1. Regional Research on Intellectual Disability, Crisis Response and Justice System Involvement Susan Braedley, Assistant Professor School of Social Work, Carleton University with support from Aaron Howes, Analyst

2. This research was funded by: CIHR/CHSRF Chair in Health Services and Nursing Research at York University Carleton University Faculty Research Fund

3. Todays Outline: 1. What is the research about? 2. What did we find so far? 3. What other questions do our findings suggest? 4. Where to from here ?

4. What is the research about? I am investigating the growth and expansion of crisis/emergency services that serve vulnerable populations to ascertain the degree to which crisis services are used regularly. Some people are living in constant crisis.

5. Sub-study: Community Crisis Response Quantitative study of service data from Central East Network of Specialized Care, serving adults with ID and mental health or behavioural conditions Established in 2007 across Ontario as part of policy shift to community care

6. Community Crisis Response for those 16+ who have an ID Available 24/7 Time-limited intervention Active process – relief for the immediate crisis Can be used to prevent escalation of difficulties

7. What did we want to know? Who uses crisis response for people with intellectual disabilities? What problems or issues does this service address? How often do people use this crisis response? What factors are most associated with multiple crisis response use? How does crisis response use compare to intensive case management services use for people with intellectual disabilities?

8. Why should HSJCs care? Our findings show a relation between crisis response use and justice system involvement that may offer opportunities for early intervention. Our findings show that some regions are doing better than others at keeping people out of the justice system... Further research will tell us how and why.

9. What did we do? Quantitative analysis of service statistics from the crisis response and intensive case management services using SPSS. Aggregation of data by individual, rather than by incident. Analysis of correlations with justice system involvement, among other factors Comparison of service data from individual areas of the Central East region to see if local matters..

10. Parameters: Central East Network of Specialized Care Data ( HKPR, Simcoe County, York Region, Durham Region) from inception of service in Aug 2007 to June 2009. This is 18 months of data. An update is currently being prepared.

11. Population: Our analysis identified: 320 unique individuals in the data set. 65 had used only intensive case management (20%). 255 had used the crisis response service (80%). 60 individuals had used at least one incident of crisis response and case management services.

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

13. General Profile 53% of clients have used crisis services more than once Overall, males receive service more often than women (59/41). The average age of clients is 31 years. Half of clients are described as dual diagnosis. Just over half of clients have involvement with the justice system.

14. Living Arrangements Living Arrangement Total Unique Clients (n= 320) Intensive Case Management (n=65) Crisis Response (n=255) Independent 21%29%19% Family 46%39%48% Supportive Housing 8% Group Home8%6%9% Shelter11%9%11% IRM Hospital6%5%7%

15. Reason for Referral Overall (n= 320) Crisis Response ( n=255) Intensive Case Management (n=65) Homelessness or risk of 45%48%34% Lack of Community supports 68%66%77% Mental Health55%54%57% Behavioural Issues58%53%75% Family Sit Change27%28%25% Safety Concerns48%44%60% Indicates significant at 95% confidence Indicates significant at 99% confidence Indicates significant at 95% confidence Indicates significant at 99% confidence Indicates significance at 99% confidence Indicates significant at 95% confidence Indicates significant at 99% confidence Indicates significance at 95% confidence

16. Crisis Response Level Comparison ICM (n=65) One Crisis (n=85) Two+ Crisis (n=170) Crisis None--- One--- Two+--- Gender Male 75% 54%55% Female25%46%45% AgeMean27.7 yrs31.1 yrs32.6 yrs Diagnosis Code Developmental Delay 49%46%54% Dual Diagnosis63%57%52% Mental Health only11%7%8% Autism15%18%13% Justice Concerns99%25%48% Living Arrangement Independent29%20%18% Family39%44%50% Support House8% Group Home6%4%12% Shelter9%13%11% IRM0% 1% Hospital5% 8%

17. Reason for Referral Homeless (or at risk of) 34%42%51% Lack of Community Supports 77%66%65% Mental Health57%53%55% Behavioural Issues75%41%59% Family Situation Change 25%18%33% Safety Concerns60%31%51%

18. HKPR: What does the data say? Size of sample : ICM = 14 individuals 1 Crisis = 69 individuals 2+ Crises = 45 individuals For those who had 1 crisis, justice involvement was a factor for 33%. For those who had 2+ crises, justice involvement was a factor in 41% of the cases.

19. HKPR Data The client average age for crisis response is 30.5 years – older than the 25.9 years of ICM clients. The ratio of men to women is 62%/38% Those who have 2+ incidents are much more likely to live with families, and behaviour issues are significantly higher than for those who have only 1 incident.

20. HKPR Data compared to other areas Ratio of 1 instance to 2+ instances is consistent across regions – about 66 % of individuals use service more than once. HKPR Crisis serves more men than other regions At one incident, justice concerns are a factor for 58% of clients. At 2+incidents they are a factor for 71% of clients. This is by far the highest incidence of justice involvement in the region, with York region at 50% for 2 + incidents, and Simcoe the lowest at 18%

21. HKPR Data HKPR crisis clients also seem to have fewer behavioural issues, fewer safety concerns and much less risk of family situation change. Is this an actual difference or are peoples situations being interpreted differently by workers in HKPR?

22. To summarize so far: Repeat crisis response use appears to be related to justice system involvement In Central East, those who use crisis response tend to be older than what is sometimes expected. More than half of clients use crisis response more than once ( up to nine times) in an 18 mo. period

23. So what? We can follow up with qualitative research that will identify why some regions have different rates. This can assist us to identify promising practices, or advocate for resources.

24. Critical Questions 1. The goal is to provide this service. But is there a goal behind the goal? Is this a service designed for frequent use? 2. Is the service really seeing situational crises or is it seeing structural crisis in multiple service users? 3. What other services are these clients and their care providers and/or supporters using? 4. When we talk about linkages and coordination, what is the outcome we expect?

25. Where to from here? Update the data set and have a trend analysis completed in order to assess change over time Qualitative study conducted to assess reliability of quantitative data and to get better data on interventions. Propose that some provincial comparisons could be useful to inform policy. Closer look at those factors that show most significance in order to identify promising practices and plan effective services.

26. An invitation to research A CIHR application has been made for a planning meeting for those interested in partnering in a research project that will extend this research across Ontario. All Networks of Specialized Care have signed on, along with many other agencies. We expect to be funded within the next year. If you are interested, please contact me! (susan_braedley@carleton.ca)