Rapid Intervention Service Kenora (RISK) Table Report May 2016 - May 2017
Rapid Intervention Service Kenora (RISK) Table Report May 2016 - May 2017 Table of Contents Background... p3 Introduction.... p4 Acutely Elevated Risk (AER)... p4 Purpose.... p5 RISK Strategies.... p5 Rapid Intervention Services Kenora (Risk) and Guiding Principles.... p5 Founding Members and Participating Agencies... p6 RISK currently has representation and/or participation from the following agencies.... p6 Roles, Responsibilities and Governance Model.... p7 RISK Table Privacy.... p8 RISK Table Process... p8 Data Analysis: May 1, 2016 May 1, 2017.... p9 Appendix A: Four Filter Privacy Process.... p22 Appendix B: Planning An Intervention.... p23 Appendix C: Steering Committee Members.... p24
Background Situation Tables began in Glasgow, Scotland. An overwhelming frustration of addressing crime and disorder, which relied heavily on police services, motivated a project to address their concerns. The project invited front-line practitioners to come together and put on the table regularly occurring risks that were coming to agencies. The Violence Reduction Unit in Scotland explained that crime is a public health issue and the more tools an individual has to succeed, the better the outcome for that individual. The philosophy behind the Situation Table model is to identify the root causes of crime and social disorder and to work to prevent or mitigate them. The Situation Table model made its way to Canada, to Prince Albert, Saskatchewan, when they were experiencing a wave of violent crime. The first Situation Table put together in Ontario was in Rexdale (FOCUS). There are now 44 (2016) across our province. In the context of the figure, the idea behind risk intervention is to avoid triggering an emergency response. The best way to do this is through social development and promoting and maintaining community safety and well-being. (Prevention comes into play once risks have been identified.) When numerous risks are encountered that individual, family, group or place is experiencing acutely elevated risk and is in need of an intervention, before the situation results in an emergency response. 3
Introduction Rapid Intervention Services Kenora (RISK) is a community-led initiative that brings together representatives from across sectors, including mental health, addiction, justice, social services and education, to help those at acutely-elevated risk of imminent harm or victimization. These are individuals in the community facing complex situations and multiple risk factors. They may be experiencing issues related to mental and physical health, addictions, poverty, negative relationships, housing, education, employment, domestic and physical violence and more. These are also situations where a single agency may have exhausted all its resources trying to help. The goal is to mitigate risk factors and imminent threats of harm of victimization to individuals, families, groups or places. RISK is not case management, but rather a way of utilizing and mobilizing existing systems and resources in a coordinated and collaborative way. Acutely Elevated Risk (AER) Understanding the clear definition of Acutely Elevated Risk (AER) is critical for the RISK team: AER is a situation negatively affecting the health or safety of an individual, family, group or place where there is a high probability of imminent and significant harm to self or others (e.g. offending or being victimized, lapsing on a treatment plan, overt mental health crisis situations, etc.). The risk factors contributing cut across multiple human service disciplines. (Standing Committee on Community Safety and Crime Prevention 2016). To determine whether a situation is of AER that requires intervention, the following points are considered: There is a high probability that without intervention within the next 48 hours, the situation will escalate Risky situations that are on the verge of becoming emergency situations These emergency situations will require the services of our community s crisis and emergency response systems. There are often warning signs or risk factors. The situation is distinct from other operating thresholds and characterized by common terms such as crisis, imminent danger, violent threat or criminal activity in progress. It involves an increasing level of risk that implicates high probability of intense harm that crosses multiple human service sectors. Is an elevated risk of harm or victimization from any of the wide range of risks where protective factors are limited or non-existent. The acutely elevated nature of these risk situations means that: o Chronic conditions have accumulated to the point where a crisis is imminent. o New circumstances have contributed to significantly increase chances of severe harm or victimization; and/or o The effort to mitigate risk and thus avoid harms exceeds the capacities of any one agency or even two agencies acting in partnership. The situation must entail two or more risk factors. 4
Purpose The purpose of RISK is to bring multiple human-service sectors together to collectively identify systemic issues and risk factors that are prevalent locally and to provide a network of support for vulnerable populations in our community in order to prevent crisis situations. RISK Strategies A situation table brings front line human services agencies together across a range of sectors to identify situations involving individuals who are at an AER of harm and to provide immediate, coordinated intervention with appropriate supports before they reach a crisis point. To collaborate across sectors to build a sustainable and endorsed Community Plan for Safety and Well-being for Kenora that is part of a risk-driven, community safety model that evolves as social needs change. To enhance efficiency and effectiveness of human service connections with a view to increasing positive social outcomes. RISK: Nine Guiding Principles RISK will: 1. Develop protocols to enable or enhance effective information sharing across disciplines and agencies. 2. Develop and operate a RISK Table for Kenora to address situations deemed to be of acutely elevated risk through rapid, multi-agency interventions and service connections. 3. Ensure confidentiality is maintained and reinforced throughout the RISK Table process as governed by Ontario s Freedom of Information and Protection of Privacy Act, Ontario s Municipal Freedom of Information and Protection of Privacy Act and the Personal Health Information Protection Act as they apply to the case, the presenter or the Situation Table participants. 4. Gather and develop a repository/database for shared, inter-disciplinary research related to social services, health, policing, and education to develop an inventory of local needs and/or gaps and identify opportunities for enhanced programming/supports related to wellness and the social determinants of health. 5. Develop a robust measurement system to support collective and individual accountabilities and reporting requirements of participating member agencies. 6. Contribute to, learn from and share with parallel initiatives in collaborative risk-drive Community Safety and Well-Being occurring across jurisdictions. 7. Identify systemic issues, trends, risk factors and vulnerable populations in order to make recommendations for effective intervention and prevention strategies. 8. Strive to have the RISK Table and Community Plan for Safety and Well-being become an integral, sustainable and endorsed part of a risk-driven, collaborative community safety model in Kenora. 9. Develop and execute a communications strategy designed to engage the community and inform the public and other stakeholders on the achievements of RISK. 5
Founding Members and Participating Agencies RISK relies on actively engaged members to effectively address situations of acutely elevating risk and maintain the ability to assist individuals and the community. RISK continues to invite agencies from the human services sector to participate and join the founding members. Risk founding members are: Ontario Provincial police, Kenora Detachment Canadian Mental Health Association-Kenora Branch Lake of the Woods District Hospital Youth Justice Services Anishinaabe Abinoojii Child and Family Services FIREFLY Kenora Rainy River child and Family Services Changes Recovery Homes RISK draws upon the perspectives and expertise of multiple contributors, including founding members and those not yet present. As such, the project is expected to move forward amid a range of related initiatives and programs. Every effort will be made to avoid duplication and to take advantage of existing and ongoing initiatives at the local, regional and provincial levels. RISK currently has representation and/or participation from the following agencies Adult Probation and Parole - Ministry of Community Safety and Correctional Services - Kenora Anishinaabe Abinoojii Family Services - Kenora Brain Injury Services of Northern Ontario Canadian Mental Health Association - Kenora Branch Centre for Addiction and Mental Health - Kenora Changes Recovery Homes Dryden Regional Health Centre FIREFLY Home and Community Care - North West - Kenora Kenora Association for Community Living Kenora Catholic District School Board Kenora Chiefs Advisory Kenora District Services Board - Kenora Kenora Jail - Ministry of Community Safety and Correctional Services Kenora Patricia District School Board Kenora Sunset Country Family Health Team Kenora-Rainy River Districts Child and Family Services - Kenora Kitapinoonjiiminaanik Family Services Lake of the Woods District Hospital Nechee Friendship Centre Northwestern Health Unit - Kenora Ontario Provincial Police - Kenora Detachment Sunset Area Victim Crisis Assistance and Referral Service Tikinigan Child and Family Services - Kenora Treaty Three Police Service Waasegiizhig Nanaandawe iyewigamig Health Access Centre Wabseemong Child and Family Services William W. Creighton Youth Services - Community Support Team WJS Northern Youth Centre Youth Justice Services - Ministry of Children and Youth Services - Kenora 6
Roles, Responsibilities and Governance Model RISK members have abided by and will continue to go forward following the established RISK Roles, Responsibilities and Governance model, which are: 1. During the start-up phase of RISK, the Kenora OPP will provide leadership, secretariat functions, facilitation support and other expertise as needed. 2. Each charter member will contribute appropriately qualified resources as necessary and as available to accomplish the deliverables and priority tasks of RISK. 3. Each charter member directly involved in the operations of a situation table will contribute at least one sector specialist to be available as needed to fulfill the ongoing work and to attend regular meetings as determined. 4. RISK Table participants will bring cases to the table when all other avenues of resolution have been exhausted, appropriate options have not been identified and the safety of an individual, family or group is at a potential risk. 5. The RISK Table should include membership from at least the following sectors: police/justice, social services, health/mental health and education. 6. Only designated or back-up staff will attend RISK Table meetings unless previously approved by the Situation Table Chair. 7. All participants in the RISK Table must execute a confidentiality agreement and comply with protocols established as part of RISK. 8. As champions of RISK, all founding members will encourage and facilitate broad and ongoing multi-sectoral participation wherever possible. 9. The Governance Model of the RISK is a Steering Committee and its purpose is the following: To champion the RISK Table initiative within partner agencies and with community stakeholders. To advise and guide the establishment and ongoing operation of the RISK Table initiative. This includes but is not limited to: o Partner recruitment and retention o Processes to guide the functioning of the RISK Table o Data analysis, evaluation and reporting o Communications and community engagement o To provide final approval on significant RISK Table resources, communications and knowledge products. o To serve as a unified, multi-sectoral voice on issues influencing situations of acutely elevated risk and community well-being. This includes the identification and communication of community strengths, gaps and opportunities to improve human service systems and service delivery. 7
RISK Table Privacy Agency participation and referrals span multiple organizations and privacy bounds must apply to all staff. The privacy process and confidentiality is governed by all applicable agency policies, Personal Health Information Act (PHIPA), Personal Information Protection and Electronic Documents Act (PIPEDA), and Freedom of Information and Privacy Act (FIPPA). In order to ensure that privacy requirements are maintained throughout the RISK Situation Table discussions, a four filter (Appendix A: Four Filter Privacy Process) approach has been developed. These filters establish the presence of AER, identify relevant risk factors, identify the agencies required to mitigate risk and guide the coordinated, collaborative response, sharing minimum personal and identifying information as possible. RISK Table Process The RISK Situation Table will have representatives from partner agencies meet twice a month. The Situation Table is a focused, disciplined discussion where participants collaboratively identify situations of AER. Once a situation is identified, all necessary agency partners participate in a coordinated, joint response; ensuring that those at risk are connected to appropriate, timely, effective and caring supports. Once all new cases are brought to the Situation Table, discussed and a determination is made regarding AER, the identified lead and assisting agencies meet and plan details of an intervention, which usually happens within 24-48 hours of the meeting. Discussion is still limited to only the information that is deemed necessary to assess the situation and determine appropriate actions. An intervention usually takes the form of a door-knock, calling on the individual, family or group on their home territory. Sometimes it will take place during a meeting at one of the participating agencies. Occasionally outreach is done by follow-up phone call. The intervention results in referring individuals, families, groups or places to those agencies and organizations which can best provide services that are needed to reduce the chances of harm or victimization. The services can come from the originating, lead or assisting agency or even from other agencies in the community. All responding, participating agencies work to ensure access to services occur in a timely fashion. If consent to share private and confidential information has not been obtained, it is requested at this point. The lead agency takes responsibility for recording information and reporting back to the Situation Table at their next meeting about the status of the intervention (Appendix B: Planning an Intervention & Appendix B: Intervention). 8
Data Analysis: May 1, 2016 May 1, 2017 Total situations brought to RISK Breakdown of age groups 80 70 64% 60 50 67 situations brought forward 40 30 20 10 13% 5% 10% 6% 2% 0 12-17 18-24 25-29 30-39 40-59 AGE GROUPS (YEARS) 60+ Top three risk factors 13% Mental Health 11% Negative Peers 10% Alcohol Top Lead agencies in intervention discussions 19 Lake of the Woods District Hospital 11 Kenora-Rainy River Districts Child and Family Services 7 CMHA Kenora 7 OPP Kenora Kenora: Overall Risk Information Report Sixty-one unique referrals were brought to the RISK Table over a one-year period. Six referrals were re-opened that year bringing the total number of discussions to 67. 9
Demographics Referrals to situation tables can be made for an individual, families or even an entire area in a community. Data from the RISK Table shows that all 61 referrals were made for individuals. Data further identifies that of these referrals 65.57% were female, 32.79% were male and the gender of one individual was unknown. Youth aged 12-17 were the most referred at 63.93%. 10
Risk Categories and Risk Priorities There were 443 risk factors identified through these discussions as indicated in the chart below. The top 3 risk factors were the following: Mental Health (13%) Negative Peers (11%) Alcohol (10%) Community Safety and Well-Being (CSWB) High Level Risk Priorities The Community Safety and Well-Being high level risk priorities identify areas where a community is struggling to maintain a healthy and safe community. The top three areas for the province around risk priorities are the following: Mental Health (29%) Antisocial/Problematic Behaviour (non-criminal) (18%) Substance Abuse Issues (16%) 11
Kenora Risk Information by Age and Risk Factors The following charts associate identified risk factors with age group. As previously mentioned in this report, the first chart under each gender and age heading demonstrates the risk factors identified through RISK discussions. The second chart collates risk factors under the appropriate Community Safety and Well-Being high level risk priority categories within the province. Male, 12-17 years The charts above indicate that for males aged 12-17, Other accounts for the highest rate of acutely elevated situations brought forward to the RISK Table at 37% followed by Mental Health at 16%. Within this age category and gender the Community Safety and Well-Being priorities indicate that Mental Health is the highest risk level priority for this age group at 25% followed by Other at 24%. 12
Female, 12 17 years The charts above indicate that for females 12-17 years of age Other accounts for 47% of the acutely elevated situations brought forward to the RISK Table. Negative Peers at 12%, is the second top risk factor followed by Mental Health at 11%. The Community Safety and Well-Being priorities within this age group and gender indicate that Mental Health is the lead risk factor (31%) followed by Substance Abuse Issues (17%) and then Other (16%). 13
Male, 18-24 years The charts above indicate that for males aged 18-24 years, Other accounts for 21% of the acutely elevated situations brought forward to the RISK Table and Negative Peers, Mental Health and Criminal Involvement are the next most present risk factors all at 13%. Other is the highest risk level priority for this age group within the Community Safety and Well-Being priorities at 25%. 14
Female, 18-24 years The charts above indicate that for females aged 18-24 years, Other accounts for 27% of the acutely elevated situations brought forward to the RISK Table. Criminal Involvement is the next most present risk factor at 24%, followed by Mental Health at 15%. The Community Safety and Well-Being priorities within this age group and gender identify that Ciminal Involvement and Mental Health are the lead risk factors at 24% followed bysubstance Abuse Issues at 21%. 15
Male, 30-39 years The charts above indicate that for males 30-39 years of age it is identified that Other accounts for 48% of the acutely elevated situations brought forward to the RISK Table. Mental Health and Drugs are both next at 13%. The Community Safety and Well-Being priorities within this age group and gender identify that Mental Health is the top risk factor at 28% followed by Substance Abuse Issues at 22%. 16
Female, 30-39 years The charts above indicate that for females 30-39 years of age the following are all equal risk factors for acutely elevated situations brought forward to the RISK Table: Mental Health (18%) Missing/Runaway (18%) Physical Violence (18%) The Community Safety and Well-Being priorities within this age group and gender identify that Antisocial/Problematic Behaviour (non-criminal) is the highest risk priority (37%) followed by Mental Health (18%). 17
Closure Reasons Report for Kenora from May 1, 2016- May 1, 2017 Data indicates that overall risk was lowered for 85% of referrals. The remaining referrals were assigned to conclusion groupings as indicated in the chart below. Overall risk was lowered by 85% of the cases identified. Eighty-three percent of those cases were individuals already connected to services. (see below) 18
Of the nine percent of cases that were rejected, it was identified that 50% of those cases were individuals already connected to services. In 33% of those cases, the situation was not deemed to be one of AER. (see below) Sector and Agency Engagement Data gathered shows four primary sectors where cases were identified for the RISK Table from May 2016 to May 2017. They include the following: Justice, Child and Youth Services; Education; and Health. 19
The justice sector was the primary sector to present referrals, presenting 62 out of 67 (92.54%) referrals brought to the Table between May 2016-17. The Child and Youth Services sector made two referrals (2.99%); the Education sector made two referrals (2.99%); and the Health sector made one referral (1.49%). The chart below indicates that the justice sector was also the top lead assisting agency, involved in 35 interventions (24.82%), followed by the Lake of the Woods District Hospital that assisted with 31 interventions (21.99%). Agency Discussions Percentage Ontario Provincial Police - Kenora Detachment 35 24.82% Lake of the Woods District Hospital 31 21.99% Canadian Mental Health Association - Kenora Branch 20 14.18% Firefly Northwest - Kenora 11 7.80% Kenora-Rainy River Districts Child and Family Services - Kenora 9 6.38% Other 35 24.82% 20
Kenora Agency Engagement Report The chart below indicates the level of involvement demonstrated by the top 10 agencies engaged in discussions as well as the extent of their involvement within the intervention. Where it has been shown that the Kenora OPP detachment has had the greatest involvement bringing forward referrals to the Table as well as assisting, the data below identifies that Lake of the Woods District Hospital has ranked as the top agency to take the lead. Of 67 interventions Lake of the Woods District Hospital took the lead 19 times, followed by the Kenora Rainy-River Districts Child and Family Services with 11 leads, and then the Kenora OPP detachment and the Canadian Mental Health Association, Kenora Branch who both participated as the lead seven times. The chart also demonstrates the percentage of overall engagement in the four filter process by each of these 10 agencies. 21
Appendix A: Four Filter Privacy Process Filter One (Risk Mitigation) is the process of a recognizing an individual, family, group or place that is at imminent risk of harm or victimization and deciding to begin the referral process. Filter Two is when a referral is brought to the table and presented using de-identified information (no identifiers relating to individual such as name, D.O.B, address, etc.) Conversations will happen to determine if referral is experiencing Acutely Elevated Risk. Filter Three allows for minimal disclosure of privacy protected information. Lead agency will be decided, usually based on relevance of the highest priority risk factor. Assisting agencies will be identified. Only necessary information required to begin planning intervention is shared. Record keeping will identify referral using an anonymous number. Filter Four involves only agencies participating in intervention, only information relating to current referral and situation or information deemed necessary for successful intervention is shared. Consents to discuss are obtained at this time. Every participant of the RISK Table acknowledges and agrees to abide by strict confidentiality protocols. Each agency that is participating in the intervention keeps records of their role and actions as per the policies, procedures and standards of their home agency, in accordance with RISK Table confidentiality. The designated lead agency in the planned and coordinated intervention takes responsibility for recording the information it needs to report back to the RISK Table at the next meeting about the status of the intervention. Filter 1: Internal Agency Screening Questions Is the presenting risk of such concern that the individual s privacy intrusion may be justified by bringing the situation forward for multi-sectoral discussion? Is it reasonable for the disclosing agency to believe that sharing this information with one or more human or social service agencies will substantially help in mitigating the risks? Is the individual, family, group or location at significant risk of serious physical, mental or emotional harm, or, do they pose a significant risk of serious harm to others? Is the disclosing agency unable to mitigate these risks without disclosing that information? Is it possible to limit the amount of information disclosed to that which is necessary for planning and implementing effective risk mitigation? Does each agency which is targeted to receive personal information have a role to play in the risk mitigation strategy as well as the authority to receive personal information? 22
Appendix B: Planning an Intervention Once all cases are brought to the RISK Table, discussed and a determination is made regarding AER, the lead and assisting agencies meet privately. The lead and assisting agencies plan details of the intervention prior to implementation- which usually happens within 24-48 hours. Discussion is still limited to only information that is deemed necessary to assess the situation and to determine appropriate actions. Obtaining consent will be the first priority of the combined agencies responding to the situation. If at any point in the above sequence it becomes evident that resources are currently being provided within existing agencies, and the situation table is confident elevated risk is already being mitigated, the situation is closed. Appendix B: Intervention Most often interventions take the form of a door-knock- calling on the individual, family or group on their home territory. Sometimes it will take place during a meeting at one of the participating agencies. Occasionally outreach is done by follow-up phone call. Interventions implement plans to refer individual, family, group or place to those agencies and organizations which can best provide services needed to reduce the chances of harm or victimization. Services are provided by the responding participating agencies and sometimes, from other agencies in the community. The responding participating agencies ensure access to services in a timely fashion. Referrals may be made to acute care agencies or agencies, which are enabled by their own legislation, policies and practices to make home visits. If consent to share private and confidential information has not yet been obtained, then it is requested at this point. The individual will also be informed about the minimal information shared to enable the intervention. Information regarding the intervention and conclusion is recorded by the lead agency and reported back the RISK Table at the next meeting. Case brought to Table. Discussed using de-identified information. Vote to determine existing AER. Lead and assisting agencies plan intervention. Implement intervention within 24-48 hours. Intervention and obtain consents. Appendix C: Steering Committee Members Constable Bob Bernie: Ontario Provincial Police Sara Dias: Canadian Mental Health Association, Kenora Branch Ashley Hendy: FIREFLY Bill Leonard: Kenora Rainy River Child & Family Services Sean Spencer: Anishinaabe Abinoojii Child & Family Services Daniel Smith: Lake of the Woods District Hospital Josh Brodhagen: Ministry of Children & Youth Services Michelle Queen: Changes Recovery Homes 23