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Clinician’s Training Package

Clinician’s Training Package. Responding to Mental Health Issues Within Drug & Alcohol Treatment. These training resources were funded by Drug Strategy Branch, Australian G overnment Department of Health and Ageing through the National Comorbidity Initiative. Exercise 1: Who Here Do You Think….

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Clinician’s Training Package

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  1. Clinician’s Training Package Responding to Mental Health Issues Within Drug & Alcohol Treatment These training resources were funded by Drug Strategy Branch, Australian Government Department of Health and Ageing through the National Comorbidity Initiative

  2. Exercise 1: Who Here DoYou Think… • Loves The Simpsons? • Can change a flat tyre? • Exceeds the speed limit? • Snores? • Is kind to dogs? • Would tell you that you have bad breath? • Is trustworthy?

  3. Exercise 2: How Are YouThinking-Feeling-Doing? • What are your THOUGHTS about working with clients with comorbidity? • What are your FEELINGS about this training? • Notice how you BEHAVE when I say we have 2 days to get this on board?

  4. A Snapshot: Training Modules Module 1 Introduction to comorbidity Module 2 CBT Module 3 Pre session preparation Module 4 Implementation of Brief MH Intervention • PsyCheck Mental Health Screen • Context • Development • Implementation • Scoring • Theory of CBT • Principles & application • CBT in practice • Assessment • Case Formulation • Treatment planning • Psychoeducation • Introduce CBT model • Self monitoring • Identify thoughts • Manage thoughts • Relapse planning • Termination

  5. Module 1 Module 1 Introduction to Comorbidity & PsyCheck Mental Health Screen

  6. Aims of Module 1 Module 1 • To provide a context for the PsyCheck Screening Tool • To understand the development and psychometric properties of PsyCheck • To gain skills in implementation, scoring and interpretation of PsyCheck

  7. Overview of Components of Module 1 Module 1 • Introduction to Comorbidity • Development of PsyCheck • Psychometric properties of the PsyCheck Screening Tool • Negotiating the Users Guide • Administering the PsyCheck Screening Tool • Mental Health Screen • Suicide/Self-Harm Risk Assessment • Self Reporting Questionnaire Tool • Interpreting the PsyCheck Screening

  8. Introduction to Comorbidity Module 1 • Up to a third of mental health clients have an AOD problem • May be referred in to AOD services • Up to 80% of AOD clients also have a co-occurring mental health problem • Many more may have subclinical symptoms • Rule rather than the exception in treatment settings

  9. Introduction to Comorbidity Module 1 • Those that have comorbid AOD and mental health problems have • Poorer prognosis • Higher risk of harm • Greater likelihood of relapse to both disorders • Greater use of health services

  10. Models of Comorbidity Module 1 • Secondary Psychopathology Model • Secondary Substance Use Model • Bidirectional Model

  11. Models of Comorbidity Module 1 • Common Factor Model • No Relationship Model

  12. Comorbidity in Practice Module 1 • Comorbidity is the norm • In both mental health and alcohol and drug services BUT • Client group is very different in each service

  13. Comorbidity in Practice Module 1 • In Mental Health Services • Mostly psychotic disorders with range of alcohol and other drug issues • In Alcohol and Drug Services • Mostly high prevalence disorders: anxiety and depression • Often not able to refer to Mental Health Services • Often have subclinical symptoms: often go undetected

  14. Treatment for Comorbidity Module 1 • Sequential • Treat one problem first • Parallel • Simultaneous treatment in different service provider • Integrated • Integrated treatment by same service provider • Best empirical support • Client and clinician preference

  15. Comorbidity Training Module 1 • Many AOD clinicians report training is • Concentrated on acute low prevalence disorders • Focused on relationship building with Mental Health Services

  16. PsyCheck Developed to Address Gaps Module 1 • Designed for AOD clinicians with little or no experience in mental health interventions • But can still be used by experienced clinicians • Focused on the disorders most commonly encountered in AOD Services • Anxiety, depression, some somatic symptoms • Offers a screening tool and articulated intervention • Offers options for training and support through clinical supervision

  17. PsyCheck Overview Module 1 • Screening and intervention for anxiety and depression among AOD clients • Brief screening • 4 session intervention • Youth modifications • Extension material • Accompanying resources • PsyCheck Screening Tool • PsyCheck Screening Tool User’s Guide • PsyCheck Clinical Treatment Guidelines

  18. PsyCheck Overview Module 1 • Comprehensive capacity building • 4module workshop • Clinical supervision • Part of a whole organisation approach to improving comorbidity services for our clients • Managers resources (Implementation Guidelines) • Clinical supervisors resources (Training and Clinical Supervision Guidelines)

  19. PsyCheck Screening Tool Module 1 • PsyCheck Screening Tool scientifically validated • A general mental health screen, including history of treatment • A suicide/self harm risk assessment • The Self Reporting Questionnaire (SRQ) • World Health Organization instrument • Assesses current symptoms of anxiety, depression and somatic disorders

  20. PsyCheck Intervention Module 1 • Evidence based: drawn from empirically supported treatment • Intervention is designed to be integrated into routine AOD practice • CBT principles used in both AOD and mental health • Best practice in both sectors • Easily integrated • Easily manualised • Focus on scientist-practitioner approach • Hypothesis testing • Reflective practice

  21. Psychometric Properties Module 1 • 120 newly engaged AOD clients • PsyCheck Screening Tool compared to General Health Questionnaire (GHQ) • Both compared to a diagnostic instrument (CIDI) • Results • SRQ superior to GHQ in predicting anxiety and depressive disorder • Cut-off identified that indicates presence of disorder • General mental health screen good indicator of psychosis

  22. Negotiating the PsyCheck User’s Guide Module 1 • About the PsyCheck Screening Tool • Statistical properties • Decision tree • Administration and scoring • General mental health screen • Suicide risk/self harm assessment • Self Reporting Questionnaire • PsyCheck Screening Tool • Sample contingency plan

  23. Administering the Screening Tool Module 1 • Designed for routine screening (all clients) • Administer the whole SRQ • Other parts only if information not already collected • Suicidality monitored over time • Suicide assessment a framework not a checklist • Clinical judgement is required • Assess risk of harm to others in same way

  24. Exercise 3: Celebrity Squares Module 1 • Work in groups of 3 • Select a celebrity square • One person plays the celebrity • 2 clinicians assist each other in administering the PsyCheck Screening Tool • Group Discussion

  25. Interpreting the PsyCheck Screening Tool Module 1 • Intervention or further assessment is required if • The client reaches 5 or more on the SRQ • The client is at risk of suicide/self-harm • The client has a mental health history • Consider • Readiness to change • Current symptoms

  26. SRQ Interpretation Module 1

  27. Decision Tree Module 1

  28. Exercise 4: Celebrity Squares - What Next? Module 1 • Work in the same groups of 3 • From the information you’ve collected refer to the Decision Tree and determine what the next steps would be for your celebrity client • Think about • Past mental health questions • Suicide assessment, and • SRQ score (and the types of answers endorsed) • Group Discussion

  29. What’s on Your Mind – Is It This…? Module 1 I’m never going to get this I may as well give up now I’m useless

  30. Or This …? Module 1 I’m getting some of this If I hang in it will fall into place I feel confident I will get it

  31. Or Maybe This …? Module 1 This is too easy… What if I get bored… I’ll think about how I can use it in my practice

  32. Module 2 Cognitive Behaviour Therapy

  33. Aims: Module 2 Module 2 • To understand the theory of CBT • To understand the principles of application underpinning the PsyCheck intervention • To understand of the practice of CBT

  34. Overview: Module 2 Module 2 • Introduction to CBT • Theoretical underpinnings • CBT Model • Evidenced based practice • CBT in practice • Standard sessions • Self-monitoring

  35. Exercise 5: What Works for You? Module 2 • Working individually complete the worksheet, identifying which models you have an affinity with • Then circle the main model you work with • Now find someone else in the room that uses a DIFFERENT model to the one you typically work with and discuss with your partner • Why you use this model/strategies you do? • How you know it’s working ? • Group discussion

  36. Cognitive Behavioural Approach Planned Approach Module 2 • There is emerging evidence that a single theory planned approach is more effective than an ad hoc one • Most effective to have a single framework or philosophy about treatment and incorporate a range of techniques and strategies that fit with your philosophy

  37. Evidenced Based Practice Module 2 • Best evidence for CBT compared to other types of therapies • Most high level research (RCTs) and the most positive research • Effective for a wide range of mental health problems including AOD, anxiety and depression BUT Whatever framework you use, you can create your own evidence through measuring individual outcomes – CBT emphasises this

  38. Therapy examples Cognitive Therapy (Aaron Beck) Relapse Prevention (G. Alan Marlatt) Coping Skills Therapy (Peter Monti) Mindfulness Therapy (Mark Williams) Schema Therapy (Jeff Young) Dialectical Behaviour Therapy (Marsha Linehan) Strategy examples Problem Solving Goal Setting Cue Exposure Therapy Thought stopping Urge surfing Activity scheduling… What is CBT? Module 2 • Umbrella term for a range of therapies with a cognitive and/or behavioural focus

  39. In Comparison… Module 2 • Solution-Focused Therapy • An understanding of the past and cause of problem not necessary for resolution of the problem • Change occurs as a result of a focus on the future without the problem • Narrative Therapy • Focus is on meaning, narrative and power • Talking about the influence of problems enables talk about their defeat via the new stories

  40. In Comparison… Module 2 • Gestalt Therapy • Focus is on the present rather than past or future  • Central aim is awareness-raising and creating conditions to de-construct dysfunctional fixed or habitual patterns of interaction   • Change occurs through understanding and acceptance of what is • Psychodynamic Therapy • Focus is on initial underlying causes • Understanding and having insight into the problem leads to change • Therapeutic relationship is the key to change

  41. What is CBT? Module 2 • ‘Self-help’ oriented • Clinician provides tools and framework for change • Client’s responsibility to create and maintain change • Skills oriented • Attention to therapeutic process vital but not sufficient in itself for change to occur • Structured but not inflexible • Clinical judgement necessary

  42. CBT Principles Module 2 CBT… • is based on an ever-evolving formulation of the client in cognitive terms • requires a sound therapeutic alliance • emphasises collaboration and active participation • is goal oriented and problem focused • initially emphasises the present

  43. CBT Principles Module 2 CBT… • is educative, aims to teach the client to be their own therapist, and emphasises relapse prevention • is time limited • sessions are structured • teaches clients to identify, evaluate and respond to their dysfunctional thoughts and beliefs • uses a variety of techniques to change thinking, mood and behaviour

  44. Exercise 6: Mix ‘n’ Match Module 2 • From the cards you have been given, keep the ones that represent the way you work (in the majority) and trade unwanted cards for wanted cards with other participants • Either • Line up on the cognitive/behavioural continuum to show whether you work more in a cognitive or behavioral approach, or • Place your cards on the grid (cognitive/behavioural vs skills/process) • Group discussion • Why did you put your card or yourself where you did? • Did the cards fall in a pattern?

  45. The CBT Model Module 2 Early Experience Core beliefs Trigger Unhelpful thoughts Behaviour Feelings

  46. Absent father, poor role models I’m unlovable and need food to make me happy Smell of restricted food Eating makes me feel better Over-eating, relapse Craving Bruce: Eating Disorder Module 2

  47. Bruce: Simplified CBT Model Module 2

  48. Bruce: ABC Model Module 2

  49. Exercise 7: The Cognitive Model Module 2 • In pairs take it in turns to use the CBT model worksheet, choose a simple target problem for example, eating chocolate, public speaking, learning a new skill • Use a recent real example or a made up one • Complete the CBTmodel sheet with thoughts feelings and behaviours.

  50. Typical Session Format Module 2 • I: Review and feedback from last session • II: Information and practice of session topic • III: Summary and feedback from this session

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