Many clients have complex needs and as a result there are clients who exhibit inappropriate behavior (i.e. aggressiveness) and receive a service restriction. Restrictions impact the client’s ability to access services; negatively impact client/staff relationship; and do not change client behavior.
To reduce the average time length of restrictions by 30 percent by December 31st2017
EQIP Support to the Project
QI coach: Kim Elke
Data Coach: Andrew Span
St. Stephen’s Community House Corner Drop-in program serves a very vulnerable and marginalized population in downtown Toronto. Their clients who are caught in a cycle of street life, chaotic substance use and poverty often have very limited access to services and supports.
Each year, they serve close to 200,000 meals, secure housing for nearly 446 people and help approximately 575 people enter addiction services and harm reduction support.
Unfortunately, there are times when clients behave inappropriately at the Corner Drop-in – for example, they are aggressive or violent – putting other clients and staff at risk. In these cases, the client is asked to leave and is not allowed to attend the Corner Drop-in for a period of time (called a service restriction). Although this addresses the immediate concern, it leaves the client without access to one of the limited services they are eligible for, it doesn’t change the client behaviour, and has a negative impact on the client staff relationship.
The staff want to ensure their services are as accessible as possible, by reducing the number of and length of drop-in centre service restrictions which aren’t serving anyone well. St. Stephen’s Community House was pleased to be accepted as one of the EQIP projects so that they could tackle this challenge.
They started by developing run charts to look at the average monthly length of restrictions, followed by a Fishbone diagram to identify root causes. After removing the root causes that they had no control over, the team voted and determined the top three primary drivers:
• Lack of consistent model for reintegration
• Staff perception
• Equitable treatment of all clients
Next, they used the 5 whys tool to dig deeper into the issue, and identify change ideas.
“For us, the QI tools were extremely helpful in getting past the assumption that the only solution was more resources,” explains Caroline Jemmott, Manager of Drop-in and Housing Services. “We learned a lot from the data, and were able to identify innovative change ideas.”
St. Stephen’s put their focus on
- Applying consistent restrictions:
- Collecting data and incident information
- Streamlining the reintegration process, including assigning dedicated staff to this
- Implementing a restorative justice model
Through an analysis of the data, they were able to debunk the myth that there were a high number of repeat offenders, and they were able to commend themselves for being more consistent than they thought about restrictions for violence.
The St. Stephen’s Community House Corner Drop-in QI project is an important reminder that there are innovative solutions to some of the most challenging problems. For those people who use the Corner Drop-in, having a better, more consistent process for managing service restrictions means they will have more access to a warm meal and community supports. For this highly vulnerable population, that could be the difference between life and death.