DSA Specialist Intervention Services commencing psychological services at Port Macquarie

1. DSA Specialist Intervention Servicescommencing psychological services at Port Macquarie 3 November 2008 Mercure Centro

2. Introduction Presenters Profiles What is Specialist Intervention Service? Why Port Macquarie? What services we can offer... How to access Medicare services? How accessing our services can help Mental health and disability Stress and its impact on the carers Autism Spectrum Disorders How to contact us? Questions

3. Presenters Profiles Specialist Intervention Services Team members presenting today.... Laura LeVan - Consultant Psychologist Lorraine Teeuwen – Green (Assistant Manager/ Psychologist) Ewa Geba – Consultancy Manager /Principal Psychologist

4. DSA Specialist Intervention Services Disability Services Australia is a not-for-profit organisation (NGO) providing services to people with a disability for over 50 years. The Specialist Intervention Services (SIS) provide psychological and speech pathology services for children, adolescents and adults across several areas of the Sydney Metropolitan as well as regional areas of NSW. Specialist Intervention Service specialises in intervention and consultancy services for people with a disability who are displaying challenging behaviours, their families, and people working in the disability field (special interest in ASD and DD).

5. Who are we? SIS Consultants are experienced and highly skilled in the delivery of individualised intervention services aimed at assisting people to learn functional skills and strategies in order to deal positively with life experiences and situations. We consist of: 8 Registered Psychologists (3 Seniors) 3 Intern Psychologists 1 Speech Pathologist 1 Administration Support / Intake Officer

6. SIS Services available in NSW DADHC Funded Behaviour Intervention and Support (Sydney South East & Inner West) Consultancy services to DSA Supported Accommodation and Day Services Fee for service Consultancy (all areas) Medicare services (Redfern, Seven Hills, Bankstown, Campbelltown, Taren Point, Moss Vale and now Port Macquarie!) Early Intervention for children with ASD (0-6) coming soon

7. Why Port Macquarie? Partnership with ACES Inc. Identified need for psychological services for adults with a disability and challenging behaviours Need for more services for people with ASD Need for more services and programs to support families and staff Promoting mental health awareness Developing partnerships and networks

8. Services available in Port Macquarie Assessments & Reports (cognitive, functional, disability, ASD, mental health, Guardianship, DADHC eligibility) Psycho-education (sexual knowledge, disability specific, Autism, mental health), motivational interviewing Behaviour Intervention and Support Intervention for Anxiety and Depression (SFBT, CBT) Relaxation Programs Skills Development Training Problem Solving Skills; Anger Management; Social Skills Training; Communication Training; Stress Management; Parenting Skills Training Autism and Disability Consultancy (Early Intervention*) Training and Support to staff Supervision for Intern Psychologists

9. How to access Medicare Services GP / Pediatrician / Psychiatrist referral is necessary SIS Medicare Services are available to any person eligible under: “Enhanced Primary Care ” “Better Access to Mental Health Care” “Helping Children with Autism” GP – In order to access our Medicare Services a....... Initiatives – Your Doctor can provide you with further details on eligibility under these initiatives.GP – In order to access our Medicare Services a....... Initiatives – Your Doctor can provide you with further details on eligibility under these initiatives.

10. Enhanced Primary Care - Eligibility Persons with chronic conditions and complex care needs The GP has to provide a referral letter and ECP 5 sessions (30 min) per year for allied health professionals Only individual service not a group The referral lasts for 12 months Allied health services include psychologists, speech pathologists, OT, physio, dieticians, podiatrists, audiologists, Aboriginal health, chiropractors, diabetes educators, osteopaths)

11. Better Access to Mental Health... Introduced in November 2006 Persons with an assessed mental disorder (e.g depression, anxiety) Services: Psychological therapy ( individual and group) Solution focussed psychological strategies 12 ind. sessions per year (18) + 12 group (6-10) Session length – 30 -50 min Requirements: Referral letter GP/Paediatrician /Psyciiatrist+ Mental Health Care Plan

12. Helping Children with Autism scheme Introduced in July 2008 Access to assessment and intervention services provided by Paediatricians/Psychologists/Speech Pathologists/OT Eligible children under the age of 12 – 15 Services Assessment (5 sessions) & Intervention (20 sessions) per child per lifespan, to be shared Requirements: Referral from Paediatrician + ASD Management Plan

13. How accessing our services can help? Enhance generic services available to individuals with a disability, especially those who have mental health issues Reduce waiting lists of other government and non-government organisations Assist with family support during times of crisis Assist in the improvement of the health and well being of persons with a disability Assist with the development of resilience and coping skills for long term benefit. Point one: Medicare services can assist people with a disability to maintain their access to other services for example a person who is experiencing anxiety when involved in activities with groups could access assistance to manage their anxiety and therefore assisting in their access to work or Day Services. Point two: We are currently seeing a number of clients who are waiting for assistance with behaviour intervention and support from other NGOs and Government agencies. In this way people can have access to some assistance while they wait. Point three: Families can often be unable to receive assistance for associated concerns when their family member is receiving support from disability services. Medicare offers a pathway towards assisting families when they require it. Point four: As you will see further in our presentation PWD are often experiencing higher levels of mental health concerns than the rest of the population. Psychological services through medicare can assist in the management of these issues particularly for those who would not ordinarily have access to private providers due to financial restraints or whose access could be limited by their disability or challenging behaviours. Point five: In order to reduce symptoms of mental illness / disorders and to assist with life transitions Psychological services can offer a range of options for people with a disability, their families and carers.Point one: Medicare services can assist people with a disability to maintain their access to other services for example a person who is experiencing anxiety when involved in activities with groups could access assistance to manage their anxiety and therefore assisting in their access to work or Day Services. Point two: We are currently seeing a number of clients who are waiting for assistance with behaviour intervention and support from other NGOs and Government agencies. In this way people can have access to some assistance while they wait. Point three: Families can often be unable to receive assistance for associated concerns when their family member is receiving support from disability services. Medicare offers a pathway towards assisting families when they require it. Point four: As you will see further in our presentation PWD are often experiencing higher levels of mental health concerns than the rest of the population. Psychological services through medicare can assist in the management of these issues particularly for those who would not ordinarily have access to private providers due to financial restraints or whose access could be limited by their disability or challenging behaviours. Point five: In order to reduce symptoms of mental illness / disorders and to assist with life transitions Psychological services can offer a range of options for people with a disability, their families and carers.

14. Advantages of Medicare Items Clients often bring themselves to therapy Short term progress is often visable Provides individualised services to family members Assists with waiting time for other services Encourages parents participation in therapy Assists in improving quality of life outcomes for individuals with disabilities within existing services

15. Disadvantages of Medicare items Short term intervention and support (6, 12 or 18 sessions per year subject to review by GP/Dr) Families with referrals to multiple services can sometimes feel overwhelmed Unable to claim ‘family therapy’ under Medicare Separate referrals for each family member required Lack of understanding within the sector about the role of Psychologists and services Psychologists can provide Gabriela will now present to you some statistics on the provision of DSA Medicare services and some case studies to provide you with a greater understanding of what can be achieved through DSA’s Medicare Services.Gabriela will now present to you some statistics on the provision of DSA Medicare services and some case studies to provide you with a greater understanding of what can be achieved through DSA’s Medicare Services.

16. Historically, individuals with developmental disability were assumed to be free from mental health concerns. More recently, however research has suggested that people with intellectual disabilities may be at an increased risk for psychological problems (Deb, Thomas, & Bright, 2001; Stromme & Diseth, 2000). Individuals with mild or moderate intellectual disabilities are more likely to experience anxiety, depression and psychosis than those with severe or profound intellectual disabilities (Holden & Gitlesen, 2004). Disability and Mental health

17. Australian Psychological Society (APS)

18. APS

19. Medicare Survey

20. Primary Disability 2008

21. Secondary Disability 2008

22. Case “Anna” Anna is 13 years old Anna was born with developmental delay and speech impairment Anna was diagnosed by her GP with depression and sleeping problems Anna was referred for aggressive behaviour at school Treatment Plan consisted of: Makaton sign training Social skills development Referral to respite and dancing classes Treatment has resulted in a complete extinction of Anna’s aggressive behaviour

23. Case “Paul” Paul is 32 years old Paul has learning disabilities Paul was diagnosed by his GP with depression Paul was referred for depression and aggressive outbursts Treatment Plan consisted of: CBT thought monitoring Using a diary to keep on track Thermometer * SFBT exceptions Treatment has resulted in a considerable decrease of Paul’s outburst behaviour and a significant reduction of symptoms of depression

24. Thermometer

25. Case “Suzie” Suzie is 9 years old Suzie was born with developmental global delay Suzie was referred for aggressive behaviour at home 6 session Treatment Plan consisted of drawing therapy to explore feelings and Motivation Assessment Scale (Attention) Referral for Suzie’s parents to receive counselling Parents currently attending individual and couple counselling sessions Treatment plan resulted in a reduction of Suzie’s aggressive behaviour at home

26. Stress and its impact on carers The additional challenge of supporting an individual with an ASD and an intellectual disability The impact on primary caregivers The impact on siblings The impact on other family members The impact on the family unit as a whole

27. What can be done to assist carers and family members? Stress management strategies can be provided directly to family members during individual medicare funded sessions Behaviour intervention can be provided to family members to assist in the support of the individual with the disability Education about the disability can be provided to family members

28. Training and education “Positive Behaviour Support” “Duty of care/Guardianship/Restrictive Practices” “Dual Diagnosis – mental health and disability” “Working with families” “Building staff cross-cultural competency” “Using Augmentative and Alternative Communication and Support “ “Using social stories to support clients with ASD” “Person Centred Active Support” “Supporting Individuals with Autism Spectrum Disorders” “Supporting Individuals with Specific Developmental Disabilities “ “ Sensory Issues in Clients with Developmental Disability” “ Engagement in Meaningful Activities” “Grief, Loss & Disability” “Stress and Burn-out Prevention”

29. What is Autism? Autism is a lifelong developmental disability Autism is a dysfunction of some parts of the central nervous system that affects the way an individual processes information (how the individual understands our world and what is happening around) Onset prior to age 36 months There is no cure for autism 29

30. Triad of Impairments Impairment of Communication 30 Communication: lack of facial expression/gestures; may be verbal/non verbal or some speech; repeats/echoes words or phrases; does not appear to understand word meanings; understands and uses words literally Communication: lack of facial expression/gestures; may be verbal/non verbal or some speech; repeats/echoes words or phrases; does not appear to understand word meanings; understands and uses words literally

31. Pattern of behaviours consistent with Autism Impaired communication: Flat or limited facial expressions Poor use of gesture Little or no speech or very verbal Echolalia Difficulties understanding word meanings Understanding and taking words literally 31

32. Pattern of behaviours consistent with Autism Impairment of Social Relating Unresponsive to people Difficulties using social smile Unusual use of eye contact Appears to be happy when left alone Seeks social interactions in unusual way Uses adult’s hand as a tool Difficulties in turn taking Different sensory responses 32

33. Pattern of behaviours consistent with Autism Repetitive , stereotyped and restricted interests: Responds to objects/toys in an unusual/repetitive way ie lining up cars Shows intense interest in one area (such as Thomas the Tank Engine or Star Wars) - Can help to relieve anxiety Likes to watch or listen to same story/video/DVD repeatedly Might appear to pay little or no attention to the needs and feeling of others (if someone is in pain or distressed) May actually be very aware of others emotional state but unable to know how to label or respond to emotions appropriately Unable to generalize uses from one purpose to another 33

34. What can be done to assist Individuals with an Autistic Spectrum Disorder??

35. Supporting Person with Autism Visuals Environmental Support Staff ratio Trigger control Routine Sensory Integration Physical health Social skills Training 35

36. Contact us DSA Specialist Intervention Services Ph: (02) 4620 9660 Fax: (02) 4620 9550 Email: sisadmin@dsa.org.au  Website: www.interventionservices.com.au