BRANT COMMUNITY PROTOCOLS AND PROCESSES Welcome to the Brant community electronic orientation package on community Protocols and processes. Revised April 2013
BRANT COMMUNITY PROTOCOLS
AND PROCESSES
Welcome to the Brant community electronic orientation package
on community Protocols and processes.
Revised April 2013
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
Communication, Coordination, CollaborationThe 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
Guiding Community Principles
Person/Family-centered service Work collaboratively Address ‘Most in Need’ Least intrusive services Utilize best practice Confidentiality Maximizing available resources
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
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”
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
CASE CONFERENCES
Meeting together ensures: Seamless system for families Planning for individual’s outcomes Communication between services Coordination & collaboration of
supports
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
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
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
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
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
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 outcomesof 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
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?
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
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
Crisis Protocol - cont’d
Crisis PlanningUse the Crisis Plan form
Crisis Response – follow plan Post Crisis Follow-up – improve
response
Transitioning from Children’s Mental Health
Services ProtocolTransitioning 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
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
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
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
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
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
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
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
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
.
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
Community Collaboration around supporting people…
Communicate
Coordinate
Collaborate
Together we can make things happen!