Step up: HRstory

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

2. Story NGO 'Susret', Zagreb/Croatia

3. 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) NGO 'Susret', Zagreb/Croatia

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

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

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

7. 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 NGO 'Susret', Zagreb/Croatia

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

9. CM services - essential in community-basedtreatment, 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 Case Management (CM) NGO 'Susret', Zagreb/Croatia

10. 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? NGO 'Susret', Zagreb/Croatia

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

12. 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) NGO 'Susret', Zagreb/Croatia

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

14. 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 NGO 'Susret', Zagreb/Croatia

15. 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 NGO 'Susret', Zagreb/Croatia

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