“Implementing an evidence-based model of recovery in an inter-sectoral setting.” Alex Couley ausMHLP participant 2008

SNAP Partnerships with the University of Wollongong & MHRI of Victoria

Introducing an evidence based model of care PARCS Collaborative Therapy Demonstrate process using Kotter’s eight step process Where to from here?

PARCS Residential service for people eligible for adult mental health services It accommodates and provides care and treatment from 7 to 28 days to people who; ~ No longer require acute inpatient care and treatment and would benefit from short term intensive treatment and support in a residential setting ~ Are living in the community and require short term intensive treatment and support to prevent risk of further deterioration

PARCS Crucially no evidence to support efficacy Differing models emerging under vague guidelines Partnerships or sub contractual arrangements? Despite all of this state government pumping huge dollars into these services

Collaborative Therapy (CT) A therapeutic framework for working with consumers, carers, service providers and others in a systematic way, in order to achieve optimal health outcomes. It has 3 core components: - Education - Coping Strategies - Skills Development

SessionTitleContent 1What is health?Perceptions of health and behaviours that influence health 2The “I Can Do” model, Part 1: StressUnderstanding stress and how to recognise it; breathing exercises 3The “I Can Do” model, Part 2: Coping strategies Positive and negative stressors; goal setting 4The “How to” of the “I Can Do” ModelHealth Plan I – Daily Coping Plan 5The “I Can Do” model, Part 3: Vulnerability Cumulative stress, sub-optimal health, recognising vulnerable situations and early warning signs, collaborative partners 6Coping strategies for optimal health Health Plan II – Collaborative Strategies; problem solving 7The “I Can Do” model: Episode of illness What does it mean to experience an episode of illness; medication; Health Plan III – Action Plan 8Review: Putting it all togetherWhat is optimal health to me? Maintaining optimal health BoosterWhat is my health like now?Review health plans, problem solve vulnerable situations.

Establishing the sense of urgency This was self evident About to open new unit with a team of individuals who had never worked in the mental health field Fractured relationship with clinical partners Restructuring the model became a very last minute thing Questions by clinical staff about efficacy of adapted approach Disputes about the time of delivery of CT

Forming a powerful guiding coalition Small group brought together Myself Clinical services manager PARCS manager PARCS clinician

Creating a vision The vision- to demonstrate that PARCS can work through the use of evidence based interventions To compare with a PARCS using an eclectic psychosocial approach

Empowering others to act on the vision Brand new internal structure External barriers huge All staff trained together in CT Joint training delivered by the researchers and ourselves Generally well received by NGO staff but lots of scepticism by clinical team

Planning for and creating short term wins Introduced outcome measures to capture the results Early results really positive, fed back to team

Consolidating improvements and producing still more change Created a lead person to monitor system Fidelity became a major issue Supervision of team +++ Clinicians attitudes changed slowly but their manager’s didn’t Still bickering about the time of the day of delivery

Institutionalizing new approaches Agreement reached with two research teams to compare outcomes with another PARC Research proposal before ethics committees I left to take up post in NSW

Where to from here Have agreed to implement three evidenced based recovery models across service in rural NSW and research the results Bigger challenges with staff attitude Plan involves using Kotter’s eight point process again Would like to look at the role of the change agent