Module 13: Active Treatment

Objectives

• To be able to recognise the signs of “readiness to change”

• To be aware of treatment options for active treatment

• To be able to devise an action plan using SMART goals

Dual Diagnosis Capabilities

• Interpersonal Skills: To be able to demonstrate effective skills such as active listening, reflection, paraphrasing, summarising, utilising open-ended questions, affirming, elaboration. Dual Diagnosis capability 7 level 2

• Care Planning in partnership with Service User: To be able to plan and coordinate care in collaboration with person with combined mental health and substance use, their carers, and other professionals. Dual Diagnosis Capability 12 level 2

• Evaluate care: To be able to collaboratively review and evaluate care provided with service user, carers and other professionals. To be flexible in changing plans if they are not meeting the needs of the service user. Dual Diagnosis Capability 14 level 2

• Help People to Access Care from Other Services: To have local knowledge of services appropriate to meeting needs of people with combined mental health and substance use; their eligibility criteria; to know how to refer to such agencies, and to support the service user whilst the referral is being processed. Dual Diagnosis Capability 15 level 2.

Transtheoretical Model Osher and Kofoed’s Four Stages

Precontemplation Engagement/early persuasion

Contemplation Early persuasion

Preparation Late persuasion

Action Active Treatment

Maintenance Relapse prevention

Active Treatment

• Client is both verbalising and showing behavioural indications of a desire to make active changes in their substance use.

• Defined as significantly reducing their use for one month

• Actively seeking ways to maintain or enhance this reduction.

• Decision MUST come from the client

Interventions For Active Treatment

• Individual focused counselling

• Group work (“active treatment” group)

• Self-help (-caution!!)

• Detox

• Family problem solving

• Substitute activities e.g. work programme, sport

• Contingency management

Exercise 1: Ready?

In pairs, discuss

• How do you know when someone is really ready for change? What would they be doing, saying etc?

• Think about the prisoners that you work with, and also yourself.

• 10 minutes

Readiness to change:

• decreased resistance

• resolve

• self-motivational statements

• increased questions about change

• envisioning

• experimenting

Hazards

• Underestimating ambivalence

• Overprescription

• Insufficient direction

Interventions include:

• Detox• Specific counselling• Assertiveness training• Self-help groups• Work and meaningful activities

• Usually involves other agencies at this point.

Exercise 2: What do you offer for AT?

• What kinds of treatments do you offer for people who are committed to change?

• What else is available?

• How successful are these treatment options?

• What else should be available?

Goal Setting (Egan)

• S=SPECIFIC

• M=MEASURABLE

• A=ACHIEVABLE

• R-REALISTIC

• T=TIME-LIMITED

• Collaboration/negotiation with client

• Evaluate progress-if struggling, review.