Implementation of screening and brief intervention for high prevalence mental health disorders in al

1
Implementation of screening and brief
intervention for high prevalence mental health
disorders in alcohol and other drug services The
PsyCheck Project

• Nicole Lee
• Turning Point Alcohol and Drug centre
• Josephine Norman1, Linda Jenner2, Amanda Baker3,
  Alison Ritter1, Leanne Hides4, Frances
  Kay-Lambkin3, Kate Hall1, Fiona Dann1
• 1Turning Point Alcohol and Drug Centre, 2JenCo
  Consulting, 3Newcastle University, 4Orygen Youth
  Health

2

• This project was funded byIllicit Drugs
  SectionDrug Strategy Branch
• Australian Government Department of Health and
  Ageing

3

• Many thanks to everyone involved
• Participating sites
• Team leaders
• Clinicians
• Clients
• Expert Advisory Group

4
Comorbidity in AOD

• Rates of comorbidity high
• Mostly high prevalence disorders
• Not suitable for Mental Health Services referral
• Subclinical symptoms
• Integrated treatment preferable
• Clients prefer a one-stop-shop
• Many AOD clinicians not trained in MH

5
PsyCheck Focus

• Integrated treatment
• Stepped care
• Evidence based practice
• Manual guided but flexible therapy
• Upskilling AOD workers in MH
• Training
• Supervision
• Workforce development approach

6
Method

• Participants
• 20 practitioners, 4 agencies, 5 sites, 3 states
• Variety of backgrounds
• Range of services
• Measures
• Pre-post file audit
• Semi-structured interviews
• Procedure
• Training and supervision 6 months
• Toolkit support
• Evaluate clinician confidence, skill, practice
  changes

7
Screening

• PsyCheck screening tool
• Risk assessment
• Self Reporting Questionnaire (WHO)
• Mental health probes
• Validated previously (Jenner, Lee Saunders)
• Good internal and convergent reliability with the
  CIDI
• Good sensitivity and specificity
• Cut-off scores for mental health intervention

8
Intervention

• Cognitive behaviour therapy based
• Best practice in mental health and AOD
• Familiar to AOD clinicians
• Amenable to brief intervention
• Amenable to integration
• Up to 4 modules
• Four or more weeks
• Basic module plus extension material

9
Results Practice Change

• Increase in skill and confidence
• Increase in detection
• they had already slipped throughbeen picked up
  now I hadnt noticed
• Increase in recording (file audit)
• Increase in reflective practice
• led me to formulate clients in a different way
  and has allowed sessions to be more client driven

10
Results Evaluation of Tools

• Screening tool useful and easy to use
• Some format adjustments
• Intervention package useful
• Reduced content
• Flexible format
• Extension material

11
Results Supervision

• Important component
• Comorbidity increases complexity
• New skills require additional support
• Useful
• It helps with my own confidence to run things by
  my supervisor to make sure I am not barking up
  the wrong tree
• It guided me through the process and was really
  helpful

12
Results Supervision
13
Future Directions

• Publication
• Revision and publication of manuals
• Adaptation for youth specific services
• Dissemination
• National training workforce development
  approach
• Managers
• Supervisors
• Clinicians
• Increasing access to supervision
• Evaluation
• Clinician outcomes of training
• Client outcomes of clinician training and support