Service teams and home visit - Mental Health Commission of Canada

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
• 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
How to “do ACT” and Housing First
 Follow Housing First Fidelity measures with your
 Team rather than standard ACT fidelity measures
 Yearly fidelity review
 Always maintain a Housing first philosophy
 Ask advice, talk to other folks doing Housing First
 Be Innovative and daring
 Try new things
 Avoid too many rules
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
 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
① Immediate access to housing with no readiness conditions
② Personal choice and self –determination
③ Recovery orientation
④ Individualized person-driven supports
⑤ Social 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
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
Resources and supports
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
• Ongoing active engagement
• Focus on Person’s Choices not
the programs goals
Opportunity for Engagement
Opportunity to
develop a trusting
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
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
• Reminders, calendars, notes on fridges
• Varies over time
• Non-linear process
• Need to be flexible and
accommodate the needs of the
• Efficiency is important
• Distribute workload by specialty and
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
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.
Thank you
Contact us: [email protected]
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