LONDON CMSM ONTARIO WORKS ADDICTIONS SERVICES …€¦ · Ontario Works Regular Case Management identifies participant's need for ASI support and sends referral to ASI Team "Team

LONDON CMSM

ONTARIO WORKS ADDICTIONS SERVICES INITIATIVE (ASI)

2014 – 2015 SERVICE PLAN

Addendum to Ontario Works Service Plan 2013 – 2014

Submitted by: Ontario Works, CMSM for London and Middlesex March 31, 2014

LONDON CMSM

ONTARIO WORKS ADDICTIONS SERVICES INITIATIVE (ASI)

2014 – 2015 SERVICE PLAN

Addendum to 2013-2014 Ontario Works Service Plan

Prepared: March 31, 2014 Ontario Works Administrator: Sandra Datars Bere Project Lead: Kim Godin Project Contributors: Pauline Andrew Mamta Chail-Teves

Sandra Datars Bere Susan Godin Cindy Howard

Momodou Jeng Martina Kaiser Nicola Memo Randy MacTaggart Pina Sauro Eleanor Weedmark Elisabeth White

TABLE OF CONTENTS Section 1: ASI Service Strategy ................................................................................. 1

London CMSM ASI Strategic Vision and Service Approach ................................................ 1 London ASI Client Service Pathway ..................................................................................... 3 Alignment with ASI Logic Model .......................................................................................... 4

Section 2: Program Management ASI Service Delivery Model ................................ 5

Overview of London’s Integrated ASI Service Delivery ........................................................ 5 Management and Monitoring of the ASI Caseload .............................................................. 7 Caseload Composition ........................................................................................................ 9

Section 3: Link Strategies to Outcome Measures .................................................. 16

ASI Treatment Providers ................................................................................................... 16 Prevalence of Addiction within London and the Ontario Works ASI Caseload ................... 16 Referrals and Number of People Served ........................................................................... 18 External Influences that may Impact Service Delivery ....................................................... 18

Section 4: Service Provider and Partner Linkages ................................................. 20

London’s ASI Fresh Start Program .................................................................................... 20 Addiction Services of Thames Valley (ADSTV) Partner’s role ........................................... 20 ASI Client Data and Reporting Indicators .......................................................................... 21

Section 5: Monitoring Service Strategies ................................................................ 23

Intake ................................................................................................................................. 23 Client Progress Monitoring ................................................................................................ 23 Waitlist .............................................................................................................................. 24 Employment Outcomes ..................................................................................................... 24 Staff Training Plan ............................................................................................................. 25

Appendices

Appendix A London ASI Client Service Pathway ........................................................... 27

Appendix B Ministry of Community and Social Services Ontario Works Branch ASI Renewed Logic Model .............................................................................. 28

Appendix C Employment Assistance Framework ........................................................... 29 Participant Path to Employment Service ..................................................... 30 Employment Assistance Employability and Service Level ........................... 31

Appendix D London ASI Fresh Start Manual .................................................................. 32

Appendix E London CMSM Monthly ASI Statistical Report ............................................ 48

Appendix F Ontario Works London Business Practices - ASI Internal Referral Process . 49 Ontario Works London Business Practices - ASI Referral to Addiction

Service Provider ....................................................................................... 52

1

Section 1: ASI Service Strategy

London CMSM ASI Strategic Vision and Service Approach

The London CMSM has always focused services on supporting participants to increased

employment, getting, and keeping jobs. The London CMSM ASI Service Strategy is led by our

City of London’s Ontario Works Mandate: “We help individuals and families realize their hopes

and dreams. Make a difference. Every person. Every day”.

The Provincial Ontario Works Vision and Mandate (as noted on page 2 of the London CMSM

2013 - 2014 Ontario Works Service Plan) also guides our ASI work as a client-centred,

community focused professional organization, we engage with individuals and families

connecting them to support services and opportunities. Through leadership, strong systems,

and our community presence, we achieve a balance of community supports and mandated

requirements.

Addictions Services is one component of a broad range of employment services designed to

meet the needs of individual clients and is delivered in partnership with the community to

achieve successful outcomes for people served by Ontario Works.

The Addiction Services framework for the London CMSM uses a coordinated approach for all

participants within the Addictions Services Initiative for the City of London and the County of

Middlesex. London CMSM Addictions Services Initiative (ASI) framework is consistent with the

Ministry’s Addictions Services Initiative Guidelines and delivers services through an

Addiction/Intensive Case Management team that provides specialized and individualized

supports to Ontario Works participants whose substance abuse is preventing them from finding

and keeping employment and from meaningfully contributing to their community. Values that

guide our work include: voluntary, non-judgmental, client centered, respectful, empowering,

empathy, encouragement, creativity with problem solving and goal focused.

London’s ASI Service Delivery Strategy is based on an integrated approach which includes the

following key features:

A contracted partnership with our community Ontario Ministry of Health and Long-Term

Care (MOHLTC) designated Addiction Assessment and Treatment Service Provider,

Addiction Services of Thames Valley (ADSTV). ADSTV provides a formalized

dedicated program for Ontario Works participants in London and Middlesex County

called “Fresh Start” offering a full range of services including:

o community based addiction/mental health counselling

o addiction assessment

o treatment planning

o referrals

2

o topical group sessions

o education

o discharge planning

o after care supports using both individual and group sessions.

The Fresh Start program provides the full range of continuum of care during the stages

of recovery, prevention and relapse

Collectively, alongside our addiction partner, we assist individuals to choose a treatment

path that will reduce their addiction severity, increase their employability and job

readiness with the long term goal of self-sufficiency

ASI Ontario Works Fresh Start Participant experiences are enriched because of what

we have learned together through our continuous improvement approach, monitoring

outcomes and collaborative work with our MOHLTC partners

Ontario Works and ADSTV are aligned philosophically in supporting ASI Ontario Works

participants through Harm Reduction Strategies, Stages of Change – Motivational

Interviewing, and early Pre-Employability work with referrals utilizing the London Ontario

Works Employment Services Framework - Essential Employment Services and Skills

Training, Specialized Individual Services and Employment Placement. Together we

employ an intensive case management model to support participants in reaching their

individual goals, address recovery, remove barriers, celebrate their achievements,

sustain employment and improve overall quality of life

The Ontario Works and ADSTV partnership is built on open communication, joint case

management, ongoing professional development, tracking, monitoring outcomes and

program evaluation

As depicted on the following two pages, the London ASI Client Service Pathway demonstrates

London’s ASI model and its alignment with the ASI Logic Model. Partnership roles and core

activities are outlined within the Program Management section.

London ASI Client Service Pathway

Assessment Group

Alternate Tuesdays from 2:00-3:30

Check in at ADSTV reception

Triage Process

Complete INTAKE FORM while waiting

Brief Assessment Individual appointment given by

Fresh Start Intake staff

For clients who have recently completed an assessment

elsewhere or recent residential treatment graduates

Bypass Assessment

Individual appointment given by Fresh Start Intake staff

For clients who cannot attend the Assessment Group due to

scheduling conflicts, mental health, literacy, etc.

Community Treatment Treatment Planning Completed - ongoing joint case management with ASI OW Caseworker

One to One Couselling, Group Referrals based on stage of change

Referrals to other forms of treatment as appropriate (may include residential)

Discharge due to TX complete, drop out/ no show, source of income change, etc.

Ontario Works Regular Case Management identifies participant's need for ASI support and sends referral to ASI Team "Team A"

ASI - "Team A" Fresh Start Program Screening

ASI - "Team A" Fresh Start Intake Group

Co

nti

nu

e to

Te

am A

Not appropriate for Team A •New participation

agreement

•Referral back to ASI Team A when ready

•Exiting OW due to employment

OW Team of origin

INTAKE & SCREENING BOOKING AT ADSTV (as directed by Fresh Start Intake Counsellor)

SCREENING PROCESS FOR ADDICTION SERVICES OF THAMES VALLEY (ADSTV) OW ASI Caseworker completes screening tools (TEQ &

Socrates), Consent signed OW faxes referral to Fresh Start at ADSTV,

OW informs client of intake

•Complete 70% of assessment in non-sharing group format

•Sign Confidentiality Form

•Receive appointment time for individual feedback session.

Assessment Group

•Finish Assessment and receive feedback from tools filled out in asessment group

•GAIN Q3

•90-120 minute appointment

•Start Treatment Planning if time permits

Feedback Session

•Assessment Tools completed on an individual basis with counsellor

•Treatment Planning started if time permits

Assessment

One hour information session held

at Addiction Services of Thames

Valley monthly

Information about OW Addictions

team alongside ADSTV Fresh Start

treatment Program

Information about ADSTV

5

Section 2: Program Management ASI Service Delivery Model

Team Structures:

The London ASI team is comprised of five Caseworkers, one Manager, one half-time

Community Support Specialist, and one Unit Clerk. The unit is overseen by the Senior Manager

of Employment Strategies who reports to the Senior Manager of Employment and Strategic

Initiatives. Each Caseworker carries a caseload of 60 cases which is approximately half the size

of a caseload for London’s regular case management. The ASI caseload is designed to ensure

intensive case management through personal, frequent attention and monthly contact.

Middlesex County ASI services are delivered by the Employment/ASI Caseworker who reports

to the Employment Services Manager reporting into the Director. Middlesex follows London’s

and ADSTV best practices, protocols and referral processes for their ASI Ontario Works

participants.

A contracted partnership with ADSTV, the MOHLTC designated and funded Addiction

Assessment and Treatment Service Provider, provides the assessment and treatment

component of ASI. The Fresh Start Program is a formalized service agreement/partnership

delivered through ADSTV for London by three Addiction Counsellors and one Manager that

oversees the program. ADSTV Fresh Start staff ensures a holistic approach with Ontario Works

participants that integrates the full range of ADSTV services including: the London Drug

Treatment Court (LDTC), Addiction Supportive Housing, and Heartspace, a program for families

and children. This integrated service model provides the opportunity to broaden our partnership

with ADSTV and expand Fresh Start program supports to Ontario Works ASI participants

involved in the London Drug Treatment Court pilot. London Drug Treatment Court provides the

court supervised addiction treatment and Ontario Works ASI Fresh Start ensures participants

are involved in a structured outpatient addiction treatment program with individualized referrals.

Over the past eight years our partnership with ADSTV has strengthened with a focus on

continuous exploration of opportunities to enhance services and to meet the needs of our

common clientele.

Overview of London’s Integrated ASI Service Delivery

The contract between the City of London Ontario Works and ADSTV outlines roles and

responsibilities that include coordinated access for the CMSM. The City’s role in this partnership

includes:

Acting as the lead for the overall governance of the Ontario Works ASI London CMSM

program

Tracking, monitoring and reporting progress to the Ministry and Addiction Service

Provider on a quarterly basis

6

Ontario Works ASI Caseworkers providing the overall case management of Ontario

Works participants’ case files who are ASI participants. This includes ongoing

monitoring for Ontario Works eligibility, income, and employment supports

ASI Caseworkers being expected to build a trusting and effective relationship with

Ontario Works ASI participants as a key support person who at times will provide

advocacy and intercessor when needed to provide fair and equable access

Conducting screening of Ontario Works participants who have self-identified as having

a substance abuse problem as a barrier to employment. ASI Caseworkers will

complete the approved addiction screening assessment tools of SOCRATES (Stages

of Change Readiness and Treatment Eagerness Scale), Treatment Entry

Questionnaire (TEQ), GAINS Short Screener and Acquired Brain Injury. Employment

readiness inventory and future return to work goals are explored and documented

during the initial screening appointment as this information will assist in building a

comprehensive Participation Agreement.

Note: only ASI Ontario Works participants in the Contemplative Stage of Change will

be accepted. Supports are offered to Pre-contemplation Ontario Works participants at

ADSTV through their group sessions in moving people to the next stage of change.

The ASI Caseworker introducing the participant to various program components during

the screening appointment, including the partnership with ADSTV Fresh Start program.

ASI participants are guaranteed timely entry into the Fresh Start program (initial

appointment is within a two week window)

ASI Caseworkers sending referrals to ADSTV Fresh Start program including completed

assessment tools scores, consents and additional information as required for the next

step of the intake process

The ASI participant and ADSTV Fresh Start Counsellor developing an individual case

management plan including short and long term addiction recovery goals alongside the

development of the Ontario Works Participation Agreement which includes short and

long term employment goals. Focus is on a “Wrap-around” approach for ongoing

coordinated support including income and employment supports, eligibility reviews, and

coaching with problem solving

Employment Related Expenses (ERE) being used to support child care, transportation

costs, “diversion activities” such as recreation to build new positive behaviors and

activities that replace substance abusing patterns

Additional referrals also being made for the ASI participants through London’s

Employment Services Framework, Purchase of Services Employment partners for pre-

employability, life skills, employment counselling, Skills Training, Employment

Placement, etc. (see Appendix C)

Ongoing case management including; frequent monthly contact with ASI participants

depending on participant need, progress monitoring, seeing “drop-in” participants,

encouraging changes, determining Ontario Works eligibility and entitlement, continuous

development of Participation Agreement and stabilization, employment, and recovery

next steps

7

ASI Caseworkers participating in monthly joint case conference meetings with ADSTV

Fresh Start Counsellors sharing information, coordinating care, reviewing progress,

refocusing goals and participant follow up items

Coordinating case conferences and referrals with other Service Providers regarding

stabilization concerns, housing, trauma, acquired brain injury, medical appointment,

Children Aid Society. etc., as required

ASI Caseworkers participating in the collective program vision, professional skill

development alongside the ADSTV team with a common mission of decreasing

barriers in the stages of change, building self-efficacy, encouraging choice and

exploring recovery options, exploring reemployment skill building, creating timelines for

returning to work and celebrating success

Management and Monitoring of the ASI Caseload

London’s CMSM adheres to the Ontario Works Addictions Services Initiative Service Planning

Guidelines through a model whereby ASI Caseworkers provide employment, income and

intensive case management supports and ADSTV Counsellors provide assessment and

treatment services, with both parties having clear and defined roles within the wraparound

intensive case management model/program. The role of the ASI Caseworker is to address the

participant’s barriers to employment, connect them to additional community services, housing,

childcare, healthcare, employment services, etc. The role of the ASI Caseworker is very much

that of a system navigator: a consistent support person identifying challenges and linking

participants to appropriate supports that encourage sobriety and wellbeing. Caseworkers are

able to offer quick responses to financial emergency, financial and employment supports, and

financial preparation for residential addiction treatment such as transportation and personal

items needed for their stay. Financial supports are always individualized to a participant’s

recovery journey. Other important aspects of ASI Caseworkers are participant advocacy, crisis

intervention, attending community meetings for additional support and at times interceding on

ASI participant’s behalf. Examples include: Probation and Parole, London Drug Treatment

Court, Work Readiness Assessments, Children’s Aid, Medical appointments, etc., to provide

additional emotional support. ASI Caseworkers may also advocate with an employer or assist in

obtaining essential documents required for job applications or addiction treatment.

The program, through proactive management, ensures a quality service that adheres to ASI

Guidelines, supports participants and leads to outcomes through regular management

supervision/coaching meetings with all ASI Caseworkers. Key components of this approach

include:

Ontario Works ASI Directives

Ontario Works Participant Boundaries

ADSTV and Ontario Works role clarity

Professional Self-care

Professional Development

8

ADSTV and Ontario Works ASI staff teams conduct monthly joint case management meetings

which allow for ongoing review of ASI participants, addressing staff needs for professional

development through addiction “in-service” teaching, open communication, collective problem

solving and the development of best practices for the Fresh Start partnership. We feel this

promotes our vision of excellent service delivery for ASI Ontario Works participants.

The Fresh Start Program Manual was developed jointly between the City and ADSTV and

includes chapters that outline each Stage of Change, sample questions for both staff teams;

suggested goals/treatment plans for each stage and outlines the ADSTV Fresh Start Counsellor

and Ontario Works ASI role descriptions (see Appendix D). Suggested readings and the Centre

for Addiction and Mental Health website are included for ongoing staff professional development

needs. Each ASI Counsellor has this manual in hard copy as well as electronic for daily access

as the manual is often used with the ASI participant for educational purposes as well as

providing explanations of the program elements. Regular training, workshops and courses are

offered to all ASI staff through ADSTV, the Centre of Addiction and Mental Health (CAMH), and

other community agencies including London’s Employment Purchase of Service organizations.

Over the past few years concurrent disorders (addiction/mental health) have been identified as

a growing trend within both the ASI and Ontario Works regular caseloads. ASI Caseworkers,

along with our other Intensive Case Management teams receive specialized Mental Health

training through London’s Canadian Mental Health Association (CMHA) for a greater

understanding in supporting this clientele.

Our ASI program is also available to OSDP spouses, dependents and deferred Ontario Works

participants. The referrals utilize the same processes as for any Ontario Works participant. The

key ASI program determination is compliance with the goal of reducing the barriers to

employment, addiction recovery and return to work. Once accepted into the ASI program,

progress and ongoing monitoring of their situation is consistent with the ASI London program

principles and supports. This population represents a small percentage of the ASI caseload.

A participant will move back to regular Ontario Works case management under the following

circumstances:

The participant has demonstrated a movement backward to a pre-contemplative stage

The participant shows a lack of engagement or follow through for a period of time

(usually 3 months in duration)

Progress has stopped

Participant requests to leave the ASI program

Participant has completed treatment and is engaged in employment readiness

activities/return to work.

The decision to return to regular caseload is jointly made and agreed upon by the participant,

ASI Caseworker, and the ADSTV Fresh Start Counsellor. The process to return to regular case

9

management includes updating the Participation Agreement, consultation between the ASI

Caseworker and the regular case management Caseworker, reviewing the participant’s history,

current situation and making recommendations for next steps. Alternative options for some ASI

participants who have achieved substance abuse recovery but continue to need more intensive

employment supports can be transferred to our Intensive Case Management team which

focuses on supports to employment. Case consultation during the transfer process is a

requirement to achieve comprehensive customer service and supports for these participants.

We believe London’s ASI Fresh Start program demonstrates the Ministry’s ASI principles of

rigorous client screening and assessment, voluntary participation, comprehensive holistic “wrap-

around” approach, responsive to community needs, full commitment and co-operation of

partners and ongoing performance monitoring and data collection.

Throughout the participant’s involvement with ASI, small employability steps are encouraged

through referrals to our Employment Purchase of Service partners who deliver Essential

Employment Services, Employment Placement, Skills Training, Specialized Individual Supports,

Life Skills coaching, Employment Counselling, Employment Placement and Self-Employment.

The ASI Caseworker, during the monthly meetings, engages the ASI participant in ongoing

employment goal development discussions building upon successes achieved, ensuring

employment related expenses benefits are issued and focusing on the fuller plan of returning to

work.

The following information supporting our Ontario Works ASI service delivery model are included

in the Appendices:


Ministry of Community and Social Services Ontario Works Branch ASI Renewed Logic

Model

Employment Assistance Framework, Participant Path to Employment Service and

Employment Assistance Employability and Service Level

London ASI Fresh Start Manual

London CMSM Monthly ASI Statistical Report

Ontario Works London Business Practices - ASI Internal Referral Process, Ontario Works

London Business Practices - ASI Referral to Addiction Service Provider

Caseload Composition

In February 2014, the London caseload was 11,018 with an additional 473 cases in Middlesex

County for a total CMSM caseload of 11,491. Participants in Middlesex County represent

approximately 4.2% of the caseload.

10

Addictions Services Initiative Caseload Demographics

The following data provides a high level demographic overview of the ASI caseload. Data for

this report was derived from London’s February, 2014 Ontario Works caseload SDMT data

extract produced by Information Technology Services of the City of London.

Data from September, 2013 was also examined and this confirms that February, 2014 is a

representative month.

The Ontario Works caseload data extract contains information on 10,784 London Ontario Works

applicants of which 260 are participants in the ASI.

1. Basic Demographics

a. Age

The ASI caseload has a greater percentage of individuals aged 22 to 55 as compared

to the regular OW caseload.

The average age of individuals on the ASI caseload is 36.5 years which is similar to

the Ontario Works caseload where the average age is 36 years

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Under18

18 to 21 22 to 29 30 to 35 36 to 45 46 to 55 56 to 65 Over 65

Age Type

Caseload ASI

11

b. Gender

The Ontario Works caseload has a slightly higher percentage of females (51.2%)

compared to males (48.8%) whereas the ASI caseload has a much higher percentage

of males (57.3%) compared to females (42.7%)

c. Marital Status

The ASI caseload has a higher percentage of individuals who are single or separated

than the Ontario Works caseload.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Male Female

Gender

Caseload

ASI

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Marital Status

Caseload

ASI

12

d. Individuals, Couples and Dependent Children

The ASI caseload has a higher percentage of individuals and couples with no

dependent children as compared to the Ontario Works caseload. Amongst individuals

and couples with a dependent child or dependent children, those on the ASI caseload

are more likely to have a single dependent child (56.1%) as compared to the Ontario

Works caseload (48.5) and the ASI caseload.

Individuals and couples with dependent children on the Ontario Works caseload

averaged 1.8 children per family which is higher than the ASI caseload with an

average of 1.6 children per family.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

No Children 1 2 3 4

Individuals, Couples and Dependent Children

Caseload

ASI

# of Children per

Benefit Unit Caseload ASI

0 7247 219

1 1716 23

2 1096 12

3 435 6

4 199 0

5 60 0

6 23 0

7 6 0

8 1 0

9 1 0

Avg. per Family 1.8 1.6

13

e. Education

Overall individuals on the ASI caseload have slightly lower levels of education than

those on the Ontario Works caseload. Individuals on the ASI caseload are more likely

to have less than grade 9 and less likely to have post-secondary education compared

to the Ontario Works caseload.

f. Accommodation

Accommodation patterns are similar for both the Ontario Works caseload and the ASI

caseload with about 90% of each renting at the market rate and about 8% of each

renting at a subsidized rate. The level of home ownership is small for both groups

with the ASI caseload at 0.4% and the Ontario Works caseload at 1.6%.

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

< Grade 9 Grade 9 to11

Grade 12 -13

PostSecondary

Unknown

Education

Caseload

ASI

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Renting Renting-Sub Owned Home Board/Lodging Homeless

Accommodation

Caseload

ASI

14

g. Foreign Born

The ASI caseload has a much lower percentage of foreign born individuals (5.4%)

compared to the Ontario Works caseload (21.8%)

2. Ontario Works Status

a. Reason for Applying (top five Ontario Works and ASI Caseloads)

For both Ontario Works (67.8%) and ASI caseloads (75.4%) the primary reason for

applying for Ontario Works was “inability to obtain employment” For the Ontario

Works caseload this was followed by ”separated with dependents” (8.3%) and

“temporary ill health” (7.5%). The reverse order occurs with the ASI caseload

“temporary ill health” (9.6%) and “separated with “dependents” (4.2%)

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Caseload ASI

Foreign Born

Yes

No

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Inability toObtain

Employment

Separatedwith

Dependents

TemporaryIll Health

EI Exhausted EarningsLess thanBudget

Hostel -Homeless

Reason for Applying for Ontario Works

Caseload

ASI

15

b. Family Type

The ASI caseload has a higher percentage of “single” cases (82.7%) as compared to the Ontario Works caseload (63.9%). Conversely the Ontario Works caseload has a higher percentage of” sole support" and “couples” with children cases than the ASI caseload. The percentage of “couples” cases is similar between the ASI and OW caseloads.

c. Months on Assistance

The ASI caseload has a lower percentage of individuals on assistance between 0 and 17 months than the Ontario Works caseload. This is based on the fact that generally individuals transition from a regular Ontario Works caseload to a specialized ASI caseload after a period of time on assistance.

For all time periods of 18 months and longer the percentage of the ASI caseload on assistance exceeds that of the OW caseload.

The average number of months on assistance is higher for the ASI caseload (39.6)

than the OW caseload (29.8).

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Single Sole Support Couple Couple withChildren

Family Type

Caseload

ASI

0.0%

5.0%

10.0%

15.0%

20.0%

Months on Assistance

Caseload ASI

16

Section 3: Link Strategies to Outcome Measures

ASI Treatment Providers

ASI participants are able to access treatment services from a range of providers. The local Addiction Treatment providers include:

Addiction Service of Thames Valley (ADSTV)

Quintin Warner House

Turning Point

Salvation Army - Centre of Hope – Withdrawal Management

Opiate Addiction and Treatment Resource – Methadone Clinics

Canadian Addiction Mental Health Medical Withdrawal Centre

In addition, ASI participants also access treatment services in other Ontario communities, including:

House of Sophrosyne

Westover

Brentwood

Camillus Oak Centre in Elliot Lake

Wayside Holmes House

Stonehenge Treatment Centre

Prevalence of Addiction within London and the Ontario Works ASI Caseload Addiction Services of Thames Valley, in their 2013 Annual General Meeting data, provided the

following report regarding the top 5 problem substances for all open admissions in their

geographic area of Elgin, Middlesex and Oxford Counties:

17

ASI Fresh Start Program open admissions self-reported substance use from March 2013-2014 from ADSTV reports:

As shown in the chart above, the top substances used by participants were:

Alcohol at 73%

Cannabis at 63%

Cocaine at 46%

Prescribed opiates at 44%

Crystal methamphetamines at 40%

Crack at 34%

In addition, ASI participants also reported using the following:

Methamphetamines 27%

Heroin 18%

Benzodiazepines 16%

Hallucinogens 15%

Ecstasy 12%

Other prescribed drugs 6%

Steroids 2%

Barbiturates 1%

Glue and other inhalants 1%

The ASI caseload reports a similar, though not identical pattern for problem substances.

73%

44%

63%

46%

34%

40%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Alcohol PrescriptionOpiates

Cannabis Cocaine Crack Crystal

ASI Fresh Start

18

Referrals and Number of People Served

The London CMSM Addictions Services program commenced in mid 2006. Referrals from

regular caseload have always been strong and there is always a waiting list. Due to this

demand and the positive impacts of the program, a decision was made to reassign one

Caseworker position from the Cost of Administration complement resulting in 5.25 Caseworkers

managing the ASI caseload. With this model, referral patterns are as follows:

Annual Average

2010 - 2013 2014 2015

Total

2014 - 2015

# referred to ASI from regular

case management 369 350 350 700

# of new participants 248 234 234 468

# served per month 260 306 306 306 (avg)

# unique people served 522 450 450 600

(note carry over of

caseload 2014-2015

# referred to Fresh Start 217 215 215 430

External Influences that may Impact Service Delivery

This ASI revitalizing and renewing service delivery phase is occurring at a time of rapid societal

and economic change, along with program restructuring by the different levels of government.

Impacts and opportunities may arise from the following:

The continuing instability within the economy, with the Southwest region being among

the hardest hit in Canada

Funding availability for the overall employment and training sector is unknown due to

the midst of renegotiation of the Labour Market Agreement which ends as of April 1,

2014 and the Federal government’s introduction of the Canada Jobs Grant program

The Ministry of Health and Long Term Care revitalization of mental health and

addictions services with a focus on community delivery and integration.

These factors could have implications with the broader Employment Framework for our

community. The City of London will continue to work closely with the Employment, Training and

Education sectors and key stakeholders and will provide leadership through advisory

committees to ensure a community service continuum that maximizes resources and supports

strong service systems.

The CMSM’s service delivery of Ontario Works is also evolving. The City of London is

undertaking decentralization of our office with a vision of connecting services closer to where

clients live to enhance customer service, delivery partnerships and access. In the summer of

19

2014, the first satellite office will be opened in the North East part of the City to serve

approximately 23% of the caseload. A second decentralized location, scheduled to open in the

summer of 2015, will be co-located with the South London Community Centre, Settlement

Services, and Jalna Public Library in South London. Full implementation to 5 sites will be

complete by early 2017. The ASI program will remain as a united team operating within the

core centralized office. ASI Caseworkers will provide services at decentralized sites based on

ASI participants’ needs and service requests. All ASI delivery will continue consistent with the

Principles and Guidelines of the ASI model.

20

Section 4: Service Provider and Partner Linkages

London’s ASI Fresh Start Program

Our local MOHLTC designated Addiction Assessment and Treatment Service Provider, ADSTV,

manages referrals, formal assessments and determines treatment paths for people in our

community. The City of London entered into a formalized service agreement with ADSTV in

2006. The Agreement outlines a dedicated program for Ontario Works ASI participants in

London and Middlesex County called “Fresh Start” which offers a full range of services

including; community based addiction/mental health counselling, addiction assessment,

treatment planning, referrals, topical group sessions, education, discharge planning, after care

supports using both individual and group sessions. The Fresh Start program was created to

provide the full range of addiction continuum of care during the stages of recovery, prevention,

relapse, and discharge planning.

As outlined in the Service Delivery section, this is a comprehensive model which includes

ongoing communication at the front line level, regular joint case management, collective team

training and monthly data and outcomes tracking. Quarterly analysis of performance outcomes

and yearly partnership review with both Ontario Works and ADSTV Senior Management are

best practice strategies to ensure program fidelity. Outcomes are achieved using a continuous

improvement model.

Addiction Services of Thames Valley (ADSTV) Partner’s Role

The ADSTV service contract roles and responsibilities include:

Acting as the lead for the provision of addiction assessment, treatment, discharge

plan/aftercare working from an intensive case management model

Providing three full time equivalent staff positions dedicated to the provision of Services to a range of 45- 55 cases per year

Delivering addictions services in compliance with the Southwest Local Health

Integration Network (LHIN)

Conducting addiction assessments of referred ASI OW participants to the Fresh Start

program; identification of substance abuse problem, exploring effect of substance

abuse on participant’s employability and determine appropriate addiction recovery

treatment path

Providing Fresh Start Program Assessment tools including MOHLTC approved

admission, discharge and assessment criteria (ADAT) in a comprehensive approach to

establishing an initial treatment plan and level of intensity. ADSTV administering the

following; Psychoactive Drug History Questionnaire, Adverse Consequences of

Substance Use, Health Screening From, Perceived Social Support, Drug-Taking

21

Confidence Questionnaire, BASIS-32, Readiness Rule, Gain Short Screener, Eight

Gambling Screen, Clinical Profile Form, Stages of Change

Working collaboratively with City staff and the participant to develop and modify the

individual case management plan with respect to screening, addiction assessment and

treatment issues

Jointly participating in the development of the Individual Case Management Plan alongside ASI OW Caseworkers and ASI OW Participate, “Wrap-around” model approach

Providing appropriate treatment to OW participants via one-to-one and/or group

counselling that includes the continuum of addiction and non-addiction treatment

services available

Conducting weekly 1:1 individual counselling sessions that increases awareness,

increase health, wellness, stability and substance abuse recovery for ASI OW

participants

Maintaining regular contact, respecting confidentiality and privacy protocols, with the

designated City staff person regarding the participant's progress in the treatment

process including any identified needs to support the participant in treatment, such as

child care, transportation and other needs

Providing informal education to OW ASI staff regarding the field of addictions, best

practices, trends, treatment paths, concurrent disorders, Stages of Change refresher,

clinical skill development and other relevant information

Maintaining clear and accurate administrative program-related records;

Monitoring internal evaluation mechanisms to ensure adherence to service contact

responsibilities

Tracking and reporting on the agreed upon key data elements

ASI Client Data and Reporting Indicators

To ensure ongoing monitoring and understanding of the caseload and services that are being

provided, ADSTV provides monthly reports on the following Key Data Elements:

# of referrals, male, female,

length of wait time (referral to assessment)

# who attended and completed assessment

# who attended Assessment Intake Group

# of participants in community treatment

# of active participants

# referred to groups

# referred and attended to Withdrawal Management

# referred and attended Residential Treatment

# referred and attended Residential support 1 and ll

# referred to stabilization

22

length of wait time from referral to available treatment

# of files closed treatment complete

# of files closed drop out/no show

# of files transferred to another ADSTV program

# of clients in specialized programming

# of Concurrent Disorder outreach clinic

# Fresh Start participants presented via Ontario Telemedicine Network for psychiatric

concurrent assessments

As described within the management and monitoring section above, London’s ASI Fresh Start

Program Manual was developed jointly and outlines each Stage of Change, sample questions,

goals/treatment plans for each stage and ADSTV Fresh Start Counsellor and Ontario Works ASI

role description. For full details please reference the manual in Appendix D.

Through the long standing, effective partnership with ADSTV, ongoing review, development and

joint program monitoring, with a common vision of program standards, this program is tailored to

ensure it is meeting the needs of the Ontario Works ASI participant.

23

Section 5: Monitoring Service Strategies

Intake

The process for intake is outlined within the London ASI Client Service Pathway chart (see page

3 and Appendix A) and described in more detail within the previous section, Integrated ASI

Service Delivery on page 5.

Participants who have identified substance abuse as a barrier to finding and keeping

sustainable employment through self-disclosure or in discussion with regular case management

are referred by their Caseworker through our local Employment Assistance Referral system to

the ASI team. The ASI Unit Clerk receives, processes the referral, books the initial ASI

screening appointment with the ASI Caseworker, and mails out a Fresh Start brochure and

introductory letter to the participant.

The ASI Caseworker conducts an initial screening appointment with the approved addiction

screening assessment tools, explores short and long term return to work goals and determines

readiness through the Stages of Change model. Participants within the contemplative stage will

be accepted. Pre-contemplative participants are returned back to the Ontario Works team of

origin with recommendations and participation activities. They are encouraged to reapply when

ready to address their substance use concerns and move towards the development of their

return to work plan.

During the screening appointment the ASI Caseworker introduces the participant to various

program components including the partnership with ADSTV Fresh Start program as part of their

Participation Agreement requirements. Participants are guaranteed timely entry into the ADSTV

Fresh Start program for initial addiction assessment intake appointment. During the individual

appointments the ADSTV Fresh Start Counsellor and ASI Caseworker, guided by participant

input, develop the individual case management plan, treatment goals, and Participation

Agreement. The plans include short and long term addiction recovery goals along with short

and long term employment goals. Progress, encouragement and problem solving are discussed

each month and updates are made to the individual case management plan.

Client Progress Monitoring

ASI Caseworkers, during their ongoing monthly contact with the participant, record and monitor

all participation activities, engagement in treatment and employability activities progress. At the

monthly joint case conferencing meeting with ADSTV Fresh Start, all addiction recovery and

employment goals are discussed, reviewed and determination of next steps are collectively

agreed upon. The wrap-around model is a key strategy used by all parties to ensure consistent

communication to the participant. One of the ASI service delivery principles is the recognition of

voluntary participation and that relapse can be a reality for many individuals as part of their

24

treatment path. We seek to respond with sensitivity to the individual’s experience and draw on

ADTSV guidance, recommendations and supports through the addiction recovery path. The

intensive case management focus of service delivery is one of supporting the participant to

address barriers with respect for their situation guiding all decisions. A progressive, supportive

approach is used through the developed trusting relationship between the Caseworker and

participant. The ASI Manager is involved in regular staff coaching, ongoing support to staff and

participants and if it appears that non-compliance should be considered, a senior manager will

be consulted prior to this being applied. ASI participants returning to regular case management

(as described above in managing and monitoring section) include updating the Participation

Agreement, consultation between the ASI Caseworker and the regular case management

Caseworker, reviewing participant’s history, progress, employment goals and making

recommendations for next steps. Alternative options for some ASI participants who have

achieved substance abuse recovery but continue to need more intensive employment supports

can be transferred to the Intensive Case Management team which focuses on supports to

employment. Case consultation during the transfer process is a requirement to achieve

comprehensive customer service and supports for these participants.

ASI Caseworkers determine employment readiness through monthly intensive case

management contact with Ontario Works ASI participants, self-reporting, reviewing completed

employability steps, involvement with Employment Purchase of Service partners, progression

with Addiction treatment providers, updating Participation Agreements, building upon successes

and discharge planning all guide the length of participation within the ASI program. One of

London Ontario Works ASI best practices is a formal review process at six months and again at

a year to ensure that the participant meets the intent and expectations of the ASI program. The

process includes a meeting between the ASI Caseworker and the participant to review

progress, goals and commitment to meeting outcomes. This meeting is followed by a review

discussion between the Caseworker and the ASI Manager for next steps.

Waitlist

Throughout our eight year history of delivering ASI, demand for services has always exceeded

the capacity and we have had to utilize a waiting list process. Waiting list process and

management includes a mailed out information package with ASI Fresh Start Program

brochure, ADSTV Fresh Start “Walk in” intake dates/times, anticipated length of wait for initial

screening appointment with Ontario Works ASI Caseworker and an invitation with date and time

to attend a Fresh Start information session at ADSTV. Telephone follow up is completed by the

ASI Unit Clerk and communication with the regular Case Management Caseworker.

Employment Outcomes

ASI Caseworkers submit monthly statistics (see Appendix E) that provide information to

measure both the reduction of addiction severity through the progression of addiction treatment

and increased employability through outcome tracking. Data is collated and reviewed each

25

month by the ASI Manager and reported to the Senior Manager of Employment and Strategic

Initiatives. Quarterly and annual communication reviews with ADSTV Management and Ontario

Works ASI Management allows for continual improvement and adjustments with our ASI local

strategies as well as identifying emerging trends.

To ensure ongoing monitoring and understanding of the caseload and services that are being

provided, the CMSM tracks the following monthly statistics:

# of new referrals received from regular case management

# of screening appointments

# of new participants

# of new benefit units

# of files transferred off ASI team

# of files closed

Outcome statistical tracking include:

# of participants obtains employment and remains on Ontario Works

# of participants left Ontario Works for employment

# of participants left Ontario Works for other income (ODSP, CPP, etc.)

# of participants left Ontario Works for education

# of participants left for Ontario Works other reasons

# of participants returned to regular case management

Addiction Service Statistical tracking:

# of participants completed assessments

# of participants in addiction treatment

# of participants completed treatment

Additional data collected includes annual number of participants referred from regular case

management, number of screening appointments and wait list length. As we move into the

renewal process, we will add these to the statistical tracking form.

Staff Training Plan

Training will continue to be an integral part of providing services that focus on positive

outcomes, system integration and continuous improvement. As the CMSM moves into the ASI

renewal phase, training plans will fully incorporate all tools developed by Ontario Works Branch

including the renewed training package, guidelines, research, tracking tools and expected

timelines. Once all resources have been released from the MCSS ASI Renewal Advisory

Committee, a comprehensive local training plan will be developed. London’s CMSM ASI staff,

management, ADSTV Fresh Start staff, management will learn, share and refresh together to

26

achieve our integrated service delivery model. Training timelines will be guided by the ASI

Renewal Advisory Committee targeting late summer or early fall. We look forward to

participating in any provincial led training that may occur.

Training will incorporate all MCSS documents and expectations, research and best practices.

The curriculum will include:

ASI program development and renewal implementation

Alignment with new ASI service guidelines and logic model

Review of principles of a “wrap-around” approach and positive impacts each partner

plays in working together supporting the participant to addiction recovery, sustained

employment and improved overall quality of life

Motivational Interviewing and Stages of Change theory

ASI intake, screening, goal development, discharge/aftercare and celebration of

successes

Enhanced understanding with research relating to addiction recovery imbedded in early

employment skill building activities

New screening tools including measuring employment readiness

Harm reduction strategies

Boundary identification, debriefing and self-care

Intensive Case Management and role expectations/clarity

Service Coordination with ADSTV and Employment Partners and local partnership roles

Outcome statistical tracking and new Provincial evaluation data tracking tool

Training will be led by ASI management with delivery of training provided by:

London’s ASI Employment Senior Manager who is the South West representative on

the Provincial ASI Renewal Advisory Committee

ADSTV subject matter experts including the Fresh Start Manager

Employment partner subject matter experts

Employment purchase of service partners

Mental Health experts

As part of the MCSS ASI two year renewal timeline, monthly meeting between the ADSTV

Fresh Start Manager, London ASI Manager, Senior Manager of Employment Strategies and

Middlesex County Employment Services Manager have begun to start analyzing program data,

share information, ensure program fidelity alignment with new ASI Framework and the

development of ongoing best practices. This information will also support the training plan.

We look forward in embracing the next two years as opportunity to enhance our supports to

Ontario Works participants as they receive the much needed addiction and employment

supports moving towards self-sufficiency and recovery.

Appendix A: London ASI Client Service Pathway

Assessment Group



Triage Process






Bypass Assessment











Co

nti

nu

e to

Te

am A


agreement



OW Team of origin








Assessment Group


•GAIN Q3



Feedback Session



Assessment



Valley monthly



treatment Program


28

Appendix B:

29

Appendix C:

Employment Assistance FrameworkOntario Works

ONTARIO WORKS

Participant

PURCHASE OF SERVICE

OTHER FUNDED

EMPLOYMENT SUPPORTS

E

M

P

L

O

Y

E

R

S

LEGEND

Broader Community

Supports

Legislation & Policies

Accountability & Results

ONTARIO WORKS: Team Structure; Pilot Initiatives; Employer Incentives; Individual Services & Supports; Assessment; Employment Planning; Participation Agree-ments; Stabilization & Income Support; Crisis Intervention; Intensive Case Management; Referrals

Purchase of Service (POS): Employment Placement; Essential Employment Services (Foundational Skills, Career Management, Workplace Experience, Individualized Program Delivery); Skills Training Linked to Employment; Pilot Initiatives; Specialized Individual Supports; Self-Employment Development

OTHER FUNDED EMPLOYMENT SUPPORTS: Literacy; Basic Education & Training; Employment Ontario; Immigrant Employment Services; Pillar

ACCOUNTABILITY & RESULTS: Quality Assurance; Communication;Commitment to Reporting; Customer Satisfaction; Education and Employment Outcomes

TARGETED INITIATIVESEmployer facing;One time;Employment outcome

TARGETED INITIATIVES

Participant Path to Employment Service

Other funded

employment supports:

Employment Ontario,

Education

Immigrants

Targeted Initiative

Eg: new company

comes to London or

company expands

and needs customer

service staff. Apply

to OW for targeted

employment program

funding in exchange

for hiring participants

Purchase of Service Self-Employment Specialized

Individual Services

Literacy,

Counselling,

Work Readiness

Assessment

Employment

Placement

Intake/ Common

Assessme

nt

Skills Training Linked to

Employment

Essential Employment

Services

Employment

Review for

detailed PA

OW Verification

Participant Application

32

Appendix D: Ontario Works and Addiction Services of Thames Valley Fresh Start Manual

London ASI Stage Based Programming

The key to success is the appropriately timed use of a variety of interventions.

______________________________________________

Stage One: Pre-contemplation- Not eligible for London ASI

____________________________________________________________________

Stage Two: Contemplation- Acknowledging that there is a problem but not

yet ready or sure of wanting to make a change.

“Decision is the bridge between wishing and acting.”

33

In the contemplation stage people are more aware of the personal consequences of their bad habit and they spend time thinking about their problem. Although they are able to consider the possibility of changing, they tend to be ambivalent about it. They are planning to change sometime.

In this stage, people are on a teeter-totter, weighing the pros and cons of quitting or modifying their behavior. Although they think about the negative aspects of their bad habit and the positives associated with giving it up (or reducing), they may doubt that the long-term benefits associated with quitting will outweigh the short-term costs.

It might take as little as a couple weeks or as long as a lifetime to get through the contemplation stage. (In fact, some people think and think and think about giving up their bad habit and may die never having gotten beyond this stage- chronic contemplators)

On the plus side, people are more open to receiving information about their issues, and more likely to actually use educational interventions and reflect on their own feelings and thoughts concerning their problem.

At a glance Contemplators are:

Planning to change sometime

On the fence

Back and forth on decisions

No behaviour change with regards to use

Think there may be a problem but not sure there is

Extremely ambivalent

Lacking self confidence

34

Goals for Contemplation

TX Plan ADSTV role OW role

Move to preparation 1:1 sessions weekly (alternating at ADSTV & OW) for first month of engagement

Assessment

Personalized feedback

GSC #1

Referral to Fresh Start- administer TEQ and Socrates to assess treatment readiness

Consciousness raising- decisional balance

Move to monthly 1:1 appointments during cheque cut off week

Monitor SIS attendance & report to OW

Decrease barriers to change

Identify reasons for change (Guided self change 1)

Mandatory attendance at __ SIS groups per months

Build self efficacy Build self efficacy

Decrease ambivalence

No formal treatment plan- NEW “contemplators contract”

Need to connect emotion to reason for change

Encourage choice and menu of options

Identify “what do they need in order to be able to change?”

Identify employment goals

Validate lack of readiness

Begin to explore recovery options

Increase health, wellness and stability of client

Referrals as necessary

Recommend referrals based on assessment findings

Recommend referrals based on participation agreement

Examine the impact of substance use on what is important to the participant (ex. Family, health, job).

Get up to date physical competed.

Clarify; the decision is theirs.

Reduce resistance!

Start to explore future dreams/goals reemployment ideas and what skills building is needed

Increased awareness

Monitor substance use

Give realistic feedback about level of use

Identify participant’s ideal timeline for return to work

Some Questions for the Contemplator:

If you changed, what would your new life be like? If you changed, what would your life be like 5 years from now? If you could make change immediately, by magic, how might things be better for you? When else in your life have you made significant changes like this? How did you do it? What personal strengths do you have that will help you succeed? What did you want to be when you “grew up” – ideas from childhood, unexplored dreams

or hopes

35

Contemplation Menu of Group options at ADSTV:

Group Name Group Membership

How to Register Additional Information

Assessment Group

For new Ontario Works referrals

ADSTV Intake worker (Cathy) will book newly referred clients into the assessment group.

During this one-time group, participants will learn about services offered at ADSTV, confidentiality and they will begin the standardized assessment.

SIS Groups Available to open ADSTV clients.

Arrive 5 minutes before group and check in at reception. No pre-registration required.

Topics every day Monday to Thursday include Coping with

Boredom, Coping with Cravings, Money Matters, Coping with Withdrawal, Healthy Relationships, Community Resources, Self Care and Coping with Stress and Anxiety

Fresh Start New Ways

Group

Fresh Start Clients only- contemplators welcome to apply

Fresh Start Counsellor to refer clients after treatment planning

This new 6 week group will teach Fresh Start clients Coping Skills for Life!

Fresh Start Expressive Arts Group

Fresh Start Clients only- contemplation to maintenance


Another new and exciting group tailored to the unique treatment preferences of Fresh Start clients. Over 6 weeks, clients will explore alternative expressions of emotion to support their recovery journey.

Substance Use Educational

Support Series

For ADSTV clients and community referrals coping with Brain Injury & Substance Abuse

Referrals accepted from ADSTV, DBIS, Parkwood Hospital’s ABI Programs, PABICOP & private ABI service providers

Open group consisting of 10 sessions.

36

______________________________________________

Preparation/Determination (Getting ready to change)

“You are the sole creator of your experience.” — Luke Rhinehart

In the preparation/determination stage, people have made a commitment to make a change. Their motivation for changing is reflected by statements such as: "I've got to do something about this - this is serious. Something has to change. What can I do?"

This is sort of a research phase: people are now taking small steps toward cessation. They are trying to gather information about what they will need to do to change their behavior.

Or they will call a lot of clinics, trying to find out what strategies and resources are available to help them in their attempt. Too often, people skip this stage: they try to move directly from contemplation into action and fall flat on their faces because they haven't adequately researched or accepted what it is going to take to make this major lifestyle change.

At a glance people in Preparation:

Are planning to change soon

May have picked a quit date/ change date

Have decided to move ahead, plans are a bit more specific

Need assistance to commit to a plan

May be taking some behavioural steps in a new direction

Are showing some enthusiasm

37

Goals for Preparation


Move into action (usually within 1-60 days)

Treatment change plan formulated

Employment goals explored

Individual sessions frequently


Choose a “quit” date or “change date”

Increase supports Build self efficacy Build self efficacy- verify underlying skills for behaviour change

Set realistic goals (s.m.a.r.t. goals)

Learn new strategies to support change

Set small tangible skill development goals

Encouragement- even small initial steps

Encouragement- even small initial steps

Learn about addictions programs and services

Learn about addictions programs and services

Give participants employment development menu of options

Help client identify social support

Identify and assist in problem solving re: obstacles

Remind self of reasons for change

Identify strengths, allow creativity within goal setting

Explore pros and cons of change actively to examine benefits

Active helping

Get support from family or friends

Choose a “quit” date or “change date”

Assist client to set treatment goals and incremental steps to achieve goals

Evaluate value of competing activities (work, school, volunteer work)

38

Some questions for people in Preparation:

What have you heard others say about what has worked for them? Will any of their suggestions work for you?

What have you considered doing? What have you tried in the past? What is the craziest thing you can think of to do to bring about this change? Is there anything employment related that will assist with next steps towards recovery?

Ex. A job, volunteer work or training may help to compete against boredom, improve self worth, etc.

Preparation Menu of Group options at ADSTV:



Assessment Group









Group








39


Support Series




40

______________________________________________

Action (Changing behavior)

“Good thoughts are no better than good dreams, unless they be executed.” — Ralph Waldo Emerson

This is the stage where people believe they have the ability to change their behavior and are actively involved in taking steps to change their bad behavior by using a variety of different techniques.

This is the shortest of all the stages. The amount of time people spend in action varies. It generally lasts about 6 months, but it can literally be as short as one hour! This is a stage when people most depend on their own willpower. They are making overt efforts to quit or change the behavior and are at greatest risk for relapse.

Mentally, they review their commitment to themselves and develop plans to deal with both personal and external pressures that may lead to slips. They may use short-term rewards to sustain their motivation, and analyze their behavior change efforts in a way that enhances their self-confidence. People in this stage also tend to be open to receiving help and are also likely to seek support from others (a very important element).

At a glance people in Action:

Have recently started new behaviour

Have high energy and enthusiasm

Do not need to look at the past, explore

Need to focus on action oriented strategies

Need assistance to take steps towards continued change

41

Goals for Action TX Plan ADSTV role OW role

Move into maintenance

Begin abstinence, moderation or harm reduction

Individual sessions frequently


Return to employment

Withdrawal Management at this stage if necessary

Referral to groups Referrals to Employment Development Services – see attached documents for resources

Increased support system

Residential treatment at this stage if necessary

Skills building Help client to substitute alternatives for problem behaviours

Avoid people, places and things that put you at risk of exceeding you substances use goals

Engage with Self Help groups

Build self efficacy Evaluate benefit of competing activities to enhance relapse prevention (work, school, volunteer work, recreation)

Focus on recovery basics (RP calendar)

Begin Methadone/ suboxone

Relapse prevention/ planning

Support planning, problem solving and encouragement

Learn and practice new behaviours

Change their environment (ex. remove temptations)

Reiterate long-term benefits

Celebrate steps of success during monthly check -ins, being their coach

Learn to say no Finds new rewards Combat feelings of loss

Referrals to Counselling re: trauma, or other issues that create a barrier of moving forward

42

Action Menu of Group options at ADSTV:



Assessment Group









Group








Men’s Support Group

ADSTV male clients seeking weekly support for their abstinence goal

Referrals via participant’s Fresh Start Counsellor

Open ended group, Maximum 16 sessions.

Women’s Support Group

ADSTV female clients seeking weekly support for their abstinence goal



43

Relapse Prevention

Group

Fresh Start participants only who are stable with their abstinence goal



Mixed Goal Relapse

Prevention Group

ADSTV clients working on a mixed goal


Open group consisting of 10 sessions. Clients learn relapse prevention for primary problem substance and moderation strategies for alcohol or cannabis.

Fully Alive Group

ADSTV clients 55+ who are exploring ways to live life more fully: issues such as communicating with family, relationships, transitions, self- care.

Prerequisite: assessment and referral by ADSTV counsellor. Clients must be stable in their recovery.

Closed group, 10 sessions Peer counsellor (older adult) and staff co facilitated

Relaxation & Recovery

Group

A quiet time of breath-work, guided meditation, gentle stretching and gentle yoga. There is no discussion during this class except for instruction.


Closed group with four sessions Guided by a qualified yoga instructor with counselling staff present.


Support Series




44

______________________________________________

Maintenance (Maintaining the behavior change)

“Nobody trips over mountains. It is the small pebble that causes you to stumble. Pass all the pebbles in your path, and you will find you have crossed the mountain.”

Maintenance involves being able to successfully avoid any temptations to return to the bad habit. The goal of the maintenance stage is to maintain the new status quo. People in this stage tend to remind themselves of how much progress they have made.

People in maintenance constantly reformulate the rules of their lives and are acquiring new skills to deal with life and avoid relapse. They are able to anticipate the situations in which a relapse could occur and prepare coping strategies in advance.

They remain aware that what they are striving for is personally worthwhile and meaningful. They are patient with themselves and recognize that it often takes a while to let go of old behavior patterns and practice new ones until they are second nature to them. Even though they may have thoughts of returning to their old bad habits, they resist the temptation and stay on track.

As you progress through your own stages of change, it can be helpful to re-evaluate your progress in moving up and down through these stages.

(Even in the course of one day, you may go through several different stages of change).

And remember: it is normal and natural to regress, to attain one stage only to fall back to a previous stage. This is just a normal part of making changes in your behavior.

At a glance people in Maintenance:

Have maintained change more than 60 days

Continue to work towards goal

Are facing their most difficult work

Are prone to relapse in the early part of maintenance Need to assimilate and integrate new thoughts, feelings and behaviours Can become bored, lose interest, slip back into old ways

Can face post acute withdrawal hazards

45

Goals for Maintenance


Maintain recovery goals (abstinence OR using less of a drug, less often)

Maintain abstinence Second stage recovery work

Referral to Fresh Start for short term treatment- TEQ and Socrates not needed. Likely book for a bypass app’t.

Exit Ontario Works Attend Fresh Start Alumni Group once per month

Reinforce internal rewards

Graduation- ensure they have employment and other community supports in place if needed

Return to employment

Plans for follow up support identified

Discuss coping with relapse

Ensure client has access to future resources

Positive lifestyle changes

Reintegration into community, workforce- meaningful activity

Continue to identify triggers and cues – re-administer DTCQ or IDTS

Plan for follow up or check in

Reducing or eliminating high risk behaviours

Consider a self help group

Emphasize and transition Participation Agreement to competing activities to enhance relapse prevention (work, school, volunteer work, recreation)

Plan for unexpected high risk situations

Be aware of urges and temptations

Internet based addiction groups/ forums

46

Maintenance Menu of Group options at ADSTV:




A new group tailored to the unique treatment preferences of Fresh Start clients. Over 6 weeks, clients will explore alternative expressions of emotion to support their recovery journey.

Men’s Support Group

ADSTV male clients seeking weekly support for their abstinence goal



Women’s Support Group

ADSTV female clients seeking weekly support for their abstinence goal



Relapse Prevention

Group

ADSTV clients who are stable with their abstinence goal



Mixed Goal Relapse

Prevention Group

ADSTV clients working on a mixed goal


Open group consisting of 10 sessions. Clients learn relapse prevention for primary problem substance and moderation strategies for alcohol or cannabis.

Fully Alive Group

ADSTV clients 55+ who are exploring ways to live life more fully: issues such as communicating with family, relationships, transitions, self- care.


Closed group, 10 sessions Peer counsellor (older adult) and staff co facilitated

47

Relaxation & Recovery

Group

A quiet time of breath-work, guided meditation, gentle stretching and gentle yoga. There is no discussion during this class except for instruction.


Closed group with four sessions Guided by a qualified yoga instructor with counselling staff present.

NEW Fresh Start Alumni

Group

For successful graduates of the Fresh Start Program


Alumni from the Fresh Start Program will gather monthly to renew their commitment to recovery and receive support and feedback from staff and peers

48

2013 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Year Total

# of New Benefit Units 0

# of New Participants 0

# of Files Transferred off Team 0

# of Files Closed 0

# of Active Benefit Units #DIV/0!

# of Extended Employment Health 0

Outcomes

Participant obtains employment and remains on Ontario

Works 0

Participant left OW for employment 0

Participant left OW for other income (ODSP, CPP, etc) 0

Participant left OW for education 0

Participant left OW for other reasons 0

Return to regular caseload 0

SERVICE

# of Participants completed assessments 0

# of Participants in addiction treatment #DIV/0!

# of Participants completed treatments 0

Total Monthly Statistical Report - CMSM MONTHLY

Ap

pe

nd

ix E

: Lo

nd

on

CM

SM

Mo

nth

ly A

SI S

tatis

tica

l Rep

ort

49

48

Appendix F: Ontario Works London Business Practices ONTARIO WORKS LONDON BUSINESS PRACTICES

LBP #8.4 – 1

Page 1 of 3

ADDICTIONS SERVICES INITIATIVE (ASI) TEAM A – Referral

Process

Date Revised: March 2014

REF: 2009 DIRECTIVE #8.4

*Current business process to be revised as required once all MCSS ASI renewal documents are released.

GENERAL INFORMATION The City of London, as the Consolidated Municipal Service Manager for London and Middlesex, is an approved site by the Province to implement Addictions Services Initiative (ASI). Addictions Services Initiative is another component of the full range of Employment Assistance supports available to Ontario Works participants. Participants who have self-identified substance abuse as a barrier to finding and keeping sustainable employment have the opportunity to participate in intensive case management, professional assessment and treatment for their identified addiction(s). The Province and the City of London Municipal Council have directed that participation in Addictions Services Initiative by an Ontario Works participant is to be voluntary. PROCESS

Ontario Works participant identifies, either through self-disclosure or in discussion with the Caseworker, that he/she has a substance abuse problem which may be a barrier to his or her ability to participate in an Ontario Works approved activity (including employment, school, or community participation)

Caseworker explains to the Ontario Works participant the process (outlined in this Local Business Practice) that will take place to determine what additional supports can be provided

Caseworker makes a referral through our Employment Referral system which is received by the Addictions Services Initiative (ASI) Unit Clerk

The ASI Unit Clerk books a comprehensive screening consultation appointment with the ASI Caseworker through London’s Client Management booking System (CMS)

ASI Unit Clerk mails out ASI “Team A” Introductory Letter, Fresh Start Brochure and ASI “Team A” screening appointment date and time

If the participant has two “no shows” for the ASI “Team A” comprehensive screening appointment, then the ASI Unit Clerk will notify the Case Management Caseworker by e-mail of the resulting “no shows” and no further action will be taken

The ASI Caseworker uses Motivational Interviewing techniques, Stages of Change theory and approved addiction screening tools to assess the participant’s appropriateness for a referral for “Team A” ASI Intensive Case Management or will remain on the regular caseload, with an updated Participation Agreement (identifying activities and supports to address the participant’s employment barriers)

ASI Caseworker informs the referring Caseworker, via e-mail, of the results of the ASI comprehensive screening appointment and the Benefit Unit is transferred to ASI team

Refer to the attached London ASI Client Service Pathway for additional clarity

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ONTARIO WORKS LONDON BUSINESS PRACTICES

LBP #8.4 – 1

Page 2 of 3

ADDICTIONS SERVICES INITIATIVE (ASI) TEAM A – Referral

Process

Date Revised: March 2014

REF: 2009 DIRECTIVE #8.4


SDMT DOCUMENTATION Caseworker documents in note category “Employment Assistance Details” and notes

type “PA – Participation Information” on SDMT that a referral to the ASI “Team A” has been completed

Once the ASI “Team A” Caseworker has completed the comprehensive screening consultation, the ASI Caseworker updates SDMT, as appropriate, as follows:

o If the Benefit Unit is referred to “Team A”, ASI Caseworker makes a notation in “File Transfer Notes” and notes category “Employment Assistance” and note type “PA – Participation Information”

o The ASI Caseworker will e-mail the Case Management Caseworker as well as the Unit Clerk of Team A that a transfer to the Team has been made

o If the file is to remain on the Regular Case Management Team, the ASI Caseworker updates the Participation Agreement and notes in note category “Employment Assistance” and notes type “PA – Participation Information” in what activities and supports the participant will be involved

DATE:

Sandra Datars Bere ADMINISTRATOR – ONTARIO WORKS

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LBP #8.4 - 2

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ADDICTIONS SERVICES INITIATIVE (ASI) TEAM A - Referral to

Addictions Service Provider Fresh Start Program Date Issued: March 31, 2014


GENERAL INFORMATION Addiction Services of Thames Valley (ADSTV) is the local addiction treatment provider that provides a formalized dedicated program for Ontario Works participants in London & Middlesex County called “Fresh Start” offering a full range of services including: community based addiction/mental health counselling, addiction assessment, treatment planning, referrals, topical group sessions, education, discharge planning and after care supports using both individual and group sessions. Participants who have identified substance abuse as a barrier to finding and keeping sustainable employment have the opportunity to participate in Ontario Works ASI intensive case management, professional assessment and treatment for their identified addiction(s), in addition to accessing other supports related to employment. The Ministry of Community and Social Services, Ontario Works Addiction Services Guidelines (February 2014), outlines the required components of Ontario Works addiction services: intensive case management services; screening for substance abuse; assessment of substance abuse; and treatment for substance abuse. The Ministry also defines the roles and responsibilities of the Social Services and the Health sectors with respect to the provision of support services to Ontario Works participants who have identified substance abuse as a barrier to employment. The Ministry indicates that Ontario Works agents are responsible for ASI intensive case management, screening for substance abuse, employment supports (being provided in London via ASI Team A (see Addictions Services Initiative ASI Referral Process LBP # 8.4-1 for details), while Ministry of Health and Long Term Care funded agencies are responsible for the provision of addictions assessment and treatment aspects of Ontario Works addiction services. The City of London has contracted with Addiction Services of Thames Valley (ADSTV) as a service provider for Ontario Works addiction services assessment and treatment via a purchase of service agreement. PROCESS

ASI Caseworker will use intensive case management approach (see Team A Business Practices – Intensive Case Management Delivery for details), Motivational Interviewing techniques, Stages of Change theory, as well as Addictions Best Practices (Contemplative stage) to determine if and when it is appropriate for the Ontario Works participant to be referred for assessment for substance abuse

Having determined that a referral is appropriate, ASI Caseworker will have the Ontario Works participant sign an ADSTV Consent For the Release of Information (see Appendix A) to allow the Ontario Works office and ADSTV to share information for the purpose of making a referral as well as potential case conferencing between the Caseworker and the ADSTV Addictions Mental Health Counsellor, as it relates to supporting the participant in his or her journey to address the substance abuse; it is noted that clinical details regarding the participant’s addiction assessment and treatment is kept confidential at ADSTV

ASI Caseworker will complete the Referral Information From Ontario Works to ADSTV (see Appendix B)

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ASI Caseworker will fax a completed Referral Information Form, along with a signed

Consent Form, to ADSTV to the attention of: Supervisor, Fresh Start Program for Ontario Works at (519)673-1022

Upon receipt of the referral, ADSTV will send an e-mail to the ASI Caseworker to confirm receipt of the referral

ADSTV will send an update e-mail to the ASI Caseworker once the first appointment is scheduled with the Ontario Works participant

ASI Caseworker may contact the Ontario Works participant prior to the scheduled appointment to determine if the participant requires any support to attend the assessment appointment (such as transportation, child care)

Following the appointment, ADSTV will provide further updates to the ASI Caseworker regarding the status of the assessment and/or treatment, including any missed appointments

ASI Caseworker will ensure the Individual Case Management Plan and Participation Agreement are updated as appropriate

SDMT DOCUMENTATION

ASI Caseworker will ensure that all appropriate categories of SDMT are properly updated and documented

DATE:

Elisabeth K. White MANAGER – EMPLOYMENT AND STRATEGIC INITIATIVES

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LBP #8.4 - 2

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APPENDIX A

CONSENT FOR THE RELEASE OF INFORMATION

I _______________________________________________hereby provide my consent to allow Please Print Full Name and Date of Birth (dd/mm/yyyy)

Addiction Services of Thames Valley Fresh Start Program

and _____________________________________________________________________________

Please Print Name of Agency

to share the following information: ___ relevant personal information ___ relevant information about my child(ren)__________________________ ___________________________________________________________ (child[ren]’s name(s) and date(s) of birth (dd/mm/yyyy))

___ information only as specified ____________________________________ ____________________________________________________________ I understand that this consent is valid for one year from date of signature, and I understand that I may cancel this consent at any time. _____________________________ _____________________ Signature Date _____________________________ _____________________ Witness Date

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APPENDIX B

200 - 256 Pall Mall Street / 200 - 256, rue Pall Mall

London, Ontario, N6A 5P6 Client Line: (519) 673-3242

Administration Line: (519) 673-3666 Fax / Télécopieur: (519) 673-1022

REFERRAL INFORMATION FROM

ONTARIO WORKS LONDON

TO ADDICTION SERVICES OF THAMES VALLEY

CLIENT NAME: ________________________________________ D.O.B.: (day/month/year) ________________________________________ LAST NAME AT BIRTH: ________________________________________ (if different from above)

male female WHAT IS THE PREFERRED LANGUAGE OF SERVICE?

English French other:____________________

STREET ADDRESS: __________________________________ APT/UNIT NO.: ______ ___ CITY: __________________ _______ ___ POSTAL CODE: _____________________________________ HOME PHONE: ( ) ________________________________ OK TO CALL? yes no OK TO LEAVE MESSAGE? yes no OK TO IDENTIFY AGENCY? yes no OK TO MAIL OUT TO YOUR HOME? yes no (all correspondence would come in a plain envelope without the agency name visible) Describe briefly presenting problems/concerns relating to substances:

Please best rate client’s stage of change re substance use.

Contemplation Preparation

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Action Maintenance Relapse

Is there other evidence of a problem? Convictions (# of substance related offences = ________ ) Previous history. Family history of substance abuse:

Family / marital / relationship related issues. Employment problems. Health problems.

4. Socrates scoring results Alcohol: Recognition _____ Ambivalence _____ Taking Steps _____

Drugs: Recognition _____ Ambivalence _____ Taking Steps _____

Treatment Entry Questionnaire results Internal Positive _____ Internal Negative External Coercion _____ Comments / Other Information: Referring Staff: _________________________________________________________ Date Referred: _________________________________________________________

Documents

LONDON CMSM ONTARIO WORKS ADDICTIONS SERVICES …€¦ · Ontario Works Regular Case Management identifies participant's need for ASI support and sends referral to ASI Team "Team