The Behavioral Health Intellectual Disabilities Community Treatment Team (BHID/CTT) was created by DBHIDS and CBH to address the needs of people from Philadelphia who have an intellectual disability and/or autism (ID/A) and mental health challenges.
Sometimes people with these complicated challenges have problems that seem beyond their capacity to understand and cope. Just as for people without an intellectual disability and/or Autism (ID/A), living with a mental health challenge takes strength, courage and resilience. And, maybe some help from the service delivery system! These are the people who require much from those who support them and much from themselves as they search for recovery.
Phillip Smith is a complex guy. Philip has Dual Diagnosis: He has an Intellectual Disability and a Mental Health Challenge. Phillip was also diagnosed with an Autism Spectrum Disorder several years ago. Phillip was referred to the BHID-CTT in May 2015 and they have been able to eliminate his frequent emergency department visits and hospitalizations. Read Phillip's story
Shawn is 23 years old, and had for years lived with his mom until the Behavior Health Intellectual Disabilities (BHID) team assisted him in moving to a new community home in Philadelphia. Red Shawn's story
Roseann is a twenty-two year old young woman who joined the BHID Team in August of 2014. She was living in a community home with 2:1 staffing due to her difficult behavior. Roseann however,made it clear that she did not want 2:1 staffing and wanted to live her own life. Read Roseann's story
Frank is 26 years old and had been known to the Behavioral/Mental Health system for years. Frank was the second person to be referred to the BHID team in February of 2014. Read Frank's story
Darlene is a 26 year old woman who was referred to the BHID/CTT team in March of 2014. She had been living with family, moving from house to house with family members and always having difficulty at each home. Read Darlene's story
Frank is 26 years old and had been known to the Behavioral/Mental Health system for years. Frank was the second person to be referred to the BHID team in February of 2014. Frank had experienced much trauma in his life and carried several mental health diagnoses as well as intellectual disabilities. From the age of eight onward, he was placed indifferent residential programs and also had several inpatient psychiatric hospitalization. His trauma history included: sexual abuse by family members and while in residential placement; the loss of his mother to suicide when he was 12; and, the overdose of his father when Frank was a teenager. Frank reported to the team that his father was abusive and that he, Frank, had a lot of anger about his past. After dropping out of his last residential program by age 18 or 19, Frank was either homeless or living in personal care boarding homes across the city from which he was frequently discharged due to his difficulty in following the rules and getting along with other residents. Over the years, Frank has also lived for brief periods with his grandparents. His grandfather remains involved in Frank’s life, seeing him every week.
One of Frank’s strategies for coping with life on the streets of Philadelphia and the significant trauma in his life was to build a persona that was larger and stronger and tougher than those around him. He would terrorize others, stealing money. He would characterize himself as a, “black gangsta” (Frank is not black). He would often get into fights and he would refuse to acquiesce to the demands of other dangerous people on the street. Frank was so lacking in impulse control and self-awareness that he managed to get shot in the leg when he was asked to move. After that injury, Frank came to the BHID offices from the hospital with the bullet still in his leg.
At this point, Frank moved to Upper Darby with a cousin who stole his SSI benefits and he got into altercations which resulted in law enforcement intervention. The BHID team stayed with him through all of the drama and continued to believe that there was potential for Frank’s recovery. The team assisted Frank to move back to Philadelphia and stay in the shelter system, with daily support from the BHID team, until they could find him an apartment, rather than another boarding home.
In March of 2016, Frank moved to his own apartment. The BHID team is working on vocational placement, and has been helping Frank to address the trauma he has experienced. Frank is willing to start individual therapy this year and, thanks to the BHID team and Frank’s personal determination, he has not had any inpatient hospitalizations since joining the BHID team.
Phillip Smith is a complex guy. Phillip is likeable and smart. Philip has Dual Diagnosis: He has an Intellectual Disability and a Mental Health Challenge. Phillip was also diagnosed with an Autism Spectrum Disorder several years ago. Phillip does well with people that know him well and can offer him reasonable redirection.
Phillip is in Recovery. He has a diagnosis of a Bipolar Disorder, but it is not negatively affecting his ability to do the things he needs and likes to do at the present time. He is actually employed at two places and uses community resources appropriately. His mother has been a great advocate for Phillip. She found his residential provider agencies and has attempted to find the best clinicians available for Phillip. His residential agency continues to be very supportive. Other providers might have given up on Phillip, but his current provider invested the time and effort necessary for Philip to get him where he is today. Phillip is also receiving intensive case management services from the Behavioral Health Intellectual Disability – Community Treatment Team (BHID-CTT) who sees him at least weekly and is able to provide support whenever it is needed. The BHID-CTT has been able to eliminate Phillip’s frequent emergency department visits and hospitalizations. Phillip has not had any inpatient hospitalizations since 2015. The BHID-CTT also found an opportunity for Phillip to have a meaningful job working in a community food bank.
Phillip has a serious chronic health problem called Psychogenic Polydipsia. Polydipsia means that a person drinks excessively. Often a physical health condition causes a person to drink excessively. When no physical health condition can be identified as causing the polydipsia and the person has a Bipolar Disorder or a Psychotic Disorder the condition is called Psychogenetic Polydipsia.
Drinking an excessive amount of fluid can cause serious physical and behavioral changes in a person. The physical symptom of water intoxication includes urinary incontinence, an inability to speak clearly, restlessness, lethargy and seizures. Behavioral complications include delirium, irritability, mood lability and poor judgement.
In 2014-2015, Philip had 5 psychical hospitalizations and 5 psychiatric hospitalizations, and Phillip also made frequent trips to Hospital Emergency Departments during the same period of time. In 2015, Philip was also charged with a crime. Fortunately he was able to stay out of jail, but he was placed under court supervision.
Phillip has had no hospitalizations or problems with law enforcement since 2015. What has changed? Phillip had been prescribed various psychotropic medications for approximately 20 years. None of the medications really helped him and many caused adverse side effects. Phillip had also had seen many psychiatrists, but no one seemed to understand his complex needs. Phillip has had numerous residential providers, but none had been able to positively manage Phillips behaviors. Phillip also had a number of Behavior Support Specialists but none of them seemed to really help him and his support team.
Although 2014-2015 was a very difficult time for Phillip, positive things were actually happening as well. His mother had advocated for his current residential provider and they did not give up on him even when things were really not going well. Phillip was enrolled for services from the Behavioral Health Intellectual Disability – Community Treatment Team (BHID-CTT) on 5/19/15 which provided intensive supports for Philip and their staff helped support him in the community. Phillip finally found a psychiatrist that prescribed medication that more accurately helped him.
Phillip is receiving supports from two service systems (ID and MH) that should be providing services for him. The Intellectual disability Services system has helped him attain an Everyday Life, and the intensive supports that the BHID-CTT have provided have helped him achieve a state of Recovery. Phillip is a true success story!
For more information about the BHID-CTT program and how to obtain services, please click here: https://www.pchc.org
True Tales of Recovery will begin to share some of the stories of the people who are creating mentally healthier lives in the community and the people from BHID/CTT who support them. All names are changed to protect each person’s privacy.
Shawn is 23 years old, and had for years lived with his mom until the Behavior Health Intellectual Disabilities (BHID) team assisted him in moving to a new community home in Philadelphia. Shawn was nonverbal, extremely when the BHID team first met Shawn, he was usually naked or tearing his clothes to be naked and smearing feces. Shawn’s Behavioral Specialist shared that he was extremely sensitive to touch and that it took Shawn a long time to trust and meet new people. The BHID with the joint support of the residential and BHID team members, Shawn is now very verbal and very sociable and is participating in many community activities every day. There have been no psychiatric hospitalizations since the BHID team became involved. Shawn has gone on day trips to Atlantic City and New York. He goes to art classes and swimming weekly. He loves to go to the barbershop. He plays basketball. Shawn now spends more quality time with his mother. Shawn would like to have a girlfriend and is exploring vocational opportunities. What an amazing turn around -- when the teams truly work together to support the whole person and listen to the needs of the person, however they are being expressed.team spent about four months building trust with Shawn, his family and his team. The BHID team continued to connect with Shawn’s supports coordinator (SC) to help him move from his family home to a community residential home. The BHID team worked closely with the new community provider to explore and determine new activities of interest in his new home. The BHID Certified Peer Specialist (CPS) also engaged with Shawn for community outings. The team would adjust the number of weekly visits according to Shawn’s needs.disorganized and distant when the team met him in May of 2015. In fact, there was some question as to whether the BHID team would be able to work with Shawn. Shawn’s diagnoses included Autism Spectrum Disorder, Schizophrenia NOS, and Mild Intellectual Disabilities. Before Shawn moved from his mother’s home in September 2015, he was running into the street naked in the winter. This occurred 3-4 times a week. Police would take Shawn to various Crisis Response Centers (CRCs).
Darlene is a 26 year old woman who was referred to the BHID/CTT team in March of 2014. She had been living with family, moving from house to house with family members and always having difficulty at each home.
When Darlene first met the team she was reluctant to work with them, and was cutting herself in order to be hospitalized. She was very disrespectful of the team and resistant to change. If fact, she brought her mother and grandmother to CTT to fight the case manager and the team leader. Fortunately, the situation was defused.
With Darlene, the Team’s approach has always been to stay focused on her goals and remain positive. Initially, to stabilize housing, the team found a boarding home placement. However this proved to be less than ideal so Darlene went to live with her grandmother and now support is provided in the home to keep the situation stable.
Darlene also began Dialectic Behavioral Therapy and the team supported her attendance. At the same time two further goals were in the works: financial management and weight management. Darlene went from the BHID/CTT program being her representative payee, to her grandmother and now she is her own payee and managing her finances.
Darlene has several health issues as a result of obesity. She has very much wanted to lose weight and have Bariatric surgery. Unfortunately, Darlene was turned down for the surgery with the medical suggestion that she lose weight prior to the surgery. Darlene handled the disappointment well, with the help of the team, and moved on to getting a gym membership.
So far Darlene has lost 40 pounds and the BHID Case Manager attends the gym with Darlene. Another health related issue that arose was her psychiatric medication. Darlene did not want to continue with her medications because she did not like the side effects. The CM and the team were able to support Darlene in requesting a change and the medications were lowered.
Finally, Darlene, like many people, wanted a job. She has just finished a 21 day vocational program through OVR and is working toward full employment. She has 8 more weeks of vocational training before she will be working full time. She is truly hopeful about the future!
Since joining the team in March of 2014, Darlene has had only one psychiatric hospitalization and one presentation at a CRC. She has not been hospitalized since June of 2014. Life is looking up for Darlene!
Darlene is making steady progress toward her goals with concentrated intensive efforts of herself and her BHID/CTT Team. Congratulations to all on this wonderful progress.
Roseann is a twenty-two year old young woman who joined the BHID Team in August of 2014. She was living in a community home with 2:1 staffing due to her difficult behavior. Roseann however, made it clear that she did not want 2:1 staffing and wanted to live her own life.
Roseann’s reputation preceded her when she moved from a Residential Treatment Facility (RTF) into her community home. Some of the behaviors Roseann brought with her included:
The community agency was concerned about her safety so additional staff was requested.
A New Home for Roseann
Roseann moved to her new supported living home in May of 2015 with the help of the BHID team. The team worked with Roseann and her support coordinator to find a provider willing to take a chance on the more independent setting for Roseann. The BHID team reports that Roseann:
A New Home for Roseann
Roseann moved to her new supported living home in May of 2015 with the help of the BHID team. The team worked with Roseann and her support coordinator to find a provider willing to take a chance on the more independent setting for Roseann. The BHID team reports that Roseann:
BHID Team Helps Reduce Staffing
Over the last year with the help of the BHID team, Roseann's agency staffing went from 2:1 to 1:1 all the way to 6 hours of free time and, finally with a new agency, in her own apartment in a supported living arrangement. The BHID team worked with the agency staff to help them to better understand Roseann’s wants and desires, and to recognize that she was more independent than they had understood.They worked with Roseann to help her understand how to advocate for herself and how to compromise with the CLA staff.
The fading plan for the heavy staffing started with family visits. As visits progressed without incident, Roseann was able to move to independent time in her community home in 4 hour increments, and then finally, attending a peer support group at an outpatient rehabilitation center by herself.
Roseann has had one hospitalization shortly after she joined the BHID team and none since. The BHID team is there to assist Roseann and her residential team so as to avoid hospitalization or crisis situations. The BHID team advocates for its members daily and weekly and holds meetings with the person and their team when things are not going as well as possible.
Roseann even had a house warming party and she cooked all the refreshments for her guests!
The BHID team’s involvement has been so important in helping her to reach her recovery goals of increasing her independence. They also helped to underscore the need to listen to what Roseann wanted.
Maintaining Mental Wellness
While Roseann still has challenges in managing her symptoms of mental illness, she works with the BHID team and the BHID psychiatrist to maintain her mental health wellness. Roseann is beginning to recognize the importance of her medications as part of her total well-being.
Another issue that has been a challenge is the management of her physical health issues. Her current agency does not have a nurse on staff but the BHID team does have a nurse. It was frustrating for Roseann to have to report her physical health problems to the current agency staff when they were not able to assist her because they did not have a nurse. At her recent ISP meeting, which Roseann reminded BHID staff to attend, agreement was reached that the BHID team nurse would help with physical health follow up.
Roseann has really learned how to advocate for herself! She even contacted the CEO of the agency supporting her and set up a meeting with that CEO to discuss her disappointment with communication between her and her staff as well as discuss some money issues.
OVR Support
The most recent development for Roseann is that the BHID team connected her and supported her through the Office of Vocational Rehabilitation (OVR) process. OVR considered three criteria to accept her for support:
Job Opportunities and a more Independent Life
Roseann has been doing well on all three goals! She is now ready to begin with Community Integrated Supports (CIS) to explore three possible job opportunities: custodial work, cooking, and stocking work. Roseann will have the help of a job coach as she moves forward.
Since joining the team Roseann has made great strides toward creating the kind of life she envisioned for herself. This is a great story of recovery, of resilience, and of building a reality that is person-centered and affords the person the dignity of risk in the process of growing into a more independent life.
Please note that the use of the term “Mental Retardation” on any part of this website is done so only because of direct titles from the time period that the literature was written. The SE Pennsylvania End of Life Work Group uses and promotes the use of the term “Intellectual Disability” in all our work.
Funding provided by the Philadelphia Department of Behavioral Health/Intellectual disAbility Services, the Bucks, Chester, Delaware and Montgomery County Offices of Intellectual/Developmental Disabilities and the Office of Developmental Programs, Pennsylvania Department of Human Services.
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