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Transcript of 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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Background Information
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
Background Information
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
Background Information
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
Background Information
NZ Epidemiology:
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Background Information
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
Background Information
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
1. Cultural Considerations
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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The Spirit of Te Ariari O Te Oranga
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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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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:
The Spirit of Te Ariari
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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:
The Spirit of Te Ariari
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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:
The Spirit of Te Ariari
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Well-being Orientated Care Seeking Help:
The Spirit of Te Ariari
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Well-being:
The Spirit of Te Ariari
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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
The Spirit of Te Ariari
Recovery:
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The Spirit of Te Ariari
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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The Spirit of Te Ariari
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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The Spirit of Te Ariari
Strategies to Enhance Well-being:
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www.authentichappiness.com
The Spirit of Te Ariari
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:
The Spirit of Te Ariari
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MentalHealth
Corrections
AODPhysicalHealth
Education
running an efficient system
FinancialWorkforce
Policies/Procedures
The Spirit of Te Ariari
Systems Integration:
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Treatment Integration:
The Spirit of Te Ariari
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enhancing wellbeing of people and their and families
Integrated Care:
The Spirit of Te Ariari
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Process of Integration:
The Spirit of Te Ariari
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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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1. Cultural Considerations
2. Well-being
3. Engagement
4. Motivation
5. Assessment
6. Management
7. Integrated Care
Te Ariari O Te Oranga
7 Key Principles
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Pre-treatment
Early Treatment
Middle Treatment
Late Treatment
Autonomous Independence
Te Ariari O Te Oranga
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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CEP Service Checklist
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CEP Service Checklist
Service Planning and Development:
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CEP Service Checklist
Service Workforce Development:
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