Family Services Durham: Building Collaborations for Responsive Support and Services to the Most Marginalized

By: Region of Durham

February 2025

OMSSA is featuring several 2024 Local Municipal Champion award recipients and their work in the Knowledge Exchange Blog. Please read this entry from the Region of Durham below. 

Who we are: Family Services Durham (FSD) is a division of the Region of Durham’s Social Services Department delivering services that include counselling, psychotherapy, outreach, and case management. FSD is comprised of a multidisciplinary team of Registered Social Workers and Psychotherapists, Outreach Workers, and Case Managers.

Family Services Durham (FSD) has provided affordable and no-cost quality community-based mental health services in Durham Region for almost 50 years. In 2023, over 6,600 residents were supported within FSD’s range of programs, which offer holistic, client-centered, trauma- and poverty-informed services designed to stabilize and strengthen individuals, couples, and families and respond to emerging needs.

In addition to affordable community counselling, FSD operates various outreach and specialized services aimed at vulnerable and marginalized populations who are traditionally underserved and often struggle to secure the resources they need. Many of these services are provided through collaborations and partnerships that leverage existing expertise and other resources to provide specialized services with significantly reduced barriers to access.

No-Cost Counselling and Psychotherapy for Social Assistance Recipients

FSD collaborates with Ontario Works (OW) to provide quick, seamless access to mental health and counselling supports for individuals in receipt of social assistance, helping to address personal and interpersonal challenges, strengthen self-sufficiency, and make healthy progress towards self-identified goals and community participation.

This type of early intervention contributes to individual wellness, helping to prevent further hardship and crisis and address challenges that are often barriers to employment. In 2023, over 2,000 OW clients received support for mental health and related challenges within this partnership.  

Supports for Adults Living with a Developmental Disability

Through an Adult Protective Services (APS) program, FSD provides case management and advocacy to help adults diagnosed with a developmental disability to live safely and independently in the community. APS workers engage in close collaboration with a range of other organizations who serve those living with a developmental disability, including Community Living and Developmental Services Ontario.

In addition to long-term case management, Prompt Access Single Session (PASS) and outreach support is offered on a monthly basis, where adults with diagnosed or suspected developmental challenges and/or their family or other supports are directly assisted to identify and navigate the services and resources they need.

In 2024, the APS team worked with Region of Durham's Housing Services and Blue Door to secure 10 transitional supportive housing units at Beaverton Heights for adults living with developmental disabilities. APS clients impacted by trauma are provided specialized psychotherapy under the supervision of a psychologist with expertise in developmental issues via collaboration with FSD’s Community Counselling program.

Innovative Services for those Experiencing Homelessness

Like many other areas, in recent years, Durham Region has seen a significant rise in homelessness which often intersects with mental health and substance use struggles. In response, FSD developed innovative new outreach programming for those experiencing (or at risk of) homelessness and mental health issues and/or substance misuse.

These programs are designed to overcome barriers to accessing traditional appointment-based services by meeting clients where they are, with staff traveling into settings across Durham Region, including high-needs neighbourhoods, homeless encampments, and service hubs.

These outreach programs also integrate staff from APS, to provide specialized, multi-disciplinary support to unhoused individuals with developmental disabilities that are often undiagnosed.

The Primary Care Outreach Program (PCOP) is a partnership between FSD and the Region’s Paramedic Services, launched in 2018 as a pilot project in Oshawa in direct response to the increase in homelessness.

PCOP is now a permanent program, serving all of Durham Region seven days per week. Teams consisting of an Advanced Care Paramedic and a Social Worker provide the unsheltered with immediate access to medical, mental health, and addiction services (including virtual addiction medicine), and support meeting basic needs and navigating other services.

In 2023, PCOP had over 3,600 outreach interactions with unhoused individuals.

The Mental Health Outreach Program (MHOP) consists of Social Workers who provide crisis support, service navigation and coordination, and outreach counselling/psychotherapy to the unhoused, to help address a variety of mental heath and substance use issues and overcome barriers to meeting basic needs.

In 2023, MHOP had over 1,400 interactions with individuals experiencing homelessness and in need of mental health and related supports.

Support for Older Adults at Risk

Another critical issue that is on the rise in the community is the occurrence of various forms of abuse and harm against older adults. According to Elder Abuse Prevention Ontario, up to 10% of seniors experience some type of harm every year. FSD supports this vulnerable population via its newest collaboration, the Older Adult Safety Advisor (OASA) Program.

Delivered in partnership with Durham Regional Police Services, OASA’s Social Workers offer information, support, advocacy, and service navigation for older adults at risk due to abuse, fraud, neglect, or other types of harm. Enquiries are accepted directly from older adults in need of assistance, and from members of the public or other organizations who have concerns. Program demand has been high, with OASA staff engaging in more than 3,400 interactions to support the safety and well-being of older adults in 2024.

Rural Access Initiatives

FSD has expanded access to counselling and psychotherapy services in rural areas through partnership with local health clinics and community-serving organizations in North Durham. These collaborations have significantly enhanced the reach of FSD’s services to those living in rural areas, who are often underserved, isolated, and lacking transportation.

Durham Community Walk-In Clinic (DCWIC)

The mental health needs of children and youth are increasing, and many families struggle to access appropriate care for their children due to a shortage of resources. As an onsite partner at Durham Community Walk-In Clinic (DCWIC), FSD offers counselling to families with children who are facing a range of mental health and related challenges. This timely access to professional support helps families bridge the current gap in specialized and affordable children’s mental health services.

Support for Those Impacted by Abuse

FSD is an on-site partner with Safety Network Durham (SND), a local organization that facilitates access to a variety of services and resources for survivors of gender-based violence in a centralized hub. FSD provides SND clients with immediate onsite assessment and support, and facilitates their direct connection to ongoing counselling through FSD’s Community Counselling program.

FSD’s Partner Assault Response (PAR) program works in close collaboration with various facets of the justice system to provide group education/counselling to individuals who have been ordered by the court to attend a PAR program or counselling due to abuse against an intimate partner. Those who attend the program are assisted to identify and challenge beliefs that underlie violence, and to learn non-abusive ways to manage conflict and difficult emotions. While they attend the program, their partners/victims are offered assistance with safety planning and service navigation.

Support to Other Social Services Providers

FSD works to build capacity within the social services system by offering training, resourcing, and debriefing support to other Social Services divisions (including Income, Employment, and Homelessness Supports; Housing Services; and Children’s Services). This helps staff remain effective and maintain their own well-being while working with complex clientele dealing with significant mental health, addiction, abuse, and human trafficking issues. FSD also supports residents in subsidized housing within Durham Region’s Local Housing Corporation, to strengthen their well-being, functioning, and resilience.

Collaborations with Educational Institutions

FSD collaborates with local colleges and universities to enhance social work education through curriculum development, and by providing placements where counselling students gain hands-on experience in community-based counselling and psychotherapy. These collaborations not only improve service delivery but also ensure the sustainability of high-quality community-based mental health care by helping to train the next generation of providers.

Summary: Collaboration a Key to Continuous Improvement

FSD is committed to providing high quality community-based mental health care, and seeks opportunities to enhance service delivery through continuous improvement including the creation of collaborative partnerships. Responding directly to increasing support needs for mental health and wellness across the Region, FSD has an intentional approach and commitment to build strong collaborations among a range of community organizations and programs. Priority is to deliver services in a more accessible and responsive manner, in particular, to the most marginalized populations who require crucial counselling, supports and/or resources. As needs in the community further evolve, FSD will continue to strive to address gaps with a focus on using collaboration as a key tool.   

Resources

For more information, visit the following links:

• • Family Services Durham - Counselling
  • Family Services Durham - Adult Protective Services
  • Family Services Durham (VIDEO)
  • Adult Protective Services (VIDEO)
  • Primary Care Outreach Program: Paramedicine Making a Difference (VIDEO)
  • Primary Care Outreach Program (VIDEO)
  • Primary Care Outreach Program: A Hard Life (VIDEO)

Photo credit: Region of Durham

About the Author

The Region’s Social Services Department provides human services through a variety of programs and services to the citizens of Durham. On behalf of the Region, the Social Services Department acts as the Service System Manager in areas of Housing, Homelessness, Early Learning and Child Care, and Employment and is a delivery agent for Ontario Works. On behalf of the Region, Long-term care (LTC) is provided across four regionally owned and operated LTC homes and includes Adult Day Programming.