1. BRANT COMMUNITY PROTOCOLS AND PROCESSES Welcome to the Brant community electronic orientation package on community Protocols and processes. Revised April 2013

2. Background  The Children’s Services Committee, represented by numerous sectors, has approved these community protocols  This electronic orientation was developed by the Children’s Services Committee

3. Communication, Coordination, Collaboration The Brant community Protocols guide our daily practice in serving people - Communication, coordination & collaboration help us:  Best meet the needs of the people we serve  Address services for ‘Most in Need’  Avoid duplication and contradiction

4. Guiding Community Principles Person/Family-centered service Work collaboratively Address ‘Most in Need’ Least intrusive services Utilize best practice Confidentiality Maximizing available resources

5. Service Collaboration Protocol Ensures staff are working together when multiple agencies involved:  Supports a single plan of care  Supports coordinated & complementary services  Avoids duplication and contradiction Every staff has a role in establishing and maintaining communication with other service providers

6. Collaboration Protocol cont’d Staff aware of more than 1 agency involved will communicate (with Consent): All staff are responsible to initiate communication within 2 weeks with other providers  Document* the coordinated planning Identify clients that are ‘stressing’ services as “Emergent” or “Urgent”

7. Most in Need Tool Tool describes:  Priority, Situation, & Timing of Request  Action required for those prioritized as Emergent or Urgent Emergent = Stressing service system; support needs not easily met Urgent = At risk; services exhausted

8. CASE CONFERENCES Meeting together ensures:  Seamless system for families  Planning for individual’s outcomes  Communication between services  Coordination & collaboration of supports

9. Case Conference Agenda Prepare:  Have a clear purpose for the meeting  Briefly review current situation  Identify strengths, as well as needs & barriers  *Explore support options & coordination of services  Set an action plan - define who is doing what and when

10. CASE CONFERENCE ROLES “Case Manager” Role: Identify and invite participants Identify prior who will Chair meeting Identify prior who will take Minutes Prepare/present brief summary Follow-up on your role after meeting

11. CASE RESOLUTION Protocol A community response to children/youth at risk:  Urgent and complex needs  Community services exhausted  Barriers include resources  Preceded by a case conference Facilitated by Contact Brant

12. CASE RESOLUTION AGENDA (At Risk)  Has a clear plan based on clinical goals  Case Manager prepares a Case Resolution Summary Report prior to meeting  Case Res. Team, family & case manager discuss the plan, barriers, options  Case Resolution Team only meets to address resources and how the support plan will be implemented

13. CASE RES AGENDA Transitional Aged Youth  At age 16: Identify the developing plan & supports for a youth with a developmental disability; inform adult DS services  At age 17: Identify the discharge plan at age 18 from children’s services for supports and activities  Case Manager submits the Transition Plan  Case Res. Team discuss the plan, barriers, options; ensures a realistic plan is in place

14. CASE RESOLUTION ROLES ‘Case Manager’: Requests Case Resolution Invites family & staff Submits Case Res. package 4 days prior to meeting Clarifies any questions Supports individual/family Follows-up Updates Contact Brant re outcomes of the plan Contact Brant: Confirms eligibility/date Assists Case Manager Invites Case Res. Team Sends package to Team to review prior to meeting Chairs meeting Follows-up Prepares Case Res. Report for MCYS & Team Reports updates to Team Identifies gaps & pressures for system planning

15. Transition Planning Protocol (DS) Provincially mandated Regional Protocol for youth with a developmental disability:  Start planning at age 14 by referring to Contact Brant  Develop a written transition plan; it should be realistic, evolving, and updated annually Identify personal goals and community services, as well as desired adult service supports  Plan with: youth & family, school, children’s and adult community services What will really happen at age 18?

16. TAY Planning Checklist Use the Checklist template! Transition Planning should identify: what the youth wants what they need now and in the future how they want to do things who they want to help them Involve youth, family, service providers & school; ensure transition plans are meaningful and seamless at age 18 The plan is about community involvement and quality of life - not just about services

17. Brant Community Crisis Protocol  Crisis Plan template: Complete for individuals likely to have police or ER involvement  Coordinated response for children and adults with special needs in crisis  Cross-sectoral protocol & response

18. Crisis Protocol - cont’d  Crisis Planning  Use the Crisis Plan form  Crisis Response – follow plan  Post Crisis Follow-up – improve response

19. Transitioning from Children’s Mental Health Services Protocol Transitioning Youth from Children’s Mental Health to Adult Mental Health and Addictions Services Community Protocol  Ensures a coordinated transition plan for youth with acute mental health needs/longer-term service users at highest risk and require on-going mental health and addictions supports

20. Transitioning from Children’s Mental Health cont’d  Provides definitions to understand the differences between children’s mental health services and adult mental health & addictions services  Start at age 14 to identify these youth  By age 16, provide information about services, expectations once 18, and support connections to adult mental health & addictions services Assist youth/families to develop a proactive, coordinated, and seamless transition plan

21. Transitioning from CMH Protocol cont’d  Collaboration between Children’s Mental Health Services and Adult Mental Health and Addictions Services is key  Support the need for increased independence  Provide choices and involve youth in the transition process to promote and support self-advocacy By age 18, the youth has a coordinated transition plan between children's mental health services and adult mental health & addictions services

22. Telepsychiatry Protocol  Access to child psychiatrists with various expertise through Woodview Children’s Mental Health and Autism Services’ videoconferencing equipment  One-time Psychiatric consultation, available in our community

23. Telepsychiatry Protocol cont’d Must have a ‘case manager’ for follow-up:  Completes referral form and mental health assessment specific to the consultation requested – send to Woodview  Participates in meeting (60 – 90 minutes) with child and family  Follows-up on recommendations Note: Other child psychiatry services are available through CPRI, McMaster, and St. Leonard’s Clinic

24. Residential Placement Advisory Committee Child and Family Services Act legislates an RPAC review:  For children/youth placed in a residential facility of 10+ beds, and will be staying over 90 days  To advise, inform, assist re the residential service and alternatives; recommend appropriateness  Within 45 days of placement & every 9 months after RPAC Team includes: An Informed Citizen, a Children’s Service provider, an Aboriginal representative (when appropriate) Contact Brant coordinates for Brant

25. RPAC Agenda Case Manager:  Prepares a summary report and submits 48 hours prior to Contact Brant  Makes a brief presentation; child/family & residence may also present RPAC Team reviews the reason for residential placement, the goals of placement, and appropriateness of the residential placement RPAC is chaired by Contact Brant

26. RPAC ROLES Case Manager: Notifies Contact Brant within 7 days of residential placement Prepares package 48 hours prior to RPAC Invites participants Supports child/family Presents briefly Follows-up with residential provider and community services Notifies Contact Brant when discharged Contact Brant: Assists Case Manager Sets date of RPAC meeting Invites RPAC Team Ensures package copied for RPAC Team Chairs meeting Submits RPAC Report to MCYS Identifies future review dates when needed

27.  A community publication of free workshops, courses, groups, and events provided by local organizations for families, children & teens  Watch for publications 3 times per year  Available at your agency, or electronically at: www. contactbrant.net/yourguide.

28. Community Information Database A web-based Community Services Database:  Make sure your programs are listed and updated! Check it out – www.info-bhn.ca  This database is used by 211 Ontario to provide their information for Brant, Haldimand & Norfolk: call 211 24/7 or visit 211ontario.ca Managed locally by Contact Brant

29. Community Collaboration around supporting people… Communicate Coordinate Collaborate Together we can make things happen!

30. For information & help with Community Protocols/Processes: Call: (519) 758-8228