Choose 3 strategies at a time to trial-review them and then once embedded or discarded, choose 3 more !!

Case Study -time to review

Case Study Did you find any difference when you looked at it a second time? Did you pick up more risk factors? Did you identify additional underlying reasons why Gemma may have been struggling? Were you able to identify more strategies that could help her address the problems she is currently experiencing?

What is the Number 1 Change I can make right now that will make the most difference to clients with cognitive impairment?

Wait for it, it is groundbreaking news……..

Therapeutic Alliance!!!!!!!! Be empathetic Time and patience the difficult behaviour often present in a client with CI is not an attempt to frustrate you - it is a result of their diagnosable condition Time and patience Take a strengths based approach-be aware of the impact of CI Time for a plug: Scott Miller Session Rating Scale Outcome Rating Scale

Key Points 40% of clients will have moderate to severe CI Allocate enough time Identify what you want/need to do with/for the client Plan the best way to do that Organize the resources you need Think about your communication ROLE MODEL the Cognitive Strategies you are teaching

Communication Tips Keep language simple/concrete Minimise distractions in the environment such as noise, lighting, etc. Raise only one topic at a time - clearly identify if you are going to raise a second Ask them if they understood what was said - to check: ask them to repeat back Provide written instructions in at least 14-point type Support verbal communication with written, pictorial or audio-visual cues Show rather than explain

How to get a person to start engaging in change Provide a few examples to the person on how they might start a new task If possible, start with tasks that the person enjoys Use appropriate relaxed humour Reward signs of initiative (e.g., “Well done Steve, it’s great to see that you’ve done that by yourself”) Provide more concrete rewards structure, contingency management

How to encourage staying on Task Assist with redirection of attention to the task at hand If the client regularly goes off track: discuss the issue together and come up with a quick catch phrase to redirect back to the conversation topic quickly e.g. “That was out of the ballpark - now what were we saying?” Useful internal and external attention strategy What am I doing now? What am I supposed to be doing? What am I doing next ?

How to promote mental flexibility Provide advanced warning of imminent changes and help the person accept and prepare for change Actively encourage the person to see something from the perspective of someone else

Addressing inappropriate behaviour Encourage use of the STOP-THINK-DO approach Provide immediate, clear and assertive feedback regarding any inappropriate behaviour When approached by a client at the wrong time, provide clear and emotionally neutral feedback of a more appropriate time and place to have a discussion

Addressing inappropriate behaviour Try and come from a place of compassion and empathy. They are not trying to mess up your day or frustrate you –this is what they live with 24/7

Quick question – What percentage of Organisational cultural change fails? 70% Who is best placed to identify and develop what treatment based Organisational change is needed? Clients- Clinicians Who is better placed to ensure Organisational change is implemented Managers, supervisors or clinicians?

What can agencies do to promote change … Think about your process of implementing change within your Organisation before you bring in the changes Develop a plan to evaluate that change Great project for accreditation needs

Implementation Planning Checklist   Implementation Planning Checklist What change/s do you want to initiate within your Service? What resources will would be required? E.g.: Computers, assessments etc. What staff training/support would be required? Do you think your managers will be supportive of the change/s? Which team members do you think will be most supportive of the change/s? What will ‘success’ look like? How will you measure this? E.g.: What auditing processes (currently in place or new) could be utilised?

Resources available now NADA Complex needs capable website-a practical resource for drug and alcohol services Hardcopy Website http://www.complexneedscapable.org.au elearning training in CI

Resources available now Tips for working with older people and cognitive Impairment NSW Health (2015) Older People’s AOD project full report https://www.health.nsw.gov.au/aod/professionals/Publication s/opdap-fullreport.pdf  Tips for working with Anger Fishkind, A., B., (2002) Calming Agitation with … Current Psychiatry Vol. 1, No. 4 https://www.mdedge.com/sites/default/files/Document/Septe mber-2017/0104_Fishkind.pd  Richmond, J.S., et al (2012) Verbal De-escalation of the Agitated Patient: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298202/

Any last questions or comments Would you please complete the slido questions about the presentation

Thank you for your time Jo Lunn WHOS Service Delivery and Innovation Manager jo.lunn123@outlook.com