Community Support Services Training Direct Care Series-Session 6

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Community Support Services TrainingDirect Care
Series-Session 6

• Zakia Clay, MSW, LCSW
• Zakia.Clay_at_shrp.rutgers.edu
• Ann Reilly, MA, LSW, CPRP
• Reillya2_at_shrp.rutgers.edu
• Anthony Zazzarino, MA, LPC, CPRP
• Anthony.Zazzarino_at_shrp.rutgers.edu

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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

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What makes IMR an evidenced-based practice?
(Pratt, Gill, Barrett Roberts, 2014)
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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
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IMR Modules
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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 ones 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, contd

• 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

• 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..

• 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
  timein 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 persons 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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Integrated Dual Disorder Treatment (IDDT)
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Core treatment components
(Center for Evidence-Based Practices)
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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
(Yalom, 1983)
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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)
• Dont 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 groups purpose

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Group Planning Process- Forms Discussion

• Lets 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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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/prac
  tices/sami/iddt.
• Corey, M.S., Corey, G. (2002). Groups process
  and practice. Pacific
• Grove, CA. Wadsworth Group.

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• 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.