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Service Philosophy

The philosophy of the service is to ensure that clients with significant Intellectual Disability or Head Injury and Psychiatric Disorder receive the specialist support and treatment that they require, to maximise their independence and participation

in ordinary lifestyle events and to minimise the impact upon their quality of life. The non-government services.

This is achieved by:

• Utilising principles of normalisation

• Seeking least restrictive treatment options

• Advocating and role modelling non-aversive treatment styles

• Providing specialist expertise and support to clients, families and primary care givers • Being readily accessible, responsive and mobile

• Working in partnership with generic mental health services

The Dual Disability Team is a mobile regional team which provides further assessments, intervention and treatment service for clients in the

Auckland/Northland Region, who meet the following criteria:

• Aged 19 years and over with some flexibility based upon emotional, physical and social maturity

• Who have been assessed as having moderate to severe intellectual disability or head injury, which has resulted in significant cognitive deficit

• Who have a co-exisiting psychiatric disorder

Consultation, advice and training services will be provided throughout the Northern region for clients, families, primary care givers, community agencies, general practitioners, secondary and tertiary health care providers.

Exclusion Criteria

• Assessed as having IQ over 70 • Not eligible for service from a CMHC • Not having a DSM IV Axis 1 or 2 diagnosis

Referral Policy Purpose

The purpose of the referral policy is to ensure that all referral sources are able to access services in a timely and effective manner.

Process

• Appropriate referrals will be accepted directly from secondary and tertiary health care providers in the Northern Region for the purposes of assessment and treatment of clients

• Primary health care providers, community agencies and the general public will access services via their local point of contact to mental health services, or their GP if they are not currently under a Community Mental Health Centre.

• All referrals will be responded to within set timeframes ie. Within 24hrs or the next working day for urgent referrals, within 5 days for non-urgent referrals.

• Crisis calls will be responded to by the local crisis response team. The specialist Dual Disability Team can be requested to assist on crisis calls during working hours.

• Requests for consultation, advice or training services will be accepted from community and health care providers in the Northern region. The first point of contact for external agencies may be direct to the team.

Process for accessing advice consultation and liaison services

Telephone contact numbers will be made widely available to primary health care and

for telephone advice or consultation. In the event that assessment or treatment services are subsequently required the following process will be used:

• A written referral is completed by the referral source.

• In the case or urgent telephone referrals, written information must be supplied as soon as possible (prior to the assessment occurring), to ensure that all critical information has been passed on.

• Upon receipt of the referral, the team will respond within the specified timeframes, within 24hrs for urgent referrals and within five days for non-urgent.

Interface Protocols

The Dual Disability Team is able to offer specialist assessment, screening, consultation, advice and support to generic Mental Health Services. This will be best achieved by utilising a partnership model as described below. Upon receipt of a referral from an accepted source, a member of the team will respond within the specified time frame. The Dual Disability team member/s will contact the referrer. Agreement will be reached about how to progress, including:

• Clarifying the requirements of the client • Clarifying the expectations of the referrer

• The role of the referrer in the clients treatment eg. Case management

• The role of the Dual Disability Team in the clients treatment eg. Specific key work or treatment planning advice.

• Regularity of contact between the referrer and the Dual Disability Team • Regularity of contact with the client

• Setting a date for evaluation of progress.

• Planning for service handover to appropriate follow up agencies, or back to the referral service.

Service Delivery

The Dual Disability Team is a tertiary specialist service, with clients primarily cared for by their respective District Health Board mental health services. Clients

may also be supported by intellectual disability services, head injury services or other non-governmental organisations in residential facilities or the community.

Responsibility for management of intellectual disability or head injury and accommodation remains with community agencies. The Team will generally see people within their home environment. Clients may choose to voluntarily disengage

from the Service at any time.

The Dual Disability Team provides the following services:

•• Assessment of mental illness, intellectual disability and cognitive function. •• Clarification and development of treatment/management plans.

•• Consultation on medication and medical treatment regimes.

•• Psychological consultation and assistance with the management of behavioural disturbances.

•• Development and monitoring of behavioural programmes to be implemented by caregivers in the place of residence of the client

•• Limited provision for specific interventions, to support the initial implementation of behavioural programmes in the place of residence of the

client.

•• Liaison, consultation and case conferences with the primary care team. •• Support for the maintenance of recovery through psychiatric case reviews •• Primary care/case management for the five clients with Pathways Trust, under

The Dual Disability Team will have a mobile specialist multi-disciplinary team consisting of a Psychiatrist, one and one-half Psychologists (one being located in the Auckland region and the half being located in the Northland region) a Social

Worker and a Registered Nurse.

Service Handover Protocol

To ensure that all clients who are referred to this service are appropriately discharged from

the service the following protocol will be followed:

• Prior to the completion of specialist dual disability input, the initial referral source is alerted to the expected date of discharge from service.

• A handover meeting is arranged including the client and all involved people and/or services.

• The ongoing roles of all involved care providers are clearly detailed and agreed to. • Consideration is made of any risk or safety management issues for the client. • Contingency plans are developed, including service re-entry instructions.

Interagency Collaboration Projects

Other examples of interagency collaboration projects can be identified within New Zealand although not specifically for adults with a dual diagnosis.

For example: The Child and Adolescent Liaison Team Inter-Sector

Initiative (Auckland Healthcare Services, New Zealand)

The Child and Adolescent Liaison Team (CALS) was set up in January 1998. It was

established to encourage co-operation, collaboration and co-ordination between Mental Health and the Child Youth and Family Agency (CY&FA). The CY&FA population has a lot of the risk factors for mental health problems.

The CALS team provides consultation, assessment and training to CY&FS staff. This encourages early identification of mental health problems and referral on to appropriate

services. We are contracted, funded and employed by Auckland Healthcare Services. We are one of several teams of the Community Child, Adolescent, and Family service (CCAFS). CY&FA provide some of our resources.

The service is sub-regional covering the greater Auckland area from Wellsford to Mercer. There are three Mental Health Child and Adolescent Services in Auckland, and 10 CY&FA offices in Auckland. Only CY&FA staff can make referrals. The child/young person must be allocated to a CY&FA Social Worker and the case remain open during our involvement. The CY&FA Social Workers remains the case manager to whom we consult with during our involvement. Crisis situations, particularly immediate risk of self-harm are referred directly by the Social Worker to the local Child and Adolescent Mental Health Services. Cultural advice is sought where appropriate. In Auckland CY&FA have Maori, Pacific Island and Pakeha teams. The

Child and Adolescent Liaison Service provides Liaison and consultation to help Social Workers identify and manage mental health problems in children and adolescents.

Social workers can request consultation with members of the team to discuss any concerns. Assessment (including face to face assessments and screening) is carried out with the child/young person and their families at the CY&FA office or other agreed location. Education and Training is provided on topics relevant to child and adolescent mental health. Topics include, diagnoses, child development, risk management, assessment and treatment. We are able to provide education and training on topics relevant other mental health topics