Enterphase Alternative Transition and Outreach Program (E.T.O.P.)

The Enterphase Alternative Transition and Outreach Program is a collaborative treatment model involving E.C.F.S. and various Children’s Aid Society (C.A.S.) Agencies across the GTA. They presently include The Children’s Aid Society of Toronto (C.A.S.T.), The Catholic Children’s Aid Society (C.C.A.S.), and The Durham Children’s Aid Society (D.C.A.S.).

Target Group:

E.T.O.P. is designed for young people age 16 years to 21 years whose needs are particularly hard-to-serve. Psychological testing of the clients to date suggests that the most common problems are:

developmentally disabled with serious chronic maladaptive behaviour such as aggression and self injury;
dissociative symptoms secondary to horrendous abuse histories; and
serious underlying depression and other psychiatric disorders often existing from an early age. Moreover, the stresses of middle-adolescence intensifies underlying psychiatric and developmental weaknesses. Many of the persons served in this program have a long history of traditional interventions and residential placements without success, and the need for more intensive individualized planning is apparent. Their stage of life requires them to prepare for independence but they lack the necessary emotional, social and practical skills to function on their own as a result of traumatic and abusive life experiences.

Presently, all of the E.T.O.P. programs are located in the City of Peterborough. All locations are centrally located with easy access to shopping, school and recreational activities. The persons served are housed in self-contained apartments and “mentored” by a small, consistent number of staff members. Generally, clients do not share an apartment with other clients, although that possibility can occur providing the indicators for success are present. Enterphase does operate a 3 bed, licenced program in the City of Peterborough that serves dual diagnosed youth that can manage in a group setting.

Program Summary:

The plans of care and the specific supports provided to the persons served within this program vary greatly client by client – in sharp contrast to group treatment models. The management and staff must be very flexible and innovative in their approach to the persons served. Individual persons served may have access to the Enterphase Day Treatment programs and the Enterphase Clinical Team resources (including psychological and psychiatric consultations and assessments and individual psychotherapy where required). The number of hours of one-to-one staffing provided in a week will vary significantly by client and by their stage of treatment. The E.T.O.P staff may engage other community agencies, hospitals and education facilities to meet the needs of the persons served. The majority of clients need a strong network of formal supports, such as shelters, volunteers and outreach services that would follow the persons served into adulthood – well past the formal involvement of Child Welfare. Other persons served may be best served by building a network of informal supports, such as extended family and friends. Similarly, planning around education, employment, and preparations for the future of the persons served will be highly variable and dependent on the capacities, motivations and skills of the individual client. The common thread in this model is flexibility and person-centred treatment.

Because of the variability of resources and supports that may be required, special care costs for each person served will also be variable and currently are determined on an individual basis. It is our goal to solidify staffing, lodging and programming in determining a standardized per-diem that can maintain the integrity of the program.

Housing:

The persons served are housed in apartments and “mentored” by a small, consistent number of staff members. Generally, clients do not share an apartment with other clients, although that possibility can occur providing the indicators for this to succeed are present. All locations are secured in the form of leasing arrangements. Enterphase is currently in the process of upgrading some locations that are located in questionable locations.

Summary:

Enterphase will provide psychometric testing of the persons served that has been identified in best practice literature as the most appropriate assessment tools for the clinical issues presented by the client. The outcome of the assessment will include:

a through developmental assessment identifying cognitive, emotional and social functioning of the clients;
a diagnostic assessment identifying co-morbid DSM-IV conditions that may or may not be readily apparent;
a functional assessment to understand how the client’s maladaptive behaviour or symptoms serve to meet his/her needs on some level;
a vocational assessment identifying the independence skills, interests, talents, strengths and employment potential of the client
a treatment plan that reflects the best practice for the particular client.

The treatment plan for each person served will include a coherent set of interventions that the front line staff will implement to reduce maladaptive behaviour and encourage the client to fit-in to the support systems available to him and the community. Some of the interventions that will be used by staff include:

coaching and modelling socially appropriate interactions;
teaching the young person self-reflection skills, including “positive self talk” and developing a positive mental image of the specific challenges confronting the young person; {c} educating/informing the client about his/her special needs and empowering him/her to seek solutions when he feels vulnerable;
negotiating with formal and informal supports on behalf of the young person; and
positive reinforcement, often in the form of token economies.

These are just a few of the interventions that will be matched to each client and integrated into the plan of care.

Purpose of the Program

The purpose of the E.T.O.P. program is to prepare these persons served with the tools and understanding they will require so that they can function in society. The secondary goals under this are:

to identify the types of external or outreach supports they will require even in their early adulthood years to deal with their chronic risks and needs.
to prevent further psychiatric breakdowns or an escalation of serious behavioural problems such as aggression, self-destructive acts, substance abuse and criminal activity.
for those clients already involved with the criminal justice system, to help them through it and to advocate for them as they move through the court system.
to improve the persons served problem solving ability through such things as anger management training, impulse control training and planning for dealing with distressing feelings and situations.
to teach living skills such as improving literacy, hygiene, laundry, cooking, shopping and budgeting.
to teach the persons served where to find employment that is suitable to their abilities and aptitude, how to get hired and how to keep the job when they are hired.

Because of the variability of resources and supports that may be required, special care costs for each person served will also be variable and currently are determined on an individual basis.