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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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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

  • 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..........



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?



    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?


    Offender

    AP

    OM

    Where to intervene

    Do we intervene here?

    Or perhaps direct our efforts here

    And here



    Comparison to London trend

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



    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”


    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


    Islington

    18-24 Transitions Gangs & Serious Youth Violence

    Winter 2012


    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


    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


    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


    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.



    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


    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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