The Practice Review: Approaches, skills and interventions in working with individuals with “complex needs”. Jim Cullen, M.S.W., Ph.D Clinic Head/Manager, IGT Concurrent Disorders and Rainbow Services, Centre for Addiction and Mental Health.
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The Practice Review: Approaches, skills and interventions in working with individuals with “complex needs”
Jim Cullen, M.S.W., Ph.D
Clinic Head/Manager, IGT Concurrent Disorders and Rainbow Services, Centre for Addiction and Mental Health.
Assistant Professor, Faculty of Social Work, University of Toronto
What we are talking about are people……
Usually living with a Concurrent Disorder
A person with a mental health problem has a higher risk of having a substance use problem, just as a person with a substance use problem has an increased chance of having a mental health problem. People who have combined, or concurrent, substance use and mental health problems are said to have concurrent disorders.
Concurrent disorders can include combinations such as:
• an anxiety disorder and a drinking problem
• schizophrenia and cannabis dependence
• borderline personality disorder and heroin dependence
• depression and dependence on sleeping pills.
Mental health and substance use problems can begin at any time: from childhood to older age. Causes can include genetic, environmental and psychological factors. We often speak in terms of risk, but not prediction.
Concurrent disorders is a term for any combination of mental health and substance use problems. There is no one symptom or group of symptoms that is common to all combinations. The combinations of concurrent disorders can be divided into five main groups: Substance abuse with;
) Mood and Anxiety; 2) Persistent and Severe; 3) Personality; 4) Eating Disorders 5) Trauma
• Some people who have a mental health problem may use substances to feel better. While substance use is very risky in such cases, it can help people forget their problems or relieve symptoms, at least in the short-term. People sometimes talk about using substances for “self-medication.”
Most people with concurrent disorders have mild to moderate problems that can be treated in the community, but the referrals are barriers!!!
People with severe problems may need specialized care for concurrent disorders.
Clients with severe concurrent mental health and substance use problems may need integrated treatment. Integrated treatment is a way of making sure that treatment is smooth, co-ordinated and comprehensive for the client. It ensures that the client receives help not only with the concurrent disorders, but also in other life areas, such as housing and employment.
e.g. Mental Health and Addiction Workers
Screening and Assessment Tools
1st Stage; GAIN SS, any comprehensive addiction measure.
2nd Stage: PDSQ, ASI
So we know something is going on!
Now I can just show I care, be client centred, express empathy and they will connect with me and everything will get better
We didn’t our approach work?Well what is the evidence about what works and are we doing it?
So lets back up
Let’s start with definitions
EBP (evidence Based practice)refers to preferential use of mental/addiction and behavioral health interventions for which systematic empirical research has provided evidence of statistically significant effectiveness as treatments for specific problems.
In recent years, EBP has been stressed by professional organizations and colleges such as the Ontario College of Physicians and Surgeons, Ontario College of Social Work and Social Service Workers, The College of Psychologists of Ontario, College of Nurses of Ontario, Ontario College of Pharmacists (and others)
These institutions have also strongly encouraged their members to carry out investigations to provide evidence supporting or rejecting the use of specific interventions.
Across the board no matter what concurrent
Do further assessment
Use of self (success and pitfalls)
Cognitive Behavioural Approaches
But different agencies have different mandates
To help you figure this out…..a practice review may be helpful.
So what’s a practice review?
A practice review is a systematic structure and method in which an organization or service reviews;