Open Dialogue

The Transitional Discharge Model: People-Centred, Peer-Supported Project Impactful for Both System and Clients

Lawson launched the TDM project, which builds a bridge from hospital to community for people diagnosed with a mental illness, in 2013. Less than two years later, its impact on the system is measurable ‒ a 9.8-day reduction in hospital stays ‒ while the impact on clients is immeasurable.

Ontario’s current mental health strategy, Open Minds, Healthy Minds, calls for more community supports for people with lived experience. It seeks to enhance the capacity of peer support services and to build a better quality of life for people with a mental illness.

This approach is perfectly embodied in the Transitional Discharge Model (TDM) project, a people-centered, peer-supported initiative launched in 2013 by Dr. Cheryl Forchuk, Assistant Director of the Lawson Health Research Institute, the research arm of London Health Sciences Centre and St. Joseph’s Health Care London, in partnership with the Ontario Peer Development Initiative (OPDI).

TDM is part of the Council of Academic Hospitals of Ontario’s (CAHO) Adopting Research to Improve Care (ARTIC) Program, intended to accelerate the adoption of research evidence into practice, which is now run together with Health Quality Ontario (HQO) to extend its reach as a cross-sectoral provincial resource.

TDM is a success story for both clients and the health care system. It provides better quality care and a positive client experience, and facilitates better system coordination. Preliminary results from the TDM project have shown positive client experiences and increased satisfaction with the discharge process, increased communication and collaboration among hospitals and community support groups, and a 9.8-day reduction in hospital stays.

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The transition from hospital to community is complex and can be challenging for people who have been diagnosed with a mental illness. Research shows the first days and weeks following psychiatric discharge are particularly high-risk periods, with 43% of suicides occurring within the first month post-discharge.

TDM was created as a bridge for clients from the health care facility to the community. It supports the successful community integration of people diagnosed with a mental illness, and relies on key relationships to ensure that a seamless safety net exists throughout the discharge and community reintegration processes.

TDM involves hospital staff, continuing with the discharged client until there is a therapeutic relationship with the community care provider, and peer support from someone who has successfully integrated into the community after a psychiatric diagnosis.

Shining a Spotlight on a Key Partner: OPDI

OPDI played a vital role in TDM. Funded by MOHLTC, OPDI is the umbrella organization of the Consumer/Survivor Initiatives (CSI) and Peer Support Organizations (PSO) across Ontario. It is, in fact, an organization of organizations seeking to bring forward the voice of Ontario’s Consumer/Survivor Initiatives and peer support organizations to provincial policy- and systems-level decision makers.

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Launch of the Transitional Discharge Model (TDM), April 2013. Left to right: Dr. Cheryl Forchuk, Assistant Director at Lawson and lead researcher on the TDM Project; Deborrah Sherman, Executive Director, Ontario Peer Development Initiative; Dr. David Hill, Scientific Director, Lawson Health Research Institute; and Karen Michell, Executive Director, The Council of Academic Hospitals of Ontario. Photo credit Sean Meyer.

OPDI defines peer support as “a naturally occurring, mutually beneficial support process where people who share a common experience meet as equals, sharing skills, strengths and hope; people learn from each other how to cope, thrive and flourish. Formalized peer support begins when persons with lived experience, who have received specialized training, assume unique, designated roles within the mental health system to support an individual’s expressed wishes.”

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OPDI’s Peer Support Core Essentials™ Program provided the necessary training for four of the nine peer support groups involved in the TDM project. This comprehensive instruction involves five full days face-to-face in the classroom with two trainers. This time is filled with many individual and group exercises, role playing and, as homework after class, daily written reflections.

Working with and evaluated by the trainers, participants can earn Level 1 or 1R recognition documents. Level 1 means the person successfully completed the classroom training and is ready for a friendship model of peer support such as the TDM, which asks for an hour of their time a week. Level 1R means the trainer recommends the person to continue and do an internship in order to earn their Level 2, or “OPDI Certified Peer Supporter,” which is more suited to those aspiring to paid peer support work.

This successful program is in the process of educating Ontario’s next generation of peer support workers. “As of March 2014, we have trained 391 peers across Ontario with over 95% achieving the 1R level,” says Deborrah Sherman, OPDI’s Executive Director.

Speaking with a Peer Support Coordinator

The most important outcome of TDM is in the lived experiences of clients and participants. Johnston Reesor is a Peer Support Coordinator from People Advocating for Change Through Empowerment (PACE), a CSI member organization of OPDI based in Thunder Bay.

In his role at Thunder Bay Regional Health Sciences Centre, which has had over 1,000 client contacts since TDM implementation, Reesor has been active recruiting, training and supervising peer support volunteers.

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Johnston Reesor, Peer Support Coordinator, Thunder Bay Regional Health Sciences Centre. Photograph courtesy of Johnston Reesor.

Reesor speaks to the value and impact of this program:

“The TDM model has been very positive for clients, many of whom are socially isolated prior to admission. They need encouragement to get them active and socializing appropriately again – a key component in their recovery.

“On our ward, we do group work, skills, art, activities and socials/exercise. Our groups range from five to 13 people at any given time. We take clients out into the community, where activities are conducted at other post-discharge health support agencies. For those socially isolated clients, this method of introduction has proven to be quite effective. We see positive results. Maintaining these connections post discharge, and encouraging people to remain active and engaged have been key components in client wellness.

“Sometimes something as simple as meeting a client for coffee, a couple of times a month, is enough to allow them to feel valued, connected and encouraged in their recovery.

“PACE has been a very positive environment for me. While I am several years into my own recovery, my role as Peer Support Coordinator allows me to gain perspective while teaching, learning and sharing with those around me. Clients and peers offer each other many teachable moments when we are fortunate enough to share insights into our experiences. Cultivating an environment of empathy and support is vital, so that when we talk about and share our own healing processes, everyone benefits.”

To read more about TDM, go here: http://bit.ly/1gBf3rq. To learn more about OPDI and its peer support training program, go here: http://bit.ly/13ztL19. To read London Health Sciences Centre (Lawson) press release about TDM, go here: http://bit.ly/1wGs9NV. To learn more about the PACE Program, go here: http://bit.ly/1AiLjuj.