“ Implementing an evidence-based model of recovery in an inter-sectoral setting.”

1. “Implementing an evidence-basedmodel of recovery in an inter-sectoralsetting.” Alex Couley ausMHLP participant 2008

2. SNAP2005-2008Partnerships with the University of Wollongong & MHRI of Victoria

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

4. 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

5. 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

6. 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

8. 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

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

10. 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

11. 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

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

13. 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

14. 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

15. 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