1. Step up: HRstory Sharing Successes and Challenges in Deinstitutionalization Radmila Stojanović Babić, prof.soc.pedagog Budapest (Hungary) April 24-26, 2008

2. RSBNGO 'Susret', Zagreb/Croatia Story

3. RSBNGO 'Susret', Zagreb/Croatia Who are we? NGO for psychosocial support, est. 2006 Running 2 projects:  Assisted housing for persons with mental health disorders and ID  Assertive Outreach 10 employees: –1 psychiatrist –1 social pedagogue –8 assistants (direct support stuff)

4. RSBNGO 'Susret', Zagreb/Croatia Users Main mental health disorders in groups: –F2x, F6x, F7x (ICD-10) –Comorbidity with other dg. 12 users in 3 communities

5. RSBNGO 'Susret', Zagreb/Croatia Multidisciplinary team Consists of: Psychiatrist Psychologist (API) Social worker (API) Social pedagogue (coordinator)

6. RSBNGO 'Susret', Zagreb/Croatia Team member’s roles Psychiatrist – team leader, psychopharmaco- therapy, psycho- education, supervision Psychologist – ABA specialist Social worker – social issues Soc. pedagogue - coordinator

7. RSBNGO 'Susret', Zagreb/Croatia Community based service For whom? –People with mental health disabilities – chronic and persistent mental health problems What kind of support? –for all aspects of person’s life and include: Assisted housing program Case management Care coordination

8. RSBNGO 'Susret', Zagreb/Croatia Assisted housing program Normal living environment Safe, acceptable housing – important (critical!) element Privacy

9. RSBNGO 'Susret', Zagreb/Croatia Case Management (CM) CM services - essential in community-based treatment, include: assessment of problem areas measurement of functioning level determination of needs link with necessary resources care coordination advocacy and monitoring of provided services and their outcomes

10. RSBNGO 'Susret', Zagreb/Croatia Care Coordinator Listen, talk, empathize, think - how to learn ‘catching the fish’? – Gentle teaching Identify the needs Consider how to meet identified needs, which member of the team could help, sourcing in local community?

11. RSBNGO 'Susret', Zagreb/Croatia Aims Support for living in community Psychic stability in supported housing Decline in symptoms of mental disorder (PANS, HAMILTON, GFA)

12. RSBNGO 'Susret', Zagreb/Croatia How we do it? (1) Toward Users: Communicate frequently - building up relationship PCP – person centered planning (yearly) Assisted employment (cooperation with API) Psychotherapy group (weekly) Other activities – at home (cleaning, meal preparation, etc), in the community (workshops, self advocacy group, theater, church)

13. RSBNGO 'Susret', Zagreb/Croatia How we do it? (2) To direct support stuff: Psycho-education Work on conflict relations Balance approaches toward users Increase level of professionalism

14. RSBNGO 'Susret', Zagreb/Croatia Criteria → Mental health disorder (+/- ID) → Alcohol abuse – drop out policy? → Psychosis+/-ID+ alcohol abuse = challenging behavior (life threatening (disulfiram+alcohol), para/suicidality, manipulative behavior,...) – looking for another, better model for managing users with such comorbidity

15. RSBNGO 'Susret', Zagreb/Croatia Challenges User’s involvement into activities – neg. psy. symptoms – avolition Teething problems –daily activities –supported employment –stigma Triage – open issue - diff. approach to users with substance abuse

16. RSBNGO 'Susret', Zagreb/Croatia Peek in the future...