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Psychologically- Informed case management. Stuart John Chuan Butler Trust Workshop 1 October 2013. Overview. Model of consultation, training and joint direct working Applications of the model to support mental health needs of offenders How/Why it works. Focus on the practitioner. - PowerPoint PPT Presentation
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Stuart John ChuanButler Trust Workshop
1 October 2013
Psychologically- Informed
case management
Overview
• Model of consultation, training and joint direct working
• Applications of the model to support mental health needs of offenders
• How/Why it works
Client-centred direct service
Focus on clients problems/functioning
Specialist directly assesses and diagnoses clients to make recommendations to practitioners
Refer to..........
Focus on the practitioner
Consultee-centred
Build capabilities in the practitioner (consultee)
Remedy (1) knowledge (2) skills (3) confidence (4) objectivity in consultee
Practitioner applies learning to current and future clients
Specialist tends not to meet client
Scope for joint working
Diagnosis vs formulation
PICM (psychologically-informed case
management)
• what to do - having a plan• why do it in this way - a planned approach
based on a psychological understanding of the individual
• how to do it - providing the practical knowledge and skills to translate this into practice.
Joint working and liaison with other statutory and non-statutory services may be provided to strengthen case management
‹
Consult to the system
WITH 8 NEEDS DO WE NEED 8 WORKERS?
Impact Offender
Personality Disorder Project
Summer 2009
Prison recalls Historically, large shortfall in local services aimed at offenders with personality disorder living in the community.
Probation, as a result, left in relative isolation to manage this complex and challenging client group.
Little mental health training
RECALL?
Stormy relationships
Reckless
Poor impulse control
Rapid mood changes
Sensitive to
perceived rejection
‹
Offender
APOM
Where to intervene
Do we intervene here?
Or perhaps direct our efforts here
And here
Average PPU recalls
Impact Project yearly comparison (adjusted)
Total London Recalls
(% increase on baseline)
C&I PPU recalls(vs Sept to Aug)
Pre (Oct 08 to Sep 09) - baseline
2300 59*
Year 1 (Oct 09 to Sep 10)2483
(+8%)30*
(-49%)
Year 2 (Oct 10 – Sep 11)2627
(+14%)29*
(-51%)
Year 3 (Oct 11 to Sep 12)2633
(+14%)^
* N=10 ^N=6 (therefore comparison cannot be made)
Comparison to London trend
Reasons for recall
‹
Training needs analysisPPU and the two APs
45 min semi-structured interviews (1-year follow-up)
“they are able to see things that I can’t see and tell me
how to work specifically with that from a different
perspective”
“When I was asked this before and I didn’t really understand it. I was like “well I can’t deal with those offenders cause they annoy me, they wind me up, they make me angry and I want to say something back to them.” Whereas now my experience is different cause I don’t take it personally. I can take a step back which stops me from getting so stressed out, it’s quite a big change for me”.
“it gives you more confidence, it relieves stress, and I think it makes you less likely to go off sick, because you are actually dealing with the stuff here and you feel capable whereas when you’re floundering in the dark it’s really scary … he is able to see things that I can’t see and tell me how to work specifically with that from a different perspective”.
‹
Impact - some lessons• Target intervention at staff – economical and
sustainability
• Provide a helping intervention
• It’s better to identify and intervene early rather than crisis manage
• ‘Treatment’ for PD is not the only option – think creatively to meet offender needs using community resources
• Aim for organisational culture and system change
Islington18-24 Transitions Gangs & Serious Youth Violence
Winter 2012
The team approachMulti-agency team based in probation
Supporting 18-24 year old age group and their families
Risk of involvement in serious youth violence
Reduce reoffending and gang violence
Exit gangs and offending lifestyles
‹
NHSForensic psychologist
0.5 wte Nurse0.05 wte psychologist
(supervisor)
CSPUTeam
Manager
IYPDASSubstance
misuseworker
Islington 18-24Gangs
TransitionsTeam
CSPUAdministrativ
e support officer
PoliceBIU Analyst
Support
LPTProbation
officer
CSPUTransitional Key
Workers x2
Added valueMain activities
• In-house MH Proactive screening/triage ax
• Training - eg., Motivational interviewing; Contingency
Management; Personality Disorder
• Case formulation and plans for complex cases
• Timely advice/consultation (eg., on engagement strategies)
• Integration with partners eg., YOS/CAMHS lead for transitions
planning
• Joint case management
MH Screening• GAD-7, PHQ-9, SAPAS, MVQ• 22 screened, including those not completed
questionnaires• GAD7 score ≥10 = 3 (moderate or worse anxiety)
• GAD7 score 5-9 = 1 (mild range)
• PHQ-9 score ≥ 10 = 3 (moderate or worse depression severity)
• PHQ-9 score 5-9 = 0 (mild range)
• SAPAS ≥3 = 8 (risk of ‘emerging’ PD)
• MVQ - Tendency for the young people to normalise use of violence (individual use and/or in media)
Early days data• 26 YP tracked for 9 months pre and 9 months post the
start of intervention: • 17 (65%) people offended prior to the intervention
compared to 13 (50%) people offending post intervention.
• The reoffending rate in 9mths pre intervention was 1.84 offences compared to 1.03 offences post intervention
• The average offence gravity of offences committed in the 9mths prior to intervention start was 3.19 compared to an average gravity of 3.00 post intervention start.
Winter 2013
'Troubled families' - ASB, Edge of Care Teams
Crisis teams, crisis houses,Acute inpatient wards, A&E
Early years help & CiN teams
GPs, IAPT, SPoC MH ax team
Family
Crisis services
Family
Primary care
‹
‹
‹
PICM Summary•Consulting to the system makes more coherent & efficient use of existing resources and workforce
•Service users needs can be met earlier in pathway
•Practitioners are better informed about what to do
•Iatrogenic effects are minimised
•Service users are better understood and engaged - more stable, better managed