experiences ACT-team UAIC Dag Øivind Antonsen Peer worker in ACT-team Tiller, Trondheim, Norway CompEd first Workshop Peer workers contributions in developing welfare, health and social services 1 Collaboration between education and peer workers
experiences ACT-team, Assertive Community Treatment Hospital Psychosis Addictions Personal disturbance DPS ACT-team M M M ACT-team is a collaboration between the specialist ant primary health services Used for the first time in America. The patients/users have all kinds of support they need from the team. Was established in Norway by learning from England. In Norway the ACTteam cooperate with other service supporters. Trondheim Melhus Klæbu 2
experiences ACT-team, Assertive Community Treatment ACT team Tiller is an outreach outpatient team Patients who do not utilize the services of other support services People who have met people in support services, which have not managed to convey that they can help People who experience, have learned that health care does not provide the help that they need People who experience meeting a treat from the support services that do not understand their situation ACT-team is a collaboration between the specialist ant primary health services Used for the first time in America. The patients/users have all kinds of support they need from the team. Was established in Norway by learning from England. In Norway the ACTteam cooperate with other service supporters. 3
experiences ACT-team, Assertive Community Treatment ACT team Tiller is an outreach outpatient team Patients who do not utilize the services of other support services People who have met people in support services, which have not managed to convey that they can help People who experience, have learned that health care does not provide the help that they need People who experience meeting a treat from the support services that do not understand their situation Do not care about listening to their story Do not take enough into account that they have other experiences Do not spend time to listen to what they tell Not interested in getting to know their challenges / problems 4
experiences ACT-team, Assertive Community Treatment Support services, which have not managed to convey that they can help Unapproachable Personalize Meet people with the answers right away Decided for a solution Is conscious that it is the only solution Must be so... Little faith that the patient has a good solution People that have some difficulties needs to deal with, and talk about their problems challenges life situations wishes dreams Images need 5
experiences ACT-team, Assertive Community Treatment What is sick Broken leg Obviously, perhaps sometimes complicated Health care is efficient whether what the patient think mean Believe Sick thinking Healing is depending on who the patient participate Why are it so? What was happening in the past? When did the patient begin to think like that? Can the today relationship with other people change? Do the patient know what would help her/him? 6
experiences ACT-team, Assertive Community Treatment What is sick Broken leg Sick thinking Sick performances 7
experiences ACT-team, Assertive Community Treatment What is sick Broken leg Sick thinking Sick performances References Experiences Adolescence Surroundings Social circle Pulses / impression Earlier in life Present situation 8
experiences ACT-team, Assertive Community Treatment What is sick Broken leg Sick thinking Sick performances References Experiences Adolescence Earlier in life Surroundings Social circle Present situation Pulses / impression Future (reverse with new experiences?) 9
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2 psychiatrists 1 psychologist 2 nurses (1 with continuing education, 1 in 50% as the leader of the team) 1 social education, with further education 1 assistant nurse, with extra education 3 social Workers 1 peer worker/experience consultant, 20% position (100% 1 year ago) 1 administrative employee 1-4 employees are in contact with each patient /user The patient shall have hers/his support not depending on some employees 11
The working day in the team, (7,5-hour workday) 2.5 hours patient contact Increasing contact Meeting up Ongoing Be present Create understanding to help Create an arena for conversation Make the dishwashing together Go shopping together Help getting a job Group activities/acting together Play football Trips in the nature boys group We don`t rush the results in meeting patients who need time to establish a trusting relationship, that s perhaps one of the most important reasons that we can show positive results 12
The working day in the team, (7,5-hour workday) 2.5 hours patient contact Increasing contact Meeting up Ongoing Be present Create understanding to help Create an arena for conversation Make the dishwashing together Go shopping together Help getting a job Group activities/acting together Play football Trips in the nature boys group We don`t rush the results in meeting patients who need time to establish a trusting relationship, that s perhaps one of the most important reasons that we can show positive results 13
The working day in the team, (7,5-hour workday) 5 hours to other activities Meetings Internal Partners Reporting Update About what the others have done Different subjects, methods 14
Working in an ACT-team Morning meetings Treatment meetings Meetings for team building and management Specific reflection meetings These reflection meetings has made for need for every day reflection The first summer avocation of the team, we decided to cut meetings, and concentrate on patient contact. After 2 weeks, we decided to meet for reflections. We had to talk about why we did what we did. On morning meeting employees want to discuss issues about one of the patients. During the day 2-4 employees meets to talk about one or more patients. We often se that the one in the team that normally not have asked for advice, have the most relieving proposing. 15
Working in an ACT-team Effect Give hope that help's Create confidence that someone wants to help Seeing that others, who have been patients, jobs "When can I start working like you?" Patients want to contribute with their experiences History effects 2 admissions in institutions every year (before contact with ACT-team) Two years without institutionalization (after contact with ACT-team) 16
Working in an ACT-team Feedback from users of ACT Team Easier to start contact with... Better dialogue with... who has been patient whoever understands how it can be whoever recognize any of the situations Anxious Fogies Psychoses Depressions Voice hearings Deprivations... 17
As a peer worker I has from the beginning been recognized as full member of the ACT-team. We were introduced as a team, and we had reflections together, before we started to work with patients. My experience are valued in the daily teamwork ACT-team has been evaluated by researchers, and by statistic data Found efficient It seems like peer workers has been important for the results 18
A peer worker in team will challenge the professionals, their attitudes, and the traditional way of working What is recognized as true knowledge? Traditional experts versus experts by experience Professionals make statements about peoples mental health, and discus topics with other experts, without talking with patients Some of the professionals have an unapproachable attitude, that leads to crucial misunderstandings about peoples situation, and ends with wrong treatment 19
Working in a team Psychiatrist trust monitoring of patient from others in the team Dare to reduce the use of medications Others in the team are to "to look after Let the patient make his own experiences The drugs/medicine are not as important as before Conversation Collaboration Patient Would not have medicine Using medicine without consultation with doctor Exit medication alone Reached a low dose of a type Taking medicine because he/she needs it 20
Working in a team Social educator in the team It is better that patients / users are talking about, reflect on their decisions their actions than that they have to listen to good advice and directions all the time It is the user's choice that will have the final impact On what basis does the user make his/her choice? Advice from someone who is not part of everyday life Interaction with friends natural feedback 21
Working in a team Experience consultant One patient fooled me ones I said it was not ok He fooled me twice I said it was not great He fooled me one more time I said that is usually enough I asked if someone else in the team could take over the contact with the patient, and that was ok 22
Working in a team Experience consultant One patient fooled me ones I said it was not ok He fooled me twice I said it was not great He fooled me one more time I said that is usually enough I asked if someone else in the team could take over the contact with the patient, and that was ok Actions, behaviour due to illness Explaining actions Defend actions Temporary Permanent 23
Stories from the ACT team 24
Stories from the ACT team We are visiting a shopping center. Coming out after the others, they are sitting and look out onto the parking lot. I stand with my back to the parking lot. Several of the boys are pointing toward the parking lot and makes me aware of two young ladies who have been shopping. A lot of money have been spent, and they was rented a car trailer to drive home the goods. The two young ladies obviously have trouble retrieving and fit the hanger to the vehicle. I turn toward the boys again, without responding to anything about the situation; it was the others who discovered it. The boys will not give up in order to turn my attention to the ladies in the parking lot. It ends with me going to help to fit the trailer and put the goods inside. Should I have included some of the boys to help the young ladies? Therapy Helping with positive experiences 25
Stories from the ACT team A few days later on public swimming pool I notice that one of those men, who were eager for me to help the ladies from the shopping center, stands with a mother and 7-8 year girl at poolside. They stand and point down to the deepest part of the pool and talking. The man is jumping repeatedly into the pool, and come up again, start pointing and talking together with the girl and her mother each time. Finally comes the man out of the pool with a set of swimming goggles and give it to the young girl. Did the man do the same as I did a few days ahead? Why did he do it? Therapy Helping with positive experiences 26
Stories from the ACT team A few days later on public swimming pool I notice that one of those men, who were eager for me to help the ladies from the shopping center, stands with a mother and 7-8 year girl at poolside. They stand and point down to the deepest part of the pool and talking. The man is jumping repeatedly into the pool, and come up again, start pointing and talking together with the girl and her mother each time. Finally comes the man out of the pool with a set of swimming goggles and give it to the young girl. Did the man do the same as I did a few days ahead? Why did he do it? Therapy Helping with positive experiences What is therapy? Living example Collaboration Meet a natural situation Act in natural arena / place What is treatment? Every day acting together?. 27
My job in the ACT team I want to use natural / usual venue to give people experience of interaction Natural Usual Unnatural Unusual natural human sick man along with natural people among healthy / appropriate / important people 28
I want to use natural / usual venue to give people experience of interaction Interaction / relationship Mean something to someone Close circuit Community Mean something in a larger context Feedbacks Confirmation My job in the ACT team Work Employee Family Friends College. 29
My job in the ACT team I want to use natural / usual venue to give people experience of interaction Natural feedback Positive feedback on Opinion Knowledge Engagement Can we expect that we can / know everything? Agreement Life situations Environment Domicile Workplace Geography Community Tasks Industry Agriculture Research Health Service 30
My job in the ACT team I want to use natural / usual venue to give people experience of interaction Natural feedback Is my friend expecting that I'm always right? Is the community always expecting that I m right? We know / can different things We are different Can we agree on everything? Can we understand each other? Can we understand that we live differently? Can we know that we have different needs? Can we expect that we can / know everything? 31
My job in the ACT team I want to use natural / usual venue to give people experience of interaction Natural feedback Learn that we are different, can help with what the others know less about In the "boys' group" I feel that we can disagree a lot, almost angry at each other occasionally. But after 1 hour of intense discussion, we concluded that we know the issue from different sides. It happens that one of "the boys" have to take care of themselves, and give a clear feedback to us (the group). It can be challenging for the person who receives the message, but we understand each other better in retrospect. All people should be aware of their limits and need for security. 32
experiences ACT-team-Tiller Do we use enough time, how do we use our time? 33
experiences Do we use enough time, how do we use our time? HCE Hour Confidence Enjoyment ACT-team-Tiller 34
experiences ACT-team-Tiller Do we use enough time, how do we use our time? HCE Hour, Confidence, Enjoyment To create confidence we need to spend enough time Be present / available in enough settings / situations Unsafe situations Safe situations Sharing interests Sharing feelings Nobody share their toughest questions to someone they do not trust Live along with? 35
experiences Do we use enough time, how do we use our time? HCE ACT-team-Tiller Hour, Confidence, Enjoyment With confidence we can create security Create new experiences in the same situations as mentioned above Shall safety maintain, we need to achieve well-being When we find that well-being is not achieved, will the confidence disappear, and the trust will be lost 36
experiences Recovery Recover Recovering ACT-team-Tiller Adopt something that is used previously resume functions Contact with old friends Old / previous activities What about functions that have never been present? Parents who failed Friends who never were friends Activities that was never in question Interaction that never got started 37
experiences ACT-team-Tiller Recovery What other see that we are good at What we want to do What we dream of doing One patient in inpatient unit Good to play football Staff want to facilitate him to participate Staff encourage him to spend time on football Staff join the game What does he/she wish for him/herself? Dreaming of making music, text, songs Taking a decision, starting to make a song Finally he does what he wants May well attend football Do not want to spend the most time on it 38
UAIC Dag Øivind Antonsen Peer worker in ACT-team Tiller, Trondheim, Norway CompEd first Workshop Thank you for paying attention! Peer workers contributions in developing welfare, health and social services Collaboration between education and peer workers 39