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Using Harm Reduction when working with SMI Populations

Using Harm Reduction when working with SMI Populations. By Cynthia Hoffman, MFT. Presenter Biography.

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Using Harm Reduction when working with SMI Populations

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  1. Using Harm Reduction when working with SMI Populations By Cynthia Hoffman, MFT www.cynthiahoffmanmft.com

  2. www.cynthiahoffmanmft.com

  3. Presenter Biography Cynthia Hoffman, MFT is a psychotherapist in private practice. She also currently volunteers supervision to interns working in Community Mental Health settings. She has worked with severely mentally ill adults who use substances for over 13 years. She has worked in both community mental health settings and in private practice, practicing Harm Reduction. She is a also a member of the the Harm Reduction Therapy Centers Board of Directors. She has been practicing and teaching Harm Reduction Psychotherapy for over 13 years in both private practice and agency settings. www.cynthiahoffmanmft.com www.cynthiahoffmanmft.com

  4. Workshop Objective Objective: To familiarize the attendees with ACT and similar programs that work with homeless or previously homeless psychiatrically ill adults who have co-occurring substance use issues along with co-occurring medical illnesses and to identify the Harm Reduction techniques used with this population. www.cynthiahoffmanmft.com

  5. What is Assertive Community Treatment (ACT)? How the program works/History Who ACT serves Living situations Working with all providers: Benefits of ACT www.cynthiahoffmanmft.com

  6. How Act Works An ACT team is made up of multi-disciplinary staff that generally includes case managers, nurses, psychiatrist(s) and mental health clinicians. ACT operates from a “whatever it takes” philosophy and services are provided “in-vivo”. ACT programs were initially created to be a “hospital without walls”. www.cynthiahoffmanmft.com

  7. Who ACT serves Typical ACT clients may present with a variety of diagnoses including (but not limited to): Schizophrenia, Bipolar Disorder, Personality Disorders and Substance Abuse Disorders . Additionally, they are also likely to have health conditions, developmental disorders and environmental stressors. Many are homeless or formally homeless. www.cynthiahoffmanmft.com

  8. www.cynthiahoffmanmft.com

  9. Housing Clients in an ACT program may live in a variety of housing situations. Many are homeless or at least homeless for periods of time. Some live in supervised board & care homes and some may live independently in apartments or SRO’s (single room occupancy hotels). These housing situations often present barriers in treating clients from a harm reduction approach. www.cynthiahoffmanmft.com

  10. www.cynthiahoffmanmft.com

  11. Other Providers An essential component of an ACT program is the collaboration with other providers to ensure a strong continuum of care. payee services conservators housing staff hospital staff adjunct substance abuse services Helping to educate other providers on the benefits of a harm reduction approach can present challenges and is often met with resistance. www.cynthiahoffmanmft.com

  12. Benefits of ACT Studies show that substance use is reduced when wraparound case management along with providing social skills significantly reduces a clients substance use, sometimes by 50% Socialization, a sense of belonging Main focus of ACT is helping clients to improve their quality of life and develop meaningful activities www.cynthiahoffmanmft.com

  13. www.cynthiahoffmanmft.com

  14. Typical ACT client Adult 18 – 70 Average age approx 40 People of color Poor Former foster children Homeless or Minimally Housed www.cynthiahoffmanmft.com

  15. Why SMI populations drink and use People with mental illness use substances for a variety of reasons, including the relief of depression, anxiety, boredom or to relax and socialize (Addington & Duchak 1997, Fowler et al. 1998), www.cynthiahoffmanmft.com

  16. Substances used: • Alcohol • Crack • Speed • Heroin • Marijuana • Prescription Drugs: i.e. Oxycontin, Klonopin www.cynthiahoffmanmft.com

  17. Interventions Intensive Case Management Psychiatric Interventions Individual Supportive Therapy Group Therapy Teaching Self Care Incentives www.cynthiahoffmanmft.com

  18. Intensive Case Management Both short and long term goal setting (which includes goals that add meaningful activities to a clients life) Medical appointments Help with entitlements Communication with families Psychiatrist Case managers rotate 24 hour on call for off hours www.cynthiahoffmanmft.com

  19. Psychiatric Interventions ACT psychiatrist meets with the client as needed which could be from weekly to monthly. These appointments can be in the office, at the clients home or at a café. Collaborates WITH the client in developing an effective medication regimen, taking into account the substances a client uses. Discusses substance use and its effects when combined with medications May prescribe vitamins and/or behavioral interventions (CBT, DBT, etc) instead of or in conjunction with psychiatric meds www.cynthiahoffmanmft.com

  20. Individual and Group Therapy Individual Therapy is supportive and about teaching coping skills. Group Therapy is mostly psycho-educational and open-ended www.cynthiahoffmanmft.com

  21. “I’ve never had problems with drugs. I’ve had problems with the police.”Keith Richards www.cynthiahoffmanmft.com

  22. Motivational Interviewing Whole package of Motivational Interviewing is complicated and there is much to learn. The spirit of MI is what’s essential. The Spirit of Motivational Interviewing Collaboration Evocation Autonomy Perception Curiosity Ethics Treats Resistance as thinking www.cynthiahoffmanmft.com

  23. Principles of Motivational Interviewing Express Empathy- Be affirming, help clients express their personal choice Develop Discrepancy – Develop the discrepancy between the clients goals and their current Behavior Roll with Resistance – Avoid Arguments – Know that resistance is a form of thinking about the issue Support Self Efficacy www.cynthiahoffmanmft.com

  24. Individual Therapy Supportive Client Centered Motivational Interviewing Individualized Personal Goals Quality of Life Issues Individualized Harm Reduction Strategies Identifying and helping client work towards goals that provide meaningful activities www.cynthiahoffmanmft.com

  25. Motivational Interviewing Whole package of Motivational Interviewing is complicated and there is much to learn. The spirit of MI is what’s essential. The Spirit of Motivational Interviewing Collaboration Evocation Autonomy Perception Curiosity Ethics Treats Resistance as thinking

  26. www.cynthiahoffmanmft.com

  27. Group Therapy Groups provided: • Health Groups: Diabetes/High Blood Pressure • Women’s/Men’s Groups • Anger Management • Socialization Groups – Lunch Group, Weekend Planning, Holiday Celebrations, Knitting, Walking, Music Group • Art Therapy • Seeking Safety www.cynthiahoffmanmft.com

  28. Group Therapy (continued) • Harm Reduction. Includes topics: • Stages of change • Personal Goals • Family influence • Dealing with Feelings • Drug education including safer use www.cynthiahoffmanmft.com

  29. Teaching self care to SMI population • Physical - wound care, dental, checking BP, blood sugar, liver panel regularly • Psycho-education about physical health, psychiatric illness, substances used • Prescribing vitamins i.e B6, • statistics re: smi populations --50 to 80% • Safe Injection, clean works and pipes, drinking water • Diabetes and High Blood Pressure Education www.cynthiahoffmanmft.com

  30. Incentives Incentives are offered for a variety of issues. They can be used to encourage someone to: • take a shower • attend a group • reduce use or • go on a substance use holiday Some examples of incentives used are: • Food shopping • Clothes or household items shopping • Visits to a massage parlor • Musical instruments • A meal at a favorite restaurant www.cynthiahoffmanmft.com

  31. I Incentives (cont) Some examples of incentives used are: Food shopping Clothes or household items shopping Visits to a massage parlor Musical instruments A meal at a favorite restaurant www.cynthiahoffmanmft.com

  32. Sex Severely Mentally Ill and DD clients have sex. Oftentimes, alot of it. Provide Harm reduction education about sexual practices www.cynthiahoffmanmft.com

  33. Countertransference Many come to social because of family issues experienced when growing up. To experiences are likely to arise when working with clients. These should be recognized and discussed in individual supervision with the supervisor taking care not to act as therapist to the staff member. www.cynthiahoffmanmft.com

  34. Working with staff, burnout frustration at seeing these adults make bad choices Anger at the system The ACT Team Model allows for team members to help each other in a variety of ways i.e. going on outreach together, taking over if one person is ‘burnt out’ on a particular client www.cynthiahoffmanmft.com

  35. Challenges and Obstacles Funding Stress from everyone to keep clients out of the hospital even though the hospital might be what they need Growing acuity levels in clients while resources continue to shrink. www.cynthiahoffmanmft.com

  36. Contact us cynthiahoffmanmft@yahoo.com www.cynthiahoffmanmft.com 36 www.cynthiahoffmanmft.com

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