The Modified The Modified Therapeutic Therapeutic CommunityCommunity

A Method of A Method of Treatment for Treatment for

MMentally entally iill ll

CChemical hemical AAbusers busers (MICA)(MICA)

Estoril, Estoril, Portugal,2009Portugal,2009

MICA MICA ProgramProgram

Inaugurated in 1995, the first residential program was situated Inaugurated in 1995, the first residential program was situated in our campus north of Montreal. in our campus north of Montreal.

Relocated in the City of Montreal in the year Relocated in the City of Montreal in the year 2000:2000:

Located closer to our partnersLocated closer to our partners Located closer to the medical institutionsLocated closer to the medical institutions Facilitate accessibility to our servicesFacilitate accessibility to our services Facilitate social reintegration Facilitate social reintegration

MICA ProgramMICA Program

Residential program: from 10 to Residential program: from 10 to 12 months12 months

capacity: 21 mencapacity: 21 men

Supervised apartments: 6 months Supervised apartments: 6 months to 2 yearsto 2 years

capacity: maximum 10 mencapacity: maximum 10 men

The Therapeutic The Therapeutic CommunityCommunity

Highly-structured and safe environment (24 hours) Highly-structured and safe environment (24 hours) Predictable, regular pattern and daily schedule Predictable, regular pattern and daily schedule Method of treatment based on self-help/mutual helpMethod of treatment based on self-help/mutual help The community itself - residents and staff - is the The community itself - residents and staff - is the

primary therapistprimary therapist

Learning is made possible by:Learning is made possible by:– Participation in activities and psycho-educational Participation in activities and psycho-educational

groupsgroups– Residents take on various roles and Residents take on various roles and

responsibilities responsibilities – Residents being exposed to positive role Residents being exposed to positive role

modeling from peersmodeling from peers

The Modified Therapeutic The Modified Therapeutic CommunityCommunity

Takes into consideration:Takes into consideration:• Psychiatric symptomsPsychiatric symptoms• Cognitive impairments Cognitive impairments • Capacity to integrateCapacity to integrate• Concentration difficultiesConcentration difficulties• Level of motivationLevel of motivation

Slower paced and a longer lasting programSlower paced and a longer lasting program

Our ClientsOur Clients

Admission Criteria:Admission Criteria:

Adults, male Adults, male Addiction to drugs and/or alcoholAddiction to drugs and/or alcohol Chronic psychotic disorders (Axis 1 diagnosis)Chronic psychotic disorders (Axis 1 diagnosis) Stability in regards to their mental healthStability in regards to their mental health Psychiatrist and medical team involved Psychiatrist and medical team involved Voluntary engagement to follow treatment Voluntary engagement to follow treatment

programprogram

Evaluation Process and Evaluation Process and AdmissionAdmission

Information on the programInformation on the program Screening for eligibilityScreening for eligibility Request for admissionRequest for admission Contact with medical teamContact with medical team Request for information neededRequest for information needed EvaluationEvaluation Pre-admission groupPre-admission group Visit to treatment centerVisit to treatment center AdmissionAdmission Case conferenceCase conference

Treatment ObjectivesTreatment Objectives

Eliminate abusive consumption of Eliminate abusive consumption of drugs/alcohol drugs/alcohol

Gain a greater comprehension of mental Gain a greater comprehension of mental illness, symptom management, medication illness, symptom management, medication compliancecompliance

Decrease hospitalization Decrease hospitalization Develop skills and acquire social aptitudesDevelop skills and acquire social aptitudes Improve interpersonal and family relationships Improve interpersonal and family relationships

and develop a better social support systemand develop a better social support system Facilitate social reintegration: education, Facilitate social reintegration: education,

employment and volunteer workemployment and volunteer work

Program & StructureProgram & Structure

Structure:Structure: Intense and highly structuredIntense and highly structured Predictable and safe environment Predictable and safe environment Shorter groups and activities (45 minutes)Shorter groups and activities (45 minutes) 3 phases of treatment (residential, supervised apartments and 3 phases of treatment (residential, supervised apartments and

aftercare)aftercare)

Program:Program: Adapted to the individual’s needsAdapted to the individual’s needs Individual approach (Intervention plan and case conference)Individual approach (Intervention plan and case conference) Development of competenciesDevelopment of competencies Community meetings and psycho-educational groupsCommunity meetings and psycho-educational groups Socio-cultural activities (i.e. museum, theater…)Socio-cultural activities (i.e. museum, theater…) Recreational activities and sports (water polo, volleyball, soccer)Recreational activities and sports (water polo, volleyball, soccer) Workshops (budget, cooking, ironing, sewing)Workshops (budget, cooking, ironing, sewing) Family supportFamily support

CompetenciesCompetencies

Organized and orderlyOrganized and orderly ConsistentConsistent ReliableReliable Active participation in Active participation in

own recoveryown recovery Ability to plan structured Ability to plan structured

activitiesactivities Ability to lead structured Ability to lead structured

activitiesactivities Transfer of learningTransfer of learning Take initiativeTake initiative Express self Express self

appropriatelyappropriately Encourage othersEncourage others

Accept to be supervisedAccept to be supervised Teamwork abilitiesTeamwork abilities Communicate Communicate

effectivelyeffectively Social integration Social integration

abilitiesabilities ObjectiveObjective EmpathicEmpathic Decision-making Decision-making

abilitiesabilities Problem-solving abilitiesProblem-solving abilities Ability to ask for helpAbility to ask for help Conflict resolutionConflict resolution Self-awarenessSelf-awareness

A Day in the A Day in the Therapeutic CommunityTherapeutic Community

The day starts at 6:45 a.m.The day starts at 6:45 a.m. Morning meeting Morning meeting Psycho-educational group Psycho-educational group Seminar / WorkshopsSeminar / Workshops Lunch Lunch Sport activities or workshopsSport activities or workshops Community meetingCommunity meeting SupperSupper Night meetingNight meeting

The day ends at 9:00 p.m.The day ends at 9:00 p.m.

Psycho-Educational Psycho-Educational GroupsGroups

Relapse preventionRelapse prevention Stress managementStress management Basic Values Basic Values Conflict resolutionConflict resolution Symptoms and triggersSymptoms and triggers Identifying and managing emotionsIdentifying and managing emotions Social SkillsSocial Skills Developing a positive support systemDeveloping a positive support system

Other GroupsOther Groups

Planification and presentation of Planification and presentation of outingsoutings

Presentation of intervention planPresentation of intervention plan Phase groupsPhase groups Competency groupsCompetency groups Business meetingBusiness meeting BudgetingBudgeting

Case ManagementCase Management

Case Conference:Case Conference:– Telephone conference on a monthly basisTelephone conference on a monthly basis– Every 3-4 months or when neededEvery 3-4 months or when needed– Educator, resident, medical team and family Educator, resident, medical team and family

presentpresent– Evolution of resident, goals and objectives Evolution of resident, goals and objectives

discusseddiscussed

Intervention plan:Intervention plan:– On a monthly basisOn a monthly basis– Objectives and means discussedObjectives and means discussed

Family ServicesFamily Services

Biweekly support groupsBiweekly support groups– Various themes: drug addiction, mental Various themes: drug addiction, mental

illness, dual disorder, parenting styles, illness, dual disorder, parenting styles, setting limits, dealing with crisis,setting limits, dealing with crisis, relapse relapse prevention, communication effectively.prevention, communication effectively.

Individual and family meetingsIndividual and family meetings

Family daysFamily days

Social ReintegrationSocial Reintegration

Supervised apartments: 6 months to 2 Supervised apartments: 6 months to 2 yearsyears– Weekly support groups Weekly support groups – Weekly supper meetings Weekly supper meetings – Individual counselingIndividual counseling– Active in society : volunteer work, employment, Active in society : volunteer work, employment,

schoolingschooling

Aftercare follow-upAftercare follow-up– Undetermined period, depending on the individualUndetermined period, depending on the individual– Individual meetingsIndividual meetings– Support groupsSupport groups

Portage MICA TeamPortage MICA Team

Multidisciplinary team:Multidisciplinary team:– educators, recovering addicts, social educators, recovering addicts, social

workers, psychiatric nurse working in workers, psychiatric nurse working in collaboration with the resident’s psychiatric collaboration with the resident’s psychiatric team. team.

Team responsibilities:Team responsibilities:– ensure the physical and psychological ensure the physical and psychological

safety of the residentssafety of the residents– supervise, guide, counsel and teach new supervise, guide, counsel and teach new

skills and competencies skills and competencies – ensure that medical and psychological ensure that medical and psychological

needs are metneeds are met

ConclusionConclusion

The MICA program helps residents :The MICA program helps residents :

– gain a better understanding of their mental gain a better understanding of their mental illness and addictionillness and addiction

– manage their medication and symptoms manage their medication and symptoms – reduce frequency of crisis hospitalizationreduce frequency of crisis hospitalization– increase competencies and skills developmentincrease competencies and skills development– become autonomous become autonomous – increase participation in community activitiesincrease participation in community activities– reintegrate school / work force / volunteer work reintegrate school / work force / volunteer work – reach his full potentialreach his full potential