Over several months, a 20-member, multi-sector (hospital and community-based rehabilitation, hospital and community-based mental health and addictions and women’s shelter) and lived experience working group in Southeastern Ontario (SEO) met to develop a mechanism for addressing the complex, unmet needs of adults with moderate-to-severe Acquired Brain Injury (ABI) complicated by mental health/ addictions issues. The Working Group developed the referral process, inclusion and exclusion criteria, consent process and forms, discussion format, and performance indicators for three new collaboratives that cover the region. The purpose of the ABI and Addictions/Mental Health Collabortive is to develop capacity to address complex, unmet needs using a shared-care model incorporating discussion about sequential/concurrent care. The SEO ABI System Navigator coordinates monthly “rounds,” with Collaborative members, including Psychiatry, Addictions, and community service providers, to address unmet needs of people meeting specified criteria including presence of high-risk factors.
Presenter: Dawn Downey