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Working with service users Leader level learning module
Working with service users – Leader level Learning module – print version
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Published in September 2009 by Te Pou o Te Whakaaro Nui
The National Centre of Mental Health Research, Information and Workforce Development.
PO Box 108-244, Symonds Street, Auckland, New Zealand.
ISBN 978-1-877537-31-8
Web www.tepou.co.nz/letsgetreal
Email [email protected]
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Contents
Introduction .................................................................................................................. 4
1 Recovery ............................................................................................................... 8
2 Relationships .........................................................................................................10
3 Integrating theory into practice: guiding and supporting others in their practice........................14
4 Trauma informed care ..............................................................................................16
5 Medication ............................................................................................................18
References and recommended reading .................................................................................19
Learning Review Tool......................................................................................................23
Individual Professional Development Plan .............................................................................25
Working with service users – Leader level Learning module – print version
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Introduction The Real Skill for working with service users is:
Every person working in a mental health and addiction treatment service utilises strategies to engage meaningfully and work in partnership with service users, and focuses on service users’ strengths to support recovery.
Performance indicators – leader
By the completion of this module you will demonstrate how you develop and support a service that is:
• responsive to the needs of service users
• reflective best-practice principles
• recovery focused
• culturally safe
• trauma informed
• effective at communicating.
Preparation
To help you complete this module, please familiarise yourself with national key strategy and policy documents and the service provider guidelines relevant to your specific area of practice.
It is also recommended that you undertake some background reading of recent research and publications related to the area of working with service users. For your reference a list of recommended reading is included in this module. The following New Zealand publications will provide you with an overview of working with service users.
• Mental Health Commission. (2001). Recovery Competencies for New Zealand Mental Health
Workers. Wellington: Mental Health Commission.
The purpose of this document is to provide educators with guidance on including recovery content in the courses they run. It outlines recovery-based competencies and includes extensive lists of national and international resources to support these.
• Mental Health Commission. (2004). Our Lives in 2014: A recovery vision from people with experience of mental illness. Auckland: Mental Health Commission.
The purpose of this document is to guide development of the Ministry of Health’s second mental health plan, and to influence the overall development of the services and sectors that affect people with mental illness.
• Ministry of Health. (2005). Te Tāhuhu: Improving mental health 2005-2015: The second New Zealand mental health and addiction plan. Wellington: Ministry of Health.
See in particular the leading challenges of responsiveness, prevention and promotion, workforce and culture for recovery, and Māori mental health.
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• Ministry of Health. (2006). Te Kōkiri: The mental health and addiction action plan 2006–2015. Wellington: Ministry of Health.
See in particular the leading challenges of responsiveness, prevention and promotion, workforce and culture for recovery, and Māori mental health.
• Ministry of Health. (2008). National Health and Disability Sector Standards. Wellington: Ministry of Health. This incorporates the 2001 National Mental Health Sector Standards.
• Ministry of Health. 2008. Te Puāwaiwhero: The second Māori mental health and addiction national strategic framework 2008–2015. Wellington: Ministry of Health.
• Mental Health Advocacy Coalition. (2008). Destination: Recovery: Te ungaki uta: Te oranga. Auckland: Mental Health Foundation.
• Ministry of Health. (2007). The National Drug Policy 2007–2012. Wellington: Ministry of Health.
• Ministry of Health. (2005). Preventing and Minimising Gambling Harm: Strategic plan 2004–2010. Wellington: Ministry of Health.
• Ministry of Health. (2002). Te Puāwaitanga: Māori mental health national strategic framework. Wellington: Ministry of Health.
• Ministry of Health. (2002b). He Korowai Oranga: Māori health strategy. Wellington: Ministry of Health.
The work in this module builds on the essential and practitioner levels of the working with service users Real Skill. It is designed to capture your knowledge and its application as a leader in the mental health and addiction sector. You will be expected to reflect on:
• your experiences of leadership in team and service provider contexts
• how you have managed different situations
• the type of feedback you provide to others and how this potentially impacts on service users.
There are two main themes in this module. The first explores the ways in which you ensure that your service, and those that work within it, operate with integrity and model recovery. The second requires you reflect on the strategies you use to overcome challenges.
To gain the maximum benefit from this module you are encouraged to think about how the learning module applies to you and your work context. When you have finished working through this module use the Learning Review Tool to help you reflect on how you work with service users. This will enable you to identify where your strengths are, along with any areas you may need to further explore in your Individual Professional Development Plan.
Working with service users – Leader level Learning module – print version
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Overview Recovery has become the fundamental paradigm in New Zealand mental health policy and practice.
Recovery happens when people with mental illness take an active role in improving their lives, when communities include people with mental illness, and when mental health services can enable people with mental illness and their communities and families to interact with each other (Mental Health Commission, 2001, pp. 1-2).
The recovery approach in both mental health and addiction, places emphasis on the need to draw on the resources of all people with and affected by mental illness and addiction (Mental Health Commission, 2001; Mental Health Advocacy Coalition, 2008).
The process of recovery from problematic substance use is characterised by voluntarily-sustained control over substance use which maximises health and well-being and participation in the rights roles and responsibilities of society (UK Drug Policy Commission Recovery Consensus Group, 2008).
The above statement, specific to people with addiction, reflects current thinking in the addiction sector - that an individual’s relationship with the wider world (family, peers and the community) is an intrinsic part of recovery.
Assisting service users in recovery ultimately involves attention to the needs of those who are part of the person’s social network. This is true of mental illness and addiction and for those experiencing coexisting disorders, where taking a family inclusive approach has been shown to be highly effective. In Recovery, as a Journey of the Heart (Deegan, 1995), Patricia Deegan gives a clear illustration of the role of the service user within that journey.
… Like a pebble tossed into the centre of a still pool, this simple fact [of having a mental illness] radiates in ever larger ripples until every corner of academic and applied mental health science and clinical practice are affected. Those of us who have been diagnosed are not objects to be acted upon… We are human beings and we can speak for ourselves… We can become experts in our own journey of recovery.
The goal of the recovery process is not to become normal. The goal is to embrace our human vocation of becoming more deeply, more fully human. The goal is not normalisation. The goal is to become the unique, awesome, never to be repeated human being that we are called to be…
To be human means to be a question in search of an answer. However, many of us who have been psychiatrically labelled have received powerful messages from professionals who in effect tell us that by virtue of our diagnosis the question of our being has already been answered and our futures are already sealed (p. 3).
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Recovery in mental health service delivery and policy Recovery is seen in service delivery and policy documents as a goal that will only be achieved by working collaboratively and in partnership with service users.
In New Zealand, recovery has influenced a number of important developments and has impacted on the quality and monitoring of mental health and addiction services, and consequently changed the way services are delivered. However, it is this statement from Te Tāhuhu: Improving mental health 2005–2015 (Ministry of Health, 2005) that highlights the need for services to work more collaboratively and inclusively with service users.
…recognition that social and economic factors such as employment, housing, and poverty all impact on mental health, well-being and recovery – and an understanding of how essential it is that all parts of the State Sector and wider community services, work together to provide services (p. 2)”.
Blueprint for Mental Health Services in New Zealand (Mental Health Commission, 1998) provides this statement, which outlines that services need to work in recovery-oriented and recovery-focussed ways.
Historically, mental health services have failed to use a recovery approach… Some people have experienced recovery without using mental health services. Others have experienced recovery in spite of them. But most will do much better if services are designed and delivered to facilitate their recovery. …The Blueprint builds on the National Mental Health Strategy by making more explicit the need for services to use a recovery approach, and tackle discrimination which is a major barrier to recover y(pp. 1-2).
Our lives in 2014: A recovery vision from people with experience of mental illness (Mental Health Commission, 2004) provides this vision for a fundamental shift in the way services and societies respond to people with mental illness.
In 2014 all tangata motuhake in New Zealand have personal power, a valued place in our whānau and communities, and services that support us to lead our own recovery (p. 10).
When considering recovery and how your service works in recovery-oriented ways, your attention is drawn to the following documents, which highlight examples of recovery-oriented services.
• Experiencing A Recovery–Oriented Acute Mental Health Service; Home Based Treatment from the Perspectives of Service Users, Their Families and Mental Health Professionals. (Lapsley et al, 2005).
• Te Hononga 2015: Connecting for greater well-being. (Mental Health Commission, 2007).
• Mental Health Recovery: What helps, what hinders? A national research project for the development of recovery facilitating system performance indicators (Onken et al, 2002).
Working with service users – Leader level Learning module – print version
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1 Recovery 1.1 Some of the key elements of recovery include hope, support, education, self-advocacy, and connectedness. Revisit your organisation/service’s vision and reflect on how it addresses the following elements of recovery?
Hope
Support
Education
Self-advocacy
Connectedness
1.2 Identify the formal processes or systems that exist in your service to ensure that these elements are taken into account when supporting service users.
Hope
Support
Education
Self-advocacy
Connectedness
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1.3 Give two examples to explain how you ensure your staff has the necessary knowledge, skills and attitudes to support service users in the elements of recovery outlines in the exercise above.
Support mechanism used to ensure staff have the necessary knowledge, skills and attitudes
Explanation of how it is used
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2 Relationships The ability of people working in the mental health and addiction sector to build effective relationships has proven critical in assisting the recovery of service users and promoting their safety (Barnett and Lapsley, 2006).
Establishing, developing, maintaining and reviewing relationships between your organisation and others across mental health and addiction services and other agencies is a key role of all leadership positions. Creating effective networks and information sharing, as well as gaining access to a variety of resources can be fundamental to assisting service users in their recovery.
2.1 List the key stakeholder groups, government organisations, consumer groups, and mental health and addiction services with which you have a relationship.
2.2 In your opinion what are the four key elements you use when establishing relationships with key stakeholders and other organisations?
Key elements
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2.3 Give three positive and three negative aspects of establishing and maintaining effective relationships with other organisations.
The positives The negatives
2.4 Consider one stakeholder with whom you have an excellent relationship. Outline the main functions of the relationship, and the strategies used to develop, maintain and review it. Give several examples of the benefits gained from this relationship, both for the organisation you lead and for service users.
Main functions
Strategy for building the relationship
Strategy for maintaining the relationship
Strategy for reviewing the relationship
Examples of the benefits of the relationship
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2.5 Effective consultation can enhance your service, service delivery and the quality of service for service users. Consultation with key stakeholders such as managers, Māori, community groups, your team, service users and family and/or whānau provides a broad range of perspectives when planning and evaluating the effectiveness of you services.
Using the reflective cycle outlined in the table below, examine two situations where you have felt challenged working with a stakeholder. What did you do?
Situation one
What was the issue?
What did you do?
What went well? What did not go so well?
On reflection, would you approach this situation in the same way in the future?
What have you done to prevent a similar situation occurring in the future?
What did you learn from this experience?
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Situation two
What was the issue?
What did you do?
What went well? What did not go so well?
On reflection, would you approach this situation in the same way in the future?
What have you done to prevent a similar situation occurring in the future?
What did you learn from this experience?
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3 Integrating theory into practice: guiding and supporting others in their practice
There are many factors that impact upon recovery, including the social, psychological, spiritual and biological domains.
3.1 Reflect upon the demographics of the population that access your service? What social, psychological, spiritual and biological needs are most prevalent? What staff training and ongoing development does your service provide to ensure there is an adequate response to these needs?
Social
Psychological
Spiritual
Biological
3.2 What resources or relationships do you use when supporting service users in these areas?
Social
Psychological
Spiritual
Biological
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3.3 Identify the different models of practice that are used in your service(s), for example Te Whare Tapa Wha, the Tidal model, and harm minimisation. Please describe why these particular models are used.
Model of health
Rationale for use
3.4 Describe how your service and your team(s) monitor the effectiveness of one of the models of practice identified above.
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4 Trauma informed care Within New Zealand, trauma informed care is relatively new within the mental health and addiction sector. Trauma informed care is defined as follows.
As a practice and set of interventions, trauma informed care involves professional relationships and interventions that take into account the individual’s trauma history as part of efforts to promote healing and growth (Elliot et al, 2005, p. 461).
Key characteristics of trauma informed care systems are that they:
• integrate philosophies of care at that these guide all clinical interventions
• are based on current literature
• are inclusive of the survivor’s perspective
• are informed by research and evidence of effective practice
• recognise that coercive interventions cause traumatisation and re-traumatisation and are to be avoided (Fallot and Harris, 2002).
Key features of trauma informed care systems include:
• recognition of the high rates of post-traumatic stress disorder, and other psychiatric disorders related to trauma exposure, in people with serious mental illness
• early and rigorous diagnostic evaluation, with focused consideration of trauma, in people with complicated, treatment-resistant illnesses such as dissociative identity disorder and personality disorders
• valuing the consumer in all aspects of care
• neutral, objective and supportive language
• individually flexible plans and approaches
• awareness and training on re-traumatising practices
• institutions and services that utilise advocacy services and clinical consultants
• training and supervision in assessment and treatment of people with trauma histories (Fallot and Harris, 2002).
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4.1 How does your service acknowledge the impact of trauma on the lives of service users?
4.2 Describe three examples of how your service demonstrates the features of trauma informed care outlined above.
4.3 As a leader, what do you do to facilitate awareness of contemporary and advancing knowledge in trauma informed care?
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5 Medication
5.1 What processes are used in your organisation to ensure that your team is providing accurate and up-to-date information to service users and family and whānau on the types of medication available, and the benefits and adverse effects of those medications?
5.2 What processes exist within your organisation to ensure your team are practising in safe ways when providing advice on medication? How often are these reviewed?
5.3 When a service user wants to change the medication they are on because of adverse side-effects, what processes exist within your organisation to support their choice?
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References and recommended reading Barnett H., & Lapsley H. (2006). Journeys of Despair, Journeys of Hope. Wellington: Mental Health Commission. Chapman, J., & White, T. (1995). A Guide to Effective Consumer Participation in Mental Health Services. Wellington: Ministry of Health. Deegan P. (1995). Recovery as a journey of the heart. Paper presented at Recovery from Psychiatric Disability: Implications for the training of mental health professionals. Retrieved from: http://www.uow.com.au/content/groups/public/@web/@health/documents/doc/uow042403.pdf Durie, M. (1994). Whaiora: Māori health development. Auckland: Oxford University Press. Dyall, L., Bridgman, G., Bidois, A., Gurney, H., Hawira, J., Tangitu, P., & Huata, W. (1999). Māori outcomes: Expectations of mental health services. Social Policy Journal of New Zealand, 12, p71-90. Elliott, D., Bjelajac, P., Fallot, R., Markoff, L., & Reed, B. (2005). Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33(4), 461–477. Fallot, R., & Harris, M. (2002). The Trauma Recovery and Empowerment Model (TREM): conceptual and practical issues in a group intervention for women. Community Mental Health Journal, 38(6), 475-485. Lapsley, H., Goldsack, S., Reet, S., & Gingell, M. (2005). Experiencing A Recovery–Oriented Acute Mental Health Service; Home Based Treatment from the Perspectives of Service Users, Their Families and Mental Health Professionals. Wellington: Mental Health Commission. Lapsley, H., Nikora, L.W., & Black, R. (2002). “Kia Mauri Tau!”: Narratives of recovery from disabling mental health problems. Wellington: Mental Health Commission. Mental Health Advocacy Coalition. (2008). Destination: Recovery: Te ungaki uta: Te oranga. Auckland: Mental Health Foundation of New Zealand. Mental Health Commission. (1998). Blueprint for Mental Health Services in New Zealand. Wellington: Mental Health Commission. Mental Health Commission. (2001). Recovery Competencies for New Zealand Mental Health Workers. Wellington: Mental Health Commission. Mental Health Commission. (2004). Our Lives in 2014: A recovery vision from people with experience of mental illness. Wellington: Mental Health Commission. Mental Health Commission. (2007). Te Hononga 2015: Connecting for greater well-being. Wellington: Mental Health Commission.
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Mental Health Foundation. (2002). Building on Strengths: A new approach to promoting mental health in New Zealand/Aotearoa. Auckland: Mental Health Foundation. Ministry of Health. (2002a). Building on Strengths. Wellington: Ministry of Health. Ministry of Health. (2002b). He Korowai Oranga: Māori health strategy. Wellington: Ministry of Health. Ministry of Health. (2002c). Pacific Health and Disability Action Plan. Wellington: Ministry of Health. Ministry of Health. (2002d). Te Puāwaitanga: Māori mental health national strategic framework. Wellington: Ministry of Health. Ministry of Health. (2005). Preventing and Minimising Gambling Harm: Strategic plan 2004–2010. Wellington: Ministry of Health. Ministry of Health. (2005). Te Tāhuhu: Improving mental health 2005-2015: The second New Zealand mental health and addiction plan. Wellington: Ministry of Health. Ministry of Health. (2006). Te Kōkiri: The mental health and addiction action plan 2006–2015. Wellington: Ministry of Health. Ministry of Health. (2007). The National Drug Policy 2007–2012. Wellington: Ministry of Health.
Ministry of Health. (2008). National Health and Disability Sector Standards. Wellington: Ministry of Health.
Ministry of Health. 2008. Te Puāwaiwhero: The second Māori mental health and addiction national strategic framework 2008–2015. Wellington: Ministry of Health. Onken S.J., Dumont J.M., Ridgway P., Dornan D.H., & Ralph R.O. (2002). Mental Health Recovery: What Helps? What Hinders? A national research project for the development of recovery facilitating system performance indicators. Washington D.C.: National Technical Assistance Centre for State Mental Health Planning, National Association of State Mental Health Program Directors. Repper, J., & Perkins, R. (2003). Social Inclusion and Recovery: A model for mental health practice. Edinburgh: Bailliere Tindall. UK Drug Policy Commission Recovery Consensus Group. (2008). A Vision of Recovery. London: UK Drug Policy Commission Recovery Consensus Group.
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Websites Health and Disabilities Commission – www.hdc.org.nz.
Human Rights Commission – www.hrc.co.nz.
Mental Health Commission – www.mhc.govt.nz.
Mental Health Foundation of New Zealand – www.mentalhealth.org.nz.
Ministry of Health – www.moh.govt.nz.
Office for Disability Issues – www.odi.govt.nz.
Privacy Commissioner – www.privacy.org.nz.
Working with service users – leader level Learning Review Tool and Individual Professional Development Plan
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Learning Review Tool Using the Likert scales below, rate your work in relation to working with service users.
I have a thorough and practical understanding of my role in developing and supporting a responsive service that acknowledges recovery as a foundation..
1 2 3 4 5
No idea Comprehensive understanding
I demonstrate and encourage others to understand and respond effectively to the individual needs of service users.
1 2 3 4 5
Occasionally Consistently
I can confidently articulate aspects of my service that demonstrate recovery-oriented practice.
1 2 3 4 5
Not really Absolute confidence
I understand the importance of effective communication within my team and the impact that this has on service users.
1 2 3 4 5
No idea Absolutely
Choose your response to one of the above statements, and explain why you made this response.
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What new knowledge or insights have I gained from working through this module?
What are three things I can put into practice or improve on as a result?
A B C
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Individual Professional Development Plan Working with service users (leader level) One thing I can take personal responsibility for.
Action
What will I do?
Timeframe
When will I do this?
Resources
What or who will I need?
Challenges
What barriers or resistance will I face?
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One thing I can advocate for and work towards.
Action
What will I do?
Timeframe
When will I do this?
Resources
What or who will I need?
Challenges
What barriers or resistance will I face?
Please retain this Individual Professional Development Plan: working with service users (essential level) to contribute to your summary action plan once you have completed all of the learning modules.
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