Transcript PPT, 1.64MB - Ontario ACT Association

SHIP (Supportive Housing In Peel)
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Partnership in Wellness
and Recovery:
Evidence-Based Psycho-Educational Group
Presenters:
Rekha Vaishnav, M.S.W., R.S.W
Olivia Forrest, Mental Health and
Addiction Specialist
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Overview of Presentation
• SHIP: Organizational Description
• Partnership in Wellness and Recovery : Conception,
Challenges, Rationale for Evidence-Based Practice,
Sessions in Detail, Pre and Post Findings
• Ethics and Ethical Dilemma, Components of Ethical
Decision Making, 4A’s and 4R’s
• Framework for Resolving Ethical Dilemmas and
Exploratory Exercise
• Summary and Conclusion
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Purpose of Presentation
Participants will:
• Hear about benefits of providing evidencebased services to families
• Learn how to address ethical dilemmas while
working with diverse communities
• Discover ways to formulate a unique support
group for families and significant others
• Work on the framework to handle critical
issues of ethical dilemmas
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What is SHIP?
• SHIP is a health service and housing support
provider in Peel, West Toronto and Dufferin
County
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What SHIP Does
• SHIP’s combination of safe, affordable housing
and support is supplemented by psychosocial
tools and resources to assist individuals along
their road to mental and physical health and
wellness recovery
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Who SHIP Serves
• SHIP provides housing and services for youth
aged 16 to seniors
• Applications are processed through SHIP’s
Central Intake department
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SHIP Teams
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Two Assertive Community Treatment Teams
One Residential Multi-Service Team
Early Intervention Team
Two Short Stay Crisis Support Program Teams
One Recovery Residence Team, two locations
(Mississauga and Brampton)
• One Assisted Living Program Team (SHALDufferin)
• One Wellness and Recovery Co-ordinator
• One Integrated Seniors Team
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SHIP Teams cont’d
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•
•
•
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One Central Intake and Assessment Team
One Housing and Operations Team
Two Social Purpose Enterprise Teams
Problematic Substance Use Program
The High Support Program
Peel Youth Village
In-STED Program
Assisted Living Program
One Critical Incident Stress Management Team
If You Have A Loved One With A Mental Illness And Would
Like ..
To Get Support, Learn Coping Skills And Help Your Loved
One In Their Recovery – This Group Is For You…….
Partnership In Wellness:
Supporting Your Loved One On Their Journey Toward
Recovery
Remember, you are not alone in this journey of recovery
….
Location: Brampton
Time: 5.30 pm -7.30 pm.
RSVP: Rekha Vaishnav,(905)795-8742 ext. 286
Olivia Forrest,(905)795-8742 ext.244
Light refreshment will be served
We hope to see you
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Conception of Group
• Personal passion and professional role
• Faith in recovery
• Need for creating a safe platform for family
members
• Need for strengthening the support network for
caregivers
• To establish a lasting partnership in wellness and
recovery of ACT clients
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Conception of Group cont’d
• To expand the circle of care and increase the
access to resources and options
• To provide psycho-education to learn new
coping skills
• To understand the multidisciplinary model of
ACT
• To help members develop their own self-care
plan
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Challenges in Outreach
• Inclusion of client and caregiver for the
benefit of both
• Determining a suitable time and venue that
works for all participants
• Commitment for attending all sessions
• Language barrier
• Team approach in promoting participation
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Evidence-Based Practices (EBP)
What is Evidence-Based Practice (EBP) ?
• EBP is “the conscientious, explicit and
judicious use of current best evidence in
making decisions about the care of the
individual patient. It means integrating
individual clinical expertise with the best
available external clinical evidence from
systematic research.” (Sackett D, 1996)
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EBP cont’d
• EBP is the integration of clinical expertise, patient
values, and the best research evidence into the
decision making process for the patient care. Clinical
expertise refers to the clinician’s cumulated experience,
education and clinical skills. The patient brings to the
encounter his or her own personal preferences and
unique concerns, expectations, and values. The best
research evidence is usually found in clinically relevant
research that has been conducted using sound
methodology. (Sackett D, 1996)
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EBP
Clinical
Expertise
Best Research
Evidence
Patient Values
& Preferences
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How NPACTT Used EvidenceBased Practices
• Step 1- We assessed the client needs and
discovered there was a disconnect
between them and their loved ones in
terms of understanding mental illness
and the concepts of treatment and
recovery
• Step 2- We asked the questions of loved
ones as to what their needs were
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How NPACTT Used EvidenceBased Practice cont’d
• Step 3- We acquired the evidence and
conducted thorough research on family
centered care
• Step 4- We appraised the evidence by
conducting pre and post test questions
• Step 5- We applied what we learned and
integrated this into our practice
• Step 6- We consistently self-evaluate
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Rationale for Using MultiDisciplinary Facilitation
• Complex needs of ACT clients and multiple
challenges
• To bring the expertise to topics and provide the
most effective problem-solving to manage the
symptoms
• To promote ACT Model
• To recognize and appreciate the roles of different
disciplines
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Sessions 1 – 3 in Detail
• Session 1: Introduction – purpose of group for family
members, mental health facts, myths and stigma,
pre-questionnaire, expectations and comfort
agreement
• Session 2: Mental health – definition and causes of
mental illness, different types of mental disorders,
introduction to DSM IV and DSM-5
• Session 3: Schizophrenia and mood disorders –
complex diagnosis of ACT clients (ACT psychiatrist)
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Sessions 4 – 5 in Detail
• Session 4: Treatment and management of
symptoms – medication compliance, side
effects, impact of medications on physical
health, Clozapine protocols, IM as treatment
options (ACT nursing staff)
• Session 5: Concurrent Disorder – substance use
and mental illness, types of substances,
challenges in treatment, stages of change, role
of family members
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Sessions 6 – 7 in Detail
• Session 6: Living with mental illness – role of
ACT OT; why assessment is necessary, fostering
independence in ADL, role of family members
(ACT OT)
• Session 7: Coping – community resources;
Form 1 and Form 2 in mental health,
community treatment order, ODSP
employment support, self-care plan (ACT social
worker)
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Sessions 8 – 9 in Detail
• Session 8: Coping as a family – fostering
recovery
• Session 9: Closing remarks – postquestionnaire, dinner
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Pre and Post Findings:
North Peel ACT
Family Meeting Pre and Post Results
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Definition of Ethics
The word ethics has Greek roots:
• Ta ethica, referring to philosophical inquiry into
good and evil
• Ethos, meaning personal character
(Burns, 2012)
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Ethics is:
“Our concern for good behaviour. We feel an
obligation to consider not only our own
personal well-being, but also that of other
human beings.”
(Albert Schweitzer in Certo &Certo, 2009)
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Code of Ethics for
Social Workers
• Maintain the best interest of client as the
primary professional obligation
• Carry out professional duties and obligation
with integrity and objectivity
• Protect the confidentiality of client’s
information unless required by law
• Advocate change in the best interest of the
client and overall benefit of global community
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Code of Ethics for
Occupational Therapists
• Possess qualities of integrity, loyalty and reliability
• Value and respect client’s rights to be self-directed
in their decision-making in accordance with their
own needs, values and available resources
• Ensure confidentiality and privacy of personal
information
• Recognize and manage issues related to conflict of
interest
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Code of Ethics for
Nursing Professionals
• Provide safe , compassionate, competent and
ethical care
• Promote health and well-being
• Promote and respect informed decision making
• Maintain privacy and confidentiality
• Preserve dignity
• Be accountable
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Canon of Ethical Principles
• Ensure that all interpersonal transactions
between myself and persons served are nonexploitive and essential to their good recovery
• Refrain from any activities, including the abuse of
alcohol, drugs or other mood alternating
chemicals where my personal conduct might
diminish my personal capabilities, denigrate my
professional status, or constitute a violation of law
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Canon of Ethical Principles
cont’d
• Avoid claiming or implying any professional
capabilities or professional qualifications
beyond those I have actually attained,
recognizing that competency gained in one
field of activity must not be used improperly to
imply competency in another
• Believe in the dignity and worth of all human
beings, and pledge my service to the well-being
and betterment of all members of society
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Ethical Dilemma
• An ethical dilemma is a predicament where a
person must decide between two viable
solutions that seem to have similar ethical
value.
• Ethical dilemmas are situations arising when
equally compelling ethical reasons both , for
and against a particular course of actions are
recognized and a decision must be made.
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Components of Ethical
Decision Making
Establishing Personal Boundaries:
Some healthcare professionals push the professional
boundaries by sharing large amounts of personal
information and experiences with colleagues and
clients. Establishing rapport with co-workers and
patients facilitates quality care. However, maintaining
one’s professional role by limiting personal sharing
helps to build the confidence of clients and co-workers
in one’s competence and professional purpose.
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Components of Ethical
Decision Making cont’d
Accepting Responsibility for Attendance and
Timeliness:
Some refer to a good attendance record and
reporting for work on time as a reflection of a
“work ethic.”
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Components of Ethical
Decision Making cont’d
Documenting Scrupulously:
“Certainly P&P and the law identify sound
documentation practices. Yet sometimes
healthcare professionals make a quick
checkmark for an activity they intend to
complete, but for whatever reason they do
not.”
(Kearney & Penque, 2012)
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Components of Ethical
Decision Making cont’d
Truth-Telling in Disclosing Errors and Near Misses:
Clients and their families have the right to know
about errors in their care and delivery of service.
Such disclosures are not only ethically important,
but also discourage allegations of misconduct or
malpractice. However, it is critical that healthcare
professionals learn the organization’s P&P for
these situations and follow the P&P carefully.
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4 A’s and 4 R’s
• The 4 A’s and 4 R’s can assist healthcare
professionals to address the moral distress that
arises when they encounter situations in which
they feel unable to act consistent with their
personal values
• (AACN, n.d.).
Further information about this model and examples:
http://www.aacn.org/WD/Practice/Docs/4As to Rise
Above Moral Distress.pdf
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4 A’s and 4 R’s cont’d
• 1. Ask – Reflect to become aware of your feelings
of moral distress. Are you and/or team members
experiencing moral distress?
• 2. Affirm – Validate your feelings with others and
make a commitment to address moral distress.
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4 A’s and 4 R’s cont’d
• 3. Assess – Assess the degree of your distress
and your readiness to act
• 4. Act – Make a personal and professional
action plan. Carry it out and act to sustain the
change.
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4 A’s and 4 R’s cont’d
• 1. Relevance – In what ways and to who is the
issue important?
• 2. Risks – What are the risks of taking action
and/or not taking action?
• 3. Rewards – What benefits can be obtained by
acting and various courses of action?
• 4. Roadblocks – What are the barriers to taking
action or a particular course of action?
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The Four Components Model (FMC)
Component 1: Ethical Sensitivity
• Becoming aware of and interpreting the
reactions and feelings of others.
Component 2: Ethical Judgment
• Determining that an ethical situation exists and
requires action, and then deciding which
course of action is the most justifiable in the
situation.
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The Four Components Model (FCM)
cont’d
Component 3: Ethical Motivation
• Desiring to be ethical and to act and live in a
manner consistent with one’s moral values.
• Moral courage is “the individual’s capacity to
overcome fear and to stand up for his or her
core values.”
(Lachman, 2007, p.131)
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The Four Components Model (FCM)
cont’d
Component 4: Ethical Action
• Determining the best way to implement the
chosen decision and having the ability and
confidence to persist to completion.
• “A given situation has ethical content when an
action freely performed or not performed has
the potential to harm or benefit others.”
(Robichaux, 2012, p.69)
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A Framework for Resolving Ethical
Dilemmas in Healthcare
1
Identify
Ethical
Issue
4
Define
Guiding
Principles
7
Decide
and Act
2
Clarify
Values
5
Analyze
Alternatives
8
Assess
Outcome
3
Clarify
Influencing
Factors and Barriers
6
Find
Common
Ground
Ethical Exploratory Exercises
Scenario #1: Values versus Need (Job Search)
Scenario #2: Client’s Right to Make Choices
Scenario #3: Confidentiality: Not an Exception but an
Expectation
Scenario #4: Hospitalization Vs Homelessness
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Summary
Lessons Learned:
• Collaboration with family members to find and
maintain a fine balance between protecting the
rights and welfare of ACT clients and meeting
expectations of their family members
• Working through an ethical dilemma involves
keeping an open mind and not allowing
ourselves to be motivated by our own biases
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Summary cont’d
Ways to Handle Ethical Dilemmas:
• Consult supervisors
• Use online network and research
• Discuss with clients
• Discuss with the circle of care
• Create and use professional forums
• Consult with professional licensing bodies
• Need for training supervisors on ethical issues
and dilemmas
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Moving Forward
Family Support Group and Ethical Dilemmas:
• Inclusion of topics related to ethical dilemmas in
the contents of psycho-education workshops
• Discuss about organizational policies around
professional ethics
• Family support groups as a platform for
discussing solutions for ethical issues
• Family support groups as an opportunity to learn
more about mental health and recovery as
viewed by diverse communities
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Contact Us
969 Derry Road East
Suite 107
Mississauga, ON L5T 2J7
SHIP’s main switchboard: 905-795-8742
SHIP’s Central Intake: 905-795-8742 Ext 233
[email protected]
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THANK YOU !
• [email protected]
• [email protected]
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References
• American Association of Critical Care Nursing (AACN).
(2004). The 4 A’s to Rise Above Moral Distress. Retrieved
August 2014 from:
• http://www.aacn.org/WD/Practice/Docs/4As
to_Rise_Above_Moral_Distress.pdf.
• Burns, S.A. (last updated June, 2012). Evolutionary
pragmatism, A disclosure on a modern philosophy for the
21st Century. The purpose of Ethics. Retrieved August 2014
from:
• http://www3.sympatico.ca/saburns/index.htm.
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References cont’d
• Kearney, G & Penque, S. (2012). Ethics of Everyday
Decision Making. Nursing Management, 19(1), 32 – 36.
• Lachman, V. (2007). Moral Courage: A virtue in Need of
Development? Medsurg Nursing, 16(2), 131 – 133.
• Rest.J.R. (1986). Moral Development: Advances in
Research and Theory. New York, NY: Praeger.
• http://www.ocswssw.org/en/professionalpractice.htm
• http://cna-aiic.ca/en/on-the-issues/bestnursing/nursing-ethics
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References cont’d
• Robichaux, C. (2012). Developing Ethical Skills: From
Sensitivity to Action. CriticalCareNurse, 32(2), 66 – 72.
• www.socialworktoday.com/news/eoe_101402.shtm
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