How Can the APSAO and NADD Ontario Work Together to Support Adults with a Dual Diagnosis? Alex Conant, M Ed Karen Hirstwood, MSW Jo Anne Nugent EdD Brenda Quinlan

Presentation Objectives Introduce NADD Ontario and highlight its activities Review current service issues: how to serve independent individuals and the new APSW Guidelines Discuss the training needs of case managers related to dual diagnosis Discuss how NADD Ontario and APSAO can work together

What is NADD Ontario? NADD ONTARIO (formerly The Habilitative Mental Health Resource Network) is the Ontario Chapter of the National Association for the Dually Diagnosed. Dual diagnosis is defined as the co-existence of an intellectual / developmental disability and mental health needs. The Ontario Chapter began in 1991 and was incorporated in 1993

NADD Ontario’s Mission Statement To advance mental wellness for persons with developmental disabilities through the promotion of excellence in mental health care.

NADD Ontario’s Vision We envision a society wherein persons with a developmental disability and mental health needs (dual diagnosis) and their families have full and equitable access to supports and services that promote and enhance their mental health and well- being.

Vision can be achieved through: a continuum of supports and services that includes family and natural supports and ranges from the promotion of mental health to treatment and long term care. integrated and collaborative approaches to services and supports treatment approaches that are based in biopsychosocial models of care

NADD Ontario’s Current Focus Enhancing provincial investment in sustainable education and training initiatives to support recruitment and retention of human resources.

NADD Vision 2012 Is a (more) Sustainable organization Has an expanded, vibrant membership Is a (the) focal point for dual diagnosis networking Is the recognized driver of policy directions NADD has an IMPACT NADD Ontario has contributed to the evolution of a the service system and Communities Families and professionals know what supports there are and how to get them There are more competent and capable supports and services ReputableSustainableStrong

NADD Ontario’s Activities Systems level advocacy Training & Education

Systems Level Advocacy August, 2009 cover letter re: The Lieutenant Governor in Council Draft Regulation for the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, August, 2009 cover letter re: The Lieutenant Governor in Council Draft Regulation for the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, The joint submission to the initial draft regulation for Bill 77 from NADD Ontario and the Dual Diagnosis Implementation Committee of Toronto. The joint submission to the initial draft regulation for Bill 77 from NADD Ontario and the Dual Diagnosis Implementation Committee of Toronto. August, 2008 submission on behalf of NADD Ontario) and the Dual Diagnosis Implementation Committee of Toronto (DDICT) Re: Bill 77 August, 2008 submission on behalf of NADD Ontario) and the Dual Diagnosis Implementation Committee of Toronto (DDICT) Re: Bill 77

NATIONAL COALITION ON DUAL DIAGNOSIS November 2008, NADD Ontario, CARE- ID/ACREDI, Dual Diagnosis program at the CAMH and the Developmental Disabilities Section of the Canadian Psychiatric Association launched the National Coalition on Dual Diagnosis to increase the understanding of the needs of individuals with a developmental disability and mental health needs with the Mental Health Commission of Canada (MHCC) and for all Canadians.

NATIONAL COALITION ON DUAL DIAGNOSIS An initial activity was to develop The Advocacy Toolkit so that advocates for people with dual diagnosis have the “tools” to help them make their case as effectively as possible. The toolkit is available at: March 2009 National Coalition Update: March 2009 consensus Coalition response has been sent to the MHCC.

Education & Training Dual Diagnosis: An Introduction to the Mental Health Needs of Persons with Developmental Disabilities, 2002 Workshops & conference sessions Newsletter Research into best practices

Training, Recruitment And Retention In The Field Of Developmental Disabilities And Dual Diagnosis A Review Of The Literature (NADD 2007) Investigate what factors make training sustainable Incorporate the social determinants of health and population health perspective:  community living includes social, recreational, housing sectors AND  health, education, mental health and justice sectors Training and education related to dual diagnosis needs to be broad and should be incorporated with training and education related to developmental disabilities

Findings re: Sustainability At The System Level. 1. Developmental disability policy should include health and mental health needs and recognizes the skills, training, and qualifications required to address these needs 2. Career pathways should be developed through policy as well as program/practice level initiatives, support recruitment, retention, and advancement. 3. Developmental disabilities and dual diagnosis are required aspects of generic health care curricula, practicum, and practice standards

Findings Re: Sustainability At The Program/Practice Level 1. Training sanctioned within professional practice standards and/or certification criteria supports best practice 2. A variety of creative models, approaches and strategies can be utilized to achieve success in training 3. Teaching clients and caregivers about primary care improves quality of care. 4. Standardized procedures or templates assist practitioners in the implementation of quality care. These protocols help staff to know what to do in which situations, based upon what has been proved to work best in the past.

New Guidelines and Dual Dx. Prevalence rates for dual dx range from 38% to 60% Historically a large percentage of these individuals are served by APSW’s New Policy Guidelines for the APSW Program do not reflect the unique needs of this population mandate access to formal (government-funded) and informal (mainstream community) community resources Advocacy Community Development

New Guidelines and Dual Dx. DS Transformation initiatives (IRMI) lend themselves to those who have familial support. Despite the availability of limited time frame support by APSW some individuals may disadvantaged The impact of the proposed development of Access/Funding Entities is unknown at this time Eligibility criteria not yet finalized

New Guidelines and Dual Dx. Joint Policy Guidelines for the Provision of Community Mental Health and Developmental Services for Adults with a Dual Diagnosis identify the range of service funded by MOH and MCSS Access to these services is challenging in practice: Restrictive criteria Lengthy wait lists Lack of skill and knowledge Bias toward those with dual dx

What Can Be Done? Opportunities for joint work:

New Guidelines The APSW will be the sole advocate and support for many individuals who have a dual diagnosis The APSW may be the primary contact for the Psychiatrist when assistance is required with follow up on recommendations The APSW may be the only person to assist in accessing individualized funding supports

Access to Specialized Treatment Hospitals and Specialized Treatment beds require that individuals have family or agencies that will commit to taking them back. Discharge recommendations can stipulate greater or different supports than previously existed If an individual is unable to complete referral packages the APSW will need to assist.

Conflict With The Law Medications get lost in transit between court, holding cells, remand centre’s and correctional facilities. Medication changes that occur while traversing through the system may not be known when individual is released. Advocating while going through process may mean extensive time spent in court

Psychiatric Recommendations Blood work: ensuring monitoring of therapeutic levels Side effects: recognize and monitor Medication administration: ensure compliance or accurate reporting of compliance Health Teaching