1. Clinical Planning in a Community Context: An introduction to the CAIR Program Cynthia Cabrera Leo Edwards Olivia Shaw

2. Agenda Introductions About CAIR Clinical Planning Bio-Psycho-Social Model CAIR Clinical Planning Tool Case Studies Questions

3. Partnership

4. The Team Cynthia: Resource Supervisor Leo: Clinical Facilitator H.BSW, MSW,RSW Olivia: Alternate Level of Care Behaviour Therapist M.ADS, BCBA

5. What is CAIR? A time-limited intervention and clinical support for adults with a developmental disability and complex needs, who require flexible, innovative, and individualized response to be maintained in the community. 5

6. CAIR Mandate 1)Collaborate with client’s agency/caregiver to develop an individualized Clinical Plan; 2)Provide short-term resources to implement the Clinical Plan; 3)Enhance Caregiver and System Capacity; That… IMPROVES CLIENT OUTCOMES!! 6

7. Elements of Service Coordinate Clinical Planning Capacity Building Intervention Resources to Sustain 7

8. Overall Goals Individual Level 8

9. Service Pathway Referral and Consents Clinical Planning Interventio n Planning Service Delivery 9 Ongoing collaborative review

10. What Can CAIR Do? Mentor and support existing Case Manager. Provide support access to additional assessments. Provide support to service providers regarding creation & implementation of clinical plan. Provide updates to Clinical Conference. Share evidence-based resources Participate in organizational and treatment planning meetings. Provide fiscal allocation. 10

11. What Can’t CAIR Do? Fund or resource long-term supports Crisis Response 11

12. What does ALC Mean? An individual residing in a hospital inpatient unit or treatment bed who: Presents with complex needs but can be served in the community with appropriate supports Is blocking a hospital or treatment bed Must be medically/legally designated Face barriers to discharge 12 “You’ve completed treatment and you’ve got nowhere to go.”

13. Eligibility for ALC Service Client with an: –ALC designation –Dual Diagnosis –Significant unmanaged behavioural issues including: self-injurious behaviour severe aggression Inappropriate sexual behaviours exit-seeking

14. Service Includes… A Behaviour Therapist and flexible funds Maximum length of service = two years Mobile individualized clinical supports –Assessment –Treatment –Staff Training 14

15. ALC and CAIR All ALC Clients are CAIR Clients, but not all CAIR Clients are ALC! CAIR ALC 15

16. CAIR & ALC Funding CAIR Program: MCSS &TNSC ALC Service: TCLHIN 16

17. What is Clinical Planning Clinical planning-aims to describe a person’s presenting needs/issues and use theory to make explanatory inferences about causes and maintaining factors that can inform interventions The boundaries of what constitutes a plan/formulation are arbitrary. There is no absolute definition The British Psychological Society,2011

18. Context of Clinical Planning Brief historical context Key elements presented Types of clinical planning/frameworks Biological/Medical Case Formulation Psychiatric Case Formulation Psychological Case Formulation Bio-psycho-social Case Formulation The British Psychological Society,2011

19. Purposes of a Clinical Plan Main purpose in any setting: Identifying the best way forward and informing the intervention Practice & Evidence Based Research suggest: providing an overall picture or map Noticing gaps in the information about the service user Prioritizing issues and problems Thinking about lack of progress; troubleshooting; determining criteria for successful outcome The British Psychological Society,2011

20. Purposes of a Clinical Plan Achieving a consistent team approach to intervention Helping team, service user and carers to work together Gathering key information in one place Dealing with the core issues (not just crisis management) Drawing on and valuing the expertise of all team members The British Psychological Society,2011

21. Client Family Service Provider

22. Bio-psycho-social Case Formulation

23. Example of a Clinical Plan

24. Transition Planning Another kind of clinical planning that requires time and effort Usually in the context of an individual “stuck” in a treatment setting (ALC) for many months/years Having a dual diagnosis increases the likelihood that they could become ALC if in hospital or treatment bed Involves cross-sector communication and understanding Butterill et al, 2009

25. Barriers to Discharge Barriers to discharge: –Clients left out of discharge process –All parties not having good understanding of each others’ service and capacity (hospital vs. community) –No involving both parties early-on in planning –Lack of high support housing options –Lack of capacity in the community “We need to think differently to accommodate clients” Butterill et al, 2009

26. Transition Planning Characteristics of a good transition: –Tailored to the needs of individual –Carefully planned –Inclusive of family –Appropriately timed –Collaborative and shared accountability Tool: ALC TRIP Butterill et al, 2009; Viggiano et al, 2012

27. Case Study #1 The Case of “Help I Can’t Manage” Biological? Psychological? Social?

28. The Case of “Better Safe then Sorry” Biological? Psychological? Social? Where does transition planning fit? Case Study #2

29. Contact Information Cynthia Cabrera: –ccabrera@griffincentre.org Leo Edwards: –Leonard.Edwards@camh.ca Olivia Shaw: –Olivia.Shaw@camh.ca

30. References Butterill, D., Lin, E., Durbin, J., Lunsky, Y., Urbanoski, K., and Soberman, H. From Hospital to Home: The Transitioning of Alternate Level of Care and Long-stay Mental Health Clients Health Systems Research and Consulting Unit, CAMH, September 2009. Viggiano, T., Pincus, H., and Crystal, S. (2012). Care transition interventions in mental health. Current Opinion in Psychiatry. 25(6): 551-558 Good Practice Guidelines on the use of formulation: The British Psychological Society (2011)