IMPLEMENTATION OF THE STRENGTHS RECOVERY MODEL OF CASE MANAGEMENT

1. IMPLEMENTATION OF THE STRENGTHS RECOVERY MODEL OF CASE MANAGEMENT Lee Cordell-Smith Paul Liddy

2. Total Population SCDHB Population 52,785 Under age 15 3222 Over age 65 9078 Adult population 40,485 High Need 212 Overall Percentage of Population seen to be moderate to severe psychiatric illness 0.5% Total Maori Population SCDHB Population 2841 Under age 15 1116 Over age 65 93 Adult population 1,632 High Need 8 Overall Percentage of Population seen to be moderate to severe psychiatric illness 0.5%

3. WHAT WERE WE WANTING TO ACHIEVE? • Develop MHS demonstrate and sustain recovery approach to case management to produce the best outcomes for those with moderate to severe psychiatric disability.

4. OBJECTIVES • Introduce the strengths model of case management –inpatient – community. • Compare and measure outcomes for clients • Compare and measure outcomes for the staff

5. WHY? What were the guides that were encouraging us to do this?

6. RECOVERY APPROACH NZ • Underpins public policy • Blueprint: How things need to be • MHC vision is for a recovery approach to become standard practice for MHS at all levels • Competencies for mental health workforce • MHWD Programme 2002 (training and development, retention and recruitment, organisational development, research and evaluation) • Moving Forward: The NMH Plan for More and Better Services • NMHS and HDSS

7. Recovery Principles Personhood (hope, respect, individuality) Basic Needs (housing, income, transport) Social connectedness Citizenship (connected to the community) Empowerment (power and control over lives) Best practice culture Resources Strengths Principles Focus on strengths not pathology Community is an oasis of resources Self determination Relationship with Key Worker Assertive outreach People can learn, grow and change PRINCIPLES

8. Benefits to People using Services • Increased opportunities to participate in: • Employment • Education • Leisure • Quality housing • Increased satisfaction (e.g. client rights) • Ease of access to services • Stable workforce • Reduced no. relying on formal psychiatric services • Reduction in use of restrictive practices (e.g. MHA, seclusion and restraint.)

9. How did we go about achieving this?

10. PROJECT DEVELOPMENT • REFERENCE TO GUIDING DOCUMENTS • CONSULTATION WITH CONSUMERS AND FAMILIES & MENTAL HEALTH WORKERS • BUILDING ON THE FOUNDATIONS OF SERVICE PROVISION FRAMEWORK • TRAINING OF MANAGEMENT IN PERSON-CENTRED PRINCIPLES AND PRACTICE

11. Risks and Resistances • Perception of increased paperwork • Succession planning • Time and financial costs • Inadequate data collection system • Client resistances • Length of time to change the culture • Meeting existing standards

12. PROJECT IMPLEMENTATION • 2001 TRAINING OF STRENGTHS MODEL TO ALL SOUTH CANTERBURY MENTAL HEALTH WORKERS • 2002 IMPLEMENTATION OF STRENGTHS MODEL ADULT MENTAL HEALTH SERVICES – INPATIENT AND COMMUNITY • 2003 IMPLEMENTATION OF STRENGTHS MODEL ALCOHOL AND OTHER DRUGS SERVICES • 2005 IMPLEMENTATION OF STRENGTHS MODEL CHILD AND ADOLESCENT SERVICE

13. TOOLS IMPLEMENTED • STRENGTHS PRINCIPLES • STRENGTHS ASSESSMENT • GOAL PLAN • WELLNESS RECOVERY ACTION PLAN • GROUP SUPERVISION • FOCUS ON COMMUNITY RESOURCES

14. IMPLEMENTATION SUPPORTS • STRENGTHS WORKSHOP’S • GROUP SUPERVISION • PERSON CENTRED MANAGEMENT • SERVICE PROVISION FRAMEWORK • PERFORMANCE REVIEW PROCESS • AUDITING TOOLS • KNOWING THE PEOPLE PLANNING • ONGOING TRAINING

15. Monitoring of the day to day requirements • Recruitment and defining of team roles • Performance Management • Team motivation and Morale • Reward/recognition/incentives linked to the goals • Training and Support provided

16. Review of progress • Monitoring of the quality of the Recovery Work. • Development of the skills of the management team to promote recovery enhancing environment • Maintaining the momentum • Involving Families • Incorporating within existing cultural practices.

17. EVALUATION – TRENDS BFORE AND AFTER

18. ACCREDITATION FINANCIAL COMPLAINTS 2000 = 48 2003 = 6 1.5 MILLION UNDERSPEND 2000 = 24 2002 = 12 2004 = 16 PRELIMINARY REPORT

19. SERVICE UTILISATION

20. BED DAYS 2001-2004

21. TOTAL COMMUNITY CASELOAD

22. GROUP THREE RESULTS • PEOPLE IN THE TIMARU PSYCHIATRIC SERVICE FOR 5 YEARS OR MORE • TOTAL NUMBER = 155

23. ADMISSIONS

24. INPATIENT ADMISSIONS 2001-2004

25. INPATIENT BED DAYS

26. BED DAYS 2001 - 2004

27. CLIENT SATISFACTION SURVEY

28. VOCATIONAL ACTIVITY 2004 • 119 People considered as High Need • 71 of those individuals have been in the service for 5 plus years • 34% of those people were in some form of vocational activity • 10 individuals in part-time employment • 14 individuals in full-time employment

29. VOCATIONAL ACTIVITY

30. ACCOMMODATION outcomes • TOTAL OF 119 LONG-TERM PEOPLE • Living independently = 69 (58%) • Living semi independently = 26 (22%) • Living semi dependent = 8 (6%) • Living dependent = 15 (13%)

31. Comparison accommodation

32. STAFF SATISFACTION

33. In the past I felt like the tail of the dog now I feel the head. Feel I’m on the same level as my Key Worker Its now acceptable to have dreams even if they are dreams Before strengths professionals were like God now they are like people I didn’t like it at the beginning cause I felt there was nothing good about me, it made me mad PEOPLES COMMENTS

34. SI REGIONAL PLAN - VISION SIDHB’S support the funding and provision of services for people with serious mental health problems that are delivered by a competent mental health workforce that understands the practices and principles of recovery and supports the destigmatisation of mental illness in South Island communities.

35. HIDEAWAY MENTAL HEALTH SERVICE • Identify the strengths and weaknesses of the service? • What are the potential barriers and risks? • What are the outcomes you would like to achieve? • How are you going to measure them?