CDSS’ model of service was developed through a collaborative process with 15 partnering agencies. Its purpose was to reduce the barriers to service for clients with a concurrent disorder and complex needs (here called CD-complex clients) through prioritized access, CD-knowledgeable service and flexible procedures. It was further mandated to explore ways to improve access and service provision.
Barriers to Service
Clients with a concurrent disorder and complex needs are less likely to meet the traditional eligibility, attendance and behavioural expectations of most agencies.
CDSS has noted the following barriers through its discussions with clients, workers and partners and through its trainings with partners’ workers:
- Requirement for identification, health cards, immigration status, etc.
- Requirement for prerequisites, such as medical referral, accompaniment, case management, etc.
- Screening that excludes challenging clients.
- Wait lists that discourage attendance.
- Not enough housing, accommodation or stability to assist attendance.
- Lack of language and translation services.
- Agency practices regarding attendance, substance use or other behaviours that can affect the continuation of their own and CDSS service.
- Inconsistency of service, lack of planning and inability to build on previous service across agencies.
- Premature termination of service.
Service Solutions
In order to balance partners’ existing services with the prioritized access to CD-complex individuals, CDSS was structured to employ:
- Transitional supports: Depending upon the service, transitional supports may be one session (as in a psychiatric consultation) or three months (as in case management). However, other features – such as case facilitation or service planning – are put in place to ensure continuity of service within and beyond CDSS service.
- Internal referral: Partnering agencies provide both referral and service. As a partnering worker is the only one who can negotiate a referral, there is no community referral (at present) from outside agencies, clients or families.
- A “discrete space” system: Partners provide a limited number of service “spaces” at any one time. This system works well with the internal partnership referral. However, there are two drawbacks. First, given the number and variation in services, it is difficult to track the termination of each. Second, as referrals increase, the system may have to change in order to preserve prioritized access.