Psychiatric Purchase from Kinark 0-19 unknown Consultation Ptbo. Point in Time Counseling MH interv./train./tx 0-19 220

Point in Time Vol./respite Mental health needs 0-19 30

Kawartha Lakes No data available Northumberland

Rebound DEAP. Drug education 12- 180 awareness 18 Ptbo. Youth Serv. Non-resid. Office/school counsel. 10- 410 Soc/emot.needs 19 Ptbo. Youth Serv. Suprvn/support Intensive MH serv. 10- unknown 19 Wraparound N. Wraparound Children/youth/family 99 support Kinark Intensive Serv. MH in 6-18 51 home/school/comm. Kinark Crisis Response Response/assess. 0-18 54

Kinark Intensive/outreach Youth support 13- 25-28 18 Peterborough

Kinark STRIVE Ptbo Cty Interv/chronic MH 13- 51 18 Kinark N. Cty Intensive Service MH schools/home/CC 0-6 33

Kinark N. Cty. Family Service MH intervention 0-18 300+

Kinark N. Cty. H. Promotion Public/parent Ed. 0-18 250+

Kinark N. Cty. Intensive c/family MH 6-18 51 home/school/com. Kinark N. Cty. Intensive c/family MH 6-18 51 home/school/com. PRHC Family/Youth Clin. Psycho-ther. Tx. 0-18 350

Ptbo Youth Serv Non-residential Clinical counselling 10- 410 19 FourCAST HS Program Counselling serv. 14- 160 18 Ptbo Youth Serv Intensive Severe MH needs 10- unknown sprvn/support 19

33

5) Youth Profile for Central East LHIN Area

Sex Age Number Sex Age Number LHIN Total

297,125

Male 10-14 51,990 Female 10-14 49,360

15-19 52,600 15-19 49,875

20-24 47,075 20-24 46,225

Total 151, 665 Total 145,460

6) Youth Employment for Central East LHIN Area

Population 15-24 Dimension Total

Labour Force Activity 194,960

# in Labour Force 120,745

Participation Rate 61.9%

# Unemployed 20,080

Unemployment Rate 16.6%

34

7) Year Youth Population Projections in the Haliburton, Kawartha, Pineridge District, 2009-2016

2009 2011 2016

County H KL N P H KL N P H KL N P

Age 0-4 549 2904 3746 5453 600 3063 3964 5713 760 3587 4696 6347

Age 5-9 658 3085 3883 5900 619 2925 3814 5555 701 3251 4184 6005

Age 10-14 746 4446 4965 7494 762 3974 4582 6982 697 3091 3999 5814

Age 15-19 969 5309 5994 8846 851 5084 5748 8399 847 4138 4755 7247

Total 2922 15744 18588 27693 2832 15046 18108 26649 3005 14067 17634 2541

Source: 2006-16 estimates: Map info Estimates & Projections Canada

8) Peterborough County Total Male Female

15 to 19 years 9,375 4,775 4,605

20 to 24 years 9,420 4,690 4,730

25 to 29 years 6,565 3,220 3,345

CMHA Peterborough provides supported housing services yet the wait list is fairly lengthly.

The goals of supportive housing are as follows:

• Assist people to live as independently as possible; • Assist people to participate in the community, accessing community resources and supports;

35 • Provide supports to minimize stress, provide illness management, and prevent crisis and hospitalization; • Provide education and support to people to enable them to develop and maintain skills and relationships.

Inventory of Housing

Peterborough

• 80 one bedroom head leased units through private landlords. Of those, 8 are designated as forensics units, geared towards lowering the probability of the tenant being in conflict with the law; • 2 non-residential properties owned by CMHA. 1 administrative office building and one Crisis Program / Safe Beds facility; • 11 residential properties with a total of 35 units.

Northumberland

• 24 head leased 1 bedroom units through private landlords. All clients are supported. Of those, 4 are designated as forensics units, geared towards lowering the probability of the tenant being in conflict with the law.

Eligibility Criteria

Peterborough and Northumberland

• 16 years of age and older; • The individual must be diagnosed with a severe and persistent mental illness as determined by a professional; • All clients approved for supportive housing will be required to receive support through a Mental Health Case Management Service and voluntarily accept case management and housing support; • There are additionally a total of 12 units in Peterborough and Northumberland available for individuals who meet the previous criteria and would benefit from the program by having a lower probability of conflict with the law.

Additional criteria in Northumberland:

• Serious and persistent mental illness includes: Schizophreniform disorders; Psychosis NOS (not otherwise specified), Bipolar Affective Disorder (mania and depression) who require a high degree of support (8:1 clinician to client ratio) to maintain holistic wellness in the community; • Priority will be given to individuals who meet the aforementioned criteria and who also have a history or are at risk due to their illness and symptom severity of becoming involved with the Criminal Justice System;

36 • In addition, clients who are suffering with severe co-occurring disorder and who have active addiction issues which may cause housing to be jeopardized due to behaviours commonly associated with addictive behaviours must show a period of 6-month commitment, working towards a harm reduction or abstinence, and further display a willingness to achieve less risk of addictive behaviours which would have or could cause housing to be in jeopardy.

There is a crisis housing possibility through the 4 County Crisis Services Safe Bed Program yet the stay is highly time limited (10 days max) and limited in space. This voluntary service is available to individuals 16 years of age and older, who reside in the catchment areas of Haliburton, City of Kawartha Lakes, Peterborough and Haliburton. Six (6) residential crisis support beds, also known as Safe Beds, are located are not accepted. A short stay will provide an individual with a safe, supportive environment to help them through their crisis. Individuals are assisted to link with community supports through information and referral. Individuals must have independent self-care and are expected to fully participate in activities of daily living such as preparing meals, grooming and laundry. The stay is at no cost to the individual.

The Youth Emergency Shelter supplies housing for youth in transition yet they too are space limited. They also offer a preparation for independence type program through Abbott House yet this is limited to 10 youth for a maximum of 1 year. They offer employment programs for you (16-24) as well as training programs for street youth. On site they have a school and shelter for 30. Shelter workers assist in providing emergency accommodation, accessing resources, housing search, Ontario Works and other related needs.

There are two shelters in the area. Brock Mission provides emergency short-term shelter for single men and women aged 25 and up. Singles 16 years and up may be accepted if they cannot access other shelters. Support services include help to find housing, get personal identification, and accessing community services. Cameron House focuses primarily on providing shelter services for women.

With respect to younger ages and including 16 years. There are a number of group homes in the area operated by CHIMO. Youth 12 - 18 years of age from City of Kawartha lakes, Durham Region, Northumberland, Haliburton and Peterborough Counties. This program is for adolescents who cannot remain in the community: they may have been in trouble with the law, be involved with drugs, are not attending school, be depressed, have relationships or other behaviours that are destructive. Their families, for a variety of reasons, have not been able to assist their adolescent in directing their energy toward more positive ways of relating to others and acting responsibly. They may have had community-based services which have not been helpful in turning things around for the youth and family. After an assessment with the consultant psychiatrist and everyone is in agreement with a residential placement, a pre-placement visit can take place and then planning for admission. There are two homes one in Port Bolster for girls and one outside of Kinmount for boys. The waitlist is substantial and the focus is not so much on transition but reunification with families.

37 The Community Counselling and Resource Centre do offer some help with housing as well as some supportive elements to housing. Basically, they assist in finding existing housing stock and assist in assessment, case management, individual support and advocacy for people facing significant barriers related to finding housing or maintaining affordable housing such as; homelessness, poverty, disabilities including mental, physical, or developmental, chronic illness or injury, fleeing abuse, discrimination, vulnerable youth, frail elderly, and persons with literacy or language difficulties. It is my understanding that there are substantial waiting lists for this (almost 5 months or more). Haliburton County

Total Male Female

15 to 19 years 1,025 505 520

20 to 24 years 650 320 330

25 to 29 years 495 255 240

Haliburton Highlands Mental Health Services operates a Homelessness Initiative providing transition housing to people who are homeless or at risk of becoming homeless. Currently they operate 19 separate units in which residents are required to supply OW or ODSP housing rental allotments that are topped up by the Mental Health Service. Demand far outreaches the capacity of the program at this time. Residents must be connected to a counsellor at the Mental Health Service and are also assigned a housing support worker.

Haliburton has made limited use in the past of housing programs through CMHA Peterborough and Victoria County when space was available yet that demands that potential residents move out of the area and away from family supports.

City of Kawartha Lakes Total Male Female

15 to 19 years 5,060 2,685 2,375

20 to 24 years 3,900 2,055 1,840

25 to 29 years 3,095 1,525 1,575

30 to 34 years 3,360 1,670 1,690

38

The City of Kawartha Lakes offers affordable housing subsidies yet this wait list is considerable (1-2 years). They do not offer support to speak of and youth are in competition with adults and families for spots. These programs also extend into Haliburton County and have been made use of there as well.

Housing Provider Mandate (if any) Housing Projects Location

Kawartha Lakes - Rent-Geared-To- 467 Public Housing units for Housing projects and rent Haliburton Housing Income units. For Seniors, Singles and Family. supplement units are located Corporation Families, Seniors 102 Rent Supplement units. throughout the Kawartha 322 Kent Street and Singles. Lakes/Haliburton area. West, P.O. Box 2600 Lindsay, ON K9V 4S7 (705) 324-6401

Lindsay Non-Profit Provide affordable Municipal Non-Profit Flynn Gardens Housing Corporation housing to Families, housing project with a total Nayoro Place 322 Kent Street W. Seniors and of 210 units for mixed Red Pine Estates P.O. Box 2600 Singles. singles and seniors, and 100 Hamilton Place Lindsay, ON RGI and Market units for families All located in Lindsay K9V 4S7 Rent (705) 324-6401

Haliburton Provide affordable 95 Private Non-Profit units. 1 and 2 bedroom units. Community Housing housing to Seniors Parklane Apts. Corporation only at Parklane. Echo Hills Apts. R.R.#1 P.O. Box 500 Seniors and Singles Located in Haliburton Haliburton, ON at Echo Hills. K0M 1S0 No families with (705) 457-3973 children under 16. (705) 457-9119

Monmouth Township Provide affordable 34 Private Non-Profit units. 1, 2 and 3 bedroom units Non-Profit Housing housing for Seniors, Mapleview, Wilberforce Corporation Singles and County Road 648 Families South of Wilberforce. P.O. Box 70 Wilberforce, ON K0L 3C0 (705) 448-3652

Staanworth Non Provide affordable 74 Private Non-Profit units. Staanworth Court, Profit Housing housing for Seniors, 1, 2 and 3 bedroom units Staanworth Terrace and Corporation Singles and Floralan Park, 44 Parkside Street, Families Minden Minden, ON K0M 2K0

39 (705) 286-3444

Neighbourhood Provide affordable 8 Private Non-Profit units. Dunoon Terrace, Housing In Lindsay housing of Special All 1 bedroom Lindsay 31 Peel Street, Needs. Hard to Lindsay, ON House single adults K9V 3L9 (705) 328-1255

Fenelon Area Provide affordable 25 Private Non – Profit units. Murray Street, Independent Living housing for Seniors 20 – 1 bedroom Fenelon Falls Association 5 – 2 bedroom 70 Murray Street, Offers a dinning room and Fenelon Falls, ON on site service providers. K0M 1N0 (705) 887-9604

As far as my understanding goes…. all the above are at capacity and offer no extra supports other than those listed. CMHA Kawartha Lakes offers a number of housing programs to areas covering Haliburton, Durham and Kawartha Lakes. • Harrison House offers supportive housing and case management. It is an eight bed transitional, co-ed, psychosocial rehabilitative housing program geared to those with serious mental illness. Stays are time limited and focused on returning to independent living. Individuals are followed after discharge through community support program. Serves ages 16 and up. Mainly kids would be housed with adults at this time. • Market Square apartments in Bobcaygeon offers 4 one bedroom and 2 two bedroom apartments and is geared to independently living individuals with a mental illness. • Further to this they offer more housing through a Homelessness Initiative similar to that in Haliburton. Once again availability and support for youth is at a minimum

A Place Called Home is a non-profit, charitable organization that believes that everyone deserves a safe place to return to at the end of his or her day. To provide subsidized shelter along with access to appropriate support services for single adults, couples and families in our community who are homeless. They run a 19-bed hostel service, which involves some support for those 16 and up. They also run Youth in Transition program (just new) for youth 16-21 who are at risk of becoming homeless (they can be residents of the hostel or community members). They provide considerable assistance primarily in getting set up and grounded. CMHA provides counselling support it appears. A Place Called Home also provides some assistance to those at risk of losing housing due to an inability of pay rent, utilities and so forth.

40 Northumberland County

15 to 19 years 5,650 2,920 2,720

20 to 24 years 4,075 2,125 1,955

25 to 29 years 3,235 1,590 1,640

41

Housing Services for TAY Project

Youth/Adolescent Housing: Scarborough

Most of the mental health patients aged 14-18 still live at home. In exceptional circumstances foster care will get involved for brief periods. Youth/Adult:

1) Age 16-30: The main website used at Rouge Valley Hospital is the Scarborough Housing Help Center http://www.shhc.org/

2) Scarborough Housing Help Center: 2500 Lawrence Ave. East 416-285-8070 ‐ assists youth with finding subsidized housing through a housing counselor

3) Emergency Housing and Shelters: Covenant House, YMCA, Native child and family youth shelters ‐ these shelters will house drug abuse and violence cases; mental illness is not required

4) Safebeds through the CMHA: short term crisis beds; must have a mental health diagnosis ‐ offered for 30 days where they work with the client to find more stable permanent housing ‐ criteria for acceptance: must be homeless or potentially homeless with a mental illness, low risk (not suicidal because people are not there 24/7), but they are able to call the staff who live in the same designated building for assistance

5) Gerstein Center: 10 bed short stay residence; must be low risk and have a mental illness

6) Salvation Army: Maxwell Meighan Center ‐ for homeless men experiencing a mental health issue ‐ housed for up to 3 weeks, ages 18-65 ‐ a referral must come from healthcare staff ‐ those with homicidal/suicidal/aggressive behaviour are red flagged and less likely to be accepted 7) Manse Rd. Residential Support Services (age 16+) 416-286-0766

Long Stay: Manse Road is a transitional supportive housing program for clients of the mental health system who are suffering from a severe and persistent mental illness. Program focus is on a psychosocial rehabilitation through client- centered goal planning and life skill teaching. The clients need to demonstrate a

42 need for high support and for learning housing skills and activities of daily living skills.

Respite Care: clients can come for a short stay of two to three weeks. They must have a return address. Average length of stay is up to two or three years for the long stay and two to three weeks for the respite care.

Youth/Adolescent Housing – Durham

Frontenac Youth Services: 3 residences which provide short/long term assessment and treatment who may have complex care issues, involvement with CAS, and experiencing severe difficulty within the home environment (ages 10 to 18 years).

CHIMO Family and Youth Services: residential treatment program for youth who may have come into conflict with the law, experiencing problems in the home, involved with drugs , have severe treatment needs(ages 12-18 years).

Kinark Child and family Services: home like settings within communities, provides for daily careand facilitate plans of care. Family involvement included. Respite services are available to families.

John Howard Society of Durham: Whitby and Oshawa Residence for males and females, teaching residence living skills, and ongoing support to enable individual to live successfully and independently in the community. Age 15 to 18 years.

Durham Youth Housing & Support Services: Shelter for Homeless in Durham Region. 10 bed emergency shelter for youth, ages 16-24.

Whitby Mental Health Centre: Homes for Special Care Program provides residential opportunities and support to enable adults in need of assistance to live in the community. Accommodation is available in privately operated homes. (Age 18 and over).

Durham Mental Health Services: offers a range of housing options to people with longstanding mental health difficulties who wish to live in the community. High, medium and minimal support available and a rent supplement program (age 16-65 years).

Durham Canadian Mental Health Association: supportive housing and case management services, subsidized independent housing units, group living accommodations (9 residences) and assists homeless and at risk of homelessness.

Durham YWCA Adelaide House: emergency housing for women and children and support to locate permanent housing in the community.

Cornerstone - emergency shelter for men. Domiciliary hostel for men age 18 years and up.

43

9) TRANSITIONAL AGE YOUTH

TRANSFER REPORT/FINAL SUMMARY

______

DATE

NAME: ______DOB______

ADDRESS______HOME PHONE ______

______WORK PHONE______

______CELL PHONE______

IF THE ABOVE YOUTH IS NOT THE CONTACT PERSON PLEASE SPECIFY

NAME______RELATIONSHIP______

HOME PHONE______WORK PHONE______

CELL PHONE______

REFERRING AGENCY

AGENCY NAME______

REFERRING WORKER’S NAME______PHONE

#______FAX #______

E-MAIL______

44 SUMMARY OF CONTACT

DATE FIRST SEEN: ______DATE LAST SEEN: ______

APPROX # OF MEETINGS: ______

PRESENTING PROBLEM/CURRENT DIAGNOSIS

______

______

______

______

______

______

CURRENT RELEVANT MEDICATION(S)______

______

WHO PRESCRIBES MEDICATION?______

______

RELEVANT MEDICAL HISTORY/MEDICAL CONDITIONS______

______45

ASSESSMENT FINDINGS/SUMMARY OF INVOLVEMENT

______

______

______

______

______

______

______

______

TREATMENT PLAN/GOALS/RECOMMENDATIONS: ______

______

______

46 ______

______

______

______

LIST ANY OTHER AGENCIES/THERAPISTS OR PHYSICIANS CURRENTLY INVOLVED

______

______

______

10) Personal Health Information Protection Act, 2004

(PHIPA)

What information is protected by PHIPA?

Personal health information includes oral or written information about the individual if it relates to the individual’s physical or mental health.

The person or organization retaining the information is referred to as the custodian of the personal health information

47 Is consent needed prior to sending referral information from a child/adolescent service to an adult service?

A custodian is entitled to assume that it has the individual’s implied consent to

collect, use or disclose the information for the purposes of providing health care

unless the individual has expressly withheld or withdrawn the consent.

PHIPA 20. (2)

A health information custodian may disclose personal health information about an individual, for the purpose of determining or verifying the eligibility of the individual to receive health care or related good, services or benefits…

PHIPA 39. (1) (A)

Custodians may transfer records to a successor, as long as the custodian makes

reasonable efforts to notify the individual before the transfer. If notification before the transfer is not reasonably possible, it should be done as soon as possible after the transfer. However, the information cannot be transferred if the individual has expressly instructed the custodian not to make the disclosure.

PHIPA 38. (1) (A)

Are contracts and/or agreements between the organizations required?

A health information custodian may disclose personal health information about an individual to a potential successor if the potential successor first enters into an agreement with the custodian to keep the information confidential and secure and not to retain any of the information longer than is necessary for the purpose of the assessment or evaluation.

PHIPA 42. (1)

Must the consent be written?

Where consent is required under PHIPA, it may be given verbally, in writing or by electronic means. Implied consent permits a health care custodian to infer from the

48 surrounding circumstances that an individual would reasonably agree to the collection, use or disclosure of his/her personal health information.

Information and Privacy Commissioner/Ontario Website (www.ipc.on.ca)

What is the “circle of care”?

The “circle of care” is not a defined term under PHIPA. It is a term of reference used to describe health information custodians and their authorized agents who are permitted to rely on an individual’s implied consent when collecting, using and disclosing personal health information for the purpose of providing direct health care. For example, in a hospital, the circle of care includes: the attending physician and the health care team (e.g., residents, nurses, technicians, clinical clerks and employees assigned to the patient) who have direct responsibilities of providing care to the individual. The circle of care does not include: A physician who is not part of the direct or follow-up treatment.

Information and Privacy Commissioner/Ontario Website (www.ipc.on.ca)

port Title on One Or Two Lines 2007-2008 Annual Report

49