ENGAGING THE DISENGAGED CLIENT
Hello! Matthew Cheng, BN Assistant Team Lead
Jane Kinoshita, BN, RN Registered Nurse Pathways to Housing – The Alex Calgary, Alberta, Canada
Pathways to Housing Mission To end homelessness for people who suffer from psychiatric disabilities by providing housing first and giving support and treatment for their recovery and integration into the community.
Pathways to Housing • Part of the Alexandra (Alex) Community Health Center. • Based on the Pathways to Housing program in New York started by a Canadian psychologist from Montreal. • P2H is an interdisciplinary team. • Uses a housing first approach. • Using Evidence-Based approaches to recovery and community integration for people with psychiatric disabilities. • Has been in operation for 7 years.
Program Design • There are 200 client spots in the program and we are currently at capacity. • Team One: Mental Health and Addictions and Team Two: Justice focus and Addictions Team Three: Hospital and Justice focus (as of Jan 1/2013) Team Four: Step down team • Each team has a capacity of 60 clients.
Learning Objectives • Attempt to define what “disengagement” looks like • Explore the signs and symptoms of burnout • Identify tools for engaging the disengaged
Activity!
Symptoms of Disengagement • • • • • •
Multiple physical health challenges Mental health diagnoses or concerns Concerns with daily living skills Addiction Challenging behaviours Justice Involvement
Jim
“He’s never home”
The Risks of Disengagement
• • • • •
Language and culture of a program Labeling/blaming of clients Risk of staff disengagement Client care is compromised Risk of returning to homelessness
Cheryl
“She’s so unpredictable”
Roots of Disengagement • • • • • •
Institutionalization Trauma Negative prior experiences with system Major transition is terrifying Health/healthcare is not a priority (yet) Low tolerance for accepting care/support
James
“He can’t stay housed”
Break
Sympathy vs. Empathy https://www.youtube.com/watch?v=1Evwg u369Jw
What to do?
Engaging is our responsibility!
Utilize a Strength Based Approach
-Acknowledges clients have the strength, resources and ability to recover from adversity -Shifting away from “what is wrong” towards “what can you do” -An understanding of strength can help to prevent or lessen the damage of disease, stress and disorder
Resilience Is demonstrated in the ability to remain flexible and experience positive adaptations even when one’s life circumstances are riled with stressors and strain.
Resourceful
Hope • Carrying hope for others • “If we believe recovery is possible, even if people cannot it for themselves, we will hang in there and maintain a posture of patience while keeping our creative energies open”
Empowerment • • • • •
Choices and options Autonomy Perception of choices Confidence Ability to seek facilitate action
Motivational interviewing
http://motivationalinterviewing.org/ https://vimeo.com/56949751
Spirit of Motivational interviewing
Activity • One person describes a recent event in their life (event can be a struggle, a success, a very normal day) • Others in the group split up so some offer reflections and/or affirmations • Others just sit back and watch.. Then give feedback
Break?
What approaches and strategies have worked for you?
History of IDDT
• Developed by R. Drake, MD in 2003 at Dartmouth University • EBP: substance use treatment + mental health services = success
Components of IDDT • • • •
ACT or ICM Harm reduction Motivational interviewing Stage Wise Treatment
•
10
Integrated Dual Disorder Treatment
• • • • •
Diagnoses Strengths of the client Stages of change, Stage of Treatment Interventions Intentional Follow Up
•
10
Stages of Change
Precontemplation
Defensive Resistant to suggestions Uncommitted/passive towards treatment Lacking awareness Feeling coerced /pressured
Contemplation
Seeking to understand behaviour Distressed Seeking mastery Thinking about change Hasn’t taken action or prepared Has attempted change in the past Evaluating pros/cons of behaviour
Preparation/Action
Ready to change Engaged in the change process Has made a decision Shows effort Taking steps to modify behaviour/actions Open to suggestions
Maintenance
Working on sustaining change Working toward avoiding relapse
Stage Wise Treatment Stages of Change
Stages of IDDT Treatment
Clinical Focus
Consumer’s Internal Readiness to Change
Stage-specific Behaviours
Clinical Action
Pre-Contemplation
Contemplation and Preparation
Action
Maintenance
Engagement
- Build a relationship and working alliance with the consumer - Provide practical support for daily living; assess continuously.
Persuasion
- Understand the engaged client’s personal goals - Help the client find his or her motivation to consider reduction in substance use and to participate in other recovery-oriented activities.
Active Treatment
- Help the motivated client reduce substance use by acquiring skills and supports for managing symptoms of both disorders in pursuit of personal goals.
Relapse Prevention
- Help clients in stable remission develop and use strategies for maintaining abstinence and recovery.
IDDT Example – Dalt Wisney -
Name Diagnosis Stage of Change Stage of Treatment Substance Use Strengths Goal: - Intervention - Modality - Staff
Justin
NOW YOUR TURN?!?
IDDT Discussion -
Name Diagnosis Stage of Change Stage of Treatment Substance Use Strengths Goal: - Intervention - Modality - Staff
Team Health
This is hard! Acknowledge it!
People who work on the front lines in mental health and are trying to help folks who are the most disenfranchised are really the people I admire the most. ... They really save lives.
Robert E. Drake, MD, PhD
“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.” Elisabeth Kübler-Ross
Resources Clinical Guide for IDDT
Questions, Comments?
