Service teams and home visit Saint John, New Brunswick, March 12 & 13, 2015 Murielle Doucet, Housing First Trainer (Moncton) Nancy Keays, clinical nurse, Housing First Trainer (Montreal)

Topics today  Act team in a Housing first model  ICM team in a Housing first model  Training  Video « the visit » Pathways  Home visit (principles and chalenges)

At Home / ACT Team Intensive treatment and support in community Model where almost all services are provided by team clinicians Client/staff ratio of 10:1 or less if higher needs 24 hour coverage 7 days a week 90% visits in the community Medication delivery program/injections Program staff are closely involved in hospital admissions and discharges

At Home / Act Team  Peer engagement specialists  Psychiatrist & Physician  Nursing (medical and mental health)  Social worker  Substance abuse counselors  Supported employment specialist  Counsellors, Home Economist, other outreach workers  Housing specialist All staff trained in client choice as a model of care

MHCC decided on adding evidence based interventions to the Housing First ACT teams standards. Minimum one peer worker as full team member Motivational interviewing Integrated Dual Diagnosis Treatment - harm reduction “IPS” Employment specialist “Illness Management and Recovery” programs Family psycho-education and support

Doing ACT Morning meeting Weekly clinical/planning meeting/complex cases Scheduling Flexibility all around to meet participant needs Challenges of trans-disciplinary care and staff burnout are very big issues Team leader needs to keep eye on workload and team cohesion

How to “do ACT” and Housing First

ICM teams (At home )  15-20:1 ratio of Staff  Services for people with moderate needs  7 days a week/ 12 hours a day  Outreach/ home visits primarily  Weekly team meetings  Non clinical staff, services brokered out  Challenges are developing linkages to health and mental health and addiction services

Building a good team Great team leader with skills, experience Provide basic and ongoing trainings Hire Peer Workers in fully integrated roles !!! Staff need to be eternally Hopeful, Empathic and Flexible Ability to work with challenging personalities and behaviours Innovative strategies are needed

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

Video « The visit » Pathways

Home Visit

5 principles of Housing First ①Immediate access to housing with no readiness conditions ②Personal choice and self –determination ③Recovery orientation ④Individualized person-driven supports ⑤Social and community integration 2 Conditions : 1)Visit once a week 2)Pay 30 percent of income for rent

Choice based Goals work towards the persons goals Recovery/Care plans should be focused. Doing a Recovery plan - way to get to know people - their hopes and dreams Use motivational interviewing techniques to make goals more specific and focused

Strength-based approach Recovery is based on strengths Focus on the healthy part of the person and believe in the potential of recovery Recovery is a personal journey of healing and transformation An on-going process, takes time and is multi-dimensional

Recovery is the main focus The person in recovery « owns » his or her recovery process. The person searches for… Hope for the future A more positive sense of self Positive social roles A sense of belonging within the community A sense of purpose The sense that what he or she does and decides matters

How Housing First differs… From what’s wrong to what’s STRONG Rather than focusing primarily on what is “wrong” with the person symptoms substance use concerns skill and resource deficits HF focuses foremost on what is “right” with people Goals Skills Knowledge Interests Resources and supports Motivation What they are already doing that helps them manage their condition

Home Visit Philosophy Respectful of the person’s : Boundaries Culture Space and time Their tolerance for degree of contact ( length and # of visits) Ongoing active engagement Focus on Person’s Choices not the programs goals

Opportunity for Engagement Opportunity to develop a trusting relationship Clues about tastes, interests and hopes Learn who they are

Targeted Intervention Purposeful and goal directed Focus on person’s chosen goals (recovery plans) Provides continuity of support and treatment Opportunity for continuous engagement Interventions extends from home to community settings

Assess Well-being How is the person today? Their greeting Clothing State of alertness Mood Changes from usual patterns

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

Team operations/home visits Minimum once a week Schedule in advance/avoid surprise visits Reminders, calendars, notes on fridges Varies over time Non-linear process Need to be flexible and accommodate the needs of the individual Efficiency is important Distribute workload by specialty and geographically

To look at the condition of the apartment Organized to disorganized? Do you look in every room? Careful observation Are there repairs that need to be made? Liaising with property manager?

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

Do you intervene?

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

Are there dreams and hopes that you would not support?

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

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