Elizabeth House has space for up to 18 clients (pregnant women, mothers and babies) in its residential programs. There are 9 bedrooms and each client has her own bedroom, which she can keep locked. Babies share the room with their mother. Accommodation can be made for a mother with 2 children depending on the number of residents at the time of referral.

There is no age limit for the mother; the child must be between the ages of 0 and 5. There is no pre-determined length of stay; it depends on the individual needs of the client. Clients have stayed from 1 month until up to close to 2 years. Lengths of stay average between 6 months and 1 year.

Residential services are divided into two programs: the program for pregnant clients and the mother-baby program where mothers and their children live together. Clients are admitted into one of these two programs. Clients who are pregnant and in residence and who need to transfer to the mother-baby program go through a new admission process.

Residential programs provide 24 hour a day, 7 day a week services for clients who are unable to reside in the community, either by themselves or with family, and who are in need of a warm and caring, structured living environment within which to pursue their goals. Each clients participates with staff in developing their personal intervention plan shortly after admission into program that includes needs, goals, strategies, a projected discharge date and discharge orientation. These plans are monitored and amended on a regular basis as goals are reached and or new issues arise.

All clients in the residential programs are expected to be in school if they have not completed high school. All other clients are expected to be involved in a structured weekday program the nature of which is determined at intake with the client and referring social worker.

During the client’s pregnancy, the focus is on helping the client either to come to a decision regarding the pregnancy or confirm their decision regarding the pregnancy. Most of the clients at Elizabeth House have made the decision to keep their babies at the time of admission. For these clients, work is focussed on helping the client prepare for the actual birth, prepare for the transition to motherhood and ensure that they have the appropriate and necessary baby items. For other clients, information and counselling are provided regarding the pregnancy and decisions to be made as well as preparing for the actual birth. Clients are also assisted to ensure that they receive good medical and physical care and are supported to continue with their education.

Some reasons for referral to the pre-natal residential program include:

• Client is pregnant, has court order for a rehabilitation centre and it is not appropriate for her to remain in her other placement.
• Client has no family support and is unable to live independently in the community.

In this program, the emphasis is on helping the young mothers make the transition to the life task of being a parent. Along with helping them assume the child care tasks of early infancy or toddlerhood, staff assist the clients learn how to balance their own adolescent needs with that of being a full time parent. Clients have to learn to give up spontaneity and begin to learn to plan ahead. They must establish routines and stick to them. They have to learn to anticipate and respond to the baby’s needs. Depending on their own level of development, these tasks may range from daunting but attainable to sometimes impossible. The level of social and family support is integral to the client’s chances for success and much work is put into developing a network of social support systems for the client. Activities and interventions geared towards helping these young women identify and work towards reaching their own personal goals as well as specific goals as a parent.

Some reasons for referral to the mother-baby residential program include:

• Requests for parental capacity assessments, i.e. the baby and or mother are under Youth Protection;
• The mother and or baby have court orders for rehabilitation centres and there is a plan for them to be together;
• Supporting the re-unification of parents with their young child(ren) from foster care when the situation is high risk;
• Client is very young, has little to no family support and requires intensive support;
• Client has been in the program for pregnant clients and requires a period of transition and support before returning home to her family or going into independent living.

This program is currently in the planning stages. One apartment with space for two mothers and two babies is expected to open in the 2000 – 20001 fiscal year. The program will be geared for parents who no longer require or do not require the intensive intervention of institutional placement but who need a semi-supervised living situation on a long term basis i.e. 6 months to one year or longer, within which to develop their independent living skills. Overnight on-site supervision along with daily individualized support from educators will be a central part of the program. Bed space in these apartments comprise a portion of the 18 places available in residential programs, therefore the program can accommodate court ordered placements and the clients are considered to be admitted to a rehabilitation centre.

• The client must be pregnant or a young mother of a child from ages 0 to 5 years. For pregnant clients, the pregnancy must be medically confirmed.

• The client must be in need of second line services. This means that placement is seen as a last resort, that the client is unable to live with family members and is unable to live independently in the community. Our clients often exhibit the following characteristics: history of placement outside the home; victims of physical and sexual abuse; involvement with drugs, delinquencies; psychiatric illnesses, poor academic achievement, learning difficulties, low self esteem. They have a need for stability, structure and safety, the need to experience a trusting relationship with an adult, the need to have a sense of belonging, and the need to feel heard and understood.

• Being pregnant does not automatically mean admission to the program. Clients must be able to actively participate in the admission process in understanding why they are being referred to Elizabeth House and that they are choosing to come to Elizabeth House. Clients are assisted with this process at the intake assessment by the Elizabeth House staff and it is understood that some clients will have more difficulty with this than others.

• The client must have a demonstrated ability to function in a community based program, i.e. the client must not need a locked program, must be able to follow rules and share a living space with other young mothers such that the safety and security of all clients is maintained.

• The client must be exhibiting significant difficulty dealing with her pregnancy or role as a parent and requires a structured living milieu with intensive, professional support and intervention in order to deal with her situation.

• The client must be willing and able to be involved in a full-time day program (school, work, working in EH nursery or other program). This is normally established with the client at intake as to what program the client will be involved in and is based on individual needs.

• The client must legally be able to live in Quebec. Clients without legal status must first be accepted through the Department of Immigration.

• The difficulties experienced by the client must be able to be dealt with within a community setting. Drug or alcohol problems must not be the primary difficulty i.e. where residential rehabilitation is first required. Mental illnesses must be able to be controlled by medication allowing the client to function adequately. The exception to this is when a clear understanding does not exist as to the degree of problems experienced by the client or the client’s ability to deal with her problems. A parental capacity assessment may then be requested.

Psychosocial services are free for Canadian citizens and landed immigrants. However, there may be a financial contribution required for residential services (room and board). The amount of the contribution is determined by the Bureau d’Hébérgement. All adult clients and clients with babies must complete an application form which is then forwarded to the Bureau d’Hébérgement for assessment. The Bureau will then notify Elizabeth House of the amount of the contribution. Most clients are not required to pay any contribution; in fact, clients with few financial resources are eligible to receive monies from the Bureau d’Hébérgement which currently amount to $151.00 per month per client. Checks arrive at the end of each month and are made out in the client’s name.

Clients who are minors and who have not yet had their babies are not eligible for the $151.00 provided through the Bureau d’Hébérgement. Financial arrangements must be made with their families and or social worker to ensure that they have adequate funding during their pregnancy. The expectation is that a minimum of $80.00 per month be made available to these clients.

Clients are expected to pay for their own personal expenses, including clothing, transportation, toiletries and other personal items. Clients who are mothers are expected to pay for their children’s expenses including clothing, car seat, toys, toiletries, formula and diapers.

Elizabeth House assumes the costs for food (other than formula) and for prescription medication.

The residential team includes 4 full-time and 2 part-time educators, 1 full-time and 2 part-time resident supervisors (overnight staff), 1 part-time housekeeper and 1 part-time cook. At times, the team may also include student educators. The Director of Professional and Rehabilitation Services is responsible for overseeing the clinical program. The Director of Professional and Rehabilitation Services is part of a larger management team including the Co-ordinator of Administrative and Auxiliary Services, who is responsible for finances, personnel and auxiliary services, and the Executive Director who is responsible for the overall functioning of Elizabeth House.

Clinical services are provided through a team approach at Elizabeth House. Within this team approach, each of the full-time educators takes on the role of case co-ordinator for at least 2 of the clients in the program. In this role, the educator is responsible for case management, writing up the intervention plans, attending family and other significant treatment meetings, court hearings, and generally overseeing the needs of the case. The case co-ordinator is not necessarily a primary treater. Clients in Elizabeth House are encouraged and supported in the development of significant relationships with workers of their choices.

• Provide a warm and nurturing, therapeutic milieu through which basic care and psycho-social intervention are provided. This intervention is provided thorough the activities of daily living along with individual and group counselling.
• Ensure the daily functioning of the program.
• In conjunction with other team members, participate in the development and implementation of the clients’ intervention plans.
• Liase and communicate with the client’s social worker and significant others (family, other professionals) on a regular basis, concerning information pertinent to the client’s plan while at Elizabeth House.
• Lead program-related groups such as the weekly residents’ group, life skills, parenting, pre-natal support, infant nutrition or groups that support the bonding and attachment process.
• Log and prepare court reports and parental capacity reports as required.
• Testify in court when necessary.

• Ensure the safety and security of the clients and facility during the overnight period.
• Assist the mothers with any feeding or other difficulties as needed.
• Log and report significant occurrences to the morning staff.

• A recognized member of the treatment team, who at times, will form important relationships with the clients and assists in the development of independent living skills.

• Plans, orders and purchases the major food supplies.
• With the educator, assists clients with menu planning.
• As per schedule, assists clients with meal preparation.
• Oversees the maintaining of a clean kitchen environment.

• Oversee the overall functioning of the clinical program, ensuring supervision of staff members, effective treatment planning and program development.
• Co-ordinate admissions to programs and facilitating the intake assessments for referrals to residential programs.
• Prepare clinical policies and procedures.
• Administrative functions, including statistics, the handling of complaints, budget preparation.
• Ensure a high standard of professional and quality services.

All residential clients must have a social worker while they are in placement. While the social worker is not an employee of Elizabeth House, he/she is nevertheless considered an integral and active member of the treatment team. The social worker may or may not be the person who referred the client for placement.

For clients who are under Youth Protection, their social worker is their Youth Protection worker. For clients under the Health and Social Services Act, their social worker is a CLSC worker, either through the CLSC of where they normally live in the community or through the NDG- Mtl. West CLSC.

• Assessing that residential placement is most likely indicated and appropriate for their client
• Making the referral according to identified procedures, including relevant clinical documentation
• Ensuring that clients who are under 18 and pregnant have appropriate financial resources to take care of their personal expenses while they are at Elizabeth House i.e. clothing, transportation, toiletries, etc. Normally, the family provides the financial support; in some Youth Protection cases, the Youth Protection Agency provides the support.

• Arranging for and support the admission of the client to Elizabeth House.

• Meeting regularly with their client and with Elizabeth House staff (frequency to be determined at development of initial intervention plan).
• Participating in Elizabeth House team meetings as required (Normally, at least once a month, more often if necessary).
• Participating in the development of the client’s intervention plan.
• Providing family counselling as indicated.
• Communicating in a timely fashion with Elizabeth House educators regarding information that they may have from their work with the clients that would be pertinent for educators at Elizabeth House to know in their work with clients, i.e. decisions from court hearings, significant events in the family, significant issues from their individual counseling, etc.

• Find alternative placement for the mother and or baby in the event of an unplanned discharge from Elizabeth House.

• In conjunction with Elizabeth House staff, authorizing who the client may stay with for overnight visits.
• In conjunction with Elizabeth House staff, authorizing the amount of community time the client may have from Elizabeth House.

• All clients to residential programs must be referred by a social worker.
• The social worker completes an Elizabeth House referral package and forwards it to the Director of Professional Services.

• When the appropriate documentation has been received, The DPRS arranges for an Intake Assessment with the client to include the client, the client’s parents or other family members (when indicated), the baby father (when indicated), an EH educator, the referring worker and the DPRS.

• The intake assessment is held at Elizabeth House.

• The purpose of the intake assessment is to ensure the necessity for and appropriateness of residential placement, establish initial goals and objectives, ensure financial resources and required documentation for the client are in place, determine an approximate length of stay, determine an initial discharge orientation and establish a projected date of admission.

• Once the admission date has been confirmed, the client (and client’s parent if client is under 18) sign a clinical contract for agreement to placement and agreement to follow the Elizabeth House program. This agreement will contain initial intervention goals and strategies based on the intake assessment and must be signed prior to admission.
• The client is then admitted.