Transcript Dias nummer 1 - Swedish National Board of Forensic Medicine

The ”Triple-project”
Forensic Psychiatric Center
Glostrup
Copenhagen
University
hospital
The Tripleproject” – New Hampshire Model
Mette Brandt-Christensen, MD, PhD, assistant professor
Forensic Department,
Psychiatric University Center Glostrup, Copenhagen
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Integrated treatment for dual
disorder works –
Does it also apply for “tripledisorder”-patients?
The Tripleproject” – New Hampshire Model
Mette Brandt-Christensen, MD, PhD, assistant professor
Forensic Department,
Psychiatric University Center Glostrup, Copenhagen
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Triple-disorder:
Severe mental disorder
Substance abuse
Forensic status
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Developing the ”Triple”project – integrated treatment
for Triple-disorder
costum-fit – one size does not fit all
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The NHM – program modified
Stages of the integrated Triple-disorder treatment
– the Glostrup model
Pre- consideration
Pre-engagement
Consideration
Relapse
Engagement
END
OF
ABUSE
Preparation
Maintenance
Relapseprevention
Action
Active treatment
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Stages of care and treatment.
Definitions and goals:
Mueser, Kim, et al 2006 and Prochaska James O. et al 2008.
Adapted by Retsbo, 2011
NHM - stages
NHM - stages
NMH - behaviour
Lasting changestages
Engagement
Preengagement
No contact with case- manager
Pre-consideration
Engagement
No regular contact with case-manager concerning
substance abuse
Consideration
Early persuasion
Preparation
Late persuasion
Regular contact with case-manager, but no reduction in
Substance abuse
Reduction for less than one month
Early active- treatment
Reduced substance abuse for more than one month
Preparation
Late active-treatment
No substance abuse for 1-6 months
Action
Relapse prevention
No substance abuse for at least 6 months
Maintenance
Improvement or symptom-free
No substance abuse for at least one year
Termination
Persuasion /
prepatarion
Active treatment
Relapse – prevention
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Care and treatment – the stages of NHM in the ”TripleProject”
Inspiration from: Mueser, Kim et al, 2006; modified by Retsbo, august, 2011
Engagementstage
Preparationstage
Active care &
treatment-stage
Relapse- prevention-stage
Assessment
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Case management
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Patients´ network
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Activation and daily structure
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Social – & economic stabilisation
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Psychopharmacological treatment
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Coercion
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Motivational interviewing
”Set out for a better life” – cognitive
behavioural therapy individually and as patientcourses
Self-help-groups
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Triple-disorder treatment
Goals:
Staff qualification program:
All employees (nursing staff and psychiatrists): 3 days
seminar
29 employees (nursing staff and psychiatrists): 4 days
seminar followed by supervision sessions
Assessment, care & treatment:
Screening of all patients for substance abuse
Stage-based care and treatment ad modum NHM
Compendium with detailed description of the care- &
treatment program
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Triple-disorder treatment
Hopes for the project:
Assessment, care & treatment
Experiencing increased quality of life
Reduction of drug consumption
Reduction of criminal activities
Staff qualification program:
Change in attitude and more apprecitiavely
approach towards tripple-disorder-patients
Increased job satisfaction
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Triple-disorder treatment
Challenges:
 A non-confronting and appreciative approach in all
stages
 Non-consulting approach to patient during the first two
stages
 Balancing efforts of harm-reduction and obligations
towards judicial system
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Triple-disorder treatment
Project ends autumn 2012:
Evaluation of selected out-come target from the
NHM program (ASI-data, including patients´
experience of QoL)
Evaluation of staff qualification-program
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Integrated treatment for Triple-disorder
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Integrated treatment for Triple-disorder
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Integrated treatment for Triple-disorder
Thank you for your attention!
Contact: Email:
[email protected]
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