WHOS New Beginnings ®

This presentation will briefly discuss 4 recent innovations at WHOS NB to improve client care for women accessing the TC.

These are;

1. Acceptance and Commitment Therapy Mental Wellness Groups

2. PTSD Information Groups

3. Cognitive Remediation Trial

4. Improving treatment for clients with Borderline Personality Disorder

• Women only service

• 24 Bed TC, located in Rozelle, Sydney

• 3-6 month program with the option of re-entry program and accommodation

• Occupancy – 100% (current financial year)

• 80% FaCS involvement

• Seriously disenfranchised client group with significant mental health issues as demonstrated in the next slide

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Title

During the last 30 days have you experienced? Mental Health Screening Form (June 2015)

During your lifetime

During the last 30 days

Anxiety / Panic symptoms 85% 58%

Strong fears (e.g. agoraphobia) 85% 51%

Taken psychiatric medication 74% 52%

Depressive symptoms 79% 32%

Nightmares / flashbacks from traumatic events

75% 54%

Emotional problems associated with sex life 67% 27%

Given into aggressive urges more than once 59% 5%

Psychiatric hospital admission 38% 5%

Attempt to kill themselves 52% 5%

Heard voices/saw objects others couldn’t see 39% 3%

Client assessment data demonstrated clients were experiencing serious mental health symptoms

Client and staff focus groups (2013, 2014) clearly identified the need for further mental health support, particularly in relation to managing mental health distress and trauma

A range a research and training grants were sought to:

◦ Employ a research assistant

◦ Review the relevant evidence based literature

◦ Develop a range of appropriate interventions

◦ Comprehensively evaluate the findings of the interventions

ACT is designed to help a person make life decisions and goals in-line with what they value most and to pursue these goals despite feelings of discomfort and/or distress they may experience

ACT aims to increase a persons resilience to unpleasant emotions

Six 1 hour, experiential groups were developed in consultation with ACT experts

Staff were comprehensively trained to deliver the intervention ensuring long term sustainability of the groups

A clinical trial where the control and treatment groups are facilitated simultaneously was not feasible due to small client numbers and practical considerations of running a service

The Mental Wellness ACT Group Intervention was delivered once a week, for six weeks, clients had to have completed 4 hours of the intervention to be included in the treatment group

The control group data was collected from clients who were in NB from 3 months to directly before the ACT group Intervention was trialed. To be included in the control group women had to have completed at least 4 weeks standard treatment

K10 Plus - screens for mental health symptom distress, higher the score the more the distress

PTSD Symptom Checklist - higher the score, the more the distress

EUROHIS QOL- Quality of Life, the higher the score the more satisfaction a client is feeling about their life

Qualitative data was also collected about what clients liked most, least, recommended changes and any other comments

4-6 hours of ACT group-work over 4-6 weeks,

1 hour per week

0

5

10

15

20

25

30

Control Condition

(Including CBT

Groups)

ACT Group

Recipients

(Treatment

Condition)

KesslerK10

Baseline

Kessler K10 After

4 weeks

treatment

0

5

10

15

20

25

30

35

40

45

Control Condition

(inlcuding CBT

Groups)

ACT Group

Recipients

(Treatment

condition)

PTSD Checklist

Baseline

PTSD Checklist after 4

weeks of treatment

0

5

10

15

20

25

30

35

Control Condition (including

CBT Groups)

ACT Group Recipients

(Treatment Condition)

Baseline EUROHIS QOL

EUROHIS QOL

Designed to provide psychoeducation to clients about trauma, trauma symptoms and how to safely support a peer if trauma stories are disclosed

The Intervention consisted of four, 1 hour groups received in the first four weeks of treatment

To be included in the Treatment Condition clients had to have completed between 2-4 groups

To be included in the control condition clients had to have been in treatment for a minimum of 2 -4 weeks

Minimal effort was required to achieve these results (2 - 4 hours over 2 - 4 weeks)

0

5

10

15

20

25

30

35

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45

50

NB Control Group NB PTSD group

Baseline PTSD

Checklist

At least 2 weeks

treatment

0

5

10

15

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25

30

New Beginnings control

group

New Beginnings PTSD

group

Baseline K10

At least 2 weeks

treatment

22

23

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25

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30

NB Control Group NB PTSD group

Baseline QOL

At least 2

weeks

treatment

Prior research at WHOS had identified that approximately 45% of clients accessing the service will have impairment in executive functioning.

This effects a clients capacity to make decisions quickly and recognise emotions.

Through a Research Partnerships Grant with the University of Wollongong, Cognitive remediation group-work has been trialed, August 2015. The control group data will be collected over the next few months, results should be available early next year.

52% of women accessing NB will meet the criteria for BPD

WHOS has linked with Project Air to ◦ Review key policies and procedures

◦ Train staff

◦ Develop and evaluate new systems and paperwork (primarily the development of a Safety Plan and changes to client contracts)

◦ Currently collecting control data prior to implementing the new intervention which should take place early next year

The PTSD Groups and ACT groups are currently run simultaneously and have been embedded into NB Group program schedule

Clients currently receive the PTSD Information groups for the first four weeks of treatment

Once they have completed the PTSD Information groups they then complete the ACT groups

Decisions relating to the Cognitive Remediation Group-work will be determined post study results becoming available

Similarly decisions re: the usefulness of the new BPD treatment strategies will depend upon the outcomes of the current study

Contact:

New Beginnings Manager - Sarah Etter

Phone: +61 2 85 727 421

Email: sarahe@whos.com.au

Website: www.whos.com.au