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Stuart John Chuan Butler Trust Workshop 1 October 2013

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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.

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slide1

Psychologically- Informed case management

Stuart John Chuan

Butler Trust Workshop

1 October 2013

slide2

Overview

  • Model of consultation, training and joint direct working
  • Applications of the model to support mental health needs of offenders
  • How/Why it works
slide3

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
  • Client-centred direct service
  • Focus on clients problems/functioning
  • Specialist directly assesses and diagnoses clients to make recommendations to practitioners
  • Refer to..........
slide5

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
slide6

Consult to the system

WITH 8 NEEDS DO WE NEED 8 WORKERS?

slide8

Sensitive to perceived rejection

Poor impulse control

Rapid mood changes

Stormy relationships

Reckless

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?

slide9

Offender

AP

OM

Where to intervene

Do we intervene here?

Or perhaps direct our efforts here

And here

slide11

Comparison to London trend

* N=10 ^N=6 (therefore comparison cannot be made)

slide13

“itgives 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”.

“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”.

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”

slide14

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
slide15

Islington

18-24 Transitions Gangs & Serious Youth Violence

Winter 2012

slide16

The team approach

Multi-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

slide17

NHS

Forensic psychologist

0.5 wte Nurse

0.05 wte psychologist (supervisor)

IYPDAS

Substance misuse

worker

CSPU

Team Manager

Islington 18-24

Gangs Transitions

Team

Police

BIU Analyst Support

CSPU

Administrative

support officer

CSPU

Transitional Key Workers x2

LPT

Probation officer

slide18

Added value

  • Main 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
slide19

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)
slide20

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.
slide22

Family

Early years help & CiN teams

Family

\'Troubled families\' - ASB, Edge of Care Teams

Primary care

GPs, IAPT, SPoC MH ax team

Crisis teams, crisis houses,

Acute inpatient wards, A&E

Crisis services

slide26

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

[email protected]

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