By Jeanette Robertson,2014-04-22 17:39
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    PILOT PROJECT Spring 2007






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To be added



    The Dual Diagnosis Good Practice Guide (Dh, 2002) and the National Service Framework 5 Years On review (DH,2004) have highlighted the central role of existing Assertive Outreach (AO) teams in England in the delivery of „Dual Diagnosis‟ services to those who have a co-existing diagnosis of mental health

    problems and substance misuse. Most teams have a significant percentage of clients who experience substance misuse problems (around 30-50%) (Graham et al, 2001; Fakhoury et al, 2006)

    AO teams have recently been reporting a reduction in the number of specialist practitioners within teams who have expertise in working with people with a „Dual Diagnosis‟. Therefore there is a need to increase capacity. In order to do this there needs to be a „whole-team‟ approach to working with dual diagnosis, in a multidisciplinary context, with a focus on severe mental illness.

The aims of this project are therefore as follows:-

    ; To develop a team training resource for Assertive Outreach Teams

    focused on service improvement processes and the delivery of equitable,

    accessible and sensitive services for those who experience both mental

    health problems and substance misuse difficulties, and their

    families/carers. This team training will focus on increasing the capabilities

    of the team as a whole, and of individuals within the team.

    ; To pilot the resource with identified teams and evaluate effectiveness.

    A Dual Diagnosis training resource has been commissioned and produced which will form the basis of the training to be delivered. Three methods of delivering this training will be evaluated:


    1. The first method will involve the team manager (or other appropriately

    experienced member of the team) delivering the training using the

    training Support for this will be provided by CSIP in the form of supervision

    and the provision of a short “train the trainer” programme. CSIP will play

    no specific role in delivering the training in these teams.

    2. The second method of training will involve CSIP Eastern Programme Leads

    delivering the training to specific AOT‟s.

    3. The third method will be training delivered to a forum of key individuals

    from AOT‟s within the West Midlands, and they will then be responsible for

    cascading the training within their teams (with support from the regional

    Assertive Outreach network).

    An evaluation schedule will be established which will measure before and after ratings.

    It is envisaged that the evaluation will consider the following outcomes;

    ; Ratings of confidence by staff

    ; Before/after measure of knowledge of key DD interventions

    ; Attitudes of staff towards DD users

    ; Changes in practice

Philosophy of the training resource

    The philosophy of the training is based heavily on a recovery model of mental health (NIMHE, 2005). This places the service user (and their carers) at the centre of their care, they are valued as an individual and their strengths as well as their needs are recognised. Service users and carers are active partners in care as opposed to passive recipients. The service will endeavour to provide an atmosphere of care that enables the service user (and their carers) to make their own choices about their lifestyle and treatment. The aim of treatment is to assist the person to make choices that enable them to achieve an optimum quality of


    life based on their abilities and strengths as well as taking into account the realities of their situation.


    Department of Health (2001) Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide. DH, London

    Department of Health (2004) the National Service Framework- 5 years on. DH, London

    Fakhoury, W.K.H.; Priebe, S. and the PLAO group (2006) An Unholy Alliance: substance abuse and social exclusion among assertive outreach patients. Acta Psychiatria Scandinavica. 114, 124-131

    Graham, H.; Maslin, J; Copello, A et al (2001) Drug and alcohol problems amongst individuals with severe mental health problems in an inner city area in the UK. Social Psychiatry and Psychiatric Epidemiology. 36, 448-455

    National Institute for Mental Health in England (2005) NIMHE Guiding Statement on Recovery


Capabilities for Dual Diagnosis


    Competence: This is a measure of practice in terms of the person‟s ability to perform it.

    Capability: encompasses competency but is wider in its scope as it covers attitude, application of theory to practice and reflection on that practice. It is the individuals ability to apply a competence in practice.

    The training is based on a values and evidence base to dual diagnosis and the content is designed to develop team capabilities based on “Closing the Gap” a capability framework for dual diagnosis (Hughes, 2006). This framework was developed in consultation with NHS, Higher Education , non-statutory agencies and service users. It is developed from the Ten Essential Shared Capabilities for Mental Health. The Ten Essential Shared Capabilities (ESC) lay out the core practice standards that all mental health practitioners (regardless of role) are expected to achieve. These capabilities were developed through a major consultation exercise with Service Users and carers and led by the Sainsbury Centre for Mental Health. The ESC are deliberately focused on the expectations of Service User and Carers when considering the type of care they would like to receive. We believe the ESC also describe the expectations of mental health practitioners on the standards of care they aspire to deliver. Therefore the ESC have the potential to set a common and consistent foundation on which to develop high quality Service User and carer centred mental health.

    Reference will be made throughout the training to both the Dual diagnosis capabilities and the ESCs.


    The Ten Essential Shared Capabilities (DH, 2004)

    1. Working in Partnership. Developing and maintaining constructive working relationships

    with service users, carers, families, colleagues, lay people and wider community

    networks. Working positively with any tensions created by conflict of interest or aspiration

    that may arise between the partners in care.

    2. Respecting Diversity. Working in partnership with service users, carers, families and

    colleagues to provide care and interventions that not only make a positive difference but

    also do so in ways that respect and value diversity including age, race, culture, disability,

    gender, spirituality and sexuality.

    3. Practising Ethically. Recognising the rights and aspirations of service users and their

    families, acknowledging power differentials and minimising them whenever possible.

    Providing treatment and care that is accountable to service users and carers within the

    boundaries prescribed by national (professional), legal and local codes of ethical practice. 4. Challenging Inequality. Addressing the causes and consequences of stigma,

    discrimination, social inequality and exclusion on service users, carers and mental health

    services. Creating, developing or maintaining valued social roles for people in the

    communities they come from.

    5. Promoting Recovery. Working in partnership to provide care and treatment that enables

    service users and carers to tackle mental health problems with hope and optimism and to

    work towards a valued lifestyle within and beyond the limits of any mental health problem. 6. Identifying People’s Needs and Strengths. Working in partnership to gather

    information to agree health and social care needs in the context of the preferred lifestyle

    and aspirations of service users, their families, carers and friends.

    7. Providing Service User Centred Care. Negotiating achievable and meaningful goals;

    primarily from the perspective of service users and their families. Influencing and seeking

    the means to achieve these goals and clarifying the responsibilities of the people who will

    provide any help that is needed, including systematically evaluating outcomes and


    8. Making a Difference. Facilitating access to and delivering the best quality, evidence-

    based, values-based health and social care interventions to meet the needs and

    aspirations of service users and their families and carers.

    9. Promoting Safety and Positive Risk Taking. Empowering the person to decide the

    level of risk they are prepared to take with their health and safety. This includes working

    with the tension between promoting safety and positive risk taking, including assessing

    and dealing with possible risks for service users, carers, family members, and the wider


    10. Personal Development and Learning. Keeping up to date with changes in practice and

    participating in life-long learning, personal and professional development for one‟s self

    and colleagues through supervision, appraisal and reflective practice.


Mapping Closing the Gap to the Ten Essential Shared Capabilities

     Dual Diagnosis Capability (Closing the 10 Essential Shared

    Gap) Capabilites


    1 Role legitimacy Challenging Inequality;

    making a difference;

    working in partnership

    2 Therapeutic Optimism Promoting Recovery

    3 Acceptance of the uniqueness of each Respect diversity;

    individual promoting recovery

    4 Non-judgemental attitude Practicing ethically

    5 Demonstrate Empathy Respect Diversity; Promote



    6 Engagement Making a difference;

    working in partnership;

    respect diversity; promote

    recovery; promoting safety

    and positive risk taking

    7 Interpersonal skills Providing service user led

    services; making a


    8 Education and Health promotion Promoting safety and

    positive risk taking

    9 Recognise Needs (assessment) Working in partnership;

    identifying peoples‟ needs

    and strengths

    10 Risk Management and Assessment Promoting safety and

    positive risk-taking

    11 Ethical, legal and confidentiality issues Practicing ethically;


    promoting safety and

    positive risk taking

    12 Care planning in partnership with service Providing service user-led

    user care; working in

    partnership; promoting


    13 Delivering evidence and values-based Making a difference;

    care Promoting Recovery;

    Practicing Ethically

    14 Evaluate care Providing service user-led


    15 Help people access care from other Making a difference;

    services challenging Inequalities

    16 Multi-agency/professional working Working in partnership


    17 Learning needs Practice development and


    18 Seek out and use supervision both formal Practice development and

    and peer learning

    19 Life-long learning Practice development and



    Department of Health (2004) The Ten Essential Shared Capabilities: A Framework

    for the whole of the mental health workforce. DH, London

Hughes (2006) Closing the Gap. A capability framework for working effectively

    with people with combined mental health and substance use problems (dual



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