Transcript Bowness Intensive Rehabilitation Unit Needs Assessment 2003

Centre For Recovery And Social Inclusion
11th June 2008
-TOWARDS A RECOVERY ORIENTED
MODEL OF CARE-
Dr Martin Lawlor
Consultant Psychiatrist
Carraigmor PICU
HSE, Cork & Clinical Senior
Lecturer, U.C.C.
Acknowledgements
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Dr Michael Kelleher

Dr Mike Doyle PhD
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Dr Stephanie Kennedy & Dr Robin Ellis
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Mr Malcolm Rae FRCN
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OP 64, Irish College of Psychiatry, Nov 2007
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Sainsbury Centre for Mental Health, (2008)
Shepherd, Boardman & Slade
Learning themes
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Discuss recovery as a systematic, dynamic
process
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Outline a framework for developing a recovery
oriented care pathway-Practitioner, Team and
Organisational level
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Highlight the proposed role of the CRSI in
promoting service user, staff and organisational
development
Discourse-performative effect of
language
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Systemic use: language-has a power enforcing function
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You believe what clinician says, you give permission to operate, etc
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The language game of discourse expresses and enacts the authority of
those who are empowered to use it within a social group
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It can be used to marginalise, exclude or subordinate those who are
outside it
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Rational model - ‘Show me the evidence’
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The importance of meaning, understanding and narrative
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Tension in developing a shared understanding.
Psychiatric perspective
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Prominent symptoms-cancer, multiple
sclerosis, Rheumatoid arthritis
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improve with treatment but often d'ont
recover to where they were when they
became ill
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Focus on symptoms, severity, duration
Psychiatric perspective
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Integrated model
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gene enviroment interaction-including the
social environment (Family and
Childhood)
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Psychosis-final common pathway is
dopamine dysregulation in CNS
Risk paradigm
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Risk v personal quality of
‘dangerousness’
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Two components-Probability/Impact
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Structured Professional Judgement
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Multidisciplinary approach
RECOVERY
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Re-(dis)-cover
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a sense of personal identity
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separate from illness or disability
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a movement away from pathology, illness and
symptoms
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to health, strengths and weaknesses
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Needs based approach
RECOVERY
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Recovery is not an end point, but a
continuing journey
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People are ‘recovering’
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MH staff, MH services cannot in
themselves practice recovery
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This can only be lived by service users
RECOVERY
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MH staff can try to create the conditions
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In which individuals feel empowered
And their sense of personal ‘agency’ can
flourish
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Need clear models of service delivery
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Underpinned by Policy Implementation
Guide
FAMILY & CARERS
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Family or other supporters are central to
recovery
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should be included as partners whenever
possible
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Peer support is crucial for many people
SELF MANAGEMENT
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is encouraged and facilitated
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no one size fits all
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Helping relationship between clinician
and patient moves from Expert/patient to
coach/partner
RECOVERY
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What kind of behaviours do staff need to
display to create a recovery-oriented
service?

What kind of training programmes are
required to produce those behaviours?
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What kind of organisational factors,
promote or inhibit the uptake of these
practices?
RECOVERY-Practitioner level
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OPENNESS
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COLLABORATION AS EQUALS
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A FOCUS ON THE INDIVIDUALS INNER
RESOURCES
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RECIPROCITY-Give and take-
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A WILLINGNESS TO GO THE EXTRA MILE
RECOVERY-Practitioner level
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Empathy
Positive expectation of the future
Caring
Acceptance
Mutual affirmation
‘Hope’ inspiring relationships
An encouragement of responsible risk
taking
RECOVERY-Practitioner level
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Actively listen
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Help the person identify and prioritise their
goals for recovery
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Show a belief in person’s existing strengths and
resources
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Encourage self-management (Information,
reinforce existing coping strategies)
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Discuss what the person wants in terms of
therapeutic interventions
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Convey an attitude of respect
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Express optimism
RECOVERY-Individual Needs
Based Assessments
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Diagnosis/ Co-morbidity
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Risk assessment-to inform therapeutic
risk taking
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Recovery Factors
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Personal goals
Hopes
Aspirations
Engagement with service
Motivation for self management
RECOVERY-Individual
Assessments
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Functional & Occupational skills
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Psychological well being
 Developmental model, early childhood, stressors, coping
strategies
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Cognitive Functioning
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Physical Health
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Unmet needs
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Carer assessment
RECOVERY-Individual
Assessments: Key steps
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Review history/collateral
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Engage service user and family
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MDT Assessment-SKILLS OF DIFFERENT PROFESSIONALS
MUST BE INCORPORATED INTO CARE PLANS
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Holistic-Biopsychosocial assessment, Needs Led
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Shared view of service users difficulties and strengths
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Create a person centred formulation/care plan
RECOVERY-Team level
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Opportunity for service users to be
employed in care giving roles
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Does the team encourage real user
involvement?
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How do you know that this is happening?
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Job description/ Appraisal
Clinical supervision
RECOVERY-Training
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10 essential shared capabilities,
Framework NIMHE (2004)
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Organisational rules and behaviour which
promotes recovery oriented practice
RECOVERY-Strategic Level
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‘Vision for change’ offers a template
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Assertive outreach : provision of individualised, focussed
and proactive care to service user
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Minimise risk of disengagement
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Patient centred-evident in detailed individual assessments
and carefully formulated care plans
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Practical/ Key worker / Liaison with other agencies
RECOVERY-Organisational Level
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Mission statement-goals and aims. Move form
‘excellence’ to ‘responsibility to positively
improve the lives of others’
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Commitment to involve service users in running
the organisation at all levels
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Shift towards an educational Vs Therapeutic
model
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Peer Professionals
Therapeutic relationship
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Organisational culture-what we do
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Power, role and task culture
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Mentoring
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Guided discovery
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Adult learning
Organisational culture
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Culture is the sum of shared, values and
beliefs that people in the organisation
hold
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Shared assumptions they make
Shared philosophy they identify with
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Shared attributes are the foundations of
organisational culture
Organisational culture
Power
Culture
Role Culture
Task Culture
Person centred culture
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The community is the organisation
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This organisation is service users , carers
and professional coaches/mentors
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Order/structure-by mutual consent
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Emphasis on warmth, consideration and
mutual support-Humanitarian
Centre for Recovery and Social
Inclusion, C.R.S.I.

‘Open source’ templates-customisable;
web-based support; Action Research
Model
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Role of CRSI: Develop capacity for hope,
creativity, compassion, realism and
resilience-at practitioner, team, and
organisational level
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Person centred culture-provide a service
to a community (no ‘them and us’)
Social inclusion
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People do not recover in isolation
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Recovery is closely associated with social
inclusion
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and being able to take on meaningful and
satifying social roles within local
communities as opposed to segregated
services
Recovery-Summary
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Lived experience
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Unifying force for the organisation
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Break the traditional barriers between
service users and staff
Both are respected for what they can
bring
Power of organisation stems from central
focus on service user & carer
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HOPE
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is central to recovery
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can be enhanced by each person seeing how
they can have more active control over their
lives
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and by seeing how others have found a way
forward
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RECOVERY EXPLICITLY VALUES A PERSON
CENTRED CULTURE