Monday, 25 June 2018

CAOT-BC at North Shore Foundry

Earlier this year, CAOT-BC had the privilege of receiving a tour of the new North Shore Foundry site as well as the opportunity to connect with Donna Fullerton, occupational therapist at North Shore Foundry.

Foundry is a provincial initiative to develop one-stop services for young people aged 12-24. Seven centres are currently open (Vancouver Granville, North Vancouver, Kelowna, Victoria, Campbell River, Abbotsford, Prince George), with four new centres approved and scheduled to open in 2018-19. Foundry involves over 120 partnerships across the province of BC. Each Foundry centre is operated by a lead agency that brings together local partners, service providers, young people and caregivers. Foundry’s online platform,, is powered by BC Children’s Hospital. Foundry provides safe, non-judgmental care, information and resources, and work to reach young people earlier – before health challenges become problematic. Foundry brings health and social services together in a single place to make it easier for young people to find the care, connection and support they need. Foundry is committed to working with our partners to change lives, communities and our systems, because young people are our future.

- Foundry Research Lead, Skye Barbic PhD, Reg. OT (BC)

What is the occupational therapy role at the North Shore Foundry?

To simplify, the occupational therapist (OT) role has three main parts. The first part is OT and Psychosocial Rehabilitation Program coordination. I supervise a full-time rehabilitation assistant (RA), a volunteer, and two peer support workers (PSWs) who recently have been added under the occupational therapy psychosocial rehab umbrella. We also have a Youth Care Worker who works partly under this umbrella. Because we have all of this staff, a lot of my role is coordination and program development of different group programming that is based on the needs of clients and families. The support staff runmuch of the programming, but there is so much coordination that goes into it - things like intake and screening clients, seeing if there are any risk factors, seeing how we can best support them, helping the RA with things that come up, managing waitlists and developing further programming to help clients reach their functional goals. I didn’t realize that so much of my day would be dedicated to coordination, but it makes sense and means we can offer so many different groups and programs for clients across the broad spectrum of youth that we see come through the doors of Foundry. These groups are appealing to youth because they provide opportunities to participate in activities and build skills in natural environments. From an OT perspective, we know that the best skill development happens in the actual environments where the client is going to use those skills. For example, if you want to feel more comfortable with peers at school, developing social skills by engaging with peers in the supported youth lounge is likely going to be more helpful than going to a lecture-style group on assertiveness training that doesn't involve youth actually practicing skills in real life contexts. It may look like clients are just coming in to do some cooking and have fun, when they’re actually developing independent living skills, social skills, time management skills, building routines and structure, becoming more behaviorally activated and developing tolerance for gradual return to work or school. 

Another part of my role is one-to-one occupational therapy service. I get referrals from both within Foundry as well as from the larger North Shore Community. I see my individual clients both at Foundry, as well as outreach – homes, schools, and the community. I work with clients usually from 16-24 years old and have some type of functional barrier(s). Aside from functional assessment, I also support moving forward with goals in life skills, education or employment, and leisure or wellness.  I’ve been trying to keep service short term and goal-based but with the increasing demand, only working 4 days per week and individual service being just part of my role, it is difficult to avoid a waitlist.

The third part of my role is actually running OT group programming. The Foundry model is about connecting and partnering with the community. I’ve been able to partner with a variety of agencies to run groups with. For example, I have and will be running more groups with the OTs from HOpe centre, as well as other non profit agencies. This fall I will be running the Youth Mindfulness Group partnered with HOpe and YMCA. I will also be running a group based on “interpersonal and social rhythms therapy” this fall. There are some other projects I’ve worked on this year and others I am currently working on too. It’s been a pretty great experience to build this role from the ground up, meeting with youth and families to see what the needs of the community are and then designing services based on those needs. I would say that building partnerships with agencies on the North Shore has been fairly easy. The North Shore is a pretty community-oriented area and people overall are excited about youth and mental health/addictions and want to get involved.

How do you see the occupational therapy role expanding within the Foundry program?

Eventually I would like to more fully develop the supported employment and education role, including programming. Although I do some on an individual basis, I know from experience that it is difficult to do employment and education off the side of your desk and really should be the full focus of an OT job rather than splitting with psychosocial rehabilitation and coordination. There is research for the Individual Placement and Support (IPS) model for multibarriered youth so I would love to expand that under the OT umbrella at Foundry North Shore. Other Foundry sites (Granville) have an OT specifically for employment and education and this is my “dream vision” for North Shore as well.

Now that I’ve started supervision of Peer Support Workers (PSW) and helped make the connection that PSW fell under the OT role, I'd really like to get more of a peer component to all aspects of the programming here. From a recovery perspective, it would be great to have peers involved in more of the services at every level so they’re not just at the drop-in clinic and our services are offered by people who have been there at some point. One of the core principles of recovery and psychosocial rehab is ‘least amount of professional support’ as possible. The lived experience is a powerful message of hope and a great fit with youth and young adults. I also think community building and increasing the sense of connection and community in youth is such an important piece of recovery, and a peer is going to be a lot more able to do this with a group of youth than I am. There are a lot of things that fall under the occupational therapy umbrella that don’t need to be done by an OT. A lot of the interventions I can design and plan and then get peers involved in the delivery. As much as we talk the talk, I think truly incorporating peers within all aspects of service delivery still has so much room to grow. 

I don’t have the capacity right now, but at some point, I would love to see occupational therapy being offered in single visit, drop-in basis as part of the drop-in clinic. I think this role for OT is still in it’s infancy across the system, particularly the mental health system, but I love the idea of low barrier, easy access to service for youth in terms of prevention of functional difficulties.  I’m really trying to further develop the OT role at Foundry so that people better understand and want occupational therapy. Not very many youth walk in and say they want to see an OT. Occupational therapy is brand new to not only Foundry, but also to Child & Youth Mental Health on the North Shore. I would say even in the short time though, its been really well received and welcomed by staff, as well as clients and families.

How does Foundry support families of youth who are accessing services?

Foundry uses a client and family-centred model of care in all areas of service. We offer several parent support and education groups and we also have a parent navigator support worker who is contracted from the Canadian Mental Health Association. We also have family counsellors via Family Services onsite who offer their services. Also, as an OT, for youth that consent to have their families involved, I am always working directly with parents and families in supporting their family member in their rehab and recovery. We know moving forward and making lasting change doesn’t happen in isolation and involving family can make such a difference in outcomes.
How do you think the Foundry service delivery model impacts the client experience of care?

In general, I think the biggest thing is improved access to service. Foundry is the lowest barrier mental health and addictions service I have been a part of, and I would say has existed in public health so far that I am aware of. There has obviously been drop-in medical clinics for youth for a while but it’s so new for public mental health.  Also, lower barrier integration - so not being passed from service to service that are located in different parts of the city. At Foundry, rather than the client having to navigate this big web of services and tell their story over and over again, we take care of a lot of that for them. They come in and meet with a drop-in worker which might be a youth worker or a counsellor and they get their needs assessed – needs in that moment, and service needs. If they get referred to an OT, or to Housing, or any other service – it’s almost an invisible referral because the client thinks "Oh, I’m just going back to Foundry, and I’ve already been there". Foundry is basically a hub of youth services all under one roof.
In terms of OT service, I would say access to service is improved as well. Youth can come in and access our groups right away and even self refer, or find out about OT service when they drop in. Traditionally, in public health care, clients have to jump through a few hoops before getting to see an OT, so eliminating some of that red tape is one of the best ways to engage more youth that need our services.

Another cool aspect of the drop-in clinic that falls under the OT umbrella is the concept of a “therapeutic waiting room.” It’s called Open Studio and the premise of it is capitalizing on all the wasted time spent just sitting in the waiting room. The idea is to offer therapeutic service and engage youth from the moment they walk in the doors.  It’s using activity, and art mediums and creating a sense of community. We have peer support and other support staff there to talk to youth, engage them in process-based art and activity, and connect them with each other. It’s a sensory calming, safe and supportive environment where there is no commitment and no goal. Clients can drop in off the street and stay for 5 minutes or hours. To me, it’s not just about having a bunch of “group therapy programs” but about creating community and spaces that youth want to be a part of, feel connected to, and want to come back to. Our new community garden is another example of this type of community-building project. We know that half the time youth come to groups it’s for each other. So, it’s about giving them more of those opportunities and helping them to feel connected to something and to feel comfortable here, like they want to come here. Because a 14-year-old doesn’t care what specific “interventions” or theoretical models we're using, they just care what their experience is like, if they feel connected, if they feel comfortable and if they have fun. Those are the things that I think some of the OT programming is bringing.

Can you explain the Integrated Stepped Care Model
It’s a function-based model rather than a model just based on symptoms that Foundry uses. Step 1 is a typical youth with no medical or mental health issues who perhaps present with some fairly typical short-term stressors (i.e. a break up or exam stress, etc.). Step 4 is someone with chronic and persistent addictions and mental health issues, social issues, multiple barriers that require a multi-disciplinary team approach. Step 2 and Step 3 fall between these two. These steps are not a diagnosis, they are based on function. The groups under the OT umbrella are primarily for youth within Steps 2, 3 and 4, and individual OT service is primarily reserved for youth within Step 4, and at times, Step 3. Since OT addresses function – self care, life skills, school, work, social, leisure – and since transition aged youth are often all dealing with functional concerns at some point, sometimes it can seem like all youth of this age need an OT. In a perfect world, we would have those resources to provide this. However, I am the only OT currently at Foundry North Shore, and I only
work .8 FTE/4 days per week, and individualized service is only about a 3rd of my job approximately. 
The Stepped Care model can help provide some language to how we try to reserve this service for those youth and young adults who need this service and support the most. Also, we don’t want to over support. One of the core principles of Psychosocial Rehabilitation (PSR) is providing the least amount of professional support as needed. Although OTs may be trained or educated as having expertise in occupational performance, if there is a youth who is only having minor functional struggles and could be adequately supported by a peer support worker, or other non-clinical/professional service, then I see this as actually more in line with PSR principles and in a broader sense, building capacity and empowering young people that they have expertise in their own journeys.

How do you think OTs can be most effective in improving health outcomes for youth with mental health and addiction issues?

I think it’s all about function and building capacity – addressing barriers and helping clients move forward with their functional goals.  I mostly work with youth in “transition age” – getting back to doing things, figuring out what the barriers are that are getting in the way of all of the things that they are wanting to achieve functionally in their life – and there are so many at this age. That transition from child to adulthood is often when things get interrupted like school, early work experiences, and life skill acquisition. Adolescence is often the time we see the first presentation of mental health issues, and it’s when experimental drug use can start turning into a coping mechanism. We start seeing a lot of these things that become barriers and then they start interrupting that normal typical functional development that usually people at this age have. 

The OT role is about helping them sift through what’s going on and getting in the way of participation and engagement in life occupations, and what it is they would really like to be doing with their life. It’s about figuring out how we can address some of these barriers, start working on some of the goals they have. It’s about helping them prioritize and build routines and connect to the community. It’s about helping them figure out who their community is, and who they want it to be. A lot of it’s just about getting out there, not just sitting in the office but actually working with clients in the community and environments where life happens. It’s working with them in their real environments like school, or just helping them find solutions to some of the things that are getting in the way. We know that obviously occupation is so connected to health outcomes, so in turn we see a huge improvement in mental health. We don’t wait until people start feeling better to start doing things; it’s actually the doing that starts changing the way people feel.

Also, with function – we can’t separate mental health barriers, from physical barriers, from cognitive barriers, from environmental barriers, etc. We need to look at the person as a whole within their current context and work on whatever it is that is getting in the way to functioning and meeting their goals.

For more information on North Shore Foundry, check out:


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