Dual Diagnosis Transitional Rehabilitation Housing Program (DD THRP)

Brief Description

The Dual Diagnosis Transitional Rehabilitation Housing Program (DD TRHP) is a joint initiative between the Ministry of Children, Community and Social Services (MCCSS) and the Ministry of Health (MOH). The program is in its seventh year of operations and has seen the implementation of six (currently five) specialized step-down homes (with two beds each) across the province to support individuals with a developmental disability and/or a dual diagnosis (persons with a developmental disability and a mental health condition) who are in a forensic hospital as a result of coming into contact with the law and found unfit for trial or not criminally responsible (NCR). The Program provides 18-month rehabilitative step-down supports for people with developmental disabilities that have been in contact with the law and are ready to move out of hospital into community settings.

Goals

The main goals of the program are to:

• Support people with developmental disabilities and/or a dual diagnosis who are in a forensic hospital under an Ontario Review Board (ORB) disposition as a result of coming into contact with the law;
• Successfully transition these individuals back to community; and
• Prevent reoffending.

Clientele

DD TRHP is targeted to individuals with a developmental disability and/or dual diagnosis who need extra support to transition to the community when their Ontario Review Board (ORB) disposition provides for community placement, and it is clinically appropriate to do so. These individuals must be eligible for ministry funded developmental services and supports, be residing in a forensic hospital bed under an Ontario Review Board (ORB) disposition, and are ready to begin their move out of hospital into community settings.  Eligible individuals are referred through the Developmental Services Ontario Offices – the main access point for adults seeking ministry funded developmental services and supports.

Core Components

DD TRHPs target the development of community living skills and provide specialized clinical supports, including nursing, psychiatry, social work and case management. The programs are staffed jointly by forensic hospital staff and developmental services agency staff and staffing ratios are based on the unique needs of each client (e.g., 1:1 or 3:1 depending on complexity of support needs).

The average length of stay for clients is up to 18 months in the home (based on each person’s transition and support plan), with a subsequent goal of a permanent transition into a community living setting.

There are five step-down DD TRHP community homes with 2 beds per location.

There is an MOU between MOH and MCCSS that supports the ongoing operations and funding of the DD TRHP homes.

Implementation Information

Some of the critical elements for the implementation of this program or initiative include the following:

• Organizational requirements: Each Developmental Services (DS) agency that provides services under the DD TRHP program has a forensic hospital partner that they work with and who provide direct mental health/clinical services to the individuals in the home.
• Partnerships: DD TRHP homes partners with the local Forensic Hospital for direct clinical supports, other expert community partners such as behavioural specialists as well a MOH and MCCSS teams.
• Training and technical assistance: The DS agency and forensic hospital provides adequate training to staff that support clients in the home.
• Risk assessment tools: Each individual who utilizes the program has an individual /behavior support plan which includes support needs and risk factors to manage.
• Materials & resources: Interim Activity Report back and annual activity report back templates are received from agencies to get feedback on the clients, services and supports provided through the program. Discussions with regional offices to discuss communication and feedback received from agency’s providing service to the DD TRHP and opportunities to improve services and supports. Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA)

International Endorsements

The most recognized classification systems of evidence-based crime prevention programs have classified this program or initiative as follows:

• Blueprints for Healthy Youth Development: Not applicable.
• Crime Solutions/OJJDP Model Program Guide: Not applicable.
• SAMHSA's National Registry of Evidence-based Programs and Practices: Not applicable.
• Coalition for Evidence-Based Policy: Not applicable.

Gathering Canadian Knowledge

Canadian Implementation Sites

Currently, DD TRHP runs 5 homes across 3 Regions (Toronto, East and North ). Each Region’s DD TRHP home is managed by a DS agency in partnership with the local forensic hospital. DD TRHP homes started in 2015/16.

Main Findings from Canadian Outcome Evaluation Studies

No information available.

Cost Information

MCCSS contributes annually $400K per home (total $2M) for developmental services and MOH contributes annually $400K per home (total $2M) for clinical supports.

References

There is no Canadian reference available at this time.

For more information on this program, contact:

Ministry of Children, Community and Social Services – Community Services Division

315 Front Street

Toronto, Ontario

Email: DSSB.GENERAL@ontario.ca

Website: https://www.ontario.ca/page/ministry-children-community-and-social-services