Reflective practice in homelessness services: A CBT approach 20 th - - PDF document
Reflective practice in homelessness services: A CBT approach 20 th June, 2014 Nick Maguire University of Southampton Reflective practice Staff reflection on: Experiences with service users Experiences with services Emotions related
1
20th June, 2014
Nick Maguire University of Southampton
Staff reflection on:
– Emotions related to behaviours – Enabling change
2
– Cognitive model – Complex trauma – Service issues
– Reflection on skills learned – Learning through experience of others
Abstract conceptualisation Active experimentation Concrete experience Reflective
3
(evolutionary perspective; Ekman, 1992)
– Anxiety – Anger – Sadness – Happiness (including love) – Surprise – Disgust
6
4
5
(Ellis, 1966)
Antecedent event Belief Consequence
Emotion: Behaviour:
6
7
Maintenance of the problem - cognition
(Interactive Cognitive Subsystems (ICS); Barnard & Teasdale, 1991)
Thoughts
Emotions
Behaviours
8
1986).
– Measure of staff burnout in the helping professions.
2007).
– Novel questionnaire designed to assess staff confidence with using CBT techniques with complex clients.
– Novel questionnaire designed to assess negative beliefs about complex clients.
– Services users’ general mental health functioning
9
Staff training and reflective practice
Exeter CC
Maslach Burnout Inventory 40 45 50 55 60 65 70 Time 1 Time 2 Time 3 MBI Score Maslach Burnout Inventory
30 28 12 p < .05
10
Beliefs about effectiveness of facilitating change
Effective Work With Complex Clients 40 41 42 43 44 45 46 47 48 49 50 Time 1 Time 2 Time 3 Effective Working Score Effective Work With Complex Clients
30 28 5 p<.05
Negative beliefs about the client group
Staff Attitudes and Beliefs 80 90 100 110 120 130 140 Time 1 Time 2 Time 3 SAB-42 Score Staff Attitudes and Beliefs
30 28 5 p < .05
11
Mediation analysis
Effective working beliefs Burnout Negative beliefs
. 438**
* p < .05 ** p < .01
12
1
BSMS 20th July 2014
2
AND Either a ‘top tip’ for working in Inclusion Health OR something you would like to see develop OR one thing working in IH has taught you
3
One thing IH has taught me is that we have more success when services change to suit people, rather than expecting the opposite.
Either a ‘top tip’ for working in Inclusion Health OR something you would like to see develop OR one thing working in IH has taught you
4
Primary Care
covering a hostel
Christmas Specialist Services
TB/mental health/sexual health
services
mainstream/traditional services
5
Primary Care services (GMS/PMS)
served by mainstream
local focus, funding, needs
centres
6
Either a ‘top tip’ for working in Inclusion Health OR something you would like to see develop OR one thing working in IH has taught you
London based with North,South,East Hubs and West coming
services and others
soon
later!)
7
Specialist education programme for IH under development To include: On-line/distance learning modules Stand alone educational modules Full MSc programme for IH Continuing Professional Development (started!)
patients
8
better together
and influencing the middle!
earlier
managers
Either a ‘top tip’ for working in Inclusion Health OR something you would like to see develop OR one thing working in IH has taught you
9
programme for out/ in-reach workers, social workers, nurses, doctors and medical students
Local example in Brighton
Pathway Plus Team in hospital Follow up for patients discharged to TA or street homeless Hostels team of nursing+OT, plus nurse and
Weekly Pathway MDT and hostel MDT Education programme for medical students Medical student homeless society
Bid to scale up above programme-increase
Plans for Homeless Hub for all services Plans for purpose built premises
Pre-1998 Session of GP and 3 sessions of DN in local day centre Post 1998 Specialist NP and GP services Specialist primary care care, gradual additions of substance misuse, mental health, midwife services,alcohol services. Shared MDT with MH Homeless Team Outreach to street and day centres
10