STEP LC - Module C - Continued Tx in CSC - Session 4

Transcript

• 00:05Alright. So today, welcome back
• 00:07to our overview of early
• 00:09intervention services for schizophrenia
• 00:11course.
• 00:12Today, we'll be covering module
• 00:14c,
• 00:15continuing treatment and coordinated specialty
• 00:17care. This will actually be
• 00:18a two week,
• 00:20series, so we're not gonna
• 00:21cover everything in module c
• 00:23as it's it's very robust.
• 00:31So as I mentioned, this
• 00:32this will be a two
• 00:33week,
• 00:35content area.
• 00:37But over those two weeks,
• 00:38we really hope to cover
• 00:39some key concepts of
• 00:41overviewing the main, core elements
• 00:43of care in the step,
• 00:46module c care pathway,
• 00:49which is very congruent with
• 00:51the term coordinated specialty care,
• 00:52which I will discuss.
• 00:55And in addition to overviewing
• 00:57the different elements of care,
• 00:59we also wanna introduce you
• 01:00all to just some of
• 01:01the processes and core outcomes,
• 01:04that make up the step
• 01:06care pathway module c.
• 01:08And we'll be intermixing, you
• 01:10know, discussions
• 01:12about step care and culture,
• 01:14of the clinic as that's
• 01:16a a really important piece
• 01:17in terms
• 01:18of working with our young
• 01:20clients as well as
• 01:22trying to,
• 01:23empower clinicians, prevent burnout,
• 01:25all of those things as
• 01:26I know we're facing,
• 01:29real a real strain and
• 01:30a lot of workforce
• 01:31shortages across the state and
• 01:33across the country
• 01:34in our sector.
• 01:39So I know we covered
• 01:40this, but we're gonna just,
• 01:42continue to harp this point.
• 01:44What is early intervention
• 01:46for psychosis?
• 01:47Right? Last week,
• 01:49we really went in-depth about
• 01:51that module a,
• 01:53early detection,
• 01:54and talking about just all
• 01:56those efforts to
• 01:58find and identify
• 02:00and get, those young people
• 02:01who might be experiencing,
• 02:03emerging,
• 02:04schizophrenia spectrum disorder, getting them
• 02:07to care and just everything
• 02:08that happens before kind of
• 02:09care even starts.
• 02:11But today, we'll be focused
• 02:12on what is that intensive
• 02:14treatment actually look like.
• 02:16What happens when we do
• 02:18connect with folks,
• 02:19and kinda get them in
• 02:20the door or in front
• 02:22of the telehealth screen or
• 02:23whatever way that we might
• 02:24be engaging with someone.
• 02:26So,
• 02:28historically,
• 02:29this would be
• 02:30this module c piece would
• 02:31be intensive treatment in the
• 02:33first two to five years,
• 02:35and this is termed so
• 02:36we're we're calling it EIS
• 02:38or early intervention,
• 02:40in schizophrenia
• 02:41services,
• 02:42also known as CSC or
• 02:44coordinated specialty care,
• 02:47with the real focus on
• 02:50reducing relapse and maximizing functioning
• 02:53for folks.
• 02:55These interventions were initially, you
• 02:57know, adapted from the more
• 02:58chronic
• 02:59serious mental illness
• 03:01population, kind of adapted down
• 03:03to younger patients.
• 03:05I'll talk more in-depth, but
• 03:06there's the goal of really,
• 03:09engaging with folks around phase
• 03:11specific interventions,
• 03:12which we'll talk about what
• 03:13that what that means. But
• 03:15again, this is all occurring
• 03:17during that critical period that
• 03:19we talked about
• 03:20within those first couple years
• 03:22of the illness when we
• 03:24tend to see the the
• 03:25most impact,
• 03:27of symptoms kind of both,
• 03:29you know, can be negatively
• 03:30impacting
• 03:32one's functioning and their role
• 03:33trajectories. However, it's also the
• 03:35time of,
• 03:36where intervention can have the
• 03:37most robust outcomes by kind
• 03:39of getting in there early
• 03:40and thwarting some of these,
• 03:43potentially,
• 03:45disabling,
• 03:47impacts that folks can experience.
• 03:50So
• 03:52we've we've talked about this,
• 03:53but just a little reminder,
• 03:55does early intervention for
• 03:57schizophrenia spectrum disorders or psychosis
• 03:59work? Yes.
• 04:02Schizophrenia
• 04:02is treatable. Treatment works.
• 04:05There are multiple observational studies
• 04:08that show higher rates of
• 04:09symptom remission and social and
• 04:11vocational recovery.
• 04:13There are large randomized control
• 04:14trials that have shown favorable
• 04:16outcomes. Doctor Shriheri covered these
• 04:18in our first session.
• 04:20But just a reminder, you
• 04:21know,
• 04:23of that
• 04:23large RCTs have,
• 04:26shown, you know, reductions in
• 04:28relapse, reductions in hospital readmissions,
• 04:31increases in,
• 04:33choices
• 04:34to take medications that might
• 04:36benefit a remission of positive
• 04:37symptoms,
• 04:39decreases in suicidal ideation,
• 04:41improvements in social and vocational
• 04:43functioning,
• 04:45etcetera.
• 04:46So,
• 04:48these methods have been proven
• 04:50effective,
• 04:51through various research studies.
• 04:54As we mentioned in session
• 04:55one, STEP was founded in
• 04:56two thousand six and actually
• 04:58completed the first US based
• 05:01randomized control trial of specialty
• 05:03team based care,
• 05:05which has since been termed
• 05:06CSE or coordinated specialty care.
• 05:09So lots of terms, specialty
• 05:10team based care, coordinated specialty
• 05:13care, EIS,
• 05:14all basically meaning the same
• 05:16thing. Intensive team based services,
• 05:20created for
• 05:21young folks experiencing
• 05:23recent onset schizophrenia.
• 05:26So STEP's model of care
• 05:28has been truly influential in
• 05:29the creation of first episode
• 05:32programs
• 05:33across the country, and we've
• 05:34really been working, as you
• 05:35know, to grow the capacity,
• 05:37of first episode services here
• 05:39in Connecticut.
• 05:44So everyone's favorite
• 05:45picture that you're just gonna
• 05:46have ingrained into your head
• 05:48by the end of this
• 05:49overview, but
• 05:50this is where we're focusing
• 05:51today. Right? We've we've covered
• 05:52early detection.
• 05:54We will double back to
• 05:55talk about module b in
• 05:57a future session,
• 05:58but we're really gonna focus
• 05:59on the bulk of the
• 06:01treatment today.
• 06:06So with that, in addition
• 06:08to covering what the treatment
• 06:10is made up of, we
• 06:10wanna talk about the processes
• 06:12and values and culture,
• 06:14that,
• 06:16inform the treatment. So, certainly,
• 06:19principles of step care,
• 06:21first and foremost, we want
• 06:22it to be safe.
• 06:23So there's a focus on
• 06:24suicide prevention,
• 06:26a focus on minimizing and
• 06:28monitoring
• 06:29any medication side effects.
• 06:32We wanna use effective treatments
• 06:33that are evidence based and
• 06:34empirically supported.
• 06:37A focus on patient centered
• 06:38care. Right? So with that
• 06:40offering a menu of psychosocial
• 06:42services.
• 06:45With this, we're gonna we're
• 06:46gonna anticipate in working with
• 06:47this young population,
• 06:50with schizophrenia that there'll be
• 06:51variable insight and that that
• 06:53will fluctuate throughout perhaps the
• 06:56individual throughout their course of
• 06:57treatment. So
• 06:58insight meaning,
• 07:00awareness into one's one's symptoms,
• 07:03one's illness.
• 07:05And so with that patient
• 07:06centered mindset too, we wanna
• 07:08be able to flexibly engage
• 07:10and reengage
• 07:11in care,
• 07:12not holding strict boundaries to
• 07:14the best of our ability
• 07:16with, you know, say three
• 07:17no shows and you're out.
• 07:18Like, really trying to be
• 07:19assertive and flexible with our
• 07:21engagement
• 07:21to try to help folks
• 07:22stay connected to
• 07:24this important intervention service.
• 07:27We wanna anticipate
• 07:29stigma,
• 07:30both internalized and externalized.
• 07:33Actively include,
• 07:35as long as we've got
• 07:36permission,
• 07:37family and other supportive folks,
• 07:39as well as existing community
• 07:41resources,
• 07:43in order to kinda help
• 07:44be comprehensive in the care
• 07:46that we provide.
• 07:48Another important principle is to
• 07:49be timely.
• 07:51Engaging people quickly as we
• 07:53talked about with early detection,
• 07:55being flexible,
• 07:57community based access.
• 07:59It's important to be, you
• 08:00know, equitable.
• 08:02So
• 08:03StepCare is currently blind to
• 08:04insurance status, immigration status. We
• 08:06accept all comers,
• 08:08in our catchment area. Of
• 08:09course, there are things that,
• 08:11can can impact that based
• 08:13on the agencies that you're
• 08:14at, but I understand that
• 08:15that's that's largely what, you
• 08:16know,
• 08:17LMHA's are doing. I understand
• 08:19some of the private nonprofits
• 08:20and and other organizational structures
• 08:23have different limits.
• 08:26Trying to really just if
• 08:27it with the population health
• 08:28framework where we're trying to
• 08:30truly,
• 08:31impact
• 08:33this illness and limit its
• 08:35impacts and amount kind of
• 08:36a a population level.
• 08:38These are some of the
• 08:39principles that are are necessary
• 08:40in order to do that.
• 08:42And then lastly, remaining optimistic
• 08:44and hopeful.
• 08:46So holding a recovery oriented
• 08:48framework,
• 08:50fostering autonomy and independence in
• 08:52any way possible, engaging
• 08:54in shared
• 08:55decision making,
• 08:57and trying to return help
• 08:58folks return to their premorbid
• 09:00goals and and holding on
• 09:01to that hope as providers
• 09:02that we know folks can
• 09:04recover, whatever that might look
• 09:06like for them. We don't
• 09:07have one vision of what
• 09:09recovery is,
• 09:10but it's important that especially
• 09:12when
• 09:13young people might feel,
• 09:16that they feel so far
• 09:17from maybe where they want
• 09:19to be or where they
• 09:19were or their families
• 09:21feel like, how are we
• 09:22gonna get back,
• 09:25to the place that my
• 09:25young person wanted to be
• 09:27holding on to that hope
• 09:28and and knowing that recovery
• 09:30actually is the the expectation,
• 09:32not the exception in schizophrenia
• 09:34or, early intervention.
• 09:38So
• 09:39as I mentioned,
• 09:41there's phase specific care. So
• 09:43I will talk about our
• 09:44core elements, but,
• 09:45there which is
• 09:47I'll show on the next
• 09:48slide, comprised of six main
• 09:49elements of care.
• 09:51So this is gonna include
• 09:52things like psychotherapy,
• 09:54psychopharm,
• 09:55family engagement,
• 09:57community engagement, etcetera.
• 10:00All of these aspects are
• 10:02tailored to the individual
• 10:04based on their presentation,
• 10:06their individual preferences, their goals,
• 10:09and their phase of recovery
• 10:10or phase of illness. Right?
• 10:12So just a little note
• 10:13about the different phases of
• 10:14recovery and how we think
• 10:16about them.
• 10:19Think of
• 10:21them in three main phases.
• 10:22We've got the engagement phase
• 10:24or the acute phase, which
• 10:25is
• 10:26right when someone you know,
• 10:27as as it kinda sounds
• 10:28like maybe there's acute symptoms
• 10:30coming on. This might be
• 10:32right when someone
• 10:33is, coming to us from
• 10:35a hospitalization
• 10:36or
• 10:37their first, perhaps, entry into
• 10:39care. They they might be
• 10:40coming in and experiencing kind
• 10:43of acute symptoms.
• 10:46And this is really gonna
• 10:47be, you know, thinking about
• 10:48interrupted narratives here is what
• 10:50we're engaging around. Like, okay.
• 10:52This the onset of these
• 10:54symptoms or these experiences or
• 10:56this episode is causing, you
• 10:57know, an interruption in my
• 10:58work or my relationships or
• 10:59my school functioning.
• 11:01And you're really just trying
• 11:02to kind of help stabilize
• 11:04someone,
• 11:05help connect them to care,
• 11:06develop some type of relationship.
• 11:08Then we've got the stabilization
• 11:10phase
• 11:11where,
• 11:12you know, we've been able
• 11:14to,
• 11:15minimize some of the impairments
• 11:17related to
• 11:18symptoms. Maybe not completely gone,
• 11:20maybe not complete symptom remission,
• 11:22but someone is more
• 11:24doing more stable.
• 11:26And then recovery phase.
• 11:29Patient is, you know, actively
• 11:31working on
• 11:32various goals that are important
• 11:33to them, social, educational,
• 11:36vocational,
• 11:38actively learning strategies,
• 11:40moving towards self management,
• 11:42of their experience, of their
• 11:44illness.
• 11:45So
• 11:46these phases are not linear.
• 11:48There's no there's no perfect
• 11:49way to describe it. It's
• 11:51really not uncommon
• 11:52for patients to move in
• 11:54and out of these phases
• 11:55or cycle through them several
• 11:57times,
• 11:58before reaching a more sustained
• 12:00recovery phase. And so it's
• 12:02it's important for an early
• 12:03intervention service provider to to
• 12:05just really be flexible with
• 12:06that, to recognize that someone
• 12:09might come in in a
• 12:10completely different place than they
• 12:11were in a couple weeks
• 12:12ago
• 12:13or that it might take
• 12:14a couple,
• 12:16instances of engaging in care,
• 12:19before we can reach the
• 12:21recovery phase. And just having
• 12:23that kind of,
• 12:25you know, be an expectation
• 12:27and also letting families know
• 12:29that that that's not uncommon.
• 12:32What we're gonna strive towards
• 12:33kind of work having someone
• 12:34work on meaningful goals for
• 12:36them and and helping minimize
• 12:38the impact of their symptoms
• 12:39as as soon as possible.
• 12:41And
• 12:43but recognizing that folks do
• 12:44kind of cycle in and
• 12:45out of these, and that's,
• 12:46again, not an uncommon
• 12:48occurrence.
• 12:52So
• 12:53these elements of care that
• 12:54I've talked about.
• 12:56So at step, we've identified
• 12:58six main elements of care.
• 12:59These will look pretty similar
• 13:01across coordinated specialty care programs
• 13:04across the country, across the
• 13:05world.
• 13:07Different places might call them
• 13:08slightly different things.
• 13:10So,
• 13:11again, I mentioned that all
• 13:12of these are,
• 13:14you know, tailored to the
• 13:15individual phase specific,
• 13:18but these are all things
• 13:19that we we offer at
• 13:20our clinic. So,
• 13:22you know, there previously was
• 13:24the myth that
• 13:25that perhaps some folks still,
• 13:28wonder about that, you know,
• 13:30oh,
• 13:31antipsychotic
• 13:32medication, you know, given that
• 13:33it's a it is a
• 13:34front frontline treatment,
• 13:37for the experience of psychosis
• 13:39and and schizophrenia, that that's
• 13:40all that's needed. I'm here
• 13:42to say, of course, that
• 13:43is that is absolutely not
• 13:44the case. It's important to
• 13:45offer,
• 13:47a variety
• 13:48of psychosocial,
• 13:50interventions and options for folks.
• 13:54And there's although we know
• 13:54that it can be incredibly
• 13:56effective at reducing positive symptoms,
• 13:59anticyclonic medication,
• 14:01this is not a requirement,
• 14:02right, of of being engaged
• 14:04in early intervention care.
• 14:06And as we know in,
• 14:07Connecticut, that's not something that,
• 14:10can be mandated on an
• 14:11outpatient basis.
• 14:13So
• 14:15the six elements, and I'm
• 14:16gonna cover some of these
• 14:17today,
• 14:20include psychotherapy.
• 14:22So that can look a
• 14:23lot of different ways both
• 14:25on an individual or group
• 14:26basis. At step, it's largely
• 14:27individual
• 14:28basis.
• 14:31Pharmacotherapy.
• 14:32So, you know,
• 14:34medication and health promotion. We
• 14:36kind of have those combined.
• 14:37Often the role of a
• 14:38psychiatrist or an APRN or
• 14:40a nurse.
• 14:42Support for employment and education.
• 14:46Ongoing
• 14:47longitudinal evaluation,
• 14:50family support and education,
• 14:52and then coordination with community
• 14:54supports.
• 14:56So we'll cover a couple
• 14:57of these today, and we'll
• 14:59cover the rest in a
• 14:59subsequent session.
• 15:02So first, just starting with
• 15:05psychotherapy. What might that look
• 15:06like in an early intervention
• 15:08service for schizophrenia?
• 15:11So
• 15:12lots of information on this
• 15:14slide. I'm not gonna go
• 15:15into or or demo this
• 15:17for our overview course today,
• 15:18although we do have various
• 15:20resources on our website if
• 15:21you wanna kinda look at
• 15:23in more depth of, like,
• 15:24what some of these strategies
• 15:25look like in practice.
• 15:27But here's just a kind
• 15:29of an overlay of
• 15:30some of the things that
• 15:31we might engage in in
• 15:33individual psychotherapy.
• 15:35So,
• 15:37certainly,
• 15:39and and as we mentioned
• 15:40some of those principles,
• 15:41wanting things to be evidence
• 15:43based. So at Step, we
• 15:45we flexibly implement a variety
• 15:46of evidence based therapeutic techniques,
• 15:49pulling from a lot of
• 15:50different evidence based strategies including
• 15:53CBT, CBT for psychosis,
• 15:55dialectical behavior therapy,
• 15:58family focused treatment,
• 16:00social skills training for schizophrenia,
• 16:02social cognition interaction training.
• 16:04It's not limited. We think
• 16:06that there's a part of
• 16:07kind
• 16:09of providing that patient centered
• 16:10care and phase specific is
• 16:12is being able to kind
• 16:13of flexibly implement
• 16:14these interventions based on the
• 16:16client's presentations, needs, and preferences.
• 16:19So
• 16:21first bullet point here,
• 16:23engagement
• 16:24and developing a shared understanding
• 16:26of experiences and goals.
• 16:28I think this is a
• 16:29really key piece of what
• 16:31is done in early intervention
• 16:33service.
• 16:34And as
• 16:36folks know with working with,
• 16:37perhaps older, more chronic populations
• 16:39or or different populations of
• 16:41folks. Right? Engagement in the
• 16:43alliance is is key to
• 16:45any important,
• 16:46and successful therapeutic intervention.
• 16:49I think it's particularly
• 16:51important and can take up
• 16:53a a lot of time
• 16:54when working with both young
• 16:56adults
• 16:57as well as
• 16:59individuals experiencing psychosis,
• 17:01particularly young folks who
• 17:03perhaps
• 17:04this might be their first
• 17:06true engagement
• 17:07with the mental health system,
• 17:09keeping in mind that,
• 17:12maybe they had an acute
• 17:13interaction
• 17:14with the
• 17:16emergency services or inpatient unit,
• 17:19but perhaps they've never really
• 17:20opened up and told anyone
• 17:22about this before. Maybe they've
• 17:23spent a couple years
• 17:25socially isolating, trying to keep
• 17:27these symptoms to themselves and
• 17:29self manage.
• 17:30So
• 17:31really thinking about engagement is
• 17:32such a key piece that
• 17:34for some folks,
• 17:36take a long time. You
• 17:37sit in this engagement stage
• 17:39for quite a while. Other
• 17:40folks kinda come in and
• 17:41and move right along
• 17:43and say, like, help me
• 17:44keep these symptoms away.
• 17:47And again, it can fluctuate,
• 17:50within the person over their
• 17:51course of treatment.
• 17:54So without going into detail
• 17:56about what all of these
• 17:57strategies entail,
• 17:58just a couple,
• 18:01specific techniques. We use a
• 18:02lot of befriending,
• 18:05which is a a therapeutic
• 18:07technique in order to facilitate
• 18:08engagement.
• 18:11I find particularly helpful
• 18:13to come to this shared
• 18:14understanding of one's experiences is
• 18:17the stress bucket analogy,
• 18:19which is a really just
• 18:20like normalizing
• 18:22way of talking about
• 18:25experiences.
• 18:26I don't care if you
• 18:27wanna call it psychosis or
• 18:28schizophrenia,
• 18:30stress,
• 18:30anxiety,
• 18:31whatever it might be. We
• 18:33kind of develop a shared
• 18:34language with the young person
• 18:36and find a way to
• 18:37talk about it and find
• 18:38a way to kind of
• 18:40normalize that we all experience
• 18:42stress in different ways and
• 18:44we're vulnerable to different things.
• 18:47And it's a way to
• 18:48kind of help folks
• 18:50learn to recognize early warning
• 18:51signs.
• 18:53And those examples of what
• 18:54it looks like talking about
• 18:56the the stress bucket metaphor,
• 18:59available on our website.
• 19:01Often, this is also a
• 19:03time where you're gonna do
• 19:04some early values exploration and
• 19:05goal setting.
• 19:07And you're not gonna hit
• 19:08on every single one of
• 19:09these with every patient, but
• 19:11this is just to provide
• 19:12kind of an overview of
• 19:14what some of the strategies
• 19:15look like. You'll recognize that
• 19:18even though
• 19:19it's individuals experiencing schizophrenia, a
• 19:22lot of these strategies are
• 19:23not all that different
• 19:24from what we're doing with
• 19:25with folks with other presentations.
• 19:27There's just slight adaptations
• 19:29and,
• 19:31nuances to to pay attention
• 19:32to.
• 19:35So, certainly,
• 19:36we find it important to
• 19:37promote skills.
• 19:40As I mentioned, pulling from
• 19:41a variety of evidence based
• 19:42practices,
• 19:43evidence based treatments.
• 19:46Oftentimes,
• 19:47you know, we we find
• 19:48ourselves teaching a lot of
• 19:50stress management,
• 19:51distress tolerance, grounding strategies
• 19:54to help folks handle acute
• 19:55moments and to cope.
• 19:58We hope to to move
• 20:00on to kind of some
• 20:00more CBT
• 20:02informed techniques of reality testing.
• 20:05Sometimes there's a real need
• 20:06for social skills
• 20:07training or development.
• 20:09We know that,
• 20:11social cognition can be impacted
• 20:13in schizophrenia. And so sometimes
• 20:15there's
• 20:16a a need to do
• 20:17some formal practicing,
• 20:20helping folks create their own
• 20:22coping cards and safety plans.
• 20:25Then there's the kind of
• 20:26the more in-depth cognitive work.
• 20:29And none of this is
• 20:30necessarily
• 20:32in orders. People can flex
• 20:33in and out of this,
• 20:34but
• 20:35we can refer to it
• 20:36as, you know,
• 20:37cognitive work or changing our
• 20:38relationship to internal experiences.
• 20:41Right? And we know those
• 20:42internal experiences could be a
• 20:43lot of different things. It
• 20:44could be,
• 20:46distress related to
• 20:48voices or the interpretation of
• 20:50such,
• 20:52different suspicious or paranoid beliefs,
• 20:54etcetera.
• 20:56So here, you can really
• 20:57pull from cognitive behavioral therapy
• 20:59for psychosis approaches,
• 21:01using a lot of
• 21:03Socratic questioning,
• 21:04normalizing,
• 21:05collaboration.
• 21:07You can introduce cognitive restructuring.
• 21:11Acceptance based and compassion focused
• 21:13strategies are also evidence based
• 21:15and can be really helpful.
• 21:16I particularly find
• 21:18those strategies,
• 21:20helpful for
• 21:22sometimes when I've got I've
• 21:23got those folks who are
• 21:24so good at coming up
• 21:25with, evidence
• 21:27for and against their delusions
• 21:29and their they could just
• 21:30stay in that battle all
• 21:31day long, then
• 21:33I often would implement like,
• 21:34okay. Hang on. Let's let's
• 21:35not get tied up in
• 21:36this so much. Like, is
• 21:37there a way we can
• 21:38bring a more acceptance based
• 21:39framework
• 21:40to this?
• 21:43And, certainly,
• 21:44regardless of what's going on
• 21:45for someone, we wanna help
• 21:46people kind of cultivate a
• 21:48life worth living
• 21:50or a rich and meaningful
• 21:51life. So,
• 21:52again,
• 21:54just like any other, therapeutic
• 21:56relationship, you can spend time
• 21:58exploring values.
• 21:59We want things to be
• 22:00anchored and oriented around goals
• 22:02that are meaningful to the
• 22:03young person,
• 22:04not just right meaningful to
• 22:06the provider or the family,
• 22:09and various therapeutic topics. Right?
• 22:11So it
• 22:12not everyone is gonna, again,
• 22:13hit on all of these
• 22:15categories,
• 22:16but absolutely some of the
• 22:17work with young folks or
• 22:19folks experiencing,
• 22:20you know, schizophrenia can be,
• 22:24have common themes of processing
• 22:26past episodes. What did that
• 22:28mean?
• 22:29What what was going on
• 22:30in that situation? How does,
• 22:33this experience of psychosis or
• 22:35this diagnosis of schizophrenia
• 22:37impact my identity?
• 22:38How do I wanna think
• 22:39about disclosure
• 22:42to employers, to friends, to
• 22:43family members? Do I want
• 22:45to do that? Should I
• 22:46etcetera.
• 22:48How do I develop the
• 22:48autonomy in this? So,
• 22:51really, just a wide range.
• 22:53It's it's not all about,
• 22:56again, just
• 22:57getting rid of positive symptoms
• 22:59and teaching skills. We we
• 23:01can really pull from
• 23:03a lot of different therapeutic
• 23:04interventions
• 23:05And
• 23:06folks,
• 23:08the the presentations really vary.
• 23:11And I can speak from
• 23:12what, you know, what that
• 23:13looks like specifically in our
• 23:15clinic, but also, which is
• 23:16representative of,
• 23:18early intervention clinics across the
• 23:19country.
• 23:21And then lastly, on this
• 23:22page,
• 23:23a really key thing that
• 23:25I would say, like,
• 23:26if there are
• 23:28main elements that we're gonna
• 23:29do,
• 23:30you're gonna, like, focus a
• 23:32ton on engagement
• 23:33and really try to help
• 23:34folks identify early warning signs
• 23:37in some way. Again, maybe
• 23:38someone's coming in and saying,
• 23:41there's nothing going on. There's
• 23:42nothing wrong. Like, is there
• 23:43any way that you can
• 23:45align with them
• 23:46to to orient around? Okay.
• 23:47Well, like, you did end
• 23:49up in the hospital or
• 23:50or or, you know, something
• 23:51happened
• 23:52that was getting in the
• 23:53way. Like, how can we
• 23:54think about together? Like,
• 23:56what was going on at
• 23:57that time? What that looked
• 23:58like? Again, I don't care
• 24:00what we call it. I
• 24:01don't care if we call
• 24:02it psychosis or what really
• 24:04meeting the person where they're
• 24:05at, trying to figure out,
• 24:08a way to align, a
• 24:09way to help someone
• 24:11as well as the family
• 24:12learn to recognize,
• 24:14what might be precipitating,
• 24:15an episode or a relapse
• 24:17so that we can catch
• 24:18it sooner.
• 24:21So this is my favorite
• 24:23part
• 24:24to talk about being a
• 24:25psychologist. So I I usually
• 24:26get to talk about this
• 24:27a lot more. But, again,
• 24:29there's more resources on the
• 24:30website if you're interested in
• 24:31the the specifics of what
• 24:33these
• 24:34techniques look like,
• 24:36in the context of,
• 24:38early intervention for schizophrenia.
• 24:42A little bit more of
• 24:43just principles
• 24:45within the kind of psychotherapy
• 24:46domain, but I think really
• 24:48across all of the core
• 24:49elements
• 24:50and
• 24:51all of the interactions that
• 24:53we have with,
• 24:54young people is that we
• 24:57wanna normalize
• 24:58these experiences as much as
• 24:59we can.
• 25:01So,
• 25:02often folks experiencing psychosis or
• 25:05schizophrenia
• 25:06are othered or stigmatized,
• 25:09and we can even do
• 25:10that as providers,
• 25:13distancing ourselves in some ways.
• 25:15So
• 25:16the psychoeducation piece is just
• 25:18really important.
• 25:20Again, you'd
• 25:21someone doesn't necessarily have to
• 25:22agree or we don't have
• 25:24to have a specific label,
• 25:25but but talking about how
• 25:26these experiences can occur on
• 25:28a continuum,
• 25:31informing people that,
• 25:32hey. This is actually more
• 25:33common than you think. Like,
• 25:35lots of people hear voices
• 25:36or lots of people can
• 25:38get suspicious or paranoid at
• 25:40times. You can provide actual
• 25:42statistics,
• 25:43letting folks know that,
• 25:46these experiences can impact all
• 25:48types of people.
• 25:50And then, again, holding hope,
• 25:52for recovery that,
• 25:54it's the the expectation, not
• 25:56the exception, and perhaps even,
• 25:58you know, sharing
• 26:00whether it be statistics about
• 26:01different recovery trajectories or
• 26:04success stories,
• 26:06different things like that. Providing
• 26:07all that information can really
• 26:08be key in the normalization.
• 26:10This is really important again
• 26:12for families as well.
• 26:15Another great way to do
• 26:16that is connecting folks to
• 26:17others with lived experience.
• 26:20And anytime we're doing normalizing,
• 26:21right, we wanna make sure
• 26:23that we're normalizing, not dismissing.
• 26:25So not just saying, oh,
• 26:26yeah. Well, like, you're stressed
• 26:27out by your voices. Well,
• 26:29lots of people hear voices.
• 26:30Right? Like,
• 26:32doing it's it's that fine
• 26:33balance that I know we
• 26:34all think about,
• 26:36as clinicians, but, you know,
• 26:38offering the fact that, like,
• 26:39this is more common than
• 26:40you might think. You're not
• 26:42alone in this.
• 26:44And I I really hear
• 26:45that this is your suffering.
• 26:47This is really impactful for
• 26:49you. You can even, of
• 26:50course, check-in.
• 26:53What's this? What's it like
• 26:55to hear this when I
• 26:55give you these stats or
• 26:56share that other people experience
• 26:58this? Is it
• 26:59and kinda leaving that open
• 27:01or or maybe prompting a
• 27:02bit more
• 27:03just to make sure that
• 27:04someone's feeling like
• 27:06it might be helpful
• 27:07as opposed to
• 27:09you're not getting it, doctor
• 27:10Sykes. Like, this is really
• 27:12awful for me. So as
• 27:14as we would do kind
• 27:15of in any relationship, you
• 27:17know, checking in for that
• 27:18feedback.
• 27:20So
• 27:22other core elements.
• 27:24So we covered psychotherapy a
• 27:26bit, a quick outline of
• 27:28what
• 27:29that might look like in
• 27:30the room, what you might
• 27:31be doing
• 27:32with an individual.
• 27:35Another key element is family
• 27:38support and education.
• 27:40So I know there were
• 27:41some questions about this earlier
• 27:42on,
• 27:45and it can it can
• 27:46it can look a lot
• 27:46of different ways in line
• 27:48with that
• 27:49flexible implementation
• 27:50and and kind of person
• 27:52or family centered care.
• 27:54A couple things to think
• 27:55about
• 27:56when we're trying to empower
• 27:58or engage families.
• 28:01One thing is certainly trying
• 28:02to set the expectation
• 28:04from the beginning that
• 28:06we'd like families or support
• 28:08people to be involved.
• 28:09Of course, you know,
• 28:11this is largely up to
• 28:12the the young person. Right?
• 28:15They didn't
• 28:16give permission, and we always
• 28:17make sure that we give
• 28:18that kind of autonomy and
• 28:20and power and control
• 28:22that they're the ones in
• 28:23charge of, like, how involved
• 28:24their families might be in
• 28:25their treatment and what's shared
• 28:26and what's not shared.
• 28:28But in general, we try
• 28:29to offer things that could
• 28:30help engage,
• 28:32all families.
• 28:34So it's helpful
• 28:35to engage right away with
• 28:37a family. Like, as soon
• 28:38as someone's intake, we try
• 28:39to whether the family is
• 28:41joining or try to connect
• 28:43with them right away, let
• 28:44them know who they can
• 28:45contact in the clinic, introduce
• 28:47them, try to provide them
• 28:48some education and factual
• 28:50information.
• 28:53Of course, being responsive, offering
• 28:54practical help.
• 28:58Some things that we really
• 28:59focus on.
• 29:00Our strategies to reduce stress
• 29:02and manage difficult situations at
• 29:03home.
• 29:05Of course, that would be,
• 29:06you know, perhaps the family
• 29:07has already interacted with crisis
• 29:08services, but making sure they
• 29:10have that information,
• 29:11but also teaching some skills.
• 29:14There's a couple of resources
• 29:15that I really love.
• 29:17Doctor Emily Klein, who
• 29:20is at Boston Medical Center
• 29:21right now, recently put out
• 29:23a book and has done
• 29:24some research about adapting motivational
• 29:26interviewing
• 29:27strategies. So I think her
• 29:29research study was motivational interviewing
• 29:31for loved ones and, she's
• 29:32got a book about it,
• 29:33like the school of hard
• 29:34talks, I think is what
• 29:36it's called. And it's just
• 29:37got some really rich
• 29:39strategies for really helping families.
• 29:43Yeah. Basically, engage in kind
• 29:44of the motivational interviewing spirit
• 29:46when when working with their
• 29:48young people and recognizing the
• 29:49ways in which
• 29:51they can can talk to
• 29:53their young people differently, but
• 29:54also that they inevitably don't
• 29:56really have control,
• 29:58over the decisions and motivation
• 30:00to change that their their
• 30:01young people,
• 30:03have.
• 30:04And another great resource
• 30:06is psychosis reach. I think
• 30:08developed,
• 30:11some folks at Stanford
• 30:13as well as,
• 30:15University of Washington.
• 30:17And it's,
• 30:18so, again, it's called psychosis
• 30:19reach, and it's a a
• 30:21program actually adapting
• 30:23cognitive behavioral therapy for psychosis
• 30:26skills and principles
• 30:27for family members. And
• 30:29it's actually,
• 30:31you know, for,
• 30:32the SMI population in general,
• 30:34not just directed at,
• 30:37young adults, but a lot
• 30:38of great information there. And
• 30:39we we pull from a
• 30:40lot of that in our
• 30:41stepfamily services,
• 30:42those types of interventions.
• 30:46Family members can be key
• 30:48at learning to monitor symptoms,
• 30:51looking for those early warning
• 30:52signs,
• 30:53communicating collateral with the team,
• 30:55especially if a young person
• 30:56is in a state of,
• 30:59struggling to recognize
• 31:01the the impact of their
• 31:02current
• 31:03experiences,
• 31:06on things or struggling to
• 31:08engage families, can can be
• 31:10really huge.
• 31:12So just some other strategies
• 31:14again to to try to
• 31:15do with families
• 31:17to help them support the
• 31:18young person's recovery and really
• 31:20be a unified member
• 31:21of the team.
• 31:27Just like
• 31:28kind of early intervention services
• 31:30in general, there is
• 31:32research support for
• 31:33family support and education and
• 31:35early psychosis care.
• 31:38We recommend it for all
• 31:39families and support people.
• 31:41Can have a variety of
• 31:42benefits,
• 31:44including folks who have families
• 31:45involved.
• 31:47Research has shown that they
• 31:48might experience fewer symptoms,
• 31:50fewer rehospitalizations
• 31:52or hospitalizations,
• 31:54improvements in functioning,
• 31:57decreased caregiver stress and burden,
• 31:59a lot of potential positive,
• 32:01benefits.
• 32:03So at step, what this
• 32:05actually looks like,
• 32:07we offer a variety of
• 32:08educational opportunities for families and
• 32:10support people,
• 32:11again, based on need, interest,
• 32:14accessibility.
• 32:16So at minimum, we're trying
• 32:17to provide,
• 32:18in a lot of different
• 32:20ways, education about psychosis, treatment,
• 32:22recovery, and other important topics.
• 32:24So, again, factual information about
• 32:26kind of what this is
• 32:27at minimum.
• 32:28We provide that in a
• 32:29lot of different ways, welcome
• 32:30packets, website information,
• 32:33educational workshops,
• 32:35individual support with families.
• 32:38Any way that we can
• 32:39kinda help share and disseminate
• 32:40this important information, we're gonna
• 32:42do that.
• 32:44We think that most folks
• 32:46of, families come up with
• 32:47different strengths and different growth
• 32:48areas, but
• 32:50the main focus areas are
• 32:51are on usually communication skills,
• 32:54problem solving, crisis management.
• 32:56And then certainly,
• 32:58encouraging folks to connect with
• 33:00existing local and virtual resources,
• 33:02whether that's a local, you
• 33:04know,
• 33:05NAMI, FAVOR, grassroots organization
• 33:08to connect with other family
• 33:09members who might be experiencing
• 33:11similar things.
• 33:12And then we're also
• 33:14often recommending that family members
• 33:15get their own support or
• 33:17individual therapy,
• 33:19to help cope with kind
• 33:20of the stressful time and
• 33:21the stressful change
• 33:23in their life.
• 33:24If anyone's interested on the
• 33:26slides after, you can,
• 33:28download our our step family
• 33:29packet to see an example
• 33:31of what it's like. It's
• 33:32also on the the Yale
• 33:33step website, and I think
• 33:35it's on our,
• 33:36learning health network website as
• 33:38well.
• 33:39So here's just a look
• 33:41at kind of
• 33:43the different services that we
• 33:44have at at Step. Right?
• 33:45We're we're at least trying
• 33:46to get everyone
• 33:48some type of education through
• 33:50everyone gets a family welcome
• 33:51packet and informational sheets.
• 33:54We're trying to get everyone
• 33:56at least some initial contacts,
• 33:57so whether they're coming to
• 33:58a group orientation
• 34:00or an individual joining session.
• 34:02And then some families,
• 34:04whether based on need or
• 34:05interest, are engaging in individual
• 34:07family support, which can look
• 34:08a lot of different ways.
• 34:09It can look like
• 34:11me meeting with
• 34:13parents, caregivers, whomever the support
• 34:15people might be individually
• 34:17or a young person.
• 34:19It's we we love when
• 34:20the young person is willing
• 34:21to to join those meetings.
• 34:24So
• 34:26still a look at what,
• 34:28yeah, some of the things
• 34:29from the family packet might
• 34:30include.
• 34:34Alright. So a couple more
• 34:35elements that we're gonna
• 34:36discuss before we open it
• 34:38up for for q and
• 34:39a.
• 34:40So another element of care
• 34:42would be,
• 34:44support for employment and education.
• 34:48So and just the main
• 34:50concept here as many folks
• 34:52are aware of with their
• 34:53different
• 34:55different connections with different supportive
• 34:57employment and education offerings,
• 35:01throughout Connecticut.
• 35:02We think it's really important
• 35:04to help
• 35:05young folks if they've
• 35:07had an interrupted narrative or,
• 35:10if this illness has
• 35:12interrupted their relationships, their school,
• 35:14their work.
• 35:15How can we help them
• 35:16reengage
• 35:18or engage in a different
• 35:19way that's more accessible
• 35:21with important instrumental or expressive
• 35:23roles? So, basically, school or
• 35:25work.
• 35:28So there are formal,
• 35:33kind of, protocols for this,
• 35:35but I think it can
• 35:37be implemented in a lot
• 35:37of different ways. There's,
• 35:39supported employment and education c
• 35:41or IPS.
• 35:45You know, the, a principle
• 35:46of this is that we
• 35:47don't hold people back.
• 35:49Meaning, like, if someone comes
• 35:51in and maybe they're still
• 35:52experiencing
• 35:53a variety of symptoms, but
• 35:54they're like, hey, doctor Seitz.
• 35:55Like, I wanna start working.
• 35:57I really wanna get back
• 35:58to work.
• 36:00You know, we're we're gonna
• 36:01help encourage that or, you
• 36:03know, we're not gonna get
• 36:04in the way of connecting
• 36:04them with the supported employment
• 36:06or education specialist.
• 36:08Of course, there
• 36:09can be considerations of like,
• 36:10hey. Like, is is there
• 36:12anything we think we should
• 36:13work on first or that
• 36:14might get in the way
• 36:15of being successful at work?
• 36:18But the thought is not
• 36:18to kind of,
• 36:20pigeonhole them or or put
• 36:22folks in a restrictive environment,
• 36:24but really help them reengage
• 36:26with,
• 36:28competitive employment,
• 36:30competitive education, what whatever it
• 36:32is that, you know, their
• 36:33goals are and they might
• 36:34be interested in.
• 36:41And just another word to
• 36:42this, I can say that
• 36:43a lot of times when
• 36:44we're in that engagement phase
• 36:45and we're first meeting a
• 36:46young person,
• 36:48there might not be any
• 36:49agreement
• 36:51or, you know, shared understanding
• 36:52of
• 36:53illness or it's like, hey,
• 36:54doctor Sykes. I don't you
• 36:55know, I have no idea
• 36:57why I'm here.
• 36:59This is all a misunderstanding,
• 37:00but, like, you know what?
• 37:01Okay. I do
• 37:02I do wanna get back
• 37:03to to school. That's super
• 37:05important to me. Like, whatever
• 37:06happened or, like, I was
• 37:07wrongfully hospitalized or whatever is
• 37:09going on, the stress I'm
• 37:10experiencing has gotten the way
• 37:11of school. So, like,
• 37:13how can you help me
• 37:14do that? And that's the
• 37:15way to find that common
• 37:16ground. And
• 37:18then so we we start
• 37:19talking about school or we
• 37:20get them connected
• 37:21to an education specialist and
• 37:23then,
• 37:24you know, maybe start talking
• 37:25about some of the experiences.
• 37:27Maybe their sleep is preventing
• 37:28them from being able to
• 37:29stay awake in class or
• 37:31maybe the voices are distracting
• 37:33and then there's ways in.
• 37:35A lot of times though,
• 37:36it is about reengaging in
• 37:38these important roles.
• 37:41So
• 37:42I think this is the
• 37:43last one we're gonna talk
• 37:44about today.
• 37:46Another major element of care
• 37:48is
• 37:49coordination with community supports.
• 37:53And so there's a a
• 37:54lot of different things to
• 37:55potentially cover here.
• 37:58So
• 37:59coordination with community supports,
• 38:02there's a lot of different
• 38:03elements of this.
• 38:05I think, you know, coordination
• 38:07is it's in the name,
• 38:09CSC, coordinated specialty care. So
• 38:11we do lots of coordination
• 38:14within the team,
• 38:16which the team, you know,
• 38:17can be defined different ways
• 38:18within the immediate
• 38:20treatment team.
• 38:21So between primary clinician and
• 38:23prescriber and supported education person
• 38:26and senior specialist, all of
• 38:27those people, lots of communication
• 38:29is necessary, but also including
• 38:31the young people and their
• 38:32families
• 38:33as key
• 38:35key actors,
• 38:36on this team.
• 38:38So that's kind of our
• 38:39within team
• 38:40communication,
• 38:41which takes up a lot
• 38:42of you know, can take
• 38:43up a lot of time.
• 38:44Sometimes that,
• 38:46somewhat unbillable time.
• 38:48And then there's liaising with
• 38:51existing community supports, which a
• 38:53lot of folks maybe
• 38:55can think about some of
• 38:56the the case management type
• 38:57things,
• 38:59that folks engage in. But
• 39:00we also think it's it's
• 39:01crucial
• 39:03to be,
• 39:05be educators, be informing,
• 39:08you know, be connected with
• 39:09schools if our young people
• 39:10are in schools, if they're
• 39:11in high school or college,
• 39:14with their permission.
• 39:15How can we support them
• 39:17and advocate for them in
• 39:18those settings?
• 39:19How can we,
• 39:21you know, potentially be someone
• 39:23who's
• 39:24educating
• 39:25a a key person,
• 39:26helping the special education,
• 39:30coordinator
• 39:31understand the specifics of psychosis
• 39:33and what accommodations,
• 39:34our young person might need
• 39:36to benefit from and
• 39:37maybe helping
• 39:38the school understand that, okay,
• 39:40just because
• 39:41someone's
• 39:43experiencing voices or having an
• 39:44uptick in symptoms doesn't mean
• 39:45they immediately need to call
• 39:47two one one or go
• 39:48to the hospital
• 39:49and sharing safety plans and
• 39:50and just finding ways
• 39:52to help,
• 39:53our young people access and
• 39:54be successful
• 39:56in these existing community environments.
• 39:58Right? Because, again, the goal
• 40:00wanting to be reintegrating
• 40:02folks,
• 40:04with age appropriate institutions and
• 40:06supports,
• 40:07not
• 40:08just things connected to,
• 40:11the mental health organization. Right?
• 40:13We wanna get them back,
• 40:15if possible, to to things
• 40:16that they were working on
• 40:17before, if that was mainstream
• 40:19school or main stream work.
• 40:21Of course, it's it's absolutely
• 40:22appropriate if folks are are
• 40:23not in those settings and
• 40:25not everyone is in the
• 40:26first place.
• 40:28But wanting folks to
• 40:32have that opportunity to to
• 40:33give back and finding ways
• 40:35to support them in that.
• 40:36So, again, lots of coordination
• 40:38just as everyone else is
• 40:40doing with
• 40:41other types of community supports,
• 40:43crisis services, jail diversion.
• 40:46We we coordinate very closely
• 40:48with
• 40:49the local
• 40:50crisis intervention unit or psychiatric
• 40:53ER and then patient units.
• 40:55If we if we're the
• 40:57ones
• 40:58sending our folks,
• 40:59or if we get word
• 41:01that
• 41:02something has happened and and
• 41:03they're they're back in the
• 41:04hospital or they're in the
• 41:05hospital for the first time
• 41:07and they're trying to send
• 41:07them to stuff, lots of
• 41:09coordination,
• 41:11within those organizations.
• 41:15And then, of course, not
• 41:16to be ignoring
• 41:17the practical practical case management
• 41:19needs
• 41:20that so many of our
• 41:21folks,
• 41:23would benefit from and those
• 41:24important, social determinants of mental
• 41:27health that we can try
• 41:28to have an impact on
• 41:29by supporting folks
• 41:31to engage in such benefits
• 41:32and entitlements that that might
• 41:34help their trajectory in various
• 41:35ways.
• 41:39Gonna cover this
• 41:41pretty quickly of just a
• 41:43little bit more about coordination.
• 41:45So
• 41:46we talked about some of
• 41:47the main elements.
• 41:48So this part kinda gets
• 41:50into some of the processes
• 41:52of, like, what coordination within
• 41:53a team looks like.
• 41:56So,
• 41:58you know, within team, as
• 42:00I mentioned,
• 42:01there's gonna
• 42:03be lots of communication between
• 42:05the primary clinician and the
• 42:06prescriber. That's gonna be the
• 42:07main
• 42:08treatment team.
• 42:10In in early intervention services,
• 42:12you typically have, you know,
• 42:15the prescriber being,
• 42:16I would say, probably more,
• 42:18you know, more involved than
• 42:19is is typical on the
• 42:20chronic
• 42:22basis. There's a lot more
• 42:23frequent meetings,
• 42:25more flexibility with prescribers to
• 42:27kinda be pulled in
• 42:29as needed, particularly early in
• 42:30a course where when someone's
• 42:32in that acute phase,
• 42:33to be able to make
• 42:34quick medication adjustments or
• 42:38to consult on a case
• 42:42with family and patient. Right?
• 42:44You wanna make sure you're
• 42:45available
• 42:46answering questions, concerns,
• 42:49gathering collateral,
• 42:51making sure that
• 42:53concerns are being addressed and
• 42:55relayed about any medication side
• 42:57effects.
• 42:59We've discussed the various community
• 43:00supports, various case management.
• 43:04So within step,
• 43:05one of our our processes
• 43:08or or ways that,
• 43:10you know, we we have
• 43:11coordination.
• 43:13We have a
• 43:15a daily huddle, which I'll
• 43:16talk a little bit about
• 43:17that. So
• 43:18instead of, like, one long
• 43:20team meeting every week, we
• 43:21have a it's supposed to
• 43:22be kind of a quick
• 43:24can be however long it
• 43:25needs to take, but can
• 43:26be from five minutes to
• 43:28thirty minutes.
• 43:29Rarely, it goes a little
• 43:30bit longer,
• 43:31but a kind of a
• 43:32quick meeting
• 43:33where we're huddling around,
• 43:36the needs for that day
• 43:37and
• 43:38coordination needs, checking in on
• 43:40acute
• 43:41patients, and various things. I'll
• 43:43go into more detail of
• 43:44it.
• 43:46Being able to kind of
• 43:47check-in with one another, whether
• 43:49that's in person or virtually.
• 43:52So it's just kinda really
• 43:53talking about the kind of
• 43:54the culture
• 43:55of the team and and
• 43:56how it's helpful when everyone
• 43:57is in the same
• 43:59I mean, we've managed to
• 44:00do this in a hybrid
• 44:01model.
• 44:03But sometimes teams are made
• 44:04up of, you know, we
• 44:05got a prescriber at a
• 44:06different site or things like
• 44:07that that can make things
• 44:08challenging.
• 44:10But that's where maybe you'd
• 44:11use emails or phone calls
• 44:13or or Zoom calls.
• 44:15So lots of different ways
• 44:17that we promote communication on
• 44:18the team and that it's
• 44:19an expected
• 44:21part of the culture
• 44:23and the part of kind
• 44:24of caring for folks that
• 44:25although
• 44:26the primary clinician is usually
• 44:28the main point of contact
• 44:30for the young person in
• 44:32a early intervention service
• 44:34that they are a part
• 44:35of the team. Right? That's
• 44:36specially team based care where
• 44:37you're consulting with other members.
• 44:39You're,
• 44:41pulling in other team members
• 44:42to to kinda help with
• 44:43the care.
• 44:45So a bit more about
• 44:46what Huddl
• 44:48looks like.
• 44:49Right? Perhaps folks
• 44:50have these,
• 44:53you know,
• 44:54same type of things, but
• 44:55it's, again, it's our daily
• 44:56morning meeting
• 44:58with the the function of
• 44:59providing promoting efficient team coordination,
• 45:03clinical care coordination, as well
• 45:05as team cohesion and connection.
• 45:09It's a structured opportunity for
• 45:10team members to communicate,
• 45:12collectively strategize about managing daily
• 45:15client needs.
• 45:18So usually,
• 45:19right, we kinda have a
• 45:20little working agenda through it.
• 45:21We start with
• 45:23okay. Like,
• 45:24right. Morning, everyone. Like, who
• 45:27we don't run through the
• 45:27whole pace load, but we
• 45:29check-in, like, okay. Any new
• 45:31hospitalizations or let's check-in on
• 45:32our folks that might be
• 45:33currently hospitalized or experiencing acute
• 45:36symptoms and we're concerned about.
• 45:39And then any more, like,
• 45:40acute coordination needs or okay.
• 45:42You know what? I've got
• 45:43this person coming in today,
• 45:44and I'm pretty concerned about
• 45:45them.
• 45:46I think I might need
• 45:47backup
• 45:49at this time, or I'm
• 45:50I might need
• 45:52to initiate a mobile crisis
• 45:54call. So, like, we're we're
• 45:55kind of talking, planning ahead,
• 45:57supporting each other
• 45:59emotionally,
• 46:00clinically,
• 46:01but also practically.
• 46:05It does kinda turn into
• 46:05a peer supervision at times.
• 46:07So
• 46:08sometimes it'll evolve into kind
• 46:10of consultation,
• 46:12within the team on clients
• 46:13with complex needs.
• 46:15We'll discuss new clients,
• 46:18or anyone who's like we've
• 46:19we just heard from the
• 46:20hospital that there's a new
• 46:21potential
• 46:22eligible step patient.
• 46:24We're starting to engage them.
• 46:26Wanna let you know that
• 46:26they're,
• 46:28might be getting discharged in
• 46:29a couple days. So
• 46:31who's gonna who's next up
• 46:32to take
• 46:34a a new client? Do
• 46:34you wanna engage in the
• 46:35discharge meeting at the hospital?
• 46:37If so, so we we've
• 46:38got engagement
• 46:39and coordination within our outreach
• 46:42intake team. They join the
• 46:43huddle and
• 46:44kinda talk about that.
• 46:46So in addition to all
• 46:47these, like, practical clinical things,
• 46:50it's also just a way
• 46:51to kinda have some
• 46:53daily contact, not feel so
• 46:54siloed and isolated.
• 46:57You know, we we try
• 46:58to check-in. It doesn't become
• 47:00you know, there there's always,
• 47:01like, some elements of kind
• 47:02of social
• 47:03check ins about it or,
• 47:05you know, we're,
• 47:07you know, checking in if
• 47:08anyone has
• 47:10has needs. Does anyone have
• 47:11a out for a doctor's
• 47:12appointment today and they need
• 47:13extra support or they're
• 47:15managing hybrid with a sick
• 47:17kid at home or something
• 47:18like that? And it's a
• 47:19way to you know, again,
• 47:20that's part of that team
• 47:21culture of, like, supporting one
• 47:23another,
• 47:25trying to kind of limit
• 47:27in work burnout, and and
• 47:29really helping folks feel kind
• 47:30of connected and supported
• 47:32in this, you know,
• 47:34high stress,
• 47:37occupation that all of us
• 47:38are finding ourselves in.
• 47:41So I'm not gonna go
• 47:43into this in-depth, but one
• 47:45actual communication strategy that we
• 47:47tend to use to streamline
• 47:48a lot of these clinical
• 47:49discussions is the SBAR technique.
• 47:52So these slides will be
• 47:53referenced, but this is a
• 47:55technique frequently used in hospitals
• 47:57for handoffs that shift changes,
• 47:59and we find it really
• 48:00effective to communicate.
• 48:02So you briefly
• 48:03provide an update about the
• 48:04the situation,
• 48:06relevant background, not completely comprehensive
• 48:09background,
• 48:10your current assessment, and then
• 48:12your recommendation or response. So
• 48:14it's a way to say,
• 48:14like,
• 48:16hey.
• 48:18You know,
• 48:19John Smith is twenty four
• 48:20year old white male.
• 48:22He's got persistent auditory hallucinations
• 48:24in SI.
• 48:25I'm concerned about their risk
• 48:26for self. They're coming in
• 48:27today at two o'clock.
• 48:30Background, they've had some suicide
• 48:31attempts, etcetera. They've recently stopped
• 48:33their antipsychotics.
• 48:34My assessment,
• 48:36I think they're at increased
• 48:38risk of suicide based on
• 48:39x, y, and z.
• 48:42And then
• 48:43there's a, you know, recommendation
• 48:45or kind of a call
• 48:46for support. Like,
• 48:48how do we think we
• 48:49should handle this? What do
• 48:50folks think? And then you
• 48:51kinda develop that together. So
• 48:52it's an efficient way to
• 48:53communicate
• 48:54in a a, you know,
• 48:55a time limited manner and
• 48:57to kinda get all of
• 48:57the,
• 48:59important clinical information across.
• 49:04Alright.
• 49:06So I didn't leave much
• 49:08time for