Bowness Intensive Rehabilitation Unit Needs Assessment 2003
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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
Dr Michael Kelleher
Dr Mike Doyle PhD
Dr Stephanie Kennedy & Dr Robin Ellis
Mr Malcolm Rae FRCN
OP 64, Irish College of Psychiatry, Nov 2007
Sainsbury Centre for Mental Health, (2008)
Shepherd, Boardman & Slade
Learning themes
Discuss recovery as a systematic, dynamic
process
Outline a framework for developing a recovery
oriented care pathway-Practitioner, Team and
Organisational level
Highlight the proposed role of the CRSI in
promoting service user, staff and organisational
development
Discourse-performative effect of
language
Systemic use: language-has a power enforcing function
You believe what clinician says, you give permission to operate, etc
The language game of discourse expresses and enacts the authority of
those who are empowered to use it within a social group
It can be used to marginalise, exclude or subordinate those who are
outside it
Rational model - ‘Show me the evidence’
The importance of meaning, understanding and narrative
Tension in developing a shared understanding.
Psychiatric perspective
Prominent symptoms-cancer, multiple
sclerosis, Rheumatoid arthritis
improve with treatment but often d'ont
recover to where they were when they
became ill
Focus on symptoms, severity, duration
Psychiatric perspective
Integrated model
gene enviroment interaction-including the
social environment (Family and
Childhood)
Psychosis-final common pathway is
dopamine dysregulation in CNS
Risk paradigm
Risk v personal quality of
‘dangerousness’
Two components-Probability/Impact
Structured Professional Judgement
Multidisciplinary approach
RECOVERY
Re-(dis)-cover
a sense of personal identity
separate from illness or disability
a movement away from pathology, illness and
symptoms
to health, strengths and weaknesses
Needs based approach
RECOVERY
Recovery is not an end point, but a
continuing journey
People are ‘recovering’
MH staff, MH services cannot in
themselves practice recovery
This can only be lived by service users
RECOVERY
MH staff can try to create the conditions
In which individuals feel empowered
And their sense of personal ‘agency’ can
flourish
Need clear models of service delivery
Underpinned by Policy Implementation
Guide
FAMILY & CARERS
Family or other supporters are central to
recovery
should be included as partners whenever
possible
Peer support is crucial for many people
SELF MANAGEMENT
is encouraged and facilitated
no one size fits all
Helping relationship between clinician
and patient moves from Expert/patient to
coach/partner
RECOVERY
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?
What kind of organisational factors,
promote or inhibit the uptake of these
practices?
RECOVERY-Practitioner level
OPENNESS
COLLABORATION AS EQUALS
A FOCUS ON THE INDIVIDUALS INNER
RESOURCES
RECIPROCITY-Give and take-
A WILLINGNESS TO GO THE EXTRA MILE
RECOVERY-Practitioner level
Empathy
Positive expectation of the future
Caring
Acceptance
Mutual affirmation
‘Hope’ inspiring relationships
An encouragement of responsible risk
taking
RECOVERY-Practitioner level
Actively listen
Help the person identify and prioritise their
goals for recovery
Show a belief in person’s existing strengths and
resources
Encourage self-management (Information,
reinforce existing coping strategies)
Discuss what the person wants in terms of
therapeutic interventions
Convey an attitude of respect
Express optimism
RECOVERY-Individual Needs
Based Assessments
Diagnosis/ Co-morbidity
Risk assessment-to inform therapeutic
risk taking
Recovery Factors
Personal goals
Hopes
Aspirations
Engagement with service
Motivation for self management
RECOVERY-Individual
Assessments
Functional & Occupational skills
Psychological well being
Developmental model, early childhood, stressors, coping
strategies
Cognitive Functioning
Physical Health
Unmet needs
Carer assessment
RECOVERY-Individual
Assessments: Key steps
Review history/collateral
Engage service user and family
MDT Assessment-SKILLS OF DIFFERENT PROFESSIONALS
MUST BE INCORPORATED INTO CARE PLANS
Holistic-Biopsychosocial assessment, Needs Led
Shared view of service users difficulties and strengths
Create a person centred formulation/care plan
RECOVERY-Team level
Opportunity for service users to be
employed in care giving roles
Does the team encourage real user
involvement?
How do you know that this is happening?
Job description/ Appraisal
Clinical supervision
RECOVERY-Training
10 essential shared capabilities,
Framework NIMHE (2004)
Organisational rules and behaviour which
promotes recovery oriented practice
RECOVERY-Strategic Level
‘Vision for change’ offers a template
Assertive outreach : provision of individualised, focussed
and proactive care to service user
Minimise risk of disengagement
Patient centred-evident in detailed individual assessments
and carefully formulated care plans
Practical/ Key worker / Liaison with other agencies
RECOVERY-Organisational Level
Mission statement-goals and aims. Move form
‘excellence’ to ‘responsibility to positively
improve the lives of others’
Commitment to involve service users in running
the organisation at all levels
Shift towards an educational Vs Therapeutic
model
Peer Professionals
Therapeutic relationship
Organisational culture-what we do
Power, role and task culture
Mentoring
Guided discovery
Adult learning
Organisational culture
Culture is the sum of shared, values and
beliefs that people in the organisation
hold
Shared assumptions they make
Shared philosophy they identify with
Shared attributes are the foundations of
organisational culture
Organisational culture
Power
Culture
Role Culture
Task Culture
Person centred culture
The community is the organisation
This organisation is service users , carers
and professional coaches/mentors
Order/structure-by mutual consent
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
Role of CRSI: Develop capacity for hope,
creativity, compassion, realism and
resilience-at practitioner, team, and
organisational level
Person centred culture-provide a service
to a community (no ‘them and us’)
Social inclusion
People do not recover in isolation
Recovery is closely associated with social
inclusion
and being able to take on meaningful and
satifying social roles within local
communities as opposed to segregated
services
Recovery-Summary
Lived experience
Unifying force for the organisation
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
HOPE
is central to recovery
can be enhanced by each person seeing how
they can have more active control over their
lives
and by seeing how others have found a way
forward
RECOVERY EXPLICITLY VALUES A PERSON
CENTRED CULTURE