1b. Introduction to CEP Workshop for Managers (NXPowerLite)

8/13/2019 1b. Introduction to CEP Workshop for Managers (NXPowerLite)

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Introduction to Co-existing Mental Health

& Substance Use Problems (CEP) for Managers

Fraser Todd and Michelle Fowler

2013


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Workshop Introduction


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Workshop Series Overview

MHERCo CDHBo Matua Raki/Te Pou

Te Ariari o te Oranga 7 Workshops

Workshop1a: Introduction to CEP for frontline staff (x3)

Workshop1a:1b. Introduction to CEP for managers

Workshop 2: Recovery and well-being

Workshop 3: Engagement & MotivationWorkshop 4:. AssessmentWorkshop 5: Management IWorkshop 6: Management IIWorkshop 7: Integrated Care

QR Codes: the bar code looking things for phones with camera/internet.Open QR Reader app, point phone at the barcode, it goes straight to the

website.

QR Reader: i-nigma free, downloadable from www.i-nigma .com


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Workshop Agenda

PART A Introductions Workshop Overview Learning About CEPThe Spirit of Te Ariari o te OrangaThe Spirit of Te Ariari Frameworks The Nature, Extent and Impact of CEP Te Ariari O Te Oranga and The 7 Key Principles

PART B: CDHB Action Plan Service Development Tools and Resources Wrap up, feedback and finish

Please note: Self-directed learning modules on the content of this

workshop will be available on fraserscepblog.com Part A is available now, Part B

will be posted in the next few weeks.

The hyperlinks to resources are active in PowerPoint slide show format


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Context


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A Brief History of CEP

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National Context

Policy :

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Three Dimensions of CEP Practice

Spirit Principles - Techniques:

Spirit

Principles

Techniques

1. Cultural Considerations

2. Recovery & Well-being

3. Engagement

4. Motivation

5. Assessment

6. Management

7. Integrated Care

Person-focused care

Well-being orientated care Integrated care

Walk the Talk


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The Spirit of Te Ariari O Te Oranga

Underpinning Te Ariari is a philosophy representing a set of principles & values:

person-focused wellbeing orientated integrated care Walk the talk


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Exercise 1: Personal ValuesComplete the Values Paper Card Sort Questionnaire

In pairs or threes, share your three most important values

One person leads a discussion with the other around one of the top three values

1. What is it about this value that is important to you?

2. To what extent do you feel you are or are not able to live up to this value?3. Are there ways you would like to be living up to this value more

than you are at the moment4. How do you express this value in your work?

5. Are there ways you would like to express this value more in your work?


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Part A: Overview of CEP


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Background Information:

The Nature, Extent and Impact of CEP


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Definitions:

Background Information

Clinical Definition:

The co-occurrence of mental health and substance use problems inone person at the same time

Synonyms:

Double Trouble, Dual Diagnosis, MICA, Comorbidity, Co-existing Disorders

Co-occurring Disorders

*Co-existing Problems (NZ)


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The Nature of CEP:

Heterogeneous Ranges from simple to multi-dimensional & complicated Poor outcomes Exposes weaknesses in health system


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Generic

Specific


The Nature of CEP:


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Te Rau Hinengaro: The New Zealand Mental Health Survey (2007)

Psychiatric Disorder % who suffer SUD

Depressive 30

Bipolar 50

Schizophrenia 50

Antisocial PD 80

Anxiety 30

Phobic 25


General Epidemiology SUDS in people with MH Problems:


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N=105, From Adamson, Todd et alAust NZ J Psychiatry 2006;40:164-170

Disorder Current Lifetime Onset (SD)

Any Mood 53% 73% 19 (10)

MDE 34% 44% 20 (11)

Any Anxiety 65% 77% 13(10)

PTSD 31% 45% 19(11)

Social Phobia 31% 37% 12 (7)

Any Axis 1 74% 90% 13 (9)

ASPD 27% 41% 9 (4)*

* Childhood conduct disorder


NZ Epidemiology:


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Standard Approaches to CEP Core Components:

Core Components of CEP programmes include:o Comprehensivenesso Treatment integration MH & AOD treatments delivered by a single teamo Assertive Community follow-upo Staged interventionso Harm minimisationo Long-term perspectiveo Recovery approacho MI + CBT

Integrated Continuous Systems of Care (Minkoff)o Fully integrated teamo Multiple coordinated teamS

TIP42 (2005) http://www.ncbi.nlm.nih.gov/books/NBK64197/


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Difficult to implemento training but limited action - thinking v doing gapo fidelity of implementation of EBPs e,g, MI

Effectiveness questionableo Group counselling,o Contingency management,o Long-term residential treatment

Engagement remains problematico 30-50% with serious CEP engage

Constructs and models usedo based on chronic psychosiso treatment integration = serviceso Integration = AOD + MH


Limitations of Current Approaches:


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Part B: Te Ariari & the 7 Key Principles


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Te Ariari O Te Oranga

Te Ariari o te Oranga Download

The Assessment and Management of People with

Co-existing Mental Health and Substance Use Problems 2010


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Three Dimensions of CEP Practice

Spirit Principles - Techniques:

Spirit

Principles

Techniques


2. Recovery & Well-being

3. Engagement4. Motivation

5. Assessment

6. Management

7. Integrated Care

Person-focused care

Well-being orientated care Integrated care

Walk the Talk


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Underpinning Te Ariari is a philosophy representing a set of principles & values:

person-focused wellbeing orientated integrated care Walk the talk


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The Spirit of Te Ariari: Person-focused Care


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Not patient/consumer/client

Treat problems always in the context of persons

values and vision of wellbeing

Empower partnership, participation, protection

Better:

engagement motivation,

treatment compliance service satisfaction

Person-focused Care:

The Spirit of Te Ariari


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Four interventions that can assist this process

1. Measuring treatment improvement by rating overall quality of life:

(WHOQOL (100 item questionnaire) & WHOQOL-BREF)

http://www.who.int/substance_abuse/research_tools/whoqolbref/en/

and Identifying:

2. Personal values(Values Card Sort Execise Paper Version)

3. Strengths(Character Strengths Assessment, VIA Signature Strengths)

4. Identify Hopes, Aspirations &Wellbeing

(Best Possible Self Exercise)

Person-focused Care Tools and Strategies:



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The Spirit of Te Ariari: Well-being Orientated Care


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Exercise: Best Possible SelvesThink about your best possible self at some point in the future say, in

5 years time.

Imagine yourself after everything has gone as well as it possibly couldYou have worked hard and succeeded at accomplishing all of your life

Goals.

Think of this as the realization of your own best potential. You are realistically

Identifying the best possible way that things might turn out in your life.

Take a few moments to write down what this life would be like.


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People desire a state of flourishing; a high degree of wellbeing

Well-being Orientated Care:



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They experience distress when they are languishing i.e there is a significant

gap between their desired and actual state of wellbeing.

Well-being Orientated Care Distress:



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Well-being Orientated Care Seeking Help:



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Well-being:



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Key aspects of recovery include:

Multiple unique path to recovery

Hope Self-responsibility

Meaning as a valuable member of society Identity distinct from that of patient or consumer Finding a valuable nicheBeing a consumer is a culture - Partnership, Participation,

Protection


Recovery:


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Well-being:

People who have recovered from

depression have lower levels ofwellbeing than those who have never

been depressed.

+ interventions have a moderate size

effect depressive symptoms

Quality of life can be improved withno improvement in symptoms of

disorder


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Implementing a Well-being Approach:

Key steps to implementing a well-being approach include:

Identifying the persons definition of wellbeing for themValues congruence, strengths, hopes and aspirations (Well-being)

Enhancing functioning in positive domainspositive experiences, positive thinking, relationships

Improving functioning in deficit domainscomprehensive assessment formulation

Incorporate positive interventions into treatment planning.


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Strategies to Enhance Well-being:


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www.authentichappiness.com


Strategies to Enhance Well-being:


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The Spirit of Te Ariari: Integrated Care


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Integrated care comes from:

Understanding what wellbeing means for theperson

Starting with the needs of the person Considering both pathways to wellbeing andbarriers to wellbeing (deficits)

Multi-dimensional integrated formulation & plan Effective collaboration Systems organised to support integrated care

Integrated Care:



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MentalHealth

Corrections

AODPhysicalHealth

Education

running an efficient system

FinancialWorkforce

Policies/Procedures


Systems Integration:


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running an efficient and coherent service

Treatment Integration:



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enhancing wellbeing of people and their and families

Integrated Care:



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Process of Integration:



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Walking the Talk:

The Spirit of Te Ariari: Walking the Talk

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The 7 Key Principles


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2. Well-being

3. Engagement

4. Motivation

5. Assessment

6. Management

7. Integrated Care


7 Key Principles


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Pre-treatment

Early Treatment

Middle Treatment

Late Treatment

Autonomous Independence


Phases of Treatment:


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Tools for Enhancing Practitioner & Service

Capability


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Tools for Practitioner & Service Capability

System Wide Development Model:

A number of tools have been produced to help services and practitioners

self-assess their CEP capability:

1. Co-existing Problems (CEP) Resource Map

http://www.tepou.co.nz/improving-services/co-existing-problems/cep-roadmap Part of the Te Pou website which includes a links to a large number of

local resources CEP relevant resources

2. Co-existing Problems (CEP) Service Checklisthttp://www.matuaraki.org.nz/library/matuaraki/co-existing-problems-cep-service-checklist

A checklist approach to service self-assessment of CEP capabilitydeveloped by Matua Raki (National Addiction Workforce Development

Centre

3. Co-existing Problems (CEP) Tools and Resourceshttp://www.matuaraki.org.nz/library/matuaraki/co-existing-problems-cep-tools-and-resources-may-2011

Downloadable PDF listing and linking to a range of local and international

CEP resources and readings.


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Tools for Practitioner & Service Capability

System Wide Development Model:

4. fraserscepblog.com

5. Practitioner CEP Skill Set and Capability Checklist


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Enhancing of Service Capability

Developing Capability:


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Enhancing of Service Capability

System-wide Development Model:

1. Across-servicegeneric training

2. Service-based

training

3. Collaborative

Learning


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CDHB CEP Action Plan

Goals and Objectives:

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Exercise 2: Your Service CapabilityIn small groups, look through the CEP Service Checklist. Discuss how your service

meets the objects, and what more needs to be one to meet them.


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CEP Service Checklist

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Service Planning and Development:

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Service Workforce Development:

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1b. Introduction to CEP Workshop for Managers (NXPowerLite)

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