Download Center for Evidence-Based Practices

Community Support Services Training
Direct Care Series-Session 6
Zakia Clay, MSW, LCSW
Zakia.Clay@shrp.rutgers.edu
Ann Reilly, MA, LSW, CPRP
Reillya2@shrp.rutgers.edu
Anthony Zazzarino, MA, LPC, CPRP
Anthony.Zazzarino@shrp.rutgers.edu
Rutgers, The State University of New Jersey
Learning Objectives
• Become familiar with Evidence-Based Practices
• Learn strategies and content in Illness Management and Recovery
(IMR) and its relationship to CSS.
• Demonstrate knowledge of Integrated Dual Disorder Treatment
(IDDT) best practices for supporting individuals with co-occurring
disorders
• Learn/review skills necessary to facilitate a structured task group
• Become familiar with characteristics and skills of an effective group
facilitator
Department of Psychiatric Rehabilitation & Counseling Professions
What makes IMR an evidenced-based
practice?
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(Pratt, Gill, Barrett & Roberts, 2014)
What are Evidence-Based Practices?
• Integrated Dual Diagnosis Treatment (IDDT)
• Assertive Community Treatment (ACT)
• Pharmacologic Treatment
• Psycho-Education for Families
• Supported Employment
• Illness Management and Recovery (IMR)
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Illness Management and Recovery(IMR)
• IMR is an evidence-based practice that helps people with mental
illness:
– Set meaningful personal goals
– Acquire skills necessary to cope with and manage their illness
– Make progress toward their recovery
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Core Values of IMR
Hope is the key
ingredient
Practitioners of IMR
are partners
The person is the
expert
Practitioners
demonstrate, not
dictate
Personal choice
is a must
Respect is
always present
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IMR Modules
• Recovery Strategies
• Practical Facts about Mental Illness
• The Stress-Vulnerability Model
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Building Social Support
Using Medication Effectively
Drug and Alcohol Use
Reducing Relapses
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Coping with Stress and Common Problems
Coping with Symptoms
Getting your Needs Met in the Mental Health System
Healthy Lifestyles
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IMR: Group Discussion
• Thinking of services contained in CSS
• Thinking of expected outcomes of CSS
– How do we use the tenets of IMR as an impetus to
support change?
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How does IMR relate to Community Support
Services (CSS)?
• Improved ability to manage one’s illness is a common recovery goal
• Avoiding relapses and re-hospitalizations gives people greater
control over their lives
• Less time spent dealing with mental illness allows more time to be
spent on personal recovery
• Less distress due to symptoms leads to a better quality of life
• Increases independence through skill development
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Strategies
• Motivational
-Convey confidence and hope
-Relate learning to goals
-Explore pros and cons of change
• Educational
-Active teaching
-Multiple methods
-Simple, normalizing language
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Strategies, cont’d
• Cognitive Behavioral
– Shaping
– Role Playing
– Modeling
– Reinforcement
• Homework
– Jointly agreed upon
– Individualized and goal related
– Behaviorally specific
– May involve or be facilitated by others
– Should be followed up
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Anticipated Outcomes
•
•
•
•
•
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Reduce relapses/re-hospitalization
Reduced symptom severity
Increased knowledge base
Increased medication management
Improved coping skills
Increased hopefulness and optimism
Improved social skills
Improved collaboration
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Small Group Activity
• Case Vignettes……..
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Integrated Dual Disorder Treatment
(IDDT)
The Integrated Dual Disorder Treatment (IDDT) model is
an evidence-based practice that improves the quality of life
for people with co-occurring severe mental illness and
substance use disorders by combining substance abuse
services with mental health services
(Center for Evidence-Based Practices)
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Why dual treatment?
• An estimated 45% of individuals with alcohol use
disorders had at least one co-occurring psychiatric
disorder
• In the National Comorbidity Study, approximately 78% of
alcohol-dependent men and 86% of alcohol-dependent
women men with criteria for a lifetime diagnosis of
another psychiatric disorder, including drug dependence
(Brady &Sinha, 2005)
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Negative life outcomes for individuals
dually diagnosed include…..
•
•
•
•
•
•
•
•
•
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Psychiatric episodes
Hospitalization and emergency room visits
Relationship difficulties
Violence
Suicide
Arrest and incarceration
Unemployment
Homelessness
Poverty
Infectious diseases, such as HIV, hepatitis, and sexually transmitted
diseases
• Complications resulting from chronic illnesses such as diabetes and
cancer
(Center for Evidence-Based Practices)
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Integrated Dual Disorder Treatment
(IDDT)
• Helps people address both disorders at the same time—in the same
service organization by the same team of treatment providers
• Emphasizes that individuals achieve big changes like sobriety,
symptom management, and an increase in independent living
• Takes a stages-of-change approach to treatment, which is
individualized to address the unique circumstances of each person’s
life
• Is multidisciplinary and combines pharmacological (medication),
psychological, educational, and social interventions to address the
needs of consumers and their family members
(Center for Evidence-Based Practices)
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Increases
Integrated Dual Disorder Treatment
(IDDT)
-Relapse
-Hospitalization
-Incarceration
-Duplication of
services
-High service
costs
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Reduces
-Continuity of
care
-Consumer
quality of life
outcomes
-Stable housing
-Independent
living
Core treatment components
Multidisciplinary
Team
Family
Psychoeducation
Participation in
Alcohol/Drug
Self-help
Stage-Wise
Interventions
Group
Treatment
Pharmacological
Treatment
Access to
Comprehensive
Services
Motivational
Interventions
Interventions to
Promote Health
Time Unlimited
Services
Assertive
Outreach
Substance Abuse
Counseling
Department of Psychiatric Rehabilitation & Counseling Professions (Center for Evidence-Based Practices)
Group Activity-Problem Solving
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Discussion Questions
• What is a group?
• In what situations are you called on to facilitate a group?
• How can you support your staff in their efforts to facilitate a group?
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What impacts a group?
• Content- materials brought to group
• Dynamics-internal issues (interrelationships between
members)
• Forces- external issues (time of day, membership,
environment)
• Leadership- attitude, preparedness
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Curative Factors in Groups
Installation of
Hope
Development
of Social Skills
Imitative
Behavior
Universality
Corrective
Recapturing of
Family Group
Interpersonal
Learning
Imparting of
Information
Altruism
Group
Cohesion
(Yalom, 1983)
Department of Psychiatric Rehabilitation & Counseling Professions
Types of Groups
• Counseling Groups – focus on growth and development
• Psychotherapy Groups – focus on
antecedents/diagnosis/links to present
• Self-Help Groups – peers share, support, and learn from each
other
• Task/structured Groups – skills learning and development
(our focus)
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Task/Structured Groups
• Characterized by a central theme
• Often singular or short-term
• Include readings, structured exercises and practice opportunities
(homework)
• Don’t require advanced clinical training
• Serve a variety of purposes: provide information, problem solving,
teach skills, share ideas, provide support
• NOT therapy or counseling groups
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Structure of the Group
• Each group has a lesson plan
• Plan describes the purpose and direction of the group (the what,
why, how)
• Each session addresses a topic based on the plan
• Group leader is responsible for maintaining focus on the group’s
purpose
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Group Planning Process- Forms & Discussion
Let’s take a look at a lesson plan form.
Is this plan different, or the same, as you would use for meeting
with an individual?
Can any of these steps be applied to your current preparation for
meeting with an individual?
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Characteristics of a Productive Group
• There is a focus on the here and now
• Goals of members are clear and specific
• Cohesion is high – a sense of emotional bonding in the group
• Conflict in the group is recognized and explored
• Members are willing to make themselves known
• Trust is increased and there is a sense of safety
(Corey, 2002)
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The Group Counselor: Person and Professional
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Courage
Modeling
Goodwill and caring
Openness
Non-defensiveness
Becoming aware of
your own culture
• Personal power
• Stamina
• Willingness to seek
new experiences
• Self Awareness
• Sense of humor
• Inventiveness
• Dedication and
commitment
Department of Psychiatric Rehabilitation & Counseling Professions
Group Leadership Skills
Active Listening
Questioning
Reflecting
Linking
Clarifying
Confronting
Summarizing
Supporting
Facilitating
Blocking
Empathizing
Evaluating
Interpreting
Terminating
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Round Exercise
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References
Brady, K.T., & Sinha, R. (2005). Co-occurring mental and substance
use disorders: The neurobiological effects of chronic stress.
The American Journal of Psychiatry, 162(8), 1483-1493.
Center for Evidence-Based Practices (CEBP) at Case Western
Reserve University.(n.d.). Center for Evidence-Based Practices
(CEBP) at Case Western Reserve University. Retrieved April
28, 2014, from
http://www.centerforebp.case.edu/practices/sami/iddt.
Corey, M.S., Corey, G. (2002). Groups: process and practice. Pacific
Grove, CA. Wadsworth Group.
Department of Psychiatric Rehabilitation & Counseling Professions
Jacobs, E. E., Masson, R.L., Harvill, R.L., Schimmel, C.J. (2009).
Group counseling strategies and skills. (7th ed.) Belmont, CA:
Brooks/Cole.
Pratt, C. W., Gill, K. J., N.M, & Roberts, M. M. (2014). Psychiatric
Rehabilitation. (3rd ed.) San Diego, CA: Elsevier Inc.
Yalom, Irvin D. (1983). Inpatient Group Psychotherapy. Basic Books,
NY.
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