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1. ACT Fidelity According to Research Trauma-Informed Practice Psychosocial Rehab ACT Potpourri 1pt 1 pt 1 pt 1pt 1 pt 2 pt 2 pt 2pt 2pt 2 pt 3 pt 3 pt 3 pt 3 pt 3 pt 4 pt 4 pt 4pt 4 pt 4pt 5pt 5 pt 5 pt 5 pt 5 pt

2. Topic 1 ACT Teams that score high on fidelity are serving this population

3. Who are People living with complex mental illnesses and substance use disorders and have very significant functional impairments

4. High Fidelity ACT Teams conduct outreach versus office-based work, this percentage of the time (out of 100% of the work)

5. What is GREATER THAN 75% OF THE WORK IS IN COMMUNITY – HIGH FIDELITY = 80% - 90%

6. High Fidelity ACT teams have this framework as their focus

7. What is Psychosocial Rehabilitation

8. High Fidelity ACT Team staff have these core competencies - name at least 4 – the first one is “communication skills”

9. What Are • Good Communication Skills • Motivational Interviewing • Strengths-Based /Client Centred • Trauma-Informed Lens/Practice • Conflict Resolution Skills • **Psychosocial Rehabilitation** • Knowledge of psychiatric meds • Mental Status Exam • Relapse Prevention – Addiction knowledge • Cultural competence

10. High Fidelity ACT teams complete comprehensive assessments for each client containing 7 areas of functioning. Name at least 3:

11. What are: Psychiatric history/mental status and diagnosis Use of drugs and alcohol Education and Employment Social Development and Functioning Physical Health Family Structure and Relationships Activities of Daily Living BC Program of ACT Standards. 2008

12. Topic 2 According to the “Recovery Oriented Language Guide”, our language needs to be: There are five main criteria, name 3 – hint: the first one is ‘Respectful’

13. What are • Respectful • Non-judgemental • Clear and Understandable • Free of jargon, confusing data, and speculation • Our language must carry a sense of HOPE and COMMITMENT

14. According to research, the fundamental goal of ACT, to assist people to participate fully in their communities, is congruent with this practice perspective.

15. What is A Recovery-Oriented Approach Salyers, M.P. and Tsemberis, S. (2007). ACT and recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams. Community mental health journal, 43 (6).

16. According to research, people with a strong presentation of Anti-Social Personality Disorder should be treated with these 3 “Principles of Care”on an ACT team.

17. What are: • Treat with respect and compassion and humanity like any other participant • Expect to be treated with respect and set the delineations of language, and behaviour that is team consistent…allow for progression of respect over time to engage in a relationship that can then lead to better role modelling • An emphasis on externalized control and responsibilities of sanctions are more likely to help create stability, and may lead to “internalizing” some of the “external” messages Musgrave, I. (2013). ACT services to patients with disorders of personality. ACT Provincial Conference. March 17 Workshop. Victoria, BC

18. According to research, people with this diagnosis assigned to ACT showed a significantly greater reduction in alcohol use and were less likely to go to jail than those in standard clinical case management

19. What is AntiSocial Personality Disorder Frisman, L.K., Mueser, K.T., Covell, N.H., Lin, H.J., Crocker, A., Drake, R.E. and Essock, S.M. (2009). Use of integrated dual disorder treatment via assertive community treatment versus clinical case management for persons with co-occurring disorders and antisocial personality disorder. The journal of nervous and mental disease. 197 (11).

20. According to researcher and author, Bruce Alexander (Globalization of Addiction), the cause of addiction is dislocation – separation from one another, culture and community. What is the solution to address addiction according to this perspective?

21. Restore social spending • Enhance our ability to care for one another • Invest in social housing • Reform our public services, so they become more nurturing • Rebuild programs like welfare and UI that give people choices and allow them to stay in their home communities • Place full employment once again at the top of the public policy agenda • On a global level, substantially reducing the addiction problem requires nothing less than exercising sensible, humane controls over markets, corporations, environments, public institutions, and international agencies to reduce dislocation. Alexander, B.K. (2001). The roots of addiction in a free market society. Canadian centre for policy alternatives. April.

22. Topic 3 Trauma can be stored in the body as somatic symptoms. Name at least 3:

23. What are • Headaches • Gastrointestinal problems (irritable bowel syndrome; pelvic inflammatory disease) • Hypertension • Chronic pain that is unidentified (i.e. fibromyalgia) • Low energy • Panic – rapid heartbeat; sweating; heavy feeling on the chest; weak legs

24. By its very nature, trauma is defined by events that are ____ and ___, and produce feelings of helplessness and/or feelings of ‘horror’

25. What is Unpredictable and Uncontrollable

26. Common trauma symptoms include (name at least 3):

27. What are • Avoidance • Hypervigilance • Sleep disruption (too much or too little) • Anxiety/Depression • Reliving the experience • Addictions (as coping) • Psychosomatic symptoms (body pain) • Personality disruption (developmental trauma) • Feeling numb and empty • Intense emotions seemingly from nowhere • Dissociation/ Derealization/ Depersonalization

28. In Trauma-Informed Practice, we work to provide this to clients in all our interactions: (to counteract the feelings of helplessness and of being in danger)

29. What is providing… • Safety or Predictability • Choice • Control

30. This nervous system is overactivein many people who have experienced trauma and meet criteria for PTSD

31. What is the Sympathetic Nervous System Responsible for the FIGHT, FLIGHT and FREEZE responses. Grounding and containment skills are required when people are activated

32. Topic 4 According to PSR Canada’s guidelines, the Core Principles and Values include PSR Practitioners conveying these two things:

33. What are HOPE and RESPECT http://www.psrrpscanada.ca/index.php/src=gendocs&link=About

34. Psychosocial Rehabilitation builds on these two qualities of individuals served by ACT Teams

35. What are STRENGHTS and CAPACITIES http://www.psrrpscanada.ca/index.php/src=gendocs&link=About

36. Psychosocial Rehabilitation practices help individuals improve the quality of these aspects of their lives: Name at least 3

37. What are • Social • Occupational • Education • Residential • Intellectual • Spiritual • Financial http://www.psrrpscanada.ca/index.php/src=gendocs&link=About

38. The Recovery Model and Psychosocial Rehabilitation Model are often considered synonymous. Recovery means helping people to do this:

39. What is Help people get back to work and live on their own

40. People with lived experience who have been instrumental in developing the Recovery Model, say they need mental health workers to provide these three things:

41. What are HOPE Validation & Encouragement

42. Topic 5 Compared with other community services, ACT has better outcomes for client’s in these 3 realms:

43. What are • Quality of Life • Psychiatric Symptoms • Social Functioning • Includes: reduced hospital admissions • Longer housing stability • Reduced substance use

44. According to “100 Ways to Support Recovery”, staff can support transformation in the mental health system by: (there are 7 points, name at least 4) https://www.rethink.org/media/704895/100_ways_to_support_recovery_2nd_edition.pdf

45. What is • Mental illness is part of the person, rather than the person being a mental patient – i.e. “a schizophrenic” • Having valued social roles improves symptoms • Recovery goals come from the person, and support to meet those goals comes from staff. • Assessment focuses on strengths, preferences and skills of the person than on what they cannot do. • The normal human needs of work, love and play do apply • People with mental illness are fundamentally normal – i.e. like everyone else in their aspirations and needs 7. People will, over time, make good decisions about their lives if they have the opportunity, support and encouragement, rather than being treated as people who will in general make bad decisions so staff need to take responsibility for them.

46. These are the Practice Principles of an ACT Team Name at least 3 (there are 7 – first one is “team approach”)

47. What are • Team Approach • Smaller caseload (8:1) • In-vivo care • Time-unlimited services • Shared caseload • Core providers (all care provided in context of the team) • 24/7 coverage (or in collaboration with existing services)

48. ACT is a specific modality of community based care, but according to the www.ACT-BC.com website, it is good to think of ACT as this:

49. What is A PHILOSOPHYof care with the relationshipbetween client and the team at the core

50. ACT is different from case management in 5 main ways. Name at least 2