No program illustrates the astonishing growth of DMHS’ services and supports as well as Residential Services.
DMHS started in 1987 as a provider of residential services, operating one home for eight residents, all of whom experienced schizophrenia and all of whom required a similar level of support. There were no specialized services and no transition from high- to low-support housing.
Since then, the residential program has grown to 7 homes serving 42 individuals and offering many diverse levels of support.
The core of the program is transitional housing. Residents typically begin at McKay House, which offers the highest level of support, being double-staffed 24/7. As they learn skills, connect to supports and develop healthy routines, residents move on to lower levels of support, first at Sims House and finally at one of the low-support homes. As staffing decreases, the intimacy of the homes increases – McKay House serves 15 clients, Sims House 6, and the low-support homes – Smith and Barlow – 4 and 5 clients respectively. Clients move as they demonstrate increased independence with life- and wellness-management skills.
A unique feature of Barlow House is a “step-down apartment.” As Residential Coordinator Mark Bouwmeester explains, “Within our housing program we have the ability to provide just as much support as is needed to help the individuals we support to live in a healthy way. Our step-down apartment allows an individual an opportunity to try for the most part to live as if they are in their own apartment. They maintain the environment, cook and work on developing a healthy daily routine. There still would be weekly house meeting and support from a residential councilor as needed. This can be the opportunity that some people need to help them fine-tune the skills that they will need to be successful when they move to their own place.”
In addition to these core homes, DMHS also operates specialized residential services for clients with specialized needs who may not follow the traditional DMHS housing path. These specialized services are both operated in close partnership with Ontario Shores Centre for Mental Health Sciences.
- One of these services – the Transitional Rehabilitative Housing Program (or TRHP) located at Ballantyne House –helps clients with forensics backgrounds successfully navigate the transition to community life.
- The other service provides robust, multi-disciplinary support to what the health system designates Alternate Level of Care clients – that is, clients who do not require hospitalization but whose needs are too complex to be well served in traditional residential programs.
Both programs innovate to meet the needs of clients who are not ideally served through traditional models of residential support.
Transitional Rehabilitative Housing Program (TRHP)
Forensic clients who transition to community life require effective support, particularly if they have been institutionalized by years of inpatient life.
Some TRHP clients have high-risk index offenses. Others have lower-risk offenses but experience significant mental, emotional or behavioural challenges. Depending on their needs, TRHP clients can be supported in independent units with intermittent staff support or in congregate dwellings with 24/7 housing support plus an assigned Forensic Transitional Case Manager.
CMHA-Durham operates the independent units. DMHS operates the 24/7 housing support component at its residential location Ballantyne House.
DMHS TRHP Coordinator Krista Bull remarks that “DMHS Residential Services has supported Forensics clients for many years, but the needs of some of these clients could not be met in our standard program. With this amazing partnership, DMHS and Ontario Shores have found a unique way to transition clients who may otherwise have limited options.”
TRHP is now in its fourth year of operations and continues to be a successful partnership with Ontario Shores.
In April 2014, DMHS in partnership with Ontario Shores re-opened the existing Kent House program as a high-support level of care program for clients reintegrating to the community from the hospital. The immense success of this program led to an expansion of an additional 8 beds in April 2015. Currently, there are 12 beds in 3 residential locations.
These complex care clients will typically start at the traditional intake house, McKay House, and then progress to either Scott or Kent House as they successfully adjust to community living and progress to a lower level of support needs.
The complex care support team consists of a multi-disciplinary mix of residential counsellors, Registered Practical Nurses, and Personal Support Workers. The program also receives support from Ontario Shores’ Outpatient Team, including access to a psychiatrist, a psychiatric nurse, a behavioural therapist, and a case manager. A Transitional Case Managers engages clients at the hospital to ensure a smooth hand-off to the residential team.
James Needham, a Registered Practical Nurse providing support to ALC clients, says that “Many clients have faced barriers to community living due to complex health problems. DMHS nursing support allows us to offer an appropriate level of care that can help these clients thrive. Also, the health teaching we provide regarding medications, diagnosis, symptom management, healthy coping strategies, etc. helps them succeed in the community and lessens the strain on the health care system, reducing unneeded utilization of hospital-based resources.”
Uzma Khan, a Personal Support Worker, also shared her thoughts on the complex care homes. “Our homes provide a safe and positive environment to our clients,” she says, “where we spend sensitive and respectful one-one-one time with them. We are ‘learning support assistants,’ from teaching simple kitchen skills to conflict resolution to basic budgeting. We also provide motivational coaching and emotional support. We help our clients by coaching them on the life skills needed for them to be able to live independently in the community.”