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Implementing an evidence-basedmodel of recovery
in an inter-sectoralsetting.

• Alex Couley
• ausMHLP participant 2008

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SNAP2005-2008Partnerships with the University
of Wollongong MHRI of Victoria
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Introducing an evidence based model of care

• PARCS
• Collaborative Therapy
• Demonstrate process using
• Kotters eight step process
• Where to from here?

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PARCS

• Residential service for people eligible for adult
  mental health services
• It accommodates and provides care and treatment
  from 7 to 28 days to people who
• No longer require acute inpatient care and
  treatment and would benefit from short term
  intensive treatment and support in a residential
  setting
• Are living in the community and require short
  term intensive treatment and support to prevent
  risk of further deterioration

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PARCS

• Crucially no evidence to support efficacy
• Differing models emerging under vague guidelines
• Partnerships or sub contractual arrangements?
• Despite all of this state government pumping huge
  dollars into these services

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Collaborative Therapy (CT)

• A therapeutic framework for working with
  consumers, carers, service providers and others
  in a systematic way, in order to achieve optimal
  health outcomes.
• It has 3 core components
• - Education
• - Coping Strategies
• - Skills Development

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Session Title Content
1 What is health? Perceptions of health and behaviours that influence health
2 The I Can Do model, Part 1 Stress Understanding stress and how to recognise it breathing exercises
3 The I Can Do model, Part 2 Coping strategies Positive and negative stressors goal setting
4 The How to of the I Can Do Model Health Plan I Daily Coping Plan
5 The I Can Do model, Part 3 Vulnerability Cumulative stress, sub-optimal health, recognising vulnerable situations and early warning signs, collaborative partners
6 Coping strategies for optimal health Health Plan II Collaborative Strategies problem solving
7 The I Can Do model Episode of illness What does it mean to experience an episode of illness medication Health Plan III Action Plan
8 Review Putting it all together What is optimal health to me? Maintaining optimal health
Booster What is my health like now? Review health plans, problem solve vulnerable situations.
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Establishing the sense of urgency

• This was self evident
• About to open new unit with a team of individuals
  who had never worked in the mental health field
• Fractured relationship with clinical partners
• Restructuring the model became a very last minute
  thing
• Questions by clinical staff about efficacy of
  adapted approach
• Disputes about the time of delivery of CT

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Forming a powerful guiding coalition

• Small group brought together
• Myself
• Clinical services manager
• PARCS manager
• PARCS clinician

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Creating a vision

• The vision- to demonstrate that PARCS can work
  through the use of evidence based interventions
• To compare with a PARCS using an eclectic
  psychosocial approach

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Empowering others to act on the vision

• Brand new internal structure
• External barriers huge
• All staff trained together in CT
• Joint training delivered by the researchers and
  ourselves
• Generally well received by NGO staff but lots of
  scepticism by clinical team

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Planning for and creating short term wins

• Introduced outcome measures to capture the
  results
• Early results really positive, fed back to team

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Consolidating improvements and producing still
more change

• Created a lead person to monitor system
• Fidelity became a major issue
• Supervision of team
• Clinicians attitudes changed slowly but their
  managers didnt
• Still bickering about the time of the day of
  delivery

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Institutionalizing new approaches

• Agreement reached with two research teams to
  compare outcomes with another PARC
• Research proposal before ethics committees
• I left to take up post in NSW

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Where to from here

• Have agreed to implement three evidenced based
  recovery models across service in rural NSW and
  research the results
• Bigger challenges with staff attitude
• Plan involves using Kotters eight point process
  again
• Would like to look at the role of the change
  agent