Stuart John ChuanButler Trust Workshop

1 October 2013

Psychologically- Informed

case management

Overview

• Model of consultation, training and joint direct working

• Applications of the model to support mental health needs of offenders

• How/Why it works

Client-centred direct service

Focus on clients problems/functioning

Specialist directly assesses and diagnoses clients to make recommendations to practitioners

Refer to..........

Focus on the practitioner

Consultee-centred

Build capabilities in the practitioner (consultee)

Remedy (1) knowledge (2) skills (3) confidence (4) objectivity in consultee

Practitioner applies learning to current and future clients

Specialist tends not to meet client

Scope for joint working

Diagnosis vs formulation

PICM (psychologically-informed case

management)

• what to do - having a plan• why do it in this way - a planned approach

based on a psychological understanding of the individual

• how to do it - providing the practical knowledge and skills to translate this into practice.

Joint working and liaison with other statutory and non-statutory services may be provided to strengthen case management

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Consult to the system

WITH 8 NEEDS DO WE NEED 8 WORKERS?

Impact Offender

Personality Disorder Project

Summer 2009

Prison recalls Historically, large shortfall in local services aimed at offenders with personality disorder living in the community.

Probation, as a result, left in relative isolation to manage this complex and challenging client group.

Little mental health training

RECALL?

Stormy relationships

Reckless

Poor impulse control

Rapid mood changes

Sensitive to

perceived rejection

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Offender

APOM

Where to intervene

Do we intervene here?

Or perhaps direct our efforts here

And here

Average PPU recalls

Impact Project yearly comparison (adjusted)

Total London Recalls

(% increase on baseline)

C&I PPU recalls(vs Sept to Aug)

Pre (Oct 08 to Sep 09) - baseline

2300 59*

Year 1 (Oct 09 to Sep 10)2483

(+8%)30*

(-49%)

Year 2 (Oct 10 – Sep 11)2627

(+14%)29*

(-51%)

Year 3 (Oct 11 to Sep 12)2633

(+14%)^

* N=10 ^N=6 (therefore comparison cannot be made)

Comparison to London trend

Reasons for recall

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Training needs analysisPPU and the two APs

45 min semi-structured interviews (1-year follow-up)

“they are able to see things that I can’t see and tell me

how to work specifically with that from a different

perspective”

“When I was asked this before and I didn’t really understand it. I was like “well I can’t deal with those offenders cause they annoy me, they wind me up, they make me angry and I want to say something back to them.” Whereas now my experience is different cause I don’t take it personally. I can take a step back which stops me from getting so stressed out, it’s quite a big change for me”.

“it gives you more confidence, it relieves stress, and I think it makes you less likely to go off sick, because you are actually dealing with the stuff here and you feel capable whereas when you’re floundering in the dark it’s really scary … he is able to see things that I can’t see and tell me how to work specifically with that from a different perspective”.

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Impact - some lessons• Target intervention at staff – economical and

sustainability

• Provide a helping intervention

• It’s better to identify and intervene early rather than crisis manage

• ‘Treatment’ for PD is not the only option – think creatively to meet offender needs using community resources

• Aim for organisational culture and system change

Islington18-24 Transitions Gangs & Serious Youth Violence

Winter 2012

The team approachMulti-agency team based in probation

Supporting 18-24 year old age group and their families

Risk of involvement in serious youth violence

Reduce reoffending and gang violence

Exit gangs and offending lifestyles

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NHSForensic psychologist

0.5 wte Nurse0.05 wte psychologist

(supervisor)

CSPUTeam

Manager

IYPDASSubstance

misuseworker

Islington 18-24Gangs

TransitionsTeam

CSPUAdministrativ

e support officer

PoliceBIU Analyst

Support

LPTProbation

officer

CSPUTransitional Key

Workers x2

Added valueMain activities

• In-house MH Proactive screening/triage ax

• Training - eg., Motivational interviewing; Contingency

Management; Personality Disorder

• Case formulation and plans for complex cases

• Timely advice/consultation (eg., on engagement strategies)

• Integration with partners eg., YOS/CAMHS lead for transitions

planning

• Joint case management

MH Screening• GAD-7, PHQ-9, SAPAS, MVQ• 22 screened, including those not completed

questionnaires• GAD7 score ≥10 = 3 (moderate or worse anxiety)

• GAD7 score 5-9 = 1 (mild range)

• PHQ-9 score ≥ 10 = 3 (moderate or worse depression severity)

• PHQ-9 score 5-9 = 0 (mild range)

• SAPAS ≥3 = 8 (risk of ‘emerging’ PD)

• MVQ - Tendency for the young people to normalise use of violence (individual use and/or in media)

Early days data• 26 YP tracked for 9 months pre and 9 months post the

start of intervention: • 17 (65%) people offended prior to the intervention

compared to 13 (50%) people offending post intervention.

• The reoffending rate in 9mths pre intervention was 1.84 offences compared to 1.03 offences post intervention

• The average offence gravity of offences committed in the 9mths prior to intervention start was 3.19 compared to an average gravity of 3.00 post intervention start.

Winter 2013

'Troubled families' - ASB, Edge of Care Teams

Crisis teams, crisis houses,Acute inpatient wards, A&E

Early years help & CiN teams

GPs, IAPT, SPoC MH ax team

Family

Crisis services

Family

Primary care

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PICM Summary•Consulting to the system makes more coherent & efficient use of existing resources and workforce

•Service users needs can be met earlier in pathway

•Practitioners are better informed about what to do

•Iatrogenic effects are minimised

•Service users are better understood and engaged - more stable, better managed

Stuart.johnchuan@candi.nhs.uk