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Sharing Successes and Sharing Successes and Challenges in Challenges in DeinstitutionalizationDeinstitutionalization

Radmila Stojanović Babić, prof.soc.pedagog

Budapest (Hungary) April 24-26, 2008

RSB NGO 'Susret', Zagreb/Croatia

StoryStory

RSB NGO 'Susret', Zagreb/Croatia

Who are we?Who are we?

• NGO for psychosocial support, est. 2006• Running 2 projects:

Assisted housing for persons with mental health disorders and ID

Assertive Outreach

• 10 employees:– 1 psychiatrist– 1 social pedagogue– 8 assistants (direct support stuff)

RSB NGO 'Susret', Zagreb/Croatia

UsersUsers

Main mental health disorders in groups:– F2x, F6x, F7x (ICD-10)– Comorbidity with other dg.

• 12 users in 3 communities

RSB NGO 'Susret', Zagreb/Croatia

Multidisciplinary teamMultidisciplinary team

Consists of:• Psychiatrist• Psychologist (API)• Social worker (API)• Social pedagogue

(coordinator)

RSB NGO 'Susret', Zagreb/Croatia

Team member’s rolesTeam member’s roles

• Psychiatrist – team leader, psychopharmaco-therapy, psycho-education, supervision

• Psychologist – ABA specialist

• Social worker – social issues

• Soc. pedagogue - coordinator

RSB NGO 'Susret', Zagreb/Croatia

Community based serviceCommunity based service

• For whom?– People with mental health disabilities – chronic and

persistent mental health problems

• What kind of support?– for all aspects of person’s life and include:

• Assisted housing program• Case management• Care coordination

RSB NGO 'Susret', Zagreb/Croatia

Assisted housing programAssisted housing program

• Normal living environment

• Safe, acceptable housing – important (critical!) element

• Privacy

RSB NGO 'Susret', Zagreb/Croatia

Case Management (CM)Case Management (CM)

CM services - essential in community-based treatment,

include:

• assessment of problem areas • measurement of functioning level • determination of needs • link with necessary resources • care coordination • advocacy and monitoring of provided services and their

outcomes

RSB NGO 'Susret', Zagreb/Croatia

Care CoordinatorCare Coordinator

• Listen, talk, empathize, think - how to learn

‘catching the fish’? –

• Gentle teaching

• Identify the needs

• Consider how to meet identified needs, which

member of the team could help, sourcing in

local community?

RSB NGO 'Susret', Zagreb/Croatia

AimsAims

• Support for living in community • Psychic stability in supported

housing• Decline in symptoms of mental

disorder (PANS, HAMILTON, GFA)

RSB NGO 'Susret', Zagreb/Croatia

How we do it? (1) How we do it? (1)

Toward Users:• Communicate frequently - building up

relationship• PCP – person centered planning (yearly)• Assisted employment (cooperation with API)• Psychotherapy group (weekly)• Other activities – at home (cleaning, meal

preparation, etc), in the community (workshops, self advocacy group, theater, church)

RSB NGO 'Susret', Zagreb/Croatia

How we do it? (2)How we do it? (2)

To direct support stuff:

• Psycho-education

• Work on conflict relations

• Balance approaches toward users

• Increase level of professionalism

RSB NGO 'Susret', Zagreb/Croatia

CriteriaCriteria

→ Mental health disorder (+/- ID)

→ Alcohol abuse – drop out policy?→ Psychosis+/-ID+ alcohol abuse =

challenging behavior (life threatening (disulfiram+alcohol), para/suicidality, manipulative behavior, ...) – looking for another, better model for managing users with such comorbidity

RSB NGO 'Susret', Zagreb/Croatia

ChallengesChallenges

• User’s involvement into activities – neg. psy. symptoms – avolition

• Teething problems – daily activities– supported employment– stigma

• Triage – open issue - diff. approach to users with substance abuse

RSB NGO 'Susret', Zagreb/Croatia

Peek in the future ...Peek in the future ...