In recognition of Dual Diagnosis (DD) Awareness Day, case managers with a DD specialty at Cota open up about working with individuals in the community and how that has changed during the pandemic. Here is what they had to say:
A DD means that a person is living with a development disability as well as a mental health challenge. The latter does not always present itself at a young age and therefore requires acute attention and sensitivity to changes in behaviour from a service provider in order to meet a client’s needs.
Manal (Case Manager, Toronto East Integrated Service Team): It really depends on the individual. My clients that have fewer supports at home have a more difficult time coping and understanding safety protocols. So, there are daily check-ins and education sessions and we talk about going for walks safely and other healthy coping strategies. So far, it has been manageable and successful.
Chris (Case Manager, Toronto East Integrated Service Team): Right now, I am providing different levels of supports to my caseload. While the majority of the individuals in my care have their own support networks, only a handful of individuals (my critical clients) reach out to me on a daily-basis I feel really lucky with my caseload.
Sabina (Case Manager, *Transitional Aged Youth Program): It’s about finding creative solutions to keep them connected to their families, support networks and the community. I work closely with our OPRs (service providers) to ensure the clients are adhering to safety protocols. Structure is very important for individuals with a DD, especially those who also have a diagnosis of autism, so finding ways to create structured activities when external Day Programs are no longer running has been critical. In addition, connecting with clients directly by phone or video calls are important so that clients know that their case manager is still available to them even though visits are not occurring at this time. During these calls, we can reassure them of their safety and inquire about any anxieties they may be feeling in order to find strategies to help them cope.
*Transitional Age Youth Program or TAY Program is the program for which the Ministry of Children, Community and Social Services provides funding to Cota in order to support eligible identified transitional aged youth with case management services and individualized funding options. A transitional aged youth, specifically, means former children in extended society care. The TAY program ensures that clients receive quality support while they reside in privately operated fee-for-service residential care settings (referred to as an Outside Paid Resource or OPR).
Manal: Before the pandemic, my work with individuals centred around goal setting and identifying their needs. I was able to conduct in-person wellness checks and gage how a client was doing based on their behaviour and environment. Now it’s about client safety, ensuring they have access to resources for daily needs, and finding ways to help them understand how the virus is transmitted so that they can protect themselves and their support networks. I’m on the phone, when possible, talking with clients and being there for them as much as they need. More and more are requiring support for their mental health challenges and I’m there for them when they need it!
Chris: The service users that require greater supports are feeling scared at this time and my role is to provide as much supportive listening as possible.
Sabina: I am connecting with the OPR service providers more frequently to see how they are doing and ensuring they are staying safe; while also ensuring the safety and wellbeing of our clients. Together, we are problem solving and finding creative solutions to help our clients stay physically and mentally stimulated, all while staying home and maintaining physical distance.
Manal: One of my clients was really involved in Cota Groups (Peer-led Drop-Ins, the W.R.A.P. Group, Cooking Group and Acudetox Group). They are very connected to the community. This individual lives at home with his 80-year old mother. When the pandemic hit and the world was ordered to stay home, this client had difficulties coping with the isolation. I got on the phone with their sister and we devised a strategy to help this individual through the anxiety and fear they were feeling. Through daily check-ins and education sessions that involve the *teach-back method, we’ve managed to keep them and their family safe. “It’s little successes like this that keep me fuelled and energized each day.”
*Teach-back method: using specific language to communicate important messaging to an individual with a development disability and mental health challenge. Then asking them to repeat or explain what they heard in their own words.
Chris: One of Cota’s service-delivery strategies during the pandemic is to provide our clients with a temporary phone so that they can access their case managers safely. And one of my clients who is more isolated received a temporary phone. So, I showed them how to use it and then followed up a week later. They were so happy to hear from me. The best part is that this identified a need the client has, and we are currently in the process of preparing a future plan to acquire a permanent mobile device for them post-pandemic.
Sabina:Some of our TAY clients receive what’s called ‘passport funding’ from the government that allows them to attend events in the community and connect/engage with the community. While this normally did not include purchasing items, the government has allowed us to use the funds to purchase things like computers or exercise equipment so that clients can stay mentally and physically stimulated in their living situations. This has been beneficial and really helped us manage the anxiety and fear everyone is feeling.
Manal & Chris: Our team weekly check-ins are very important. Hearing that other case managers are having the same challenges and sharing solutions to overcome those barriers has been quite helpful. We can call our manager, Jeannette, at any time and she supports us and provides resources that help us with our caseloads. The organization has also been so accommodating
Sabina: Before the pandemic, we only met once a month in person with the team because we are so spread out. Now we have weekly check-ins on Zoom and I feel much more connected to my team. Our manager, Beenish, has been so supportive and has done an amazing job making us feel comfortable and feeling connected so we can problem solve and deliver the best services possible to our clients. We’ve also used this opportunity to collaborate and find ways to make improvements to processes within the TAY Program.
Manal: My hope is that recognizing this day leads to educating more service providers about individuals who have a dual diagnosis. They are some of our most vulnerable clients and have the greatest needs. And we can’t offer traditional mental health supports because it doesn’t address all the needs that client may have.
Chris: My hope is that this understanding leads to an awareness for people with developmental/autism and co-curring mental health challenges who require a different level of support in order to understand day to day information.
Sabina: Without awareness, some of people may think that an individual with a dual diagnosis is just being difficult. But there are actually so many layers to their behaviour as a result of their diagnosis and it’s quite complex. So, my hope is that with education and awareness, employers and people in the general public are more understanding and empathetic. If there is one thing I’d love to see, it’s that organizations find creative ways to employ individuals with a DD.
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