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
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
C on tinu e t o Tea m A
Not appropriate for Team A •New participation agreement
•Referral back to ASI Team A when
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
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Appendix B:
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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;
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
IndividualServices 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
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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.”
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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
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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
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 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
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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 withCravings, Money Matters, Coping with Withdrawal, Healthy Relationships, Community Resources, Self Care and Coping with Stress and Anxiety
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 refer clients after treatment
planning
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 with Brain Injury &
Substance Abuse
Referrals
Open group consisting of 10
sessions.
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______________________________________________
Preparation/Determination (Getting ready to change)
“You are the sole creator of your experience.”
— Luke RhinehartIn 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
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Goals for Preparation
TX Plan ADSTV role OW role
Move into action (usually within 1-60 days)
Referral to Fresh Start- administer TEQ and Socrates to assess treatment readiness
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
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)
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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?
What is the craziest thing you can think of to do to bring about this change?