A Community’s Effort to Provide Collaborative Support to a Unique Set of Youth
Youth experiencing mental health issues face a number of challenges. Stigma surrounding the mental health issue, finding timely and effective support and being included with their peers are just a few examples. Among the population of youth with mental health issues is a unique set of youth who have a developmental delay combined with a mental health issue - a dual diagnosis. These youth struggle with similar issues but face a number of distinct challenges as well.
These unique challenges muddy the waters not only for service providers but also for the traditional service sectors themselves. The questions that emerge include who is responsible for serving these individuals, how do we serve them and where do we start to tackle the challenge of providing evidence-based, collaborative assessment, treatment and training?
A developmental delay is a particular state of functioning that begins in childhood and is characterized by limitations in both intelligence and adaptive skills. Evidence of limitations in adaptive functioning must occur in two or more of the following: communication, home living, community use, health and safety, leisure, self care, social skills, self direction, functional academics, and/or work. A mental health issue is defined as a significant impairment of an individual’s cognitive (thoughts), affective (emotions), behavioural and relational (relationships) abilities.
We know from experience that dual diagnosis of developmental delay and mental health difficulty is common. The research supports the observations with a range of statistics that illustrate that up to 60% of those who are developmentally delayed have a dual diagnosis. For instance, it is estimated that 17% of persons with developmental delay have also experienced mood disorders. Other research shows that 59% of intellectually disabled adolescents have mental health or behavioural problems and are four times more likely to experience abuse, neglect or exploitation. Even the more conservative prevalence rates of dual diagnosis are estimated at 30%, which indicates a rate of mental health difficulty that is significantly higher than the general population. Dual diagnosis is somewhat of a misnomer however as many young people with a developmental delay have more than one diagnosable mental health difficulty and also commonly have physical health concerns.
About two and half years ago Simcoe County created a subcommittee of the Child Youth and Family Coalition to address the questions with respect to serving these youth. The community stakeholders that participate on this committee include Behaviour Management Services of York and Simcoe, Catulpa Community Services, the Children’s Aid Society of Simcoe County, Kinark Child and Family Services, Newpath Child and Family Services, Simcoe Community Services, Simcoe County District School Board and the South Muskoka Catholic District School Board.
The first order of business was to create a one-page information flyer to spread the word to the community at large regarding what a dual diagnosis is, how to identify the possible signs of a dual diagnosis, and how to seek help if unsure. The second task was to create a manual that would outline all of the services in Simcoe County that would be able to provide support to youth with a dual diagnosis. These tasks were accomplished but not without considerable struggle and frustration. Members of the committee were accustomed to working within their own sector silos and, when discussions would arise with respect to who did what well, it was difficult not to feel blamed or attacked. The committee further explored this as a group and wondered if they were having trouble as 6-8 people, how did the rest of the community feel and function working on multidisciplinary teams? It was from these discussions that the decision to host the first Simcoe County Children’s Dual Diagnosis Forum was made.
The forum was held in April 2006 with the theme Community Collaboration. The many participants had an opportunity to see and hear what resources were available in the different sectors within the region. Three main themes emerged from the day. The first was that Simcoe County needed to investigate the need for a dual diagnosis classroom within its own region. Too many youth were leaving the region to get assessment and treatment. A proposal was put together for an exciting venture that captures the essence of community collaboration.
The second theme identified the need to investigate specialized respite for the families and service providers who provide support to children and youth with a dual diagnosis. The planning table of the Coalition reviewed and accepted the business case to develop a proposal for respite services for youth with dual diagnosis in the county.
In addition to another such forum, the participants requested more information on other services within Simcoe County that were involved with supporting youth with a dual diagnosis. The participants also requested that more experts in the field be involved to help further educate the community, as well as to help the community shape a direction to best serve the dually diagnosed population. The group also asked for a training package that would help in providing information to more of the people across the region.
The committee was excited with the response and on April 18, 2007 a second forum took place. The morning included more community partners who introduced their services and highlighted how they were impacted by working with youth with a dual diagnosis. The day finished with Darlene Spence from Behaviour Management Services of York and Simcoe providing an overview of a package she and her colleagues have developed to train trainers within organizations on how to best serve individuals with a dual diagnosis. The committee will continue its work in September with a focus on improving the services within Simcoe County to best serve youth with a dual diagnosis.
Members of the committee have worked hard with the community to try to remove barriers to service for individuals with a dual diagnosis. The task is not complete but major strides have been taken and a direction has been set. The community has accepted the collaborative approach and continues to work on establishing meaningful relationships. The mission will not be complete however, until we can be sure that every child with a dual diagnosis can receive service in a timely manner and that service is tailored to the individual’s needs.
John Clarke and Vicky Howard, on behalf of the Dual Diagnosis Committee of the Child Youth and Family Coalition, Simcoe County.
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Program Evaluation Grant Recipient: The Griffin Centre - Gauging the Success of Programs for Dually Diagnosed Children and Youth
Griffin Centre didn’t give up on the idea of evaluating its services though. Instead of completely forgoing the BCFPI with youth who are dually diagnosed, the agency went ahead and collected the information in hopes the tool might someday be normed for children and youth with developmental disabilities. With the help of a Program Evaluation Grant, the agency is stepping up to fill the information void and take a leadership role in developing evidence-based tools to gauge the success of programs for children and youth who are dually diagnosed.
“We are very excited about the capacity of the Program Evaluation Grant to contribute to knowledge within the agency and in the field regarding service delivery to youth with a dual diagnosis,” said Lydia Sai-Chew, Manager of Community & Family Support Services at Griffin Centre. “The entire program evaluation process has been an excellent one for our staff in that it brings evidence-based practice to life and helps us to integrate evaluative frameworks and clinical tools into our work in a more comprehensive way”
The Centre provided Griffin Centre with $19,000 to do a preliminary evaluation of how the BCFPI can be used with youth who have a dual diagnosis. The agency was able to hire a consultant who facilitated the learning process for agency staff. Griffin Centre staff interpreted the data that were collected and analyzed by the consultant and developed a plan for how to support and expand the use of the BCFPI within the work that is done at the agency.
Knowledge gained in this preliminary evaluation of BCFPI data in dually diagnosed youth will be shared with agencies province wide to inform clinical work in other settings. Griffin Centre is also committed to identifying research gaps related to this issue and exploring how the agency can contribute to a growing evidence base.
Back by popular demand, the Centre is once again featuring a Program Evaluation Grant competition in 2007-2008.
1) Build capacity in program evaluation among Ontario-based mental health service provider agencies;
Stay tuned, as the Centre will be posting new criteria/conditions on June 1, 2007 for this upcoming competition. This year, a limited number of grants of up to $15,000 each will be made available to Ontario-based mental health service provider organizations.
Applicants MUST apply, before Friday, September 14, 2007 by using the online application form available on our Web site. Award decisions and announcements will be made by October 19, 2007. Successful recipients will have approximately five (5) months to complete their evaluation activities, ending on March 31st, 2007. Please apply by visiting our Web site anytime between June 1 and September 14, 2007.
For more information on 2007-2008 Program Evaluation Grants and other Grants and Awards, please visit our Web site at www.excellenceforchildandyouth.ca.
More upcoming Grant and Award deadlines for 2007-2008…
The next round of Expertise Mobilization (Backfill) Awards applications is due on July 2, 2007. This unique award funds protected time or backfill to work on a specific research or educational project.
Visit our Web site for more information.
The Innovators’ Exchange is your opportunity to share your enthusiasm about the innovative initiatives you think are working well in child and youth mental health.
Candace Demick is an Adolescent Outreach Worker who is employed by New Path Youth and Family Services in Simcoe County. Candace works primarily in high schools with adolescents. This past year, with the support of New Path, Candace dedicated time to a new, exciting initiative involving youth, specifically females aged l4 to l8 – The Banting Sisterhood.
The most exciting spin off from this powerful day is the buy-in from schools. Banting High School supported this initiative in many ways: financially, with staff time and most importantly by allowing 800 students to miss class to come together. Follow up with staff will be occurring and who knows where this will lead.
Since the Sisterhood assembly was reported on both television and in the local newspaper, some of the elementary feeder schools have approached Candace, met and want to start their own Sisterhood. The core group of girls who worked for almost a year to pull this off are preparing to embark on a whole new path: teaching, supporting and role modeling for younger girls how to deal with bullying amongst girls. At the same time this core group of girls will continue to develop their own vision for themselves and their school. This initiative has surpassed everyone’s dreams and goals. Candace’s support, guidance and leadership along with that of some key school personnel, are responsible for this powerful tool that gets kids’ attention. Knowing the serious effects that bullying can have on children, this is a terrific step in helping to address the mental health challenges that many youth face today, some a direct result of bullying. This is why this nomination feels so right.
Elizabeth McKeeman, B.A., B.S.W., R.S.W., Manager, South Simcoe, New Path Youth and Family Services
We want your view on what we can learn from others as we work together to improve child and youth mental health in Ontario. Submit a brief description to us about what you think makes an initiative innovative. The Centre will follow up on your lead.
The following guidelines should help with your nomination. Consider nominating an organization, a partnership or a champion in your community whose work:
The nominations should:
The CHECKPOINT editorial team will review submissions and prepare relevant articles for publication.
She previously worked on evaluation and sustaining evidence-based innovations at the Nursing Best Practices Research Unit at the University of Ottawa, and on performance indicators at the Canadian Council on Health Services Accreditation. She has worked on various research projects involving children and families such as homelessness, developmental disabilities, prenatal cocaine exposure and childhood injuries.
In a recent letter, the Service Providers Reference Group requested that the Ontario Ombudsman extend his review of the child and youth mental health system beyond the immediate needs of military families. A meeting between representatives of the service providers’ reference group and the Ombudsman’s office is currently being organized.
The Centre is following up from last fall’s Galvanizing Forum by striking a sub-committee of our reference groups. Feedback from the Forum and other key documents on integrating the child and youth mental health system will be reviewed to come up with recommendations for the Centre’s continued work around integration.
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