Young Person and Family Rated Recovery Using client directed and outcome informed practice to achieve a recovery orientated clinical service model Headspace Youth Early Psychosis Program Rachel Barbara-May & Paul Denborough
headspace Initiated by the Australian Government in 2006 National Youth Mental Health Foundation youth-friendly integrated service hubs Now ~90 centres across Australia 100 planned by 2016 Lead agency and local partnership of organisations
headspace Continued early access to services holistic needs of young people mental health, general and sexual health, alcohol and other drug, and vocational concerns 12 to 25 years youth-friendly non-stigmatising
What is headspace YEPP? headspace Youth Early Psychosis Program (YEPP) headspace YEPP is an integrated, holistic service for young people experiencing early psychosis or young people at risk of developing psychosis, and their families. Building on the early psychosis prevention and intervention centre (EPPIC) model developed by Orygen Youth Health, this headspace service offers integrated early intervention services that are tailored to individual need.
Who Is headspace YEPP For? Young people aged 12 to 25 experiencing a first psychotic episode or those who are at risk of developing a psychotic disorder.
Hub & Spoke Model Hubs Continuing Care Team Functional Recovery Program Team Mobile Assessment and Treatment Team Management Team Spokes Continuing Care Team (with access to a range of Hub programs and services)
Vision headspace YEPP is friendly to young people and families. We will provide an accessible mental health service for young people struggling with hearing voices and unusual beliefs in partnership with the community. We will build on strengths and resilience, use the wisdom of lived experience and foster hope, potential and recovery.
Core Components Community education and awareness Easy access to service Home-based care and assessment Access to streamed youth-friendly inpatient care Access to youth-friendly sub-acute beds Continuing care case management Medical treatments Psychological interventions Functional recovery program (FRP) Mobile outreach Group programs Family programs and family peer support Youth participation and peer support program Partnerships Workforce development Ultra-high risk detection and care
Area relationships hyepp components Continuing Care Team (CCT) Mobile Assessment and Treatment Team (MATT) Functional Recovery Program
hyepp Service Model Series of coproduction workshops Need to focus on the how we do things Clients driving and choosing the experience Working in partnership Creating a culture of feedback Therapeutic relationship where client feels safe understood, valued and respected Focus on help, change and hope
1. Choice Promoting Human experience and how people are made to feel; young people are able to influence what happens in their life and in their care What does this principle look like in practice? Client directed, promoting choice, opportunity for exploration, clients driving and choosing experience; welcoming, inviting environment comfortable; positive environment; opportunity for healthy living and wellbeing; whole of person 2. Feeling Empowered Through Relationships Focus on sessions being client directed; we do not make assumptions about the roles we play and why the young person has come What does this principle look like in practice? Empowering relationships are where each person in the relationship feels safe, understood, valued and respected.
3. Family and Network Focus Thinking about the family and network around the young person and their needs, as well as a partner in treatment What does this principle look like in practice? Families engaged, involved and supported; families and networks used as a sustainable resource; busy seeing families and networks 4. Accessible and Meaningful Service Recognising that there is ongoing work in being accessible and seamless and to keep true to the commitments we make What does this principle look like in practice? Inclusive, flexible, attainable, available/reachable, not complicated, welcoming and friendly, accepting (not judgmental, no labels), to be fluid and continuous, people keep coming back, diverse client group, feedback, new referrals, busy
5. Values in Action Understanding values, implementing values and reviewing values is a constant process of checking in with each other What does this principle look like in practice? Values are alive in every day processes and interactions; we check in with each other and the people we work with; overt values when making decisions. Three steps - understanding, implementing and reviewing 6. Relationships With Other Services Being part of the system of care and the community in general through people from other services knowing who we are, where we are and what we offer What does this principle look like in practice? Part of the system of care, part of the community; holistic care, not just counselling; accessible and letting people know what is available. People would know where we are, what we do and don t offer and how to work with us. If we don t offer, we find someone who does.
Using CDOI in HYEPP Clinical tool Reporting on outcomes (accountability) Risk management tool Group evaluation tool
Using CDOI to Implement the Service Model Young people and their families in charge of their treatment, determining the direction and outcome Outcome focused, recovery is expected Outcomes achieved through relationships SRS facilitates meaningful engagement Teams able to identify clients at risk of poor outcome Feedback about outcomes used to inform team processes and supervision Youth Advisory Committee and Parent Advisory Group monitoring and auditing service according to the model
Knowing What We Are Getting Wrong Wouldn t have chosen to come to headspace He found the initial engagement difficult His girlfriend had a bad experience with headspace in the past Spoke of the difficulty of engaging with multiple clinicians early, that he couldn't build trust, connection or understanding There seemed to be differing people with differing understandings, differing amounts of information and differing ideas on what should happen. This left him confused and not trusting, also concerned about information being shared by others about him "You wouldn't choose to spend time with a friend you couldn't trust or who went and spoke about you behind your back
Helping Us Get It Right Describes that he connected and trusted more as he got involved with consistent treating staff Particularly when he felt they were actually interested and cared If you want to help people you have to have that trust, that connection or everything else isn't going to work no matter how good your learning and protocols are. It also helps if you know people are human that they are more than just professionals
Using CDOI in Single Session
Number of Service Sessions Attended across headspace Australia
Single Session Family Consultation Program headspace Southern Melbourne Jan 2014 additional funding grant Initially two part time mental health clinicians pre-booked and walk-in sessions young people, parents and families at first point of contact with headspace or via their headspace clinician who is usually providing individual treatment to the young person 4 sessions per week including X1 reflecting team slot X3 co-therapy slots
Outline of Usual Process Pre-session questionnaires emailed at intake Most sessions 2 hours 2 clinicians working as co-therapists, +/- reflecting team Outcome Rating Scales and Session Rating Scales (Miller & Duncan, 2002) ORS utilised to drive agenda of session and decision making at follow up SRS to monitor and attend to the therapeutic alliance Summary emailed or given to family at end of session Follow-up phone call after ~4 weeks Summary serves as clinical documentation for the file
Who attends SST? 2% 2% 55% 41%
Number of Sessions Attended: Jan 2014 July 2015 10% 20% 70% Total families= 117 Total sessions= 174
Age of Identified Client 21+ yo 19-20 yo 13-14 yo 17 18 yo 15 16 yo
Gender of Identified Client 43% 57% N=117
Existing headspace Client 25% 25% 75% 75%
Outcomes: Initial and Follow up
Session Rating Scale Scores
Edith ORS/SRS Intake ORS Follow up ORS Mother 15.7 30 Father 30.9 28 Edith 24.8 28 Session Ratings Mother 39.6 Father 37.5 Edith 40
Contact Rachel Barbara-May Workforce Development Coordinator, headspace YEPP r.barbara-may@alfred.org.au Dr Paul Denborough Director, headspace & Alfred CYMHS p.denborough@alfred.org.au