Within the SWCSS region, integrated case management will be implemented for children / youth aged 0 to 20, with complex needs under the guidance of the Complex Case Team. This process will connect the various ministry partners, regional authorities, and service providers involved to ensure the development of a collaborative response to meet the needs of children / youth within their communities.
For the purpose of this work, children / youth with complex needs are those who require:
- significant extraordinary care, due to the severity of their impairments, and require services from more than one service sector. Those who require such services may include children and youth:
- with multiple impairments, complex mental health and health issues, and/or severe behavioural needs;
- for whom all currently available resources have been utilized with limited success;
- who require fiscal and human resources that strain the capacity of any one service sector; and/or
- for whom there are questions about the safety of the child or youth, their family, or the public.
Purpose
Where available, multiple agencies will work cooperatively to share information, provide systems thinking, and determine a coordinated response to identify needs/gaps in services because;
- existing resources are insufficient to meet the needs of the child/youth and/or
- the allocation of existing resources requires review and/or
- the current coordination of services requires review
Desired Outcomes
It is anticipated that the following outcomes will be met:
- Develop a regional process to serve children and youth with complex needs
- Facilitate planning for provision of coordinated/integrated seamless services to children and youth within, and between, regions
- Ensure the development of a coordinated plan for wrap-around service delivery through a multidisciplinary team approach
- Integrated, coordinated and consistent service delivery and case management for children and youth with complex needs and their families
- Families are well informed and involved in determining necessary supports and services
- Appropriate and effective sharing of information for integrated planning for children and youth with complex needs.
Following parent/guardian consent, the Complex Case Team can be accessed for:
Urgent Conference
The Team can convene in response to an emergent situation where child/youth safety is at risk. The request is initiated by the Leadership Team representative working most closely with the child/youth and family.
In this case, the Complex Case Team will seek to connect the child/youth with community supports as an interim, and perhaps, ongoing measure. Depending on the circumstances, the Urgent Conference may be followed by a Case Conference once the emergent needs have been addressed.
Case Conference
School-based and Regional Multi-disciplinary Teams bring a case forward through their Leadership Team representative(s). Please note the following schedule for 2022/23
The Team will meet with school-based and school-linked team representatives along with family and /or community agency representatives to:
- review child/youth strengths, challenges, and needs
- explore additional strategies for implementation by front-line staff/family
- provide recommendations to support the child/youth
Please note that as a result of some decrease in funding, the complex case team currently runs without System Navigation members which makes it difficult for many families
Please see the role of systems navigation:
- provide assistance to children and youth ages 0-20 (and their families or caregivers) who have co-morbid diagnoses that may include a complex mental health concern, who are at risk of educational placement, family or caregiver breakdown
- provide comprehensive integrated, time-limited case management, collaborative intervention across systems – school, home and community, and a level of project coordination and evaluation. They will work to attain the primary goal to address the functional needs across environments together with existing teams so that the child/youth can be successful within their home, school and community
- bridge connections with key community resources to enhance and support the work of existing teams that are providing ongoing support to the school, home and community, engaging parents and caregivers as part of a family-centered approach
REFERRAL PROCESS:
Prior to bringing a case forward, school-based and school-linked teams will have exhausted all typical strategies and resources. Please work through the steps below to help streamline the process.
STEP #1: CLICK HERE to access the pre-referral flow chart to determine when to refer
STEP #2: CLICK HERE to access the pre-referral checklist (complete before referral)
STEP #3: CLICK HERE to access the Complex Case Referral Form – (download PDF form for fillable function)
STEP #4: CLICK HERE to access the information sharing consent form (download and print for signatures)
2022-2023 Meeting Dates:
The Complex Case Team will review the intake and determine when/if a larger collaborative team meeting is required.
Please see possible consultation dates below:
| Complex Case Review Meetings | Possible Team Consultations |
| October 13, 2022 | October 27, 2022 |
| November 10, 2022 | November 24, 2022 |
| December 8, 2022 | December 22, 2021 |
| January 12, 2023 | January 26, 2022 |
| February 9, 2023 | February 23, 2023 |
| March 9, 2023 | March 30, 2023 |
| April 20, 2023 | N/A |
| May 11, 2023 | May 25, 2023 |
| June 8, 2022 | June 22, 2022 |