Download - ACT

ACT Fidelity
According to Research
Trauma-Informed
Practice
Psychosocial Rehab
ACT
Potpourri
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ACT Teams that score high
on fidelity are serving this
population
Topic 1
Who are
People living with complex
mental illnesses and
substance use disorders
and have very significant
functional impairments
High Fidelity ACT Teams
conduct outreach versus
office-based work, this
percentage of the time
(out of 100% of the work)
What is
GREATER THAN 75% OF
THE WORK IS IN
COMMUNITY
– HIGH FIDELITY = 80% - 90%
High Fidelity ACT teams
have this framework as
their focus
What is
Psychosocial
Rehabilitation
High Fidelity ACT Team
staff have these core
competencies - name at
least 4 – the first one is
“communication skills”
What Are
1.
2.
3.
4.
5.
6.
7.
8.
9.
Good Communication Skills
Motivational Interviewing
Strengths-Based /Client Centred
Trauma-Informed Lens/Practice
Conflict Resolution Skills
**Psychosocial Rehabilitation**
Knowledge of psychiatric meds
Mental Status Exam
Relapse Prevention – Addiction
knowledge
10. Cultural competence
High Fidelity ACT teams
complete comprehensive
assessments for each
client containing 7 areas
of functioning. Name at
least 3:
What are:
1. Psychiatric history/mental
status and diagnosis
2. Use of drugs and alcohol
3. Education and Employment
4. Social Development and
Functioning
5. Physical Health
6. Family Structure and
Relationships
7. Activities of Daily Living
BC Program of ACT Standards. 2008
Topic 2
According to the “Recovery
Oriented Language Guide”,
our language needs to be:
There are five main criteria, name 3 –
hint: the first one is ‘Respectful’
What are
1.Respectful
2.Non-judgemental
3.Clear and Understandable
4.Free of jargon, confusing data,
and speculation
5.Our language must carry a sense
of HOPE and COMMITMENT
According to research,
the fundamental goal of
ACT, to assist people to
participate fully in their
communities, is congruent
with this practice
perspective.
What is
A Recovery-Oriented
Approach
Salyers, M.P. and Tsemberis, S. (2007). ACT and recovery: Integrating evidencebased practice and recovery orientation on assertive community treatment teams.
Community mental health journal, 43 (6).
According to research,
people with a strong
presentation of Anti-Social
Personality Disorder should
be treated with these 3
“Principles of Care” on an
ACT team.
What are:
1. Treat with respect and compassion and humanity
like any other participant
2. Expect to be treated with respect and set the
delineations of language, and behaviour that is
team consistent…allow for progression of
respect over time to engage in a relationship
that can then lead to better role modelling
3. An emphasis on externalized control and
responsibilities of sanctions are more likely to
help create stability, and may lead to
“internalizing” some of the “external” messages
Musgrave, I. (2013). ACT services to patients with disorders of personality.
ACT Provincial Conference. March 17 Workshop. Victoria, BC
According to research, people
with this diagnosis assigned to
ACT showed a significantly
greater reduction in alcohol use
and were less likely to go to jail
than those in standard clinical
case management
What is
AntiSocial Personality
Disorder
Frisman, L.K., Mueser, K.T., Covell, N.H., Lin, H.J., Crocker, A., Drake, R.E. and Essock,
S.M. (2009). Use of integrated dual disorder treatment via assertive community
treatment versus clinical case management for persons with co-occurring disorders
and antisocial personality disorder. The journal of nervous and mental disease. 197
(11).
According to researcher and
author, Bruce Alexander
(Globalization of Addiction), the cause of
addiction is dislocation –
separation from one another,
culture and community. What is
the solution to address
addiction according to this
perspective?
•
•
•
•
Restore social spending
Enhance our ability to care for one another
Invest in social housing
Reform our public services, so they become more
nurturing
• Rebuild programs like welfare and UI that give
people choices and allow them to stay in their
home communities
• Place full employment once again at the top of the
public policy agenda
• On a global level, substantially reducing the
addiction problem requires nothing less than
exercising sensible, humane controls over
markets, corporations, environments, public
institutions, and international agencies to reduce
dislocation.
Alexander, B.K. (2001). The roots of addiction in a free market society.
Canadian centre for policy alternatives. April.
Topic 3
Trauma can be stored in
the body as somatic
symptoms. Name at least 3:
What are
•Headaches
•Gastrointestinal problems (irritable
bowel syndrome; pelvic inflammatory
disease)
•Hypertension
•Chronic pain that is unidentified (i.e.
fibromyalgia)
•Low energy
•Panic – rapid heartbeat; sweating;
heavy feeling on the chest; weak legs
By its very nature, trauma
is defined by events that
are ____ and ___, and
produce feelings of
helplessness and/or
feelings of ‘horror’
What is
Unpredictable
and
Uncontrollable
Common trauma symptoms
include (name at least 3):
What are
•
•
•
•
•
•
•
•
•
•
•
Avoidance
Hypervigilance
Sleep disruption (too much or too little)
Anxiety/Depression
Reliving the experience
Addictions (as coping)
Psychosomatic symptoms (body pain)
Personality disruption (developmental
trauma)
Feeling numb and empty
Intense emotions seemingly from nowhere
Dissociation/ Derealization/
Depersonalization
In Trauma-Informed
Practice, we work to
provide this to clients in
all our interactions:
(to counteract the feelings of
helplessness and of being in danger)
What is providing…
• Safety or Predictability
• Choice
• Control
This nervous system is
overactive in many people
who have experienced
trauma and meet criteria
for PTSD
What is the
Sympathetic Nervous
System
Responsible for the
FIGHT, FLIGHT and FREEZE responses.
Grounding and containment skills are
required when people are activated
Topic 4
According to PSR Canada’s
guidelines, the Core Principles
and Values include PSR
Practitioners conveying these
two things:
What are
HOPE and RESPECT
http://www.psrrpscanada.ca/index.php/src=gendocs&link=About
Psychosocial
Rehabilitation builds on
these two qualities of
individuals served by
ACT Teams
What are
STRENGHTS
and
CAPACITIES
http://www.psrrpscanada.ca/index.php/src=gendocs&link=About
Psychosocial
Rehabilitation practices
help individuals improve
the quality of these
aspects of their lives:
Name at least 3
What are
1.
2.
3.
4.
5.
6.
7.
Social
Occupational
Education
Residential
Intellectual
Spiritual
Financial
http://www.psrrpscanada.ca/index.php/src=gendocs&link=About
The Recovery Model and
Psychosocial Rehabilitation
Model are often considered
synonymous. Recovery
means helping people to do
this:
What is
Help people get back
to work and live on
their own
People with lived experience
who have been instrumental in
developing the Recovery
Model, say they need mental
health workers to provide
these three things:
What are
HOPE
Validation
&
Encouragement
Topic 5
Compared with other
community services, ACT
has better outcomes for
client’s in these 3 realms:
What are
1. Quality of Life
2. Psychiatric
Symptoms
3. Social Functioning
»
»
»
Includes: reduced hospital
admissions
Longer housing stability
Reduced substance use
According to “100 Ways to
Support Recovery”, staff
can support
transformation in the
mental health system by:
(there are 7 points, name at least 4)
https://www.rethink.org/media/704895/100_ways_to_support_recovery_2nd_edition.pdf
What is
1. Mental illness is part of the person, rather than the
person being a mental patient – i.e. “a schizophrenic”
2. Having valued social roles improves symptoms
3. Recovery goals come from the person, and support to
meet those goals comes from staff.
4. Assessment focuses on strengths, preferences and skills
of the person than on what they cannot do.
5. The normal human needs of work, love and play do apply
6. People with mental illness are fundamentally normal – i.e.
like everyone else in their aspirations and needs
7. People will, over time, make good decisions about
their lives if they have the opportunity, support and
encouragement, rather than being treated as people
who will in general make bad decisions so staff need
to take responsibility for them.
These are the Practice
Principles of an ACT
Team
Name at least 3
(there are 7 –
first one is “team approach”)
What are
•
•
•
•
•
•
•
Team Approach
Smaller caseload (8:1)
In-vivo care
Time-unlimited services
Shared caseload
Core providers (all care provided in context of the team)
24/7 coverage (or in collaboration with existing
services)
ACT is a specific modality
of community based care,
but according to the
www.ACT-BC.com website,
it is good to think of ACT
as this:
What is
A PHILOSOPHY of
care
with the relationship
between client and the
team at the core
ACT is different from case
management in 5 main ways.
Name at least 2
What is
1.
2.
3.
4.
5.
CASE MANAGEMENT
Silo’d workers w varying
skill sets on a team
Outreach not usually a
component/moderate
intensity - office
Care is brokered out to
community services
Services are primarily
office-based
Time-limited service
1.
2.
3.
4.
5.
ACT TEAM
One core team of providers
with varying skill sets –
integrated team
Higher intensity and ability
to outreach 80% of the time
ACT provides ALL care – it
is not brokered out initially
Services are community and
home based < 75%
Time-unlimited service