Managing Difficult problems Ann York and Steve Kingsbury

1. Managing Difficult problems Ann York and Steve Kingsbury

2. Difficult problems… Features • Make it hard to Let Go • End point may not be clear • Lots of artificial / service variation in how managed Do you have a consistent approach as a team? As an individual?

3. Table discussion A Think about families you think of as difficult or a challenge or hard work. What about the family, child or situation makes you feel this? Write each idea / reason down.

4. Chronic, complex, severe or poor alliance? • Chronic?- persistent and relatively stable problem / issue • Complex?- multiple problems in many areas of life or many agencies or professionals involved • Severe?- problem is really bad and having major impact • Alliance? – care plan between clinician and family / young person no longer aligned or appropriate May need different approaches….

5. Table discussion B Go back and classify the reasons you gave in Table discussion A using one of the four “difficulties” • Chronic • Complex • Severe • Alliance

6. Things you can do…

7. Chronic problems • Self management • Support groups • psycho education • Rapid access to services in crisis • Be creative • Shifting to a management framework from a change framework

8. Have a systematic approach to long-term problems • Many difficulties are chronic, complex and severe • Actively plan for these • Ask users what they want • Aim for self management of chronic problems • Multiagency involvement with complex problems • Rapid crisis response to severe problems • Active use of networks crucial

9. Expert Patient programmes Run by PCTs for chronic disease management 6 weekly sessions of 150 minutes 5 core self management issues at the heart: • Problem solving • Decision making • Resource utilisation • Developing effective partnerships with health care providers • Taking action

10. Complex problems • Multiagency / multiprofessional planning essential • Consider use of Lead Professional (ECM) • Be clear about different roles of Lead Professional and Key Worker in team

11. Severe problems • Usually involve significant risk e.g suicidality; risk taking behaviours; child protection • Clarity of risk assessment- who does it? Not the therapist… • Sharing risk assessment across network • Frequent contact • Be clear about roles • Zoning can help

12. Alliance Problems • Acknowledge that you, clinicians, the child or family or the professional system are not aligned • The alliance needs to be agreed developed again • CHOICE… with families or others? • The goals and intervention needs review • CARE PLAN • Multi agency agreement

13. Table exercise • Go back to your list of Chronic, Chronic and Severe problems • What solutions can you think of?

14. Table discussion C Think of interventions for the families you described