Program Update:The Specialized Program for Enhanced Interdivisional

Responsiveness (S.P.I.D.E.R)

Executive Director, Social Development Finance and Administration

Last updated March 2015

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City Council on December 16, 2013 adopted the following:

1. City Council request the Government of Ontario to review the Mental Health Act to provide accommodation for those suffering from Compulsive Hoarding.

2. City Council request the Government of Ontario to reconsider the phrase "has shown or is showing a lack of competence to care for himself or herself" in section 15 (Application for psychiatric assessment), section 16 (Justice of the peace’s order for psychiatric examination) and section 17 (Action by police officer) in Part II of the Act (Hospitalization) to ensure application to problem hoarders and, if deemed appropriate, changed as necessary to properly address problem hoarders.

3. City Council request the Government of Ontario to provide adequate outpatient treatment options for problem hoarders.

4. City Council request the Government of Ontario to review the Conditions for Involuntary Admission under section 20 (Duty of Attending Physician) in Part II of the Act (Hospitalization) to assess whether it is appropriate to allow for options cited in Part 3 above to be included.

5 City Council authorize the Executive Director, Social Development, Finance and Administration to establish the Specialized Program for Interdivisional Enhanced Responsiveness (SPIDER) on a 'proof of concept' basis.

6. City Council authorize that the 2014 Operating Budget of Social Development, Finance and Administration be increased by $199,000 gross and zero net to reflect the two new temporary staff positions and the funds be allocated through Interdivisional Recovery (IDR) from the Toronto Employment and Social Services Division.

7. City Council authorize that the 2014 Operating Budget of Toronto Employment and Social Services be adjusted to include a draw of $199,000 equal to the gross expenditures from the Social Assistance Stabilization Reserve and transfer the funds to Social Development, Finance and Administration through Interdivisional Charges (IDC).

8. City Council forward a copy of this Item to the Board of Health for information.

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Unresolved Complex Health and Safety Risks Involving :• Vulnerable Residents, • Their Homes and Property, and• Their Neighbours

Problem Hoarding is a critical concern in many but not all of these situations.

ISSUE

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To reduce recurrence of these risks, and ensure safe integration and inclusion of vulnerable Torontonians in their neighbourhoods and communities by:

• Ensuring City of Toronto responses are coordinated;

• Ensuring existing health care, social and community services are made available; and

• Identifying and driving needed systemic reforms

PROGRAM MANDATE

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Vulnerability is the result of interaction between the challenges a person faces and the resources that they can access when facing those challenges.

A vulnerable resident must be assessed in context - a person's vulnerability or resiliency will depend on their circumstances, environment and resources in the broadest sense.

Vulnerable persons may be isolated, without identified supports, reclusive, or have underlying physical or mental health issues that pose a threat of harm to themselves and/or others.

Threat of harm to self may be due to reduced ability to manage activities of daily living, substance misuse, reduced insight, and/or reluctance to accept support services.

- Toronto Public Health – Vulnerable Adults/Seniors Team Policy 2012.

“VULNERABILITY”

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Toronto Paramedic Services Municipal Licensing & Standards Employment and Social Services Social Devel. Finance & Admin

Fire Services Toronto Community Housing

Shelter Support and Housing Toronto Public Health

with: City Solicitor Equity, Diversity & Human RightsHuman Resources Ombudsman

Toronto Central Local Health Integration NetworkHealth Care/Community Services Agencies

SPIDER PROGRAM DESIGN TEAM

Purpose of this Consultation

- SPIDER does not supersede normal services or replace interdivisional coordination when it is already working.

- The problem is often not a lack of front-line coordination among City Divisions.

- However, the types of services the City is authorized to provide (coordinated or not) may not be appropriate for addressing the immediate or longer-term issues and vulnerabilities.

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PROGRAM DESIGN TEAM FINDINGS

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December 2013: Council authorized SDFA to establish “Specialized Program for Interdivisional Enhanced Responsiveness (SPIDER)” on a 'proof of concept' basis.”

January-June 2014: Interdivisional Participation in Program DesignAugust/September: Staff Hired & TrainedSeptember 2014: Launch “Situation Table” for frontline cases

Launch Steering Committee for oversight; interdivisional troubleshooting

October 2014: Launch “System Reform Table” to drive policy change

March 2015: Systemic Reform Table has begun meeting to discuss emerging data trends and policy implications

TIMELINE

Steering Committee

System Reform Table

Local or

Inter-governmental Policy Change

Situation Table (Front

Line) Current

Situation

SPIDER STRUCTURE (based on “FOCUS REXDALE”)

Fire

Community Services

TPS

Public Health

MLS

Health Services

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Fire/ TPS

Community Services

Health Services

TPS

Public Health

Situation Table

Collective Impact vs System Navigation(green = new staff)

Case Manager

SITUATION TABLE

Referral Organizations

Referral Divisions

DISCUSSED AT THE SITUATION TABLE …

• Eligible?• Risk Factors?• Is there a Need for Intervention?

Purpose of the intervention? Approach? Client(s) Who will lead? Which agencies will be involved? Time frame for Report Back?Report Back: Have all the divisions acted with duty

to care and met service standards? Has individual been availed of all

relevant community supports and warm referrals

Underlying source of problems identified?

Illustrates an issue for the System Reform Table?

ANY DIVISION CAN SUBMIT SITUATIONS THAT MEET SPIDER ELIGIBILITY CRITERIA TO THE SITUATION TABLE. DIVISIONS MUST COME PREPARED TO EACH MEETING WITH UPDATES ON ALL THE INTERVENTIONS SUBMITTED.

PARTICIPATING DIVISIONS RECEIVE CALLS THROUGH REGULAR CHANNELS AND ADDRESS THEM THROUGH REGULAR MEANS INCLUDING COORDINATION WITH OTHERS

SITUATIONS ARE PRE-SCREENED BY STAFF AND PRESENTED TO SITUATION TABLE.

How it Could Work: The SPIDER “Situation Table” Model

- Only a Participating Division at the SPIDER Situation Table can refer a case.

- City Divisions that do not participate at SPIDER may contact SPIDER for guidance re: initiate service linkages.

- The SPIDER Program does not take referrals from the public.

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REFERRALS

• 22 numbered cases now on file: - housing vulnerability due to fire hazard, pest infestations, unsanitary,

etc.- refusal of services- seniors- property owners- elder abuse

- 2 cases redirected back to originating division for normal service linkages• System Reform Table Launched• 10 City Divisions signed Memorandum of Commitment to Participate• 4 Community/Health Care partners have joined• There has been 1 quarterly debrief and a review of operational and systemic

themes emerging at the table

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SITUATION TABLE UPDATE: August 2014 – March 2015

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PROGRAM UPDATE

Toronto Community Housing

Toronto Municipal Licensing and Standards

Toronto Public Health VAST

Shelter Support and Housing

Toronto Fire

Originating Agencies

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PROGRAM UPDATE

8%

8%

6%

8%

6%

8%

5%8%

5%

5%

15%

15%

3%

Responding Agencies

COTARevenue ServicesToronto Central CCACTCHCTESSToronto FireMLS - AnimalTPS - InvestigationsTPS (EMS)TPH - HETPH - VASTSSHAWoodgreen

-To drive system-level reforms that will increase the capacity of the City and its partners to respond effectively to complex health and safety risks involving vulnerable Torontonians, their homes or property, and their neighbours.

- Focused on policy, legislative, or resourcing barriers that preclude effective resolution of a risk situation.

- Includes: City of Toronto senior management and external decision-makers.

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System Reform Table on Vulnerability in Toronto

Purpose of this Consultation

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Emerging System Level Issues

- Capacity and Consent Issues (clients refusal of support services, even when this puts self, property, neighbours at risk) - Hospital Discharges to No Follow-Up/Social Service Supports- Need for complementary definitions, policies and procedures for responding to vulnerability. - Human and financial resources to implement services changes to respond to vulnerability.- Limited health care/community services exist to address underlying causes of problem hoarding.

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Commitments to Participate

Partner Agency Commitments

- Establish internal communications/authorization procedures for notifying staff about SPIDER program and expediting responses to SPIDER situations.* -Actively support SPIDER Program if the Situation Table decides that a nominated situation justifies an intervention involving that Division.

- Introduce SPIDER case file numbers into Division’s administrative records to permit shared reporting and evaluation, consistent with privacy legislation.

Document your communication plan so SPIDER staff understand it – we need it by October 30.

What do you need from SPIDER in order to be able to communicate about the service.

Contact

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Dan BreaultCommunity Development Officer S.P.I.D.E.RCity of Torontodbreaul@toronto.ca416.392.6414

Lavinia Corriero Yong-Ping, RNCommunity Development OfficerS.P.I.D.E.RCity of Toronto416.397-9970lcorrie@toronto.ca

Scott McKeanManager, Community DevelopmentCity of Torontosmckean2@toronto.ca416.392.0103