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US 26983 Level 4 Credits 6 Name

Workbook Describe and implement strategies for engaging with mental health and addiction service users and their natural supports

Issue 1.0 – Mar 2012 26983 Describe and implement strategies for engaging with mental health and addiction... 2

US 26983 Level 4 Credits 6 Creative Commons

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Contents

Before you start ................................................................................................................ 4

What is engagement? ...................................................................................................... 7

Strategies for engagement ............................................................................................. 14

Barriers to engagement.................................................................................................. 21

Practice models ............................................................................................................. 25

Strengths model ............................................................................................................. 25

Wellness Recovery Action Plan (WRAP) ....................................................................... 26

Family Inclusive Practice ................................................................................................ 27

Māori mental health perspectives................................................................................... 29

Pacific mental health perspectives ................................................................................. 31

Suggested answers to learning activities ....................................................................... 42


Before you start

Welcome to this workbook for: Describe and implement strategies for engaging with mental health and addiction service users and their natural supports Unit Standard 26983. For this unit standard you will have: • This workbook. • A trainee assessment.

In this workbook you will learn more about: • The principles of engagement and strategies for engaging with service users and

their family/whānau. • Barriers to engagement for service users and family/whānau. • Different practice models for engagement and providing support.

When you see a sticky note like this, it gives a tip or hint.

How to use this workbook • This is your workbook to keep – make it

your own by writing in it. • Use highlighters to identify important

ideas. • Do the learning activities included

throughout this workbook. Write your answers in the spaces provided.

• You might find it helpful to discuss your answers with colleagues or your supervisor.

• Finish this workbook before you start on the assessment.


Workbook activities

Stop – check what you know about this topic You will see this stop symbol in places where you are asked to stop and think about what you know and: • Record your current knowledge

or impressions. • Check your knowledge.

This stop provides a reference point to return to later. Stop activities have blue shading like this.

Rewind When you see this rewind symbol, go back to: • Think about what you know. • Check your knowledge.

This rewind gives you an opportunity to add to, change or confirm some of your initial thoughts and ideas. Rewind activities have green shading like this.

Learning activities You will come across learning activities as you work through this workbook. These activities help you understand and apply the information that you are learning about. Learning activities have yellow shading like this.


Before you go any further in this workbook, think about...

Key words about engagement

What do these words mean to you?

Engagement

Family/whānau

Natural supports

Barriers

Wellness


What is engagement?

Engagement is an essential part of recovery. Feedback from service users, families/whānau and healthcare workers across different cultural and demographic groups all verify its importance. So what is engagement? Engagement is the connection between service users and health care workers, service users and services, service users and family/whānau, and with health care workers, professionals and service providers. It is founded on: • The connection and rapport between the

service user and worker. • The collaborative nature of the work. • Agreement on goals. • Agreement on tasks.

As engagement is a core part of recovery and the service user’s wellness journey, it is very important to get it right at the first point of contact. Let’s get real lists the following skills and attitudes as important factors for all staff in mental health and addiction services who are working with people: • Developing trusting relationships based on

respect and mutuality. • Understanding and building strong partnerships between service users and staff. • Working from a strengths perspective. • Having and holding hope for all people to experience recovery from mental illness

and addiction. • Being informed by principles of recovery. • Recognising the importance of determining and connecting to community. • Encouraging and supporting self-determination. • Recognising and supporting the outcome of whānau ora. • Understanding manaakitanga and karakia, and being able to integrate Māori world

views into your role. • Working with people from various cultural backgrounds in a manner that respects

and upholds their cultural world view.


Why do we engage? The more a service user and their family/whānau/natural supports are engaged with, the better the outcome for the service user.

Scenario: Janet Janet is a 25-year-old university student who you have been supporting in your mobile service. She started to experience moderate symptoms of anxiety during her 3rd year architecture exams. These symptoms didn’t recede despite passing all of her exams, and she started to experience daily issues related to her levels of anxiety. To compensate for this, Janet started to use marijuana to help her relax. Over time, her friends became concerned at the amount and frequency with which she is now using.

She was taken, not very willingly, by her friends to the university GP. He also diagnosed mild depression. He has set up support from your mobile service for the next few months. Janet doesn’t believe that she has a problem and makes little attempt to attend the appointments you set up, or to develop a recovery plan. Your role requires you to engage Janet and support her through this time.

The scenario above illustrates just one scenario where engagement might be difficult. There are, of course, many barriers which can occur and which will be discussed later. However, as we can see above, the ability to engage with Janet will ultimately decide whether or not she receives support on her recovery journey.


The strategic importance of engaging Engagement with service users and family/whānau is a key requirement in a number of strategic mental health and addiction sector documents and frameworks, including: • Te Hononga 2015, Connecting for greater well-being (2007). • Let’s get real. • Te Tahuhu: Improving Mental Health 2005–2015. • Te Kōkiri: The Mental Health and Addiction Action Plan 2006–2015. • The Health and Disability Sector Standards 2008.

Te Hononga Te Hononga 2015, Connecting for greater well-being was developed by the Mental Health Commission in 2007 and identifies that the relationships and connections forged between individuals, services and sectors are necessary to provide the resources necessary for building individual and family/whānau strengths and resilience; supporting wellbeing and living well; and contributing to responsive, inclusive communities. Inclusion is a sense of belonging, feeling respected and supported by others so that you can be your best. The process of inclusion engages each individual and makes people feeling valued essential to the success of the organisation, community or family. Te Hononga identifies that these connections also help to define how people value themselves, their self-belief, their possibilities and sense of self-worth.


Let’s get real Let's get real is a framework for everyone working in the mental health and addiction sector. The framework describes the essential knowledge, skills and attitudes required to deliver effective mental health and addiction services. It is made up of seven Real Skills, that each have three levels of performance indicators. It assists services to reflect many of the National Service Framework principles and the Health and Disability standards.

The seven Real Skills are: 1 Working with service users. 2 Working with Māori. 3 Working with families/whānau. 4 Working with communities 5 Challenging stigma and discrimination. 6 Law, policy and practice. 7 Professional and personal development.

The first three of the above Real Skills are a core component for engaging with service users and their natural supports. Working with service users 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.

Themes within that skill are: • Engaging with people and building strong relationships. • Building empathy. • Understanding recovery. • Recognising strengths and understanding the whole person. • Using person-centred planning. • Addressing disparities in Māori health and wellbeing. • Understanding key aspects of mental illness and wellness.


Working with Māori The Real Skill for working with Māori is:

Every person working in a mental health and addiction treatment service contributes to Whānau ora for Māori.

Themes within that skill are: • The importance of Māori language (Te reo Māori). • Māori relationships (whakawhanaunga). • Unique Māori perspectives of health and health service delivery (Hauora Māori). • The importance and unique nature of Wairua and Māori spiritual practises (Wairua). • Belonging and connecting (Taukiri tangata). • Honouring and respecting (Manaaki).

Working with families/whānau The Real Skill for working with families/whānau is:

Every person working in a mental health and addiction treatment service encourages and supports families/whānau to participate in the recovery of service users and ensures families/whānau, including the children of service users, have access to information, education and support.

Themes within that skill are: • Understanding the context of families and whānau. • Understanding how to engage with families and whānau, in order to provide support

for them and contribute to recovery. • Understanding and connecting families and whānau to community support options

and resources. • Understanding policies of involvement and participation and the impact of these.

Let's get real also supports us all to achieve the workforce and culture for recovery challenge of Te Tāhuhu: Improving Mental Health 2005–2015, that is, building a workforce that is recovery focused, person centred, culturally capable and has an ongoing commitment to improved quality of services. For more information about Let’s get real or to download one of the seven Real Skills learning modules go to www.tepou.co.nz/supporting-workforce/lets-get-real

http://www.tepou.co.nz/supporting-workforce/lets-get-real


Real skills plus Seitapu Real skills plus Seitapu outlines the essential skills for working with Pacific peoples and is considered to be the foundation skills that any person working with Pacific people should work towards. The skills are considered to be fluid and transitional. They may not apply to all Pacific people all of the time, however, they do go some way towards providing a Pacific framework for the individual mental health and addictions worker, regardless of their role within the sector. The skills should not be viewed in isolation, and mental health and addictions workers still need to achieve the expected levels in Let’s get real. Real skills plus Seitapu cautions that given the ever changing nature of Pacific people in New Zealand it is important to keep an open mind for all people, not only Pacific, and be able to apply appropriate knowledge, skills and attitudes according to the needs of service users. The three key themes, with their associated Real Skills are:

1 Family Every person working with Pacific people understands or acknowledges the various dimensions and context of Pacific people, providing their families (biological, adopted, nuclear and extended) with information, encouragement, education and support to engage in the recovery of the service user.

2 Language

Every person working with Pacific people has an understanding of the importance of language, both spoken and unspoken, across a variety of Pacific contexts, and is able to either personally apply appropriate communication techniques in working with Pacific people, or know exactly where such skill is available.

3 Tapu

Every mental health worker is open-minded to the cultural, spiritual and relationship environments and belief systems that may accompany Pacific service users and their families.

For more information go to www.leva.co.nz or www.tepou.co.nz

http://www.leva.co.nz/

http://www.tepou.co.nz/


LEARNING ACTIVITY

Search the word search below for key words and terms from the Real Skills for working with service users, Māori and families/whānau. There are 24 words to find. (Hint: words can run backwards and upside down!)

W Z B E L O N G I N G K J E M P A T H Y

H A F T G H Y U K N M J N D C F C E R T

A R U M N T G F L U F G N I N A E M V T

N H N M O R D F G S A E W Q Y U Q Z C G

U J D H I J A G T G J L O U Y T W A W B

A L E T T O J P E R S O N C E N T R E D

O N R D A W H J P E T G B F W R M O L P

R Y S F C F G N K O H H S D U Y H U L A

A U T A U G E I N K R S F S E Y T A B R

P O A S D B T L O N H T T T R R M H E T

C O N N E C T I N G Z A F G O Y K M I N

B R D E S D S F F W H Y U P I O P L N E

T T I O M K E D A G K I P H I L P O G R

T B N I D M C I G M U U E W T T Y L O S

C F G Y S H R A S A S T R E N G T H S H

E D A F F U U B D N Q Q R T H Y Y O N I

P S W W A N O I T A P I C I T R A P Y P

S T G R E Y S V A A E Q B V C X R E M O

E G E H J K E Q Z K D G T H Y K M L N L

R E C O V E R Y B I N V O L V E M E N T


Strategies for engagement

Engaging with service users Engaging with service users requires respect and appreciation of diversity, difference and varied cultural and social backgrounds. Engaging with service users is critical for recovery. It is hard to define recovery as the experience of recovery is individualised. Let’s get real broadly defines it as:

Recovery is implicit in living well and achieving ambitions, in the presence or absence of mental illness and addiction. Each person with mental health and addiction experiences needs to define for themselves what living well means.

Recovery is a journey and not a destination. Recovery happens when: • Service users have an active role in improving their lives. • Communities include and involve people with mental illness. • Services facilitate relationships between service users, families and communities.

According to Destination: Recovery (Mental Health Advocacy Coalition, 2008), the conditions required for achieving recovery includes: • Strength in self and in social relationships. • Choice and self-determination. • Personal resources and supports. • Therapies that support holistic wellbeing. • Strong social and economic opportunities.

Engaging with service users begins with developing the relationship and then is supported by working in partnership with the service user to support them to identify their goals and aspirations and then support them to achieve these. Relevant factors from the service user’s side of the relationship include: • Attendance. • Motivation for treatment. • Interpersonal styles. • Confidence that treatment will be effective.

Relevant factors from the support worker’s side of the relationship include: • Being able to display a flexible, honest, respectful, trustworthy, confident, warm,

interested and open style. • The ability to employ techniques such as exploration, reflection, noting past

therapeutic success, accurate interpretation, facilitating the expression of emotion, and attending to the service user’s experience.


Engaging with families/whānau Family/whānau is a broad term which is used to define the relationships or interactions provided to a mental health and addiction service user by family/whānau, friends, peers, co-workers, or community volunteers. In a specifically Māori context, this may include but is not limited to kaumātua, kuia, tohunga, whānau, iwi, and hapū. Natural supports and significant others are other terms commonly used to define the unique and special relationships that service user have with family/whānau. Family/whānau is individual to each person. Family/whānau are diverse, and have different needs, values and beliefs. Te Hononga found that family/whānau: • Are critical to our sense of belonging. • Play a significant, positive role in recovery. • Are crucial for enhancing a person’s strengths, support, security, identity and well-

being. Family/whānau can experience significant distress, grief and disruption when a loved one experiences mental illness, so as part of the recovery process, families themselves may also need to recover. When engaging with and involving families it is important to remember that family/whānau need support information, education, understanding, inclusion and consideration. A little later on in this workbook we will explore some of the strategies for engaging with service users and their family/whānau and the practice models that support engagement.

“Natural supports” can be friends and family, peers or any other people in the community that the person would naturally reach out to.


Strategies These strategies provide the framework for engagement: • Identifying relationship dynamics. • Focusing on strengths. • Promoting wellness. • Promoting positive relationships. • Promoting constructive and supportive relationships. • Identifying and working with barriers. • Overcoming barriers.

To be able to achieve the above, it is very important for support workers to be well prepared when engaging with people. Relationships The ability to build close and trusting relationships is an essential skill for all workers in the mental health and addictions sector. Building an effective relationship includes: • Building rapport. • Identifying relationship dynamics. • Promoting positive relationships. • Promoting constructive and supportive relationships.

Let’s get real identifies the following important relationship-building skills as core skills: • The ability to converse, connect and build rapport. • Having and communicating empathy. • Communication and listening skills. • Being able to receive and give feedback. • Negotiating and compromise. • The ability to share and disclose personal experiences and knowledge. • Cooperation. • Showing respect for diversity in language, culture, gender, sexuality and world

views. Developing a rich and open relationship that is built on trust, respect, integrity, loyalty and understanding is the foundation to good engagement. Time is a key requirement when building relationships. It takes time to develop trust and build rapport. It is unrealistic to expect service users and family/whānau to instantly open up and share information, hopes and aspirations with workers. Also, many service users and family/whānau may have had negative experiences in the past which can impact on engagement.


Make sure you are prepared before you meet with the service user. Plan how and where the engagement will take place. What would be the most comfortable environment for the person? Consider cultural factors and values. Ensure that you work in partnership with the services user and their family/whānau. Recovery is a personalised journey for the individual, so the service user must be in control, actively participate and lead the decision making, goals setting and developing and implementing their own recovery plans. Genuine partnership is about the mutual trust and respect for the expertise that both bring to the relationship. Identifying relationships and relationship dynamics Once you have established a trusting relationship based on respect, mutuality, and understanding then you will find service users and family/whānau will be more open to engaging with you and sharing information. An important step is to identify other relationships that the service user may have. These may be close relationships such as family or close friends, ongoing relationships with colleagues, sports teams or associates, or more occasional and sporadic relationships. The relationships that a service user has can be positive or negative to their recovery. It is important to promote positive relationships to service users. A positive relationship is a relationship based on equality, mutuality, reciprocity, understanding, constructive feedback and support. Relationship dynamics is a term that covers the different relationships a person has and the power between those relationships. For example a close relationship between a divorced solo mother and son may be based on separation issues related to divorce. By identifying the relationships that service users have, we can support them to identify: • Relationship dynamics. • Unhealthy/negative relationships, eg someone who steals from them. • Positive and supportive relationships, eg a study buddy.


Scenario: Jeff Jeff is 18 years old, cannabis dependant and experiencing psychosis. He is referred to your service for support. Jeff lives at home with his mother and his younger brother Tommy who is 5. You quickly establish a rapport with Jeff, and his mother. Jeff wants to join the army and knows he must to stop using cannabis and be free of psychotic symptoms in order to achieve his dream. His mother is very supportive and encouraging. You work with Jeff and his mother to develop a personalised wellness support plan. Jeff and his mother have fully participated in the plan and are proactive in implementing the agreed actions. After two months of Jeff implementing the wellness support plan and being cannabis free, you discover that he has begun using cannabis again. You learn from the family that Jeff’s father who does not live in the family home and has sporadic contact with Jeff has been supplying the drug.

Jeff’s scenario illustrates the importance of identifying all relationships that the service user has and the dynamics of those relationships. This includes relationships that are distant or sporadic, as they still have the power to positively or negatively affect a service user’s engagement with a service or treatment plan. If all of the relationships and dynamics had been fully explored in the initial phases of engaging with Jeff, supports could have been identified for Jeff in case his father offered him cannabis. The role the worker plays within other relationships that the service user has is dictated by the service user, but this does not preclude the worker working alongside people to identify their actual and potential relationships, the dynamics of these relationships and to promote positive and supportive relationships.


Focusing on strengths Recovery is all about the individual’s path, their hopes and aspirations and the destination and journey they wish to take for themselves. Strengths-based practice supports recovery and has a strong focus on identifying people’s abilities, interests and capabilities, and their strengths and potential. Let’s get real identifies the following core requirements of mental health and addictions workers when working with a strengths-based perspective: • Committing to the idea that all people have the capacity to learn, grow and affect

positive change for themselves. • Accepting that the service user (and their family or whānau) is the primary partner in

the therapeutic relationship. • Providing continuity of support and acceptance of the individual. • Ensuring service users hold expert positions in developing their own goals and

recovery plans. Strengths-based approach focuses on the service user’s abilities and works to develop and strengthen those abilities as well as develop new skills and abilities. Tips for focusing on strengths: • Develop a relationship with the service user. • Foster and support hope. • Identify goals, dreams and aspirations. • Identify service user strengths – things that they are good at. • Identify skills the service user would like to develop. • Provide information and resources to support the service user to achieve goals. • Work alongside the service user, in partnership.


Promoting wellness The promotion of mental health and wellbeing and the prevention of mental illness and/or addiction are leading challenges of Te Tahuhu. In Te Hononga, wellbeing is defined as:

having opportunities to thrive (not just survive), contributing to society and having a sense of belonging – thereby reducing the prevalence of mental illness and/or addiction.

The concept of wellbeing can apply to individuals, groups and communities. Wellbeing is more inclusive and positive than simply the absence of mental illness or addiction. Promoting wellness and recovery is about self-determination. Service users need to be the centre of all services and the decisions around their care, treatment and support. Using a strengths-based approach is one of the ways that support workers can support and promote recovery.

Another way that support workers can promote recovery is to get alongside service users to support and promote inclusion in the community and to tackle stigma and discrimination through role modelling, support, advocacy and understanding. Te Hononga states that wellbeing depends on equitable access to resources such as housing, education and employment, as well as quality mental health and/or addiction services that enhance recovery. Service users have traditionally struggled to gain equality in all these areas because of factors including discrimination and fragmented services.


Barriers to engagement

Barriers refer to the attitudes and behaviours that prevent or reduce the likelihood or level of effective engagement. Barriers to service user engagement and participation can include: • Lack of respect and trust. • Lack of understanding. • Poor communication. • Stigma, discrimination and exclusion. • Dissatisfaction with the service. • Lack of opportunities to engage. • Lack of support. • Power or relationship imbalances. • Values, beliefs and culture. • Lack of commitment to collaboration.

Barriers to family/whānau engagement and participation can include: • The modern family is often more dispersed, not living in the same region or even

country. • Lack of family/whānau understanding – of the service user, their illness and needs. • Poor communication – with and from services, service users and professionals. • Long waiting times to access services. • Dissatisfaction with the service – past and current experiences. • Need for independence and personal choice – of the family and service user. • The effect of the service user’s illness on other family members. • The service user’s behaviour – past and current.

Barriers to the engagement of service users and family/whānau need to be understood by healthcare workers and actively challenged to support a service user’s recovery. Te Tahuhu: Improving Mental Health 2005–2015, Te Kōkiri: The Mental Health and Addiction Action Plan 2006–2015 and the Health and Disability Sector Standards 2008 all require that service providers work to overcome any barriers or constraints to service users and family/whānau accessing services.


Strategies for overcoming barriers When working with service users and family/whānau, the greatest tool in the support worker’s toolkit for overcoming barriers is the relationship. Developing a rich and open relationship that is built on trust, respect, integrity, loyalty and understanding is the foundation to good engagement. Developing a relationship is not something that can be forced or hurried. It may take several sessions or weeks to develop. Communication is a two-way process. Often we ask a lot of information about service users but do not offer any information about ourselves. A relationship based on mutuality and reciprocity, and the understanding that the people we support equally enrich our own lives, is not only important to the establishment of the relationship but also evens out power or relationship imbalances. Other strategies for overcoming barriers include:

Values, beliefs and culture

Get to know the service user and family/whānau. Find out what’s important to them, what are their likes, dislikes? What do they believe in and value? Walk alongside them to understand their culture and what’s important to them.

Lack of opportunities to engage Exclusion Lack of support

Create opportunities and different ways to engage. We are all different. Some people are comfortable sharing information and engaging in an interview type situation but many are not. Consider engaging over an activity such as going for a walk, playing cards or a daily task like washing the dishes or hanging out the washing. Create opportunities for engagement in the community such as joining the local badminton club, a walking or church group. This not only counters exclusion but can help the service user develop natural supports.

Lack of commitment to collaboration

Working in partnership and true commitment to collaboration is about being person centred and placing the service user at the centre of all decision making.

Dissatisfaction with service often stems from past experiences with mental health and addiction services. To counter this it’s important to provide up to date and timely information to service user and/or family/whānau, listen to their concerns, understand and respect their values, beliefs and culture, develop relationships based on trust, respect mutuality and reciprocity and above all truly commit to person-centred collaborative services.


LEARNING ACTIVITY

Think about your current workplace and some of the barriers you have experienced when engaging with service users, families/whānau and other agencies.

What are some barriers that you have encountered when engaging with service users?

What are some barriers that you have encountered when engaging with families/whānau?

What are some barriers you have encountered when engaging with other service agencies in supporting service users and their families/whānau?


LEARNING ACTIVITY

Building on the previous learning activity, select one barrier from each of the three areas and list some strategies you have implemented or could implement to address it.

Barrier experienced: service user

Strategies for addressing the barrier

Barrier experienced: family/whānau


Barrier experienced: service agencies



Practice models

A model is a framework or structure that informs and shapes health promotion work by providing a set of values, tools (knowledge and skills) and practice. Practice models are sometimes also referred to as Service Models, Professional Practice Models (PPM), Best Practice and Evidenced Based Best Practice. The different models are not necessarily designed to replace traditional treatments; they are tools to support service user recovery and to complement other treatment options. There is no set model that all services should use. A model should be selected because of its applicability to the service user group and their needs, the organisation’s values and beliefs, and organisational need, research and evidenced-based practice. Sometimes an organisation’s contract with their funder such as the Ministry of Health, Ministry of Social Development, Ministry of Justice or District Health Board may specify a model or framework that the organisation should adhere to.

Strengths model

The strengths model is an evidence-based model developed by Charles Rapp in the early 1980s. It is a social work practice theory that emphasises people's self-determination and strengths, rather than illness and the pathology of illness. Strengths-based practice is service user led. The service user defines their goals, aspirations and the quality of life they wish to lead. Quality of life is self-determined. It covers all aspects of an individual’s life (including cultural and spiritual) both within a service and beyond. The model focuses on future outcomes and the strengths that people bring to the problem or crisis. Its principles are: • People with mental illness can recover, reclaim and transform their lives. • The focus is on an individual’s strengths rather than deficits. • The community is an oasis of resources. • The service user is the director of the helping process. • The support worker/client relationship is primary and essential. • The primary setting for the model is the community.

Recovery is a cornerstone of the strengths model. It means different things to different people; there is no right or wrong way to recover. However, hope is central. Service users must experience hope to self-determine the quality of life they wish to experience. In the strengths model, healthcare workers support people by being alongside them to support them in exploring their dreams and aspirations and identifying their strengths so that they can use these to move towards those dreams and aspirations.


Wellness Recovery Action Plan (WRAP)

Wellness Recovery Action Plan (WRAP) was developed by Mary Ellen Copeland following research and interviews with people who had experienced mental illness. In 2005, Mary Ellen set up the Copeland Centre for Wellness and Recovery, which is a not-for-profit organisation that provides training and resources for the WRAP programme around the world. The WRAP method is practical, service user focused and adaptable to any situation. It has been developed and used by people who experience mental illness the world over. Service users design their own structured plan for wellness by identifying: • What makes them well. • Key things that they really enjoy out of life. • Things that make them feel better when they are not feeling well. • Stressors, triggers and early warning signs. • Daily plans for wellness. • Crisis plans and advanced directives for when they are unwell.

The WRAP model includes a variety of wellness tools to support the development of personal plans, including: • Wellness Toolbox. • Daily Maintenance Plan. • Identifying Triggers and an Action Plan. • Identifying Early Warning Signs and an Action Plan. • Identifying When Things Are Breaking Down and an Action Plan. • Crisis Planning (Advance Directives). • Post Crisis Planning.

The support worker’s role within WRAP is to support the service user at their request and when they define they want support as they work on their own plan. For more information go to Mary Ellen’s website www.mentalhealthrecovery.com

http://www.mentalhealthrecovery.com/


Family Inclusive Practice

Family Inclusive Practice (FIP) is a model which is implemented widely within the addiction field. It is an all-encompassing biopsychosocial model that locates the causes of addictive behaviour in the physiology, psychology and environment of the individual. As FIP works with the whole family, it has particular resonance in the Māori and Pacific context. FIP acknowledges that addictions often indicate other problems or issues within the family. It supports the view that individuals influence other members in their environment, especially family, and that family members in turn have an impact on these individuals. The benefit of this approach is that it identifies core issues and treats the issue rather than the symptom or consequence of the problem. Because the model involves the whole family there is an opportunity for everyone within the family to receive support. This allows for interventions to be used while ensuring significant members of the social environment in which the individual is located are included. Family inclusive approaches are based on these key ideas: • Services are more effective and sustaining when they involve family and whānau. • Interventions with clients include broader social issues. • Family and whānau members have a right to participate in, and receive services. • Harms associated with addiction (such as marital problems) extend beyond the

individual, and these can be addressed effectively. FIP is linked closely to the following approaches to practice: Ecological Theory – relating to social behaviour and life events and factors such as child abuse, violence, and addiction in a way that considers the complex interplay that exists between individual, relationship, community and societal factors. Resilience Theory – identifying protective factors in individuals and families that mitigate risk and promote wellbeing. Resilience approaches focus on what works in a family and are closely linked with strengths-based approaches. General Systems Theory – the relationship between addiction and family functioning, with the view that the addiction is maintained by system interactions. The emphasis is to work on family interactions to effect changes in alcohol and drug use. Behavioural Approaches – relating to the positive and aversive factors existing within a family that influence or maintain alcohol and drug use. The emphasis is on identifying these factors and developing strategies and skills to change behaviour, especially addictive behaviours.


It is essential within FIP to create a family friendly environment and develop trust and rapport with the family. The practitioner works with the family to identify strengths, attitudes and skills, address deficiencies within these and develop and strengthen the family's skills and resources. Because the FIP model involves the whole family/whānau, in large families sometimes it is beneficial for two practitioners to work with the family. As with all models and practices there can be some barriers to its application or success. FIP’s most common barriers include: • High caseloads. • Lack of time. • Lack of client consent to involve the whole family. • Unsuitable physical environments. • Difficulties with cultural issues. • Low motivation and unwillingness to change. • Concerns about family safety. • The challenges of working with more than one client. • Insufficient support for practitioners in Family Inclusive Practice.

Benefits of this model include: • Families and whānau can provide more comprehensive information and insight into

problems and issues which affect the family. • Open communication may increase within the family. • Families may start addressing issues relating to their own substance use. • Everyone involved gains insight and learning, receives support and experiences

opportunities to change. • Families can identify stressors and problem situations. • Families can develop healthy coping strategies as a group as well as individuals

within the family group. • Children can be referred to appropriate programmes or specialist services. • Support systems are developed and able to provide support beyond the sessions.

Useful family interventions for the treatment of addictions within this model include: • HSTAT/ Substance Abuse Treatment and Family Therapy. • The Stress Coping Model. • The McCrady Model. • The CRAFT Model. • Social Behaviour Network Therapy – SBNT. • The Family Disease or 12 Steps Model such as AA, NA, Al-Anon. • The Brief Strategic Family Therapy Model.

For more information on family inclusive practice and any of the above models go to Matua Raki www.matuaraki.org.nz or the Kina Trust www.kinatrust.org.nz

http://www.matuaraki.org.nz/

http://www.kinatrust.org.nz/


Māori mental health perspectives

Traditional Māori health acknowledges the link between the mind, the spirit, the human connection with whānau, and the physical world in a way that is seamless and uncontrived. Until the introduction of Western medicine there was no division between these elements. In recent years, models of Māori health have been developed in an attempt by Māori to apply broad, complex Māori concepts to better meet the mental health needs of Māori consumers. Whānau Ora Many services struggle to define Whānau Ora. He Korowai Oranga: Māori Health Strategy (2002) defines it as “Māori families being supported to achieve their maximum health and wellbeing”. Whānau Ora is about bringing together the various agencies that help whānau and delivering support in a more efficient and effective way. The idea is to work comprehensively with whānau (as opposed to individual members) through one main agency, calling on other agencies as needed (such as welfare, housing, health, justice, the police and community agencies). The key is utilising whānau strengths and ensuring that government agencies organise their services around whānau instead of the other way around. Te Wheke Te Wheke compares health to an octopus. The model was presented by Dr Rangimarie Turuki Rose Pere at the Hui Whakaoranga in 1984. The octopus’s head and body represent te whānau – the family unit. The eyes are waiora – total health and wellbeing for the individual and family. Each of the eight tentacles represents a specific dimension of health, which are all in close relationship: • Wairuatanga – spirituality and the uniqueness of being Māori. • Hinengaro – the mind and learning. • Taha tinana – physical wellbeing. • Whanaungatanga – extended family and working together. • Mauri – life force in people and in objects such as language. • Mana ake – uniqueness of the individual and each family. • Hā a koro ma, a kui ma – breath of life from forebears. The place of ancestors and

their role in shaping the family. • Whatumanawa – the open and healthy expression of feelings and emotion.


Te Whare Tapa Whā Te Whare Tapa Whā is probably the best-known model of wellness for Māori, and is implemented in Kaupapa Māori and mainstream services. Its literal translation is “the four sides of the house”. The essence of the approach is that wellbeing sits within the four cornerstones of health, which are all interlocking and essential. If one wall falls, the house will fall. The four cornerstones are as follows.

Taha hinengaro – mental and emotional wellbeing • Acknowledges values-based decisions. • Acknowledges expression of thoughts and emotions. • Is the basis for logic, thinking processes and responses.

Taha whānau – social wellbeing • People with whom you share whakapapa (family/extended family). • Relationships. • Acknowledges the individual within support system. • Feelings of belonging, compassion and caring.

Taha tinana – physical wellbeing • The physical body, its growth and development. • Ways of caring for the body. • The essence of all of the components of Te Whare Tapa Whā.

Taha wairua – spiritual wellbeing • Acknowledges spirituality of all. • Acknowledges a higher power. • Acknowledges the presence of Tīpuna and those who have passed on. • For some it is linked to a particular religion and for others it is not.


Pacific mental health perspectives

New Zealand has the largest Pacific Island population outside the Pacific Islands. New Zealand’s Pacific Island community is represented by a diverse range of cultures and countries including Samoa, Tonga, Fiji, Niue, Tokelau and the Cook Islands. Fonofale model The Fonofale model was created by Fuimaono Karl Pulotu-Endemann as a Pacific Island model of health for use in the New Zealand context. It is named after Fuimaono Karl’s maternal grandmother. The model incorporates the values and beliefs that many Samoans, Cook Islanders, Tongans, Niueans, Tokelauans and Fijians told Fuimaono Karl during workshops relating to HIV/AIDS, sexuality and mental health from the early 1970s until 1995, when it was launched. It is based on a Samoan fale (house), where the foundation or floor, four pou (posts) and roof all have symbolic meanings. Fonofale is a dynamic model, in that all elements have an interactive relationship. These elements are presented in a circle, expressing the philosophy of holism and continuity.


The foundation or floor – family The foundation of the fale represents family, nuclear and extended, which is the foundation for all Pacifica cultures. It also represents the history and genealogy which ties family to titles, lands, motu/island, sea and to the Gods of the Pacific as well as to other cultures. The roof – culture The roof represents cultural values and beliefs which shelter the family for life. These can include beliefs in traditional methods of healing as well as western method. Culture is dynamic and therefore constantly evolving and adapting. The four pou Between the roof and the foundation are the four pou (posts), connecting the family with their culture but also continually interacting with each other. These pou are:

1 Spiritual – the sense of wellbeing which stems from a belief system that includes Christianity or traditional spirituality relating to nature, spirits, language, beliefs, ancestors and history – or a combination of both.

2 Physical – biological or physical wellbeing, which includes nourishment such as food, water and air. The relationship of the body with physical or organic and inorganic substances, including medications, which can have a positive or a negative impact on physical wellbeing.

3 Mental – the wellbeing or health of the mind, which involves thinking and emotions

as well as people’s behaviour.

4 Other – the variables that can directly or indirectly affect health such as gender, sexuality/sexual orientation, age or socio-economic status.

The circle The fonofale is shown in a cocoon or circle which contains dimensions that directly or indirectly influence one another, namely: • Environment – this dimension addresses the relationships Pacific people have with

their physical environment. This environment may be a rural or an urban setting. • Time – this dimension relates to the actual or specific time in history that impacts on

Pacific people. • Context – this dimension relates to the where/how/what, and the meaning and

importance of these factors for a particular person or people. Other contexts include country of residence, legal status, politics and socio-economic factors.


Popao model The Popao model was launched in 2007, developed collaboratively by the “Popao Group” which involved a number of Pacific mental health sector key stakeholders. The Popao Model incorporates recovery and strengths concepts, as outlined by Tongan Group (2009):

Consumers utilise parts of the popao as a tool to help them identify support structures in a framework they can understand. Each consumer paddles their own popao towards their desired destination, mapping and personalising their journeys and identifying any obstacles in the lagoon.

It is depicted as an outrigger canoe, designed for use within the lagoon not the open sea.

The main body of the Popao is the Katea (hull) where people sit and where equipment and sustenance for the trip are kept. It is important that the right type of wood is used to make the hull, as it needs to be light but strong. This component represents the cultural aspects. The purpose of the Hama (outrigger) is to balance the Popao. This component represents the clinical aspects.


The Kahoki (connectors) link the outrigger to the hull and therefore need to be strong. They maintain the ideal distance between the hull and outrigger to gain maximum effectiveness of the canoe when it travels through water. This component represents all service providers that attempt to bring the cultural and clinical aspects into a workable partnership. The space between the hull and the outrigger is known as “the negotiation space”, for issues relevant/critical to cultural and clinical components. Dialogue and discussions are carried out with the knowledge that the negotiation space is a safe and culturally appropriate environment to facilitate these activities. The Kafa (lashings) bind all of the components of the Popao together. They must be strong and robust and are made from interwoven fibres of coconut husks. The lashings represent communications; if communication is weak then the whole structure will be weak. Communication between the cultural and clinical components must be strong. The Fohe/Toko (paddle/oar) is to row, direct and determine the speed of the canoe. They must be light and strong. The Popao is steered from the back of the canoe and this space can only be occupied by one person. This component represents the strength of individuals. Depending on the individual, this strength could come from family/aiga/fanau, community, friends, spiritual aspects, etc. The model identifies other factors which influence the journey of the Popao, including the environment through which it is moving and who is on board at the time. For more information, go to the Le Va Pasifika within Te Pou’s website: www.leva.co.nz

http://www.leva.co.nz/


LEARNING ACTIVITY

Think about a practice model used within your organisation.

What is the name of the model?

Briefly describe the model and its key features.

What are the advantages of this model?

What are the disadvantages of this model?


LEARNING ACTIVITY

Scenario: David In your role as a support worker, you have been asked to work alongside David who lives in a small rural community, 75km from the nearest township. David is a 63-year-old father of four and grandfather of 17 – a fact he likes to tell everyone who comes to visit. David was diagnosed as having bipolar disorder 12 years ago and has managed this well with medication. Since his wife passed away four years ago, David’s wellness has decreased due to a failure to remember to take his medication and a general lack of motivation to look after himself. David currently lives on his own, as he refuses to move from the family home. Your first impressions are that he is lonely and disengaged from both his family and community, due to his unwellness.

Outline the main barriers David may have in regard to: a) his wellness, and b) his relationships with others, including yourself

Barriers to wellness: Barriers to relationships:


For each of the categories below, describe at least two strategies you would choose to implement and the reasoning behind your decision.

Two strategies which would promote David’s wellness.

Strategy 1: Reasoning: Strategy 2: Reasoning:


Two strategies which would promote positive, constructive and supportive relationships between David and his natural supports (eg friends, community).



Scenario: Ruiha In your role as a support worker, you have been asked to provide support to Ruiha, who lives with her extended whānau in Rangiora. Ruiha is a 37-year-old mother of four, who developed a narcotic addiction following spinal surgery two years ago. Over the last 12 months Ruiha has made a lot of decisions which impacted negatively on both her children and her whānau and there is considerable friction between the families. Ruiha spends a lot of time telling you about this when you first meet. She feels that her whānau have not understood what she has been going through and is angry and hurt by their treatment. Ruiha would like to access the tohunga who is a spiritual healer on her local marae, but feels that she has brought shame to her and her whānau and doesn’t know how to make the first move.

Outline the main barriers Ruiha may have in regard to: a) her wellness, and b) her relationships with others, including yourself.

Barriers to wellness: Barriers to relationships:


For each of the categories below, describe at least two strategies you would choose to implement and the reasoning behind your decision.

Two strategies which would promote Ruiha’s wellness.



Two strategies which would promote positive, constructive and supportive relationships between Ruiha and her natural supports (eg friends, whānau and community or marae).



Suggested answers to learning activities

Page 13 Answers are in red.

W Z B E L O N G I N G K J E M P A T H Y

H A F T G H Y U K N M J N D C F C E R T

A R U M N T G F L U F G N I N A E M V T

N H N M O R D F G S A E W Q Y U Q Z C G

U J D H I J A G T G J L O U Y T W A W B

A L E T T O J P E R S O N C E N T R E D

O N R D A W H J P E T G B F W R M O L P

R Y S F C F G N K O H H S D U Y H U L A

A U T A U G E I N K R S F S E Y T A B R

P O A S D B T L O N H T T T R R M H E T

C O N N E C T I N G Z A F G O Y K M I N

B R D E S D S F F W H Y U P I O P L N E

T T I O M K E D A G K I P H I L P O G R

T B N I D M C I G M U U E W T T Y L O S

C F G Y S H R A S A S T R E N G T H S H

E D A F F U U B D N Q Q R T H Y Y O N I

P S W W A N O I T A P I C I T R A P Y P

S T G R E Y S V A A E Q B V C X R E M O

E G E H J K E Q Z K D G T H Y K M L N L

R E C O V E R Y B I N V O L V E M E N T


Pages 36–38

Outline the main barriers David may have in regard to: a) his wellness, and b) his relationships with others, including yourself.

Barriers to wellness:

As David lives on his own, his inconsistent approaches to taking medication may start to impact on his mental and physical health. His loneliness and disengagement from his family may also be a barrier in that they may prevent him from finding the motivation to stay well. His age may be a barrier, as he starts to slow down with age, and feel less motivated to be involved with others.

Barriers to relationships:

• Living away from the nearest township, and potential support of interest groups, further complicated by his refusal to move from the family home.

• His disengagement with his family and whānau. • His mental illness may be a barrier from those in the community who have a

discriminating attitude towards mental illness; further complicated if he doesn’t remain stable on his medication.

• If he doesn’t think he needs support, he may not engage with you or your services. • His age may be a barrier – he may prefer to have an older support worker. • His life in the remote community – he may not feel understood by those who live in the

main township.


Two strategies which would promote David’s wellness

Strategy 1: Supporting David to use a dosette tray, or to have reminders in place about taking his medication.

Reasoning: If David is able to maintain good mental health, he may be more motivated to engaging with other support mechanisms.

Strategy 2: Providing David with information about bipolar disorder and other ways in which he can increase his mental health, eg through exercise, diet, good sleep etc. Provide information about his medication.

Reasoning: David may not have received the information he needs to understand the necessity of taking his medication regularly. He may not like the medication or side effects and may wish to explore alternatives with his GP or psychiatrist.

Two strategies which would promote positive, constructive and supportive relationships between David and his natural supports (eg friends, community).

Strategy 1: Find out what David likes to do for a hobby or sport. Then support David to engage with a support group or activity that would be able to offer him both support and companionship. For example, David may be an avid chess player, or an artist. He may also be keen to meet with others who have experience of mental illness, but one shouldn’t assume that this is a given.

Reasoning: David may have less of an issue reaching out to strangers than to his estranged family. Providing him with support and companionship will allow him to have greater motivation and decrease his loneliness.

Strategy 2: Talk with David about how he would like the relationship with his family to be. If he is keen to be connected, and it is appropriate, support David to reach out to his family, through perhaps a letter or phone call.

Reasoning: There may be good reason why David is estranged from his family, but if he wishes to be a part of the family then their support and love would aid his recovery journey. David may not be able to make the first move and may just need some support to do this. His family may also need a liaison for the initial connections, but their involvement in his life is likely to be a strong support and comfort to David.


Pages 39–41

Outline the main barriers Ruiha may have in regard to: a) her wellness, and b) her relationships with others, including yourself.

Barriers to wellness:

Ruiha is struggling with a difficult physical illness which is further complicated by her addiction. A large barrier to achieving both physical and mental wellness lies in her lack of relationship with others. Her inability to access the tohunga will be having a negative impact on her wellness, and the mental distress she feels at being disconnected from her whānau and marae will continue to impact on her mental health.

Barriers to relationships:

The hurt and anger that Ruiha feels towards her whānau are a barrier to her returning to a strong relationship with both her whānau and her marae. Ruiha also feels whakamā (shame) about her behaviour and this is a barrier to her reaching out to her whānau.

There are several possible other barriers which may occur: • Ruiha’s race and culture may be a barrier for you as a support worker if you are not

understanding of her race and culture. • Attitudes of those around Ruiha to her addiction may be a barrier, and cause

discrimination rather than understanding. • Attitudes towards Ruiha’s parenting may be a barrier, if others feel that she is not doing

a good job of parenting her children.


Two strategies which would promote Ruiha’s wellness

Strategy 1: Work with Ruiha to re-engage with the kaumātua and kuia of the local marae, and then get them to assist with Ruiha accessing the tohunga. This may require accessing others to support this, if you are not of the same cultural background as Ruiha. Reasoning: Ruiha may not feel able to access the tohunga while she remains disconnected to her marae. Connecting her to the marae may assist with this. Strategy 2: Offer Ruiha information or access to a support group around her narcotic addiction. Reasoning: The whakamā that Ruiha feels may need the support of those who have been in a similar position to Ruiha. NA (Narcotics Anonymous) or similar, may be provide this support. This may allow Ruiha to feel less self-stigma and stronger in herself, allowing her to reach out to her whānau.

Two strategies which would promote positive, constructive and supportive relationships between Ruiha and her natural supports (eg friends, whānau and community or marae).

Strategy 1: Work alongside Ruiha to identify her natural supports and who she would like to be reconnected to. Suggest making a plan with her of ways in which she could heal any hurts, or offer reconciliation with these groups. Work to build Ruiha’s resilience and understanding around the reactions she may get from people, and how to overcome these. Reasoning: Different groups of people may require different approaches, for example reconnecting with the mums or teachers at her children’s school may require a different approach to reconnecting with her whānau. Ruiha may feel scared to re-engage. Making a plan of how she is going to do this and possible things that could go wrong might assist. Strategy 2: Provide information and/or access to an addiction support group for Ruiha’s whānau. Reasoning: Ruiha’s whānau may not understand her addiction, or her behaviour which was possibly caused by the addiction. Gaining some insight into this illness and how important their support is in her recovery, may allow the relationship between Ruiha and her family to be strengthened.


Completion and assessment Congratulations! You have come to the end of the workbook for Unit Standard 26983: Describe and implement strategies for engaging with mental health and addictions service users and their natural supports. Please check over all the activities in this workbook to make sure you have completed them.

Your assessment is next You need to complete the trainee assessment successfully to be credited with this unit standard. Your assessor will sign you off once you have completed the assessment tasks satisfactorily.

Your assessor is able to give you a “Certificate of completion” for achieving this unit standard.

Acknowledgements Careerforce would like to thank the people who have contributed their time and effort into creating this

workbook by:

• Research and content validation.

• Advice and expertise.

• Testing the activities.

• Sharing personal experiences.

• Appearing in photographs.

Disclaimer: The images contained in these workbooks are visual illustrations only and are not

representative of actual events or personal circumstances.


Issue 1.0 – Mar 2012

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