International Summer School - 2016 Shadow sessions 28 and 30th of June 1. Intensive Home Treatment – IHT team An Intensive Home Treatment (IHT) team is an ambulatory multidisciplinary mental health team, specialized in giving short home treatment with the mission of to resolving crisis situations and prevent admission to an acute ward in a psychiatric hospital. When admission is needed, the team collaborates with the hospital team to shorten the length of the admission The IHT teams are the gatekeepers for all admissions in acute psychiatric care. We started working with three IHT teams in 2011, based on the English Crisis Resolution Home Treatment (CRHT) model. Preliminary studies in the Netherlands show that after the start of the multidisciplinary working Intensive Home Treatment teams (IHT), the duration of admissions was shortened. There was no increase in suicides and no increase in coercive admissions. The satisF-ACTion of clients and their families with the treatment offered by the IHT teams was high. At this Summer School you will be joining an IHT worker (one on one) to get an impression of the flexible way of working. You will join us on a regular working day, join the start-up meeting in the morning, do house visits, meet the different professionals like psychiatrists, casemanagers, peer-specialists, psychologists and team-coordinators. Also there will be attention on collaboration with the hospital, social network and family. 2. Flexible Assertive Community Treatment – F-ACT team Flexible Assertive Community Treatment (F-ACT) is a service structure model that integrates medical and social interventions within one team. The F-ACT model has been shown to be a successful model in different contexts as a basis for community mental health care. F-ACT was developed in the Netherlands to provide community mental health care for persons with a severe mental illness (SMI). Persons with SMI have in addition to psychiatric problems many limitations in their social functioning, for instance in relation to housing, self-care, employment and finances. Strengths in persons with severe mental illness are often overlooked and treatment is frequently limited to the symptoms of the psychiatric disorder. Important aspects of F-ACT are: • • • • • • •

Two levels of care within one team The use of a digital F-ACT board for patients who need daily monitoring Daily F-ACT team meeting. Recovery-oriented care. Working in a well defined region. Evidence-based medicine and best practices. Shared integrated and comprehensive care plan.

At this Summer School you will be joining a F-ACT worker (one on one) to get an impression of the flexible way of working. You will join us on a regular working day, join the F-ACT board meeting, do house visits, meet the different professionals like psychiatrists, casemanagers, peer-specialists, psychologists and team-coordinators. Also there will be attention on working together with the hospital, social network, day activity centers, family and coordination tasks.

3. Mental Based Treatment – MBT team and Flexible Assertive Community Treatment (F-ACT) Four years ago the mental health service GGZ Noord-Holland Noord started a new way of working for people with severe personality disorders. They started a new composed ambulatory team grounded on both Mentalization Based and Flexible Assertive Community Treatment ). Characteristics of this team are: • Treatment, both individual and in groups is based on the Mentalization Based Treatment method • Organization of the team in according to the F-ACT model with two levels of care and daily FACT-board meetings. • Work with shared caseload creates a whole team approach • Up and downscaling of care • 150 clients with a personality disorder, regularly in combination with complex trauma. • Clients have often a long history of mental health treatment and admissions with a lot of experience in failure of treatment and care. In this one to one shadow session you can experience a regular working day of a psychologist. You will learn about the characteristics of mentalization based treatment in combination with F-ACT. They will share the success and fail F-ACTors and proudly present the positive results. 4. Centre for Complex Treatment – CCB INTROSPECTION OF THE GIVEN TREATMENT We Don't Analyze The Patient But We Analyze The Treatment Process Including All Dynamics Between All Involved. In this shadow session you will experience in a one on one session the practical work in the Centre for complex treatment. Meet the clients and their caregivers. When the treatment process of a patient goes to the point of reaching deadlock., the Centre for Complex treatment can be consulted. The vison of this centre is that not the patient is complex but the treatment is, thus acknowledging the F-ACT that the treatment team plays a role in the deadlock. The Centre for Complex Treatment makes an assessment and consults colleagues within the mental health service who have relevant expertise. In a consultation with te patient, carers and these the treatment is put back on track. In the few cases in which this consultation doesn’t suffice, an admission to the Centre is possible as well. In this shadow session you will learn about the experiences we have with organizing this and how to optimally use the existing expertise of your own specialists. When dynamics between the caregivers, client and his/her social network are in a deadlock, our mission is to protect the patient from being excluded because of the complexity in treatment. When we are able to see the big picture, new expertise can point out contradictions within the treatment which may often lead to a new formulation of the problems they encountered. In most cases brings new helping insights to those who are involved.

5. Mental Health Hospital Mental Health Hospital Visiting the ward and experience hospitality and transmural working. The Mental Health Service GGZ Noord-Holland Noord has three Mental Health Hospitals in the cities of Heiloo, Hoorn and Schagen. These acute admission wards serve the Intensive Home Treatment (IHT) en Flexible ACT teams. The IHT and Flexible ACT teams are the gatekeepers for all admissions in the acute ward. When admissions is needed the ward collaborates intensively with the ambulatory team and of course with the patient and his family/network. The admission will be as short as possible. During this shadow session you will learn about this transmural way of working, about the meaning and results of closing the nurses offices and about the way the clients work with their family and caregivers on their goals during the admission.

6. Activity/work Centers Visiting tour and work together at the work centers in Heiloo. There is a wide range of work which allows many people to do what they are good at. Sometimes they need and receive a little support and sometimes a lot. This flexibility is what makes us strong. The Mental Health Service Noord-Holland Noord is at the moment in the process of turning labor projects into independent companies. These companies will offer paid work for an increasing proportion of the cliënts and unpaid activities for the cliënts who are not (yet) ready or able to do paid work. Companies in the region: • Restaurant/catering - "de keuken met Karakter" (Kitchen with character) • I-Connect - a consumer run company on IT technology • Cheese Dairy – Zuivels: a cheese manuF-ACTurer • Furniture store - MindsZ: design upcycling • Greenery – de Buitenkans: looking after the grounds and glasshouse for nursery of plants • Printing office - de Dijk Work is an important value in recovery. It strengthens your identity, it encourage to participate and meet other people. It gives meaning to your life. In this shadow session we show you what we do. We show where we work, you will meet the employers of the small companies and the coaches.

7. Peer Support In 2005 the mental health service GGZ Noord-Holland Noord employed the first peer-specialist and the last 5 years 30 peer-specialists have a payed job in several services like; • Flexible Assertive Community Treatment teams • Recovery colleges • Psychiatric Hospital • Long-stay psychiatric-inpatients • Intensive Home Treatment (IHT) • Forensic Psychiatric Hospital • Center for Autism • Geriatric Psychiatry There is no better person to inspire and raise hope in an individual who suffers of mental health problems than someone who has “walked the same path” as that individual. The Peer Support Specialist credential is I.T.E., “I’m the evidence. I've been there” Peer Support is a way of sharing your personal story and of being in a relationship that empowers people to recover, a way of offering help and support as an equal, a way of teaching, learning and growing together, an attitude that values each person's experience. In this Summer School shadow session you will meet peer specialists on their regular working day in a one on one session. Learn about the different roles, their focus on recovery, the recovery colleges and the way they build bridges. 8. IPS – Individual Placement and Support Individual Placement and Support (IPS) is an integral part of the F-ACT Team. It is based on supporting people towards competitive employment and is accessible for all who want to work (zero exclusion): expressed motivation is the only criteria! Other important aspects of IPS are: • • • • •

Fitting 'the job to the person’. Depending on the clients wishes and possibilities this could be parttime or fulltime. Based on rapid job search and placement. Minimizes pre-employment assessment and training ‘place-then-train’. Relies on close working between employment specialists and clinical teams. Provides individualized, long-term support with continuity. Includes access to expert benefits counseling.

At the Summer School you will be joining a IPS professional (one on one) to get a glimpse of what this field enhances. You will join us on a regular working day which can vary from joining the F-ACT meeting, coachings sessions for people who are in the process of attaining a job, coaching on the job when already working or building a network of employment opportunities.

9. Management and policy In Europe and elsewhere, countless challenges arise from trends such as e-Health, smart medicine, robotics, demographic trends and changes in the lifestyle of people. Good management in Health Management Organisations is crucial in order to solve these and other complex issues in health care adequately. In this meeting with the Board of GGZ NHN you can learn about management of community mental health care. The Dutch healthcare system is a dynamic world in which we often have to deal with complex issues. We will make it clear that addressing these issues requires a creative and flexible approach and commitment of our professionals. In this sense it is a business administration program for managers and professionals in the healthcare sector. It focuses on optimum demand-driven and efficient care. In the session we combine the GGZ NHN strategic perspective with the use of innovative business concepts. Besides the usual business management tools, we will show how we come to solutions to the often difficult issues faced by administrators, health care managers and professionals. This session is intended for individuals with strategic responsibility, who want to enhance their managerial competence. Participants include members of a management team, care managers or (cluster) healthcare managers. For medical specialists and nurses who will have more management roles in the future, this session is also suitable.

10. Research and monitoring In The Netherlands, like in many other countries, routine measurement of outcomes of treatment and care is adopted as part of our national system of quality management. In the Mental health care organization GGZ Noord-Holland-Noord the measurement of outcomes is additionally used to do research, often naturalistic prospective research in which we evaluate the effectiveness of our treatment models. The study of the outcomes of the implementation of the Flexible ACT (Nugter et al, 2015) is an example of such research. In this study we added several clinical important outcome measures to the obligatory instrument (in this case the health of the Nation Outcome Scales, HoNOS), and we combined clinical outcomes with parameters of use of care, like the number of admission days and face-to-face-contacts. To explain changes in outcomes we generated process data about the way the Flexible ACT model was performed. This model of evaluation of care, the combination of relevant and specific outcomes with process data is now being further developed for the evaluation of other treatment packages with other patient groups. In this meeting with researchers of the Department of Research and Monitoring you will learn what is needed to implement routine measurement of outcomes, to feed outcomes back to teams in order to learn and improve and how to register and generate data to do analysis on process- and outcome data. This session is meant for researchers who are interested in research that is relevant for daily practice, for information analysts, but also for policy makers and quality managers. Reference M. Annet Nugter, Fabiana Engelsbel, Michiel Bähler, René Keet & Remmers van Veldhuizen (2005). Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study Community Mental Health Journal, DOI 10.1007/s10597-015-9831-2

11. Dolhuys – museum

Visit the Museum of the Mind in Haarlem. Experience the world of mental health problems in the Dolhuys. Meet madmen and lunatics, or clients as they are known today, in our interactive museum and find out how the Netherlands has dealt with mental health problems throughout the centuries. A printed guide is available in German, English and French. The bus trip from Heiloo to Haarlem is included. More information: http://www.hetdolhuys.nl/english-info