Conference Program

The challenge of inclusion rests with not only understanding culture and community, but also finding ways within the culture for meaningful participation. Historically, people with disabilities have been kept apart from community.　 This exclusion has set a tone for the greater community that people with disabilities are better off in their own space.　This presentation takes an active look at community and relationships with an effort toward building a community where each belongs.

In 2008 employee work-related musculoskeletal disorders (MSD) accounted for 53 per cent of lost time injuries in the healthcare and community sector, with almost half of the injuries attributed to client handling. These incidents can cause unnecessary employee and client pain and suffering. A brief overview of current and future challenges impacting employee injury rates will be discussed e.g. aging workforce, aging population demographics, recruitment and retention of frontline workers etc. This session will review key steps of a successful program that emphasizes the importance of well defined procedures and safe work practices. Practical tips, tools, leading practices, client handling technologies and solutions will be presented e.g. client mobility assessment, algorithms, and equipment pre-use inspection checklists. Insight will be provided into the significant client handling issues and challenges currently facing community and healthcare workplaces. It will assist supervisors and support workers in understanding their legal responsibilities under the OH&S Act as it relates to this hazard.

The Developmental Services Human Resource Strategy is a partnership involving the Provincial Network and the Ministry of Community and Social Services. The Developmental Services Human Resource Strategy will provide a sector-wide, competencies based, foundation for recruitment, training, succession planning, and performance management and will position developmental services as a preferred career choice across the province. The work of the strategy has been a truly collaborative initiative; this joint presentation will review the experience and the positive results of the partnership. The Committee Chairs will present on the work of their committees, the collaboration that has occurred over the last two years and the impact that their work will have on employees at all levels in agencies across the province.

This presentation/paper represents a collaboration of the Ministry of Community and Social Services ODSP Employment Supports Program and JOIN – Job Opportunity Information Network. JOIN represents 25 disability related non-profits in the City of Toronto. A one year research project collected data from clients, managers, supervisors and front-line staff about capacity building for retained employment. The key direction of the research and report was to build a service delivery template, integrating universal design principles and input from all stakeholders. A logic model, service delivery template and measurement planning template form an outline of future service directions. An ecological approach integrating stakeholder perspectives and specific terms of service delivery, service agreements and outcomes of service are identified in the report. The final report was published in June of 2009 and disseminated to the Ministry and all key stakeholders across the JOIN network.

The following study addresses long-term outcome in individuals with autism and severe developmental disability. Studies on the outcomes of adolescents and adults with autism have examined a number of different areas. The literature suggests that outcomes for this population are highly variable and dependent on factors such as IQ, language development, additional psychopathology and access to intervention programs and services. This study followed a high needs group of adolescents and adults who received comprehensive services through TRE-ADD, an Ontario specialized intensive tertiary-care program for children and youth with extreme forms of autism. These individuals received a comprehensive evaluation including an assessment of diagnostic severity, cognitive, language and academic functioning, adaptive behaviour, social outcomes and co-morbid psychopathology. The psychological and behavioural profiles of these individuals and their developmental trajectory will be presented. The categorical outcomes of participants and an in-depth case study example of each outcome group will be presented. Relevant predictors of outcome categories will be discussed. This area is essential to understand how these individuals are functioning and the level of services and supports they require.

This presentation will present findings from a three year study of behavioural crises and emergency room visits by adolescents and adults with developmental disabilities in Toronto, Peel, and Kingston, Ontario. Information was collected on the crisis experience of more than 800 individuals by over 30 agencies that support people with developmental disabilities. Close to 20% of these individuals visited hospital emergency rooms when in crisis. In addition to presenting our findings on key differences between the people who did and who did not visit emergency rooms, we will also share some findings from reviewing the hospital records of those who did visit emergency rooms. To further understand the emergency room experience, several interviews were conducted with people with disabilities and their caregivers about the hospital experience. We will explore the major themes that the hospital users identified in these interviews and make some recommendations about how to improve emergency room visits and how to prevent visits when in crisis.

In 2008 employee work-related musculoskeletal disorders (MSD) accounted for 53 per cent of lost time injuries in the healthcare and community sector, with 24% of the injuries are attributed to client handling and 29% to non-client handling MSD. A brief overview of the prevalence of MSD will be discussed. This session will focus on non-client handling MSD prevention. This session will provide insight into the prevalence of musculoskeletal disorder (MSD) currently facing community and healthcare workplaces. It will assist the support worker in understanding their legal responsibilities under the OH&S Act as it relates to MSD hazards. Methods of recognizing and assessing controls and evaluating MSD will be presented. Safe workplace practices and practical tools that can assist in the reducing the risk of MSD injuries will be discussed.

BDDP (Bayview Dual Diagnosis Program)) has developed a unique and individualized inter-professional transitional discharge model through a multistage process that includes: self-evaluation of discharge practices, client satisfaction surveys, review of discharge models from other provincial tertiary dual diagnosis programs, and a review of transitional discharge models in the literature. BDDP’s transitions are individualized based on the unique needs of the patient and the supports they will require for successful reintegration in to their community setting. Application of this model has resulted in a marked decrease in re-hospitalization and associated costs, as well as increased patient and community service provider satisfaction. An integral part of this model is the involvement of family, care givers and behavioural support providers, in all stages of the discharge planning process to ensure complete understanding of recommended individualized treatment modalities and their application in the patient’s home setting. Ultimately, the model enhances community partnerships, fosters the competence and confidence of community front-line staff, and contributes to the patient’s successful return home.

Core competencies are the underlying personal characteristics and behaviours of an individual that are important contributors to predicting outstanding performance in a job within a particular organization. They mark the difference between average job performance and outstanding performance. The Core Competencies Committee of the Developmental Services Human Resource Strategy worked with the Hay Group to identify the core competencies for seven key positions in Ontario’s Developmental Services Sector. The presentation will review the impact of the Core Competencies report and subsequent implementation for all employees in the Developmental Services Sector.

Establishing effective stakeholder – research partnerships in the field of developmental disabilities is an essential aspect of ensuring best practice, demonstrating service effectiveness, and informing policy in the developmental sector. Gone are the days of a researcher doing experiments in a lab and publishing in an academic journal, which no one in the applied world reads. Collaborations now include service providers from different sectors (health, social services, child & youth services, education), administrators, parents, clients, policy makers, community members, and researchers. This presentation will focus on the collaborative partnership process necessary for good applied research in the field of developmental disabilities. The current presentation will describe two current Emerging Team projects funded through the Brighter Futures for Kids with Disabilities initiative by the Canadian Institutes for Health Research and Bloorview Kids Rehab Foundation: Great Outcomes for Kids Impacted by Severe Developmental Disabilities and their Families (GO4KIDDS) and Health, Education and Learning Practices Promoting Social Inclusion of Children with Developmental Delays and Disabilities (HELPS Inc). HELPS Inc. explores the challenges and successes that parents, healthcare professionals and educators experience in helping preschoolers with developmental delays and disabilities transition into elementary school, and GO4KIDDS examines the health, well-being, and social inclusion of school-aged children with severe developmental/multiple disabilities. The current presentation will discuss ways in which stakeholders in the field can interface with researchers to suggest good research questions and ideas from their clinical experience, talk about trends in the research process in the 21^st century, and focus on strategies to promote broader collaboration, involve more stakeholder groups, and emphasize the importance of "knowledge transfer and translation".

Individuals with developmental disabilities have impaired social abilities and communication skills and frequently exhibit challenging behaviours, including aggression and violence, in response to a variety of biological, social or psychological triggers. Caregivers must respond to these behaviours, which may be physically and emotionally distressing. To the best of our knowledge, very little work addressing this issue has been done in Canada, particularly within Ontario, the country’s largest province. We have designed a study to assess the severity of client aggression in the developmental disabilities sector and the impact it is having on direct care workers. Our objectives are two fold: First, we want to determine the frequency and severity of client aggression experienced by direct care workers in the developmental sector and investigate its relationship on staff burnout. Second, we hope to identify the gaps in availability and knowledge of resources and supports for staff dealing with emotional difficulties related to their experiences of client aggression and violence. In this presentation we will summarize findings thus far and engage in a discussion with the audience about next steps in terms of research, training and policy. Information from this ongoing research is relevant to senior level management of transfer payment agencies, policy makers and the staff themselves.

Lack of knowledge regarding effective intervention for people impacted by FASD is the largest contributing factor to the development of Secondary Disabilities in this population. Secondary Disabilities include; mental health problems, involvement with the law, drug/alcohol abuse and homelessness. Traditional behavioural supports have proven to be ineffective with individuals with FASD. This session will describe effective practices and strategies, to support this population, in order to create better outcomes and quality of life for those affected and their families.

One of the most frequently recommended, and successfully used, communication systems is the Picture Exchange Communication System (PECS). Based on the principles of Applied Behaviour Analysis, PECS users communicate by exchanging pictures of items with a communicative partner in exchange for preferred items or a social interaction. Numerous studies link PECS to enhanced communication and speech development, as well as decreases in contextually inappropriate behaviours. However, few explore the quality of communication skills following PECS training in detail. Further, little is known about the specific child/adolescent and treatment variables associated with varying PECS outcomes. This presentation describes the impact of teaching PECS to 22 children and adolescents diagnosed with ASD and developmental disabilities in a community based summer program. The process of training and supporting staff to achieve high levels of PECS fidelity will be described. Further, communication outcomes will be explored in detail, including vocabulary diversity, sophistication of communication and generalization factors. Specific areas of communication difficulty will be discussed. Finally, child/adolescent variables (i.e., cognitive and adaptive level, autism severity) and treatment variables (i.e., fidelity, intensity and generalization factors) associated with varying PECS outcomes will be explored. Data sources include pre- and post-assessment of communicative behaviour and PECS use, daily data logs, video review and parent communication questionnaires. Implications for practice will be discussed, including appropriate outcome expectancies and recommendations for teaching PECS within community-based organizations.

Professionals and agency managers usually come into contact with families of people with developmental disabilities on a regular basis. Yet, effective family-work methods may be the most neglected area of training in our field! This presentation focuses on the efforts of one clinical team to increase the family-work skills of community professionals and managers in its large service area. This project concentrated on teaching twelve essential family-work skills with the objective of improving agency-family relations – especially important when dealing with individuals with complex needs. Learning these skills was found to improve family-system cooperation, collaboration, and stress levels for everyone involved.

This presentation will give participants an understanding of the history, support challenges and rationale leading to the creation of this innovative role in a Community Living agency (i.e. North Hastings Community Integration Association) without additional funding dollars. As well participants will learn about the community partnerships that have been fostered and/or strengthened as a result of this position; and more importantly, the practical and positive outcomes for individuals with a dual diagnosis, other health and social service providers, and families in this community.

Individuals with intellectual disabilities are sometimes prone to complex psychiatric and behavioural challenges that require a multi-disciplinary approach. In this workshop, we explore a complimentary relationship between psychiatry and applied behaviour analysis through four case vignettes. Emphasis will be placed on assessing and conceptualizing clinical presentations and setting events, slow triggers that increase the likelihood that challenging behaviour will happen (e.g., discomfort, lack of sleep, physical environment, major life changes), while exploring and problem-solving these cases using biopsychosocial and setting event strategy models. Together, both presenters and their respective disciplines offer collaboration in evidence-based, best practice perspectives.

In June 2008, the Developmental Services Worker Program was approved by the Ministry of Training, Colleges, and Universities. Since then, many community colleges have initiated this Program and there are now hundreds of DSW apprentices across Ontario. This session will provide an overview of the DSW Apprenticeship Program including how the Program operates, the different delivery models, and its many benefits. In particular, there will be a summary of Humber College’s flexible delivery format. There will also be a discussion of what the future holds for DSW Apprenticeship. Audience members will be invited to participate in the session by providing feedback and recommendations for the Program.

Workplace Safety and Insurance Board (WSIB) statistics indicate that 34% of lost time injures related to workplace violence or aggression occurs in the health and community care sector. Risk factors for acts of violence and aggression are well documented. Health care and community service workers are especially at risk when working alone, especially at night; working in the community and in clients’ homes; In contact with individuals who are under the influence of mind-altering substances; dealing with public complaints; providing care, advice or information that directly affect a client’s life; handling money or medications, especially narcotics. The risk increases when two or more of these factors occur at the same time. Using evidence based literature OSACH has developed a comprehensive program including assessment tools to assist health care workplaces to identify their individual risks related to workplace violence and aggression. This includes monitoring incidents as well as determining factors in their work settings that may contribute to or increase the risk of violence to their workforce. The following areas must be assessed to implement effective controls: Physical Environment; Work Setting and Clients; Point-of-care Work Practices; Employees’ Perception; Community Workplace Violence Issues; In addition to the tools OSACH has designed to complete a risk assessment, various control measures have also been identified. In this session, participants will recognize the prevalence and impact of workplace violence on health care employees. Also, participants will be able to identify risk assessment and control strategies including the physical environment, work setting, client risk factors and work practices to decrease the risk of violence and aggression to healthcare employees.

In January 2009, Developmental Clinical Services (DCS) at the Sudbury Regional Hospital and Community Living Greater Sudbury (CLGS) entered into a partnership to provide the district of Sudbury/Manitoulin a mandated Specialized Accommodation Bed. This partnership with CLGS was cemented when DCS was able to provide the necessary funding to renovate and furnish an apartment at an existing CLGS residence. As a community we also recognized that if a person were to access the specialized accommodation bed that this would require a highly trained staffing compliment that could be mobilized on short notice. Again, CLGS stepped forward and agreed to provide staff and supervisory support in the event of bed occupancy and DCS agreed to provide specialized training. This partnership has not been without challenges such as floods causing construction delays but the apartment and staff are now ready to be accessed by individuals in need of stabilization.

During this session, two organizations will share their experiences with the accreditation process. Both agencies are currently working with FOCUS Accreditation. One agency is larger and provides services across the province; the other is a smaller agency serving people in a particular community. The presentation will highlight the diversity in the two organizations’ approaches to preparing; the unique characteristics of both agencies and how that impacts the process; and the flexibility of the accrediting body, which does not prescribe how to achieve standards. There will be an opportunity for session participants to ask questions of the two organizations.

The presentation will describe how we have adapted Marsha Linehan’s Dialectical Behaviour Therapy (DBT) to be accessible to individuals with a dual diagnosis. This treatment combines traditional cognitive and behavioural therapies with Eastern practices, such as Meditation and Mindfulness. DBT entails skill development in the areas of Core Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. We will describe our general process for the group, for the individuals and how we monitored and evaluated our methods. Samples of the curriculum will be available for display. We will identify our use of Smartboard and videoconferencing technology for delivery of the model, supervision and consultation from our Clinical Psychologist. Descriptive information will be available for each individual (including age, SIS score if available, diagnosis, support level, service sector that provides support, etc). As well, preliminary outcomes will be presented based on pre/post assessments. Outcome measures include the FIDD (Frequency, Intensity, Discrimination, and Duration of each identified problem behaviour), Quality of Life questionnaire, Reiss Screen for Maladaptive Behaviour. We will outline some of the strengths and weaknesses of our model so that learners may benefit from our pilot project. This project continues to be collaborative between various agencies funded by the Ministry of Health and Long Term Care, the Ministry of Community and Social Services, and the Community Networks of Specialized Care.

Under the auspices of Humber College, Toronto, research was conducted into the role of the direct support worker at community agencies with respect to administration of medication to people with developmental disabilities. Topics investigated included the specific skills and knowledge that these staff require to fulfill their duties related to administration of medications, the educational background of the staff, and the nature of pharmacology-related training they receive from the agency, and medication errors. As well, comparisons were made between the job responsibilities of the direct support staff and the pharmacology curriculum in the Developmental Services Worker Program at Humber College whose graduates are employed in direct support roles. There will also be a review of how the pharmacology curriculum was modified based upon the research results. The session will also include an extensive examination of questions raised by this research. A vital issue is the significant level of responsibility given to direct support staff who work with vulnerable individuals. A related concern is the level of administrative and educational support that these staff receive – is it sufficient to ensure that they safely carry out their medication administration duties? How can we improve our services to utilize medications safely and avoid over utilization of medications?

In order to reduce restrictions placed on clients, a simple risk review assessment tool was developed and is completed by three staff members immediately prior to using privileges. This allows the treatment team a greater degree of comfort in assigning more liberal privilege levels because the client will be assessed appropriately before each exercise of the privilege is granted. The internally developed risk review assessment tool is quick and easy to administer and covers a variety of indicators of potential risk.

FOCUS Accreditation is a "Made in Canada" non-profit accreditation body that accredits organizations in the human services sector. FOCUS has embraced different forms of information technology in an effort to assist organizations as they prepare for accreditation, and to create a Community of Practice amongst these organizations. As part of its strategic outlook, FOCUS identified several aspects of accreditation that proved problematic for organizations, such as the coordination of preparation materials, and the need to share ideas and questions with others. For many of the challenges facing organizations, the solution that was ultimately determined as being most effective relied on new forms of information technology. Some examples include: FOCUS partnering with E3 Social Enterprise on an accreditation database, Building an on-line Community of Practice, Using e-conference software and Restructuring the accreditation process to facilitate smoother information exchange. The result is that organizations now have more support as they prepare for accreditation, FOCUS is able to work more effectively, and are able to spend more time during an accreditation, with the people who use and provide services. For this session, FOCUS will clearly articulate what the challenges are that organizations face when preparing, what was considered when determining how to address these challenges, and the resulting IT solutions that have been developed and are now being used by organizations pursuing accreditation with FOCUS. Demonstrations of the technology are possible.

In this　presentation we will describe the specialized Dual Diagnosis Program at the Centre for Addiction and Mental Health and how it fits in the network of services for individuals with developmental disabilities and mental health needs. We will describe the structure of the program, the services it provides and the profile of clients that we serve. We will also provide a detailed analysis of admission characteristics and clinical outcomes for a subgroup of clients who were admitted for inpatient treatment over a 2-year period.　 We will discuss our recent initiatives to partner with community agencies to build their capacity to support individuals with dual diagnosis and to minimize the need for tertiary care services, particularly inpatient admissions.

Leadership Innovations
Developmental Services Application Package Ministry of Community and Social Services

Presenter: Monica Neitzert

This presentation will provide a summary of the new Developmental Services Application Package and an overview of how it is being implemented. The presentation will include a description of the contents of both Application for Developmental Services and Supports (ADSS) and Supports Intensity Scale (SIS), which together make up the new Application Package. A summary of how the tools were developed and pilot tested for use in Ontario, and the feedback and lessons learned from the pilot will also be shared. The presentation will also describe how these new tools are being used with adults who have a developmental disability in communities across the province.

In September 2004, the Minister of Community and Social Services announced a strategy to transform services for people with a developmental disability. The goal of this transformation strategy is to create an accessible, equitable, fair and sustainable system of community-based supports. In order to help achieve this, stakeholders identified a need for accessible, reliable, trustworthy information. A Developmental Services Information Services Forum, held in February 2008, brought together representatives from DS Agencies and the Ministry of Community and Social Services to explore strategies. Based on the recommendations of those attending the forum, the Ontario Developmental Services Web Group was established with a mandate to design and support implementation of a Developmental Services networked web environment. Within this group there was a consensus that such a web environment should include: A content section for families and for staff; A local services and resource directory or database: Site management support and recommended standards (i.e. sharing knowledge, infrastructure and hosting to reduce duplication and costs system wide, etc.); Search capacity - a plain-language search function that is open source and based on best practices; Shared branding and provincial linkages – consumers should be able to easily identify the site and find the information they require from anywhere in the province; Community Oversight/ Governance - active community and family involvement and broad representation from agencies across the province, including non-DS Sector agencies. In this session "A Framework for an Ontario Developmental Services Web Service", the Web Group’s first draft of what this web environment could look like, is examined. The next step is to get feedback and input from the wider developmental services sector and stakeholders. This session will provide participants the opportunity to provide their input and ideas, including the merits, challenges and opportunities to realize the vision of the framework.

FOCUS Accreditation is a "Made in Canada" non-profit accreditation body that accredits organizations in the human services sector. FOCUS’ approach to accreditation is to accredit an organization as a whole, rather than particular programs or service streams being delivered. In 2009 FOCUS began to develop a new domain that would apply to organizations that provide ‘clinical standards.’ By developing these standards, FOCUS is able to more fully accredit organizations that provide these services either within their own organization, or to other organizations in the community. The first step in this process was to define ‘clinical standards’ within the context of developmental services, and to then develop standards for organizations that provide these services. Information about how the standards were developed and vetted will also be provided, as will the ‘indicators’ that FOCUS would look for when conducting an accreditation. The standards are scheduled for release early in 2010. This presentation would enable organizations that provide clinical standards to have one of the first opportunities to review the finalized standards and ask questions about how they would be applied to an organization. Time will also be allocated to discussion about how the standards can be used as a quality improvement tool.

In this presentation, we will discuss the two initiatives developed by the Dual Diagnosis Program at the Centre for Addiction and Mental Health. In early 2009 based on feedback from the community that staff would benefit from further individualized training on the use of evidence informed practices within community environments, the Community Capacity Behavioural Consultant (CCBC) was created. The position will address the needs of community environments (residential and day support services) at a program level as opposed to providing individual-specific assessments in a given home. A program level needs assessment is conducted with all staff, through the use of questionnaires, interviews and direct observations. The assessment evaluates support providers’ (family/staff) knowledge of general principles of applied behaviour analysis, beliefs about the causes of and responses to challenging behaviours and how well settings are structured to promote and maintain positive, adaptive behaviours. Upon completion of the needs assessment, the Community Capacity Behavioural Consultant collaborates with support providers through education forums to develop and implement achievable curriculum. The curriculum focuses on integrating evidence-informed practices to meet the needs of support staff. This presentation will discuss the process, give examples of curricula offered, and evaluate efficacy of this type of capacity building model. In addition, in late 2009 the Dual Diagnosis program at CAMH piloted a group based intervention for adults with a dual diagnosis as well as their residential staff. The group is designed to assist clients and residential staff in developing a deeper understanding of themselves and how to engage better with others. Client and staff groups are held concurrently over 8 sessions. Staff participate in group forums with CAMH staff/students on a variety of relevant and timely topics. While clients focus on skill development which includes problem solving, coping with anger and anxiety, relaxation, stretching, exercises, and humour. Following these separate sessions the groups join together and staff have the opportunity to hear/see what the clients have been learning. In this presentation we will review curriculum and provide preliminary evaluation in terms of client and staff benefits.

It has been identified that many people with a developmental disability often suffer more long-term abuse or neglect and therefore have a more complex presentation of trauma. In 2007, the Central West Network of Specialized Care identified a gap in services relating to the assessment and treatment of complex trauma in the lives of people with a developmental disability. Dr. Lori Haskell was hired to review research and identify needs/challenges, and together with the Network, subsequently brought together a group of professionals in developmental disabilities and trauma services for the purpose of building capacity and becoming more trauma informed. This Committee developed and presented a two-day workshop for agencies in Central West region, - again with the goals of collaboration, networking and education, so that trauma services could be more informed about developmental disabilities and developmental service providers be more trauma informed. This ambitious two-year project is summarized in Dr. Haskell’s final report submitted to the Central West Network of Specialized Care entitled: "Defining the Issues, Identifying the Challenges: The Mental Health Needs of Persons with Developmental Disabilities and Abuse-Related Trauma." Highlights of this report will be discussed and include: Summarizing Key Findings: Background research and literary review; Recognizing Abuse and Post-traumatic Stress in the lives of People with a developmental disability; Understanding Complex PTSD; Summary of Comprehensive workshop training to Enhance capacities; Identifying Next Steps/ Next Challenges.

OADD Annual Conference

2010 Conference Program