NO-COST DBT: referral page for case managers

Hi! This page is for you if you’re an intensive case manager in the CAS, drop-in or shelter network and you’d like to partner with me by sharing a client for 1-3 years. As in:

a) you’re committed to meeting for an average of at least 30min per week with your client to work on their intensive case management goals as long as I’m working with them (or if your client will be progressing out of your agency’s services during my time with them, your can commit to securing them a referral to other intensive case management of at least 60min/wk without an interruption to services),

b) I provide them with weekly psychotherapy for 1-3 years; and

c) the three of us have a joint meeting together every 3 months or so, to stay on the same page.

Optional Reading

Feel free to poke around my website including to learn more about how I do DBT and about me personally. Ignore any money-related stuff, which only applies to paying clients.

Required Reading for Next Steps

Please very carefully read sections 1-4 of this page before contacting me, to make sure it’s worthwhile for us to have a call.

  1. AvailabLE spot(s)

Next spot projected to be available will be in Feb 2025. Day/time of weekly spot is TBD.

2. eligibility criteria

Who Can Work With Me for No-Cost DBT?

To work with me, your client must be age 18+ and must meet all of the following criteria:

They live in, and will be attending all sessions in, Ontario.

Insecure housing or recently aged out of CAS care. They live in a shelter or subsidized housing, and their income is limited to OW, OSDP unprotected side-hustles (e.g., panning) or equivalent. Or, they have aged out of CAS care and are between the age of 18-24.

Strong internet and phone connection. They’re ok with video sessions (i.e., we’ll meet remote-only and not in-person), and they can access a private room in their shelter or home that has a strong enough internet connection for video sessions. They also have a working phone for out-of-session phone coaching calls with me. 

“BPD” or similar profile. They’re navigating “borderline personality disorder (BPD),” “BPD traits,” or any anti-ableist alt-term for this; OR, they’re navigating impulsive behaviours such as suicidal behaviours, self-injury, anger outbursts, physical aggression, mild-to-moderate alcohol or drug overuse, or bingeing or purging that doesn’t result in medically dangerous malnutrition.

Attending regular intensive case management. As long as they’re seeing me for psychotherapy, they also have an intensive case manager whom they meet with for an average of at least 30min per week. That would be you, unless they’re progressing out of your agency, in which case you’d be expected to arrange an intensive case management referral for them without an interruption to services. I expect my no-cost clients to maintain 85% attendance or higher at their weekly 30min of case management; if their case management attendance ever drops below 50% for any reason (including cancellations by the case manager), or if they miss 4 weeks in a row of case management, I consider them to be dropped out of my program.

Who Benefits Most From Working With Me?

People receiving regular psychiatric care. While it’s not required for your client to have a psychiatrist in order to work with me, it’s strongly recommended. If they don’t have a psychiatrist, and if unaddressed psychiatric issues appear to be maintaining their mental health problems (i.e., lack of clarity about diagnosis or suitable treated, or unmedicated medical symptoms) I may require at some point in their treatment that a timely psychiatric referral be made in order for them to continue working with me.

Who Can’t I Work Work With?

I can’t work with your client if any of the following apply to them:

  • any of the following eating-related problems:

    • a primary diagnosis of anorexia,

    • significant food restriction,

    • any eating-related behaviours that are causing medically dangerous malnutrition (i.e., a BMI of less than 17).

  • a primary diagnosis of OCD.

  • a primary diagnosis of psychosis.

  • active manic episodes.

  • severe enough drug or alcohol overuse that it would require detox or rehab first in order to moderate consumption.

    3. Terms for you (the Case Manager) to agree to

Please read the following carefully to ensure that you you can make the required commitment to support your client in getting the most out of treatment and to keep their enrolment in my program.

Please Carefully Consider Your Capacity for This Big Ask

To be in partnership with me, I am definitely asking a lot of you — far more than is practical for a case manager in the public system, given how over-worked and under-resourced your whole setup is. Many case managers have turned me down because their work responsibilities understandably do not allocate enough time in a week for them to provide intensive case management to a client. Psychotherapy is a luxury, and I know that most of your clients don’t have the privilege of what I’m offering our mutual client. So please read the following terms very carefully, and if your agency cannot support you to sustain this level of commitment to a single client — totally fair! Please just let me know that up-front.

Agreed-Upon Case Management (CM) Frequency & Meeting Duration

I expect your client to attend case management (CM) meetings with you at the frequency and length that we’ve agreed to. This means that if you and our client ever come to believe that it best serves treatment to change your frequency/duration of meeting, I expect to be consulted by our client about this change before it happens. This is because on my end, we will have set up treatment goals and targets based on the frequency/duration of case management meetings happening and how these can support DBT treatment goals.

CM Attendance Calculation

I figure out your client’s CM attendance rate based on minutes attended out of a possible maximum agreed-upon minutes for that meeting and frequency.

Missed Minutes Counted

Reduced minutes or meetings attended are counted regardless of who cancels — the client or case manager themself. Our client is responsible to advocate with you to reschedule missed meetings or problem-solve any patterns of cancellation, and I hope and expect that you will be proactive with them about doing this as well. Missed CM minutes are counted for ANY reason, regardless of whether it was you or the client who cancelled the meeting, and regardless of any reason that the meeting was cancelled (e.g., even due to personal or professional emergencies of either the case manager or client). The only exemption is due to case manager’s vacation with 7 days’ notice (see below). There are no “unspoken exemptions,” for example none of the following would be an attendance exemption in the case that either you or the client cancels:

      • Serious illness (including ICU level)

      • Death/funerals

      • Someone having a crisis of any kind

      • Client vacation

      • Case manager taking a vacation without my being given a week’s notice

      • You covering for a co-worker

So I urge for you to both problem-solve with our client about their attendance if it starts to go down, and for you to reschedule or have a co-worker fill in for you whenever possible in the case that you need to cancel.

Expected Minimum CM Attendance: 85% & No More Than 1-Missed Week in a Row

Based on the committed duration/frequency that you and our client meet, I expect our client to maintain at least 85% attendance in order for DBT to be effective for them, and for them to miss no more than 1 week of case management in a row. This means that if you meet every-other week for 1-hr, this is considered equivalent to meeting weekly for 30min. However, if our client misses 2-weeks in a row with you, I’ll treat this as a problem for us to solve at our next session.

Case Manager Vacation

You of course need vacations! Our client is not docked attendance rating when case management meetings are missed during your vacation IF I am given notice about this by you or the client at least 7 days prior to your departure.

Required Minimum CM Attendance: 50% & No More than 3-Missed Weeks in a Row

If at any point that the client’s case management attendance rate drops below 50%, or at any point that they miss 4-weeks in a row of case management, they will immediately be de-enrolled from my program and will need to wait 6 months before they can re-apply to my no- cost wait list (and the wait times can be years). There are no exceptions to this rule (see above), so I urge to to support our client in keeping their attendance up with you.

Rationale for Attendance Expectation

This is because our clients tend to have 99 problems, and therefore DBT becomes case management and ceases to be psychotherapy when intensive case management isn’t happening at the same time. Case management tends to take care of more of the problem-solving aspects of treatment, and DBT/psychotherapy tends to take care of the parts of problems more to do with risk assessment and management, emotional skills limitations, emotional avoidance, thinking problems and patterns of cause-and-effect that influence behaviours. These things are all crucial to successful treatment, and they just don’t get attended do if the majority of problem-solving needs aren’t taken care of in case management.

Provider Correspondences

I will never speak to you without our client also present, and even with our client present I discourage direct contact between you and I as a rule. This is so that our client can practice and get coaching from me in the important skill of relaying their own care information between their health and service providers. So you and I will mostly communicate indirectly through our client, with these few exceptions:

      1. The three of us will meet quarterly for 60min for a treatment review to make sure we’re all on the same page.

      2. The three of us will share a joint secure messaging thread on Owl for only three purposes:

            1. scheduling joint meetings;

            2. sharing confidential documents;

            3. flagging urgent items that could lead to imminent or near-future loss of client enrolment in psychotherapy, case management, or other potentially urgent risk of loss to housing or other medical resources.

Everything else can wait for our quarterly meeting.

Nothing Off-Record From our Client

If you and I are interacting outside of our mutual relationship with our client (e.g., regarding another client or in another social or professional context) please never say anything to me about our mutual client. That said, if this ever happens, expect that I will relay anything said to me back to our client. I will also provide our mutual client with your signed copy of this form.

Agreement

You’ll be asked to sign a copy of this agreement (i.e., all of Section 3 on this page) prior to my intake of your client.

4. How to hold an available NO-cost DBT spot for your client

To secure an available spot for your client, you and I will book a 30min referral call. During this call, please don’t tell me anything about your client that you’re not ok with me telling them that I’ve heard from you. In other words, please expect that if I end up working with your client, I’ll tell them anything/everything you’ve told me.

Please follow these steps:

  1. Make sure that you have carefully read ALL of sections 1-3 prior to proceeding with next steps.

  2. Make sure that your client is available to attend weekly 80min sessions at one of the days/times posted (because there are no other times available).

  3. Make sure that your client meets the criteria in Section 2 and does not meet any of its exclusion criteria.

  4. Really, really (i.e., I’m not kidding!) make sure you’ve done steps 1-3 before proceeding to step 5. Our call will begin with me confirming that your client meets all criteria in Sections 1-2 and that you’ve read and can commit to the terms for case managers in Section 3. If the answer to any of that is “No,” we’ll need to end our call.

  5. E-mail alejandra@lindan.ca the following deets:

    1. which posted no-cost DBT spot you’d like to hold for your client (please leave out their name or any identifying details);

    2. confirm that you provide intensive case management to this client and which agency you work for;

    3. the name of whoever sent you my way;

    4. confirm that your client lives in and will be attending all sessions within Ontario;

    5. your general availability for a 30min phone call with me. Based on what you send, I’ll e-mail you a few dates to pick from.

  6. Once I e-mail you back to confirm your referral call time, I will hold the requested spot for your client until the time of my call with you. That means that if you cancel our call without rescheduling immediately, I can’t promise to hold the spot for your client after that. Note that I charge paying clients $140 to reschedule an initial phone call — I know your agency can’t afford that! So while rescheduling is free for you, I can’t reschedule more than once and still save your client’s spot.

  7. If your and my instincts are both that my DBT program might be worthwhile for your client, I’ll set up a 60min meet-and-greet phone call with them. They’re welcome to call alone or to have a support person on the line, whether it’s you or anyone else. Your client and I will decide during that call whether we both want to go ahead with a first session after that.