ARC Advancing Recovery Collaborative Clinician Breakout June 24, 2014

This all sounds great, but how do I focus on strengths when there is a crisis??? Dianne Asher Karin Kalk

What is Your Experience? What about people who aren’t in crisis? How much of my time/the agency’s time is spent on crisis case management work – “The squeaky wheel gets the grease.” How much of my time/the agency’s time is spent on people who are not in crisis, but making progress? – Is there a protocol/plan for helping people not fall through the cracks? 3

Recovery Oriented Practice in the Midst of Crisis The core of recovery oriented practice is not to have the central focus of work be on crisis treatment, but rather to help people create lives that they desire, to minimize crisis episodes, to mitigate losses due to crisis situations (e.g. hospitalization, loss of housing) and assist individuals to rebound quickly from them. Rapp, C.A. & Goscha, R. J. (2006) The Strengths Model: Case Management with People with Psychiatric Disabilities, 2 nd ed. New York: Oxford University Press 4

Moving From Reactive to Proactive Practice APPROACHES TO MOVE AWAY FROM CRISIS: Provide direction by organizing your work – One example: Strengths Model Engagement Worksheet Involve the individual in shaping the work – Agenda Mapping (the big picture) – Agenda Setting (in the session) Refocus the crisis situation – Assess the situation – Use the Agenda Map to reframe – Evaluate the scope and severity – Link to the Strengths Assessment and Personal Recovery Plan Avoid an all or nothing approach if possible (e.g. go to the food bank vs. working on the personal recovery plan) 5

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Prioritizing/Agenda Mapping Housing Alcohol Use Medical Issues Benefits Drug Use Psychiatric Medication Getting a Job High Risk Behavior

Setting the Agenda* Why should an agenda be set? – People don’t always state their main concern first. – Avoids “doorknob disclosures”. – Provides structure to session and helps assure clients that their concerns will be addressed and will be heard. – Allows therapist to adjust goals if needed. Relationship-Centered Communication Presentation by Dr. Michael S. Marcin. Source materials adapted from Denise Davis & Neda Ratanawongsa's 3-Step Model Training from the American Academy on Communication in Healthcare, a SFDPH/UCSF Collaboration.

How to “Set the Agenda?” “What would you like for us to focus on today?” “Is there anything else you would like for us to focus on today?” (This continues until all concerns are stated.) “OK I hear that you have four concerns you would like to talk about today. Just to make sure we get to the ones that are most important to you, let’s take a minute to prioritize your concerns.” Summarize the list of concerns. State your concerns. Reach a shared agreement as to how the client’s clinical hour will be spent.

Levels of Crises Assess the situation – Is the person a danger to themselves or others? The treatment team steps in an makes decisions for the individual. Is there any room to explore options with the individual? – What about situations that don’t pose imminent danger?

Prepare to Take Action What plan do we need to have in place to ensure that our work as much as possible is proactive (recovery oriented) vs. reactive? Strengths Model Engagement Worksheet – Use to help think through where you are at with each person you work with – Use to offer specific support to make progress with individual people (e.g. group supervision, field mentoring, recommend using specific tools or methods, etc.) What additional information do we need to know to take action? – What are your patterns of seeing people? Do some people get more service than others? Why? (service calendar for caseload) – What is getting in the way of your being able to see people? (analysis of how you spend your time) – What is getting in the way of being able to engage or make progress with a specific person? (field mentoring or group supervision) – Other? What change ideas would I like to test when I return to my agency? 11

Report Out Prepare to report out to the whole group