CEP Workshop Series 2013

Module 5: Management 1
Fraser Todd and Michelle Fowler
2013
Workshop Introduction
Workshop Agenda
Mlhl and lnLroducuons
Pousekeeplng
Workshop overvlew
8evlew of lasL workshops acuon plannlng exerclse
lnLroducLory Mlndfulness Lxerclse
lrom lormulauon Lo 1reaLmenL lannlng
Worklng wlLh Croups
Worklng wlLh lamllles
Acuon lannlng
Exercise 1: Mindfulness Introduction
From Formulation to Treatment Planning
From Formulation to Treatment Planning
The Need for Structure:
1reaLmenL plannlng for people wlLh problems you are famlllar wlLh ls sLralghuorward
lL occurs lmpllclLly, Lhrough a process of pauern recognluon based on experlence
1hls process falls us wlLh cases whlch are complex or unfamlllar, llke CL ls llkely Lo be
SLrucLures for movlng from oplnlon Lo LreaLmenL plannlng are lnvaluable ln Lhese slLuauons
1hese sLrucLures also help pracuuoners Lo move Lo an advanced level of pracuce
From Formulation to Treatment Planning
Steps for Developing a Treatment Plan:
1he Cplnlon
PlsLory and MSL
lormulauon SLaLemenL
Coal ldenucauon and Semng
Coal lannlng
1reaLmenL lannlng
ulagnosls
roblems and SLrengLhs
Aeuologlcal formulauon
& 4x4 Crld
SLep 1:
SLep 2:
SLep 3:
SLep 4:
rlorluslng goals
Speclc lnLervenuons
10 polnL LreaLmenL sLrucLure
From Formulation to Treatment Planning
Step 1: Rachels Opinion Diagnoses, Problems and Strengths:
"#$%&
Ma[or uepresslve ulsorder
osL-Lraumauc sLress dlsorder
Alcohol dependence wlLh physlologlcal dependence
Cannabls dependence wlLh physlologlcal dependence
nlcoune dependence wlLh physlologlcal dependence
'()*+,-% ./0 12(,/324%
negauve rumlnauons
Pyper-arousal and lnLruslve memorles from rape
lmpulslvlLy
AvoldanL coplng sLyle
SLressful relauonshlp wlLh parLner
SLress of carlng for young chlld
Lack of asseruveness ln relauonshlps (dependenL LralLs)
From Formulation to Treatment Planning
Step 1: Rachels 4x4 Grid:
See age 10 of Workbook
Exercise 2: Formulation Statement
Workbook age 8
From Formulation to Treatment Planning
Step 2: Goal Identification and Setting:
1he selecuon of goals Lo focus on lnvolves:
Selecung key dlagnoses, problems, sLrengLhs & aeuologlcal facLors from Lhe oplnlon
Crganlslng Lhese lnLo a few essenual goals by a process of lumplng and spllmng
1he goals should be dlrecLly relaLed Lo speclc LreaLmenLs you mlghL underLake
1rylng Lo sLaLe as posluve or approach goals raLher Lhan negauve or avoldance goals
SLaung Lhe goals as SMA81 goals
o Speclc
o Measurable
o Achlevable
o 8eallsuc
o 1lmely
From Formulation to Treatment Planning
Step 2: Goal Identification and Setting:
Conslder:
1. presslng lssues
safeLy
SLablllzauon
2. conLexLual lssues
culLural lssues
wellbelng
engagemenL
mouvauon
lnLegrauon
3. speclc LreaLmenL LargeLs
core - relaLed dlrecLly Lo presenung/core problems
perlpheral problems
4. 8arrlers/malnLalnlng facLors
Exercise 3: Goal Identification and Setting
Workbook age 11
From Formulation to Treatment Planning
Step 3: Goal Planning:
lL ls lmporLanL Lo organlse LreaLmenL goals ln a sLage-wlse manner so LhaL:
lmporLanL and urgenL goals are addressed early
1reaLmenLs are dellvered aL Lhe approprlaLe phase or sLage
See page 14 of Lhe workbook
From Formulation to Treatment Planning
Step 3: Goal Planning Prioritising Goals:
rlorluse:
urgenL goals (lnvolvlng safeLy, sLablllsauon)
Serlous problems
lvoLal problems and Lrans-dlagnosuc facLors from Lhe formulauon
Laslly Achleved Coals
From Formulation to Treatment Planning
Step 3: Goal Planning Ease of Goal Achievement:
MosL easlly achleved goals for Lhose wlLh severe lmpalrmenL:
- reducuon ln panlc auacks
- reducuon ln oLher fears and anxleues
- lncreased asseruveness
- lncreased self-condence
LeasL easlly achleved goals for Lhose wlLh severe lmpalrmenL:
- sleep problems
- paln conLrol
- reecung on self and Lhe fuLure
- depresslve sympLoms
From Formulation to Treatment Planning
Step 3: Goal Planning:
See age 14 of Lhe Workbook
From Formulation to Treatment Planning
Step 3: Goal Planning:
MosL easlly achleved goals for Lhose wlLh severe lmpalrmenL:
- reducuon ln panlc auacks
- reducuon ln oLher fears and anxleues
- lncreased asseruveness
- lncreased self-condence
LeasL easlly achleved goals for Lhose wlLh severe lmpalrmenL:
- sleep problems
- paln conLrol
- reecung on self and Lhe fuLure
- depresslve sympLoms
Exercise 4: Goal Planning
Workbook age 13
From Formulation to Treatment Planning
Step 4: Treatment Planning:
Apply speclc LreaLmenLs Lo each problem
10-olnL sLrucLure for each phase of LreaLmenL:
1. Semng
2. lurLher lnformauon
3. 1reaLmenL of medlcal condluons
4. sychopharmacology
3. sychologlcal lnLervenuons
6. lamlly/Whanau and soclal lnLervenuons
7. SplrlLual lnLervenuons
8. Lducauon of LangaLa whalora and famlly/whanau
9. Soclal needs
10. Self-help groups
See g 17 of Lhe Workbook
From Formulation to Treatment Planning
Step 4: Treatment Planning:
Larly Mlddle LaLe AuLonomy
1. Semng
2. lurLher lnformauon
3. 1reaLmenL of med condluons
4.sychopharmacology
3. sychologlcal
6.lamlly/whanau
7. SplrlLual
8. Lducauon of cllenL and whanau
9. Soclal needs
10. Self-help
From Formulation to Treatment Planning
Step 4: Treatment Planning - Psychological Interventions:
lndlvldual Croup Self-dlrecLed
sycho-educauon
Mouvauon
ulagnoses &
problems
Well-belng,
recovery &
sLrengLhs
key sychologlcal lnLervenuons:
sycho-educauon
Mouvauon
ueclLs (dlsorders, problems
Well-belng, recovery and sLrengLhs
lormaLs:
lndlvldual
Croup
Self-dlrecLed
From Formulation to Treatment Planning
Step 4: Treatment Planning - Psychological Interventions:
MaLch psychologlcal lnLervenuons Lo sLages of LreaLmenL
LngagemenL
ersuaslon
Acuve 1reaLmenL
8elapse prevenuon
Exercise 5: Treatment Planning
Workbook age 18
Working with Groups
Working with Groups
Rationale:
Croup lnLervenuons (along wlLh conungency managemenL and resldenual CL programmes)
have Lhe sLrongesL evldence base of all CL LreaLmenLs
Moeset, k.1., NootJsy, u.l., utoke, k.., lox, l. loteqtoteJ 1teotmeot fot uool ulsotJets. A ColJe to [ecuve 1teotmeot.
1be CollJfotJ ltess, New otk 200J.
5u548
1ll 42 (ftee JowolooJ)
bup.//stote.sombso.qov/ptoJoct/1ll-42-5obstooce-Abose-1teotmeot-fot-letsoos-wltb-co-Occottloq-ulsotJets/5MA12-J992
Working with Groups
General Principles of Group Work with CEP:
SupporL auendance noL performance Avold confronLauon
Lncourage group lnLeracuon raLher Lhan
faclllLaLor vlews
8educe emouonal lnLenslLy
SLronger dlrecuon Lo malnLaln concenLrauon ShorLer durauon (40 mlnuLes)
Allow paruclpanL Lo leave early lf sLressed 8un regularly (weekly), no cancelauons
Smaller slze (2-4 ls ne) Co-faclllLauon
Conslder peer faclllLaLor 8rlef, slmple, concreLe & repeuuve commenLs
Amrmauon of posluves Address negauve behavlour rapldly
use mouvauonal Lechnlques
SeL ground rules:
o Cne person speaklng aL a ume o no lnLerrupuons
o 8e on ume o Show respecL
o LeL everyone speak who wanLs Lo o no aggresslon or LhreaLs
Working with Groups
Types of Groups by Stage and Phase:
1. LngagemenL - ersuaslon
for pre-conLemplauon Lo preparauon sLages
2. Acuve 1reaLmenL and 8elapse revenuon
for acuon and malnLenance sLages
Working with Groups
Persuasion Groups:
'()5,%% 1,%%$)/% 6,7 8)9$5%
8rlef wlLh break (43 mln) 1
sL
: sycho-educauon
Weekly 8easons for group, lnLro's,
guldellnes, wrap-up
ueclslonal balance
no more Lhan 10-12 cllenLs SubsequenL Sesslons: roblem solvlng
use Ml Lechnlques Check-ln (10-13mln) Soclal problem solvlng
Lvoke raLher Lhan provlde 8rlef dlscusslon on Loplc:
1oleraLe lnLoxlcauon lf noL
dlsrupuve
sycho-ed on drugs, menLal
healLh, lnLeracuons,
sycho-educauon around
speclc Loplcs
values and well-belng
use role play, dlagrams,
mnemonlcs
ueallng wlLh sLress
vldeo's, guesL speakers Meds and adherence
Working with Groups
:
'()*+,- 1)+:$/3
Apply Lhe problem solvlng sLraLegy above Lo dlmculL declslons and slLuauons
ldenufy and dene a problem
8eframe as a posluve goal
Seek everyone's oplnlon of Lhe problem
1hlnk of/braln-sLorm posslble soluuons
LvaluaLe each soluuon
SelecL Lhe besL soluuon
1ry ouL Lhe soluuon
LvaluaLe
ueclde whaL Lo do nexL ume
Soclal problem solvlng - apply Lo dlmculL soclal lnLeracuons
Working with Groups
Active Treatment Groups:
'()5,%% 1,%%$)/% 6,7 8)9$5%
up Lo 90 mlns Slmllar Lo persuaslon groups lurLher psycho-educauon
laclllLaLor less mouvauonal Asseruveness
SllghLly more confronLauonal Managlng cravlngs
8elaxauon, mlndfulness
behavloural acuvauon
urlnk/drug refusal skllls
Managlng LhoughLs abouL SuuS
Medlcauon adherence
Managlng MP sympLoms
Communlcauon skllls
Soclal skllls
Coplng skllls
8elapse prevenuon
Working with Families
Working with Families
Basic Family Interventions:
key Coals:
lncrease famlly's undersLandlng of CL and speclc problems of LangaLa whalora
8educe sLress ln Lhe famlly
8educe subsLance use and menLal healLh sympLoms of LangaLa whalora
8educe Lhe lmpacL of subsLance use on oLher famlly members
lncreaslng adherence of LangaLa whalora
lmproved supporL LangaLa whalora ln Lhe whanau
Lncourage Lhe famlly and cllnlclans Lo work LogeLher ln a common dlrecuon
Cpumlse famlly's problem solvlng skllls
Working with Families
Basic Family Interventions:
'()5,%% 1,%%$)/% 6,7 8)9$5%
As wlLh worklng wlLh groups As wlLh worklng wlLh groups
sycho-educauon
SLress reducuon
roblem solvlng around
speclc famlly slLuauons
Soclal problem solvlng
LlmlL semng
LsLabllshlng auLonomy-
supporuve envlronmenL
8educe lmpacL of SuuS on
famlly
Lncourage posluve acuvlues
lncreaslng adherence
Working with Families
Basic Family Interventions:
;.-$+7 '()*+,- 1)+:$/3
Apply Lhe problem solvlng sLraLegy above Lo dlmculL famlly slLuauons
ldenufy and dene a problem
8eframe as a posluve goal
Seek everyone's oplnlon of Lhe problem
1hlnk of/braln-sLorm posslble soluuons
LvaluaLe each soluuon
SelecL Lhe besL soluuon
1ry ouL Lhe soluuon
LvaluaLe
ueclde whaL Lo do nexL ume
Working with Families
Basic Family Interventions Social Problem Solving:
1)5$.+ '()*+,- 1)+:$/3
Apply Lhe problem solvlng sLraLegy above Lo dlmculL soclal lnLeracuons.
ldenufy and dene a problem
8eframe as a posluve goal
Seek everyone's oplnlon of Lhe problem
1hlnk of/braln-sLorm posslble soluuons
LvaluaLe each soluuon
SelecL Lhe besL soluuon
1ry ouL Lhe soluuon
LvaluaLe
ueclde whaL Lo do nexL ume
Working with Families
COPMIA:
hup://www.copml.neL.au
lnLegraLe key sLraLegles lnLo follow-up/Lherapy sesslons
Motivational Framework for Session Structuring:
1
1ake opporLunlues Lo reecL
& summarlse
Change Lalk
Well-belng Lalk
3a
2
3b 4
8elnforce commlLmenL Lalk SeL Agenda
SplrlL of mouvauonal lnLervlewlng
In the next episode
Management Structure
Structured Follow-up Session Planning Template:
Action Plans
Workbook age 23