~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
TIPS & TOPICS from David Mee-Lee, M.D.
Volume 5, No.9
January 2008
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In this issue
-- SAVVY
-- SKILLS
-- SOUL
-- Until Next Time
Happy
New Year and may 2008 be a successful and productive
year for you and your team.
January's
edition takes a fresh look at the Mission,
Vision & Values of both your agency
and your personal work. Similarly I also am taking
a fresh look at my Mission, Vision & Values
and -my website,
www.DMLMD.com.
I
am evaluating the website - what works, what doesn't,
what's relevant, outdated, helpful, useless, unfriendly,
missing, time-saving, cumbersome, easy, difficult.
You name it ---- the good and the bad! I want my
website to be really useful to all the people I
serve, including you, the readers of TIPS &
TOPICS.
Many
of you have given me helpful feedback about TNT.
Now I'd like to harness your feedback to help me
revamp the website. I want it to serve you better,
and build on the community of TNT readers. So I'd
like to meet you where you're at: I need your opinion.
Look
for a second email where you can express your opinions.
There just might be some prizes for three randomly
selected responders. We all love free stuff!
SAVVY
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It seems there are hardly any cities, counties,
states and health care systems NOT thinking about,
planning for, or actively working on integrating
services for people with co-occurring substance
use and mental health problems. Administrators may
decide to re- define their mission to better serve
people with multiple needs. That doesn't mean every
frontline worker is ready and willing to suddenly
shift focus. I have consulted with systems on this,
and here are a few steps I suggest:
Tip
1
-
Assemble
team members to take a fresh look at the Mission,
Vision and Values of the agency or system involved
in the change process.
Addiction
counselors may not be interested in working
with those "crazy" psychiatric patients,
and mental health clinicians in working with
"those people - those out of control alcoholics
and addicts". In fact these sentiments
partly explain why clinicians may have chosen
their 'specialty' in the first place. Suddenly
they are now expected to work with clients with
both problems (not that they weren't actually
working with them already.) The juices for working
with co-occurring disorders don't just automatically
flow simply because administration declares
a new direction.
Where does a system start in the change process?
Team members will be challenged on their attitudes,
perspectives and comfort zone of work competence.
Include all important stakeholders to fashion
the Mission. This meeting sets the context,
and establishes the process of collaboration
with all involved parties. It gives each person
the opportunity to take responsibility for re-committing
to his/her job. It is a time (if they are honest
in their heart) when some may decide/declare
they are not interested in, or committed to
the new Mission.
When you arrive at discussing Values, the team
identifies principles before policies, procedures
and personalities. This discussion usually provokes
the inevitable disagreements over "what
to do" in a variety of clinical situations.
What do we do if a client shows up to treatment
having used alcohol or some other drug on the
way? What do we do when a client refuses to
take medication? What do we do when a client
wants to stop methamphetamine or heroin, but
keep drinking alcohol or smoking marijuana?
When we discuss and name Values before a concrete
clinical situation arises, this creates an anchor,
a solid reference point to guide what to do
in the heat of the moment.
-->
For example, suppose your team agreed on this
Value:
"Any relapse -whether in addiction or mental
health - will be addressed as a crisis in a
client's treatment. This requires evaluation
of the crisis and a revision of the service
plan. We will not suspend, discharge from treatment,
or have zero tolerance for relapse with any
client - whether a substance use or mental health
crisis."
-->
When the Value is discussed as a group, all
team members have the chance to air their various
points of view.
Most clinicians are familiar with
Stages of Change, and understand that clients seek
help at different "stages of readiness."
Agencies (or program sites within an agency) are
no different, just a larger organism. Staff also
may be at different "stages" on being
ready to adopt more integrated services. However,
all would be expected to develop a formal plan that
begins where they are comfortable, but also requires
that they progress toward better integrated services.
-->
Change
leaders, technical assistance (TA) staff or consultants
guide each agency/service site in the development
of an "individualized agency development
plan" matched to the stage of change and readiness
for integrated services of that unit or provider.
-->
They then monitor the progress of the individualized
plans inside each agency in their service network.
-->
Similarly
each team member fashions an "individualized
staff development plan." This is done
in collaboration with their supervisor, Change leader
or TA consultant. The plan should honor each team
member's stage of readiness. It provides for training
to increase awareness of the need for integrated
services, as well as the skills to engage and treat
people with co-occurring disorders.
-->
Change
leaders are personnel who have embraced the mission
for integrated services. They are committed to improving
services to the co- occurring population. To give
Change leaders time to meaningfully participate
in this mission, administrators and supervisors
may need to adjust caseloads, job descriptions or
duties.
SKILLS
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It
is fairly easy to stage training workshops, write
up elaborate strategic plans and sketch out impressive
timelines for goals/tasks to integrate services.
The more challenging task is actually making change
happen, the type of change which ends up making
a difference on a daily basis to the people we
serve in the trenches.
Tip
1
-
Develop
specific implications for each Value raised
in discussions of the new Mission and Vision.
Nearly every agency and company has a Mission
Statement which very few team members can recall,
let alone articulate, or explain concrete implications
of the Mission.
-->
Test
yourself. Can you recite right now your agency's
Mission Statement without looking it up?
--> Have you always thought
of it as being so generically lofty, "motherhood
and apple pie," so broad as to be of little
practical use in the dilemmas and pressures of
daily life on the job?
A
good next step is to comprehensively explore and
list all the implications for each Value you created.
Let's work with the example Value above.
It
states: "Any relapse -whether in addiction
or mental health - will be addressed as a crisis
in a client's treatment. This requires evaluation
of the crisis and a revision of the service plan.
We will not suspend, discharge from treatment,
or have zero tolerance for relapse with any client
- whether a substance use or mental health crisis."
What
would be the implications of such a Value? The
list could include:
-->
If a crisis of substance use, suicidal, violent
or self-mutilation behavior, psychosis, mood instability
should occur, all clients will receive timely
assessment to address any immediate needs. We
will revise the treatment plan to improve the
client's progress and outcome.
-->If
a client's relapse triggers reactions in other
clients, this provides the opportunity to assist
both the relapsing client, as well as helping
other clients learn from their reactions to the
relapse and crisis.
-->
No client will be excluded from treatment because
symptoms recur. But if a client deliberately undermines
treatment by enticing others to use substances
or violates boundaries with violence or impulsive
behavior, we will likely discharge a client who
is not interested in accountable treatment.
When
you actually put pen to paper and write out the
implications, this generates open discussion of
often disparate ideologies and attitudes. When
implications are made explicit -before confronting
a "live" relapse crisis- this minimizes
the inevitable conflicts which arise amongst people
of different disciplines, personalities and life
experiences. Remember, conflict is normal. There
are policies and procedures that can make resolution
more likely. See the February
2007 edition of TIPS and TOPICS for one example.
-
Work
with team members in the same way you would
with a client: i.e. challenge/ support one another
in adhering to each team member's development
plan.
When
a client presents for services, what drives the
treatment planning process should be an alliance
around what the client wants, and why they chose
to walk in the door.
Here
is the parallel process on the agency level. When
a new Mission is written, it requires team members
to re-commit to work in that agency. So each team
member can ponder the following steps. Supervisors
and Change leaders can facilitate the team member's
personal exploration by ensuring a strong, supportive,
safe work environment:
--> What do you
want that makes you choose to work here, especially
with the new Mission? For example: being
honest, do you just want a paycheck especially
if you are close to retirement? Or are you getting
ready to go to graduate school and want to be
on the cutting edge of new directions? Or are
you wanting a paycheck and not wanting to change
what you are doing- in which case, your plan may
be to transition out of the system if you are
taking responsibility for your personal sanity
and self-care.
--> Where are
you at as regards the new directions the Mission
promotes? What is your attitude, stage
of change, comfort level and competence level?
For example, if you see no reason to change the
Mission, your personal development plan will require
attention to some consciousness-raising. What
information do I need to convince me of the need
for change, before I am ready to focus on actually
expanding knowledge and skills? If you are eager
to be on the cutting edge of new technologies
and methods, your development plan might have
you lead the team in a journal club; or plan the
in-service training curriculum; or be the local
change agent champion.
--> How best would
you acquire new skills necessary to promote the
new Mission? Do you learn best by observation,
trial and error, didactic presentations, individual
supervision, group peer supervision, discussion
of case examples, viewing videos, on the job coaching
etc.? Your personal plan would include whatever
methods will quickly and efficiently expand your
knowledge and skills.
SOUL
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I
have not gotten on the Harry Potter bandwagon of
incredibly successful books and spin-off films and
merchandise. It's not because I approve or disapprove;
I just haven't read JK Rowling's works. Her fans
may gasp at this point. What I do admire about her
is how she pressed ahead when hardly anyone believed
in what she had to offer.
In
an interview recorded in TIME Magazine's December
31, 2007 - January 7, 2008 edition, she was asked
about her beginning fame. "It happened
very, very quickly. I had written a book that I
was told repeatedly was uncommercial, overlong,
wouldn't sell. So when it happened, it really was
a profound shock." That prediction about
her book is right up there with "Who would
want a computer in every house?" What successful
author, musician, artist, entrepreneur, politician
or athlete has not faced repeated failure, before
eventually finding themselves contributing in a
way they had set their sights on? And it is not
just those professions. This is true for just about
anything worth achieving.
Most of us are involved in work,
leisure and community activities which do not require
the kind of commitment and energy that it takes
to run for the Presidency of the United States or
to compete in the Super Bowl with a perfect win
record of 18 straight games. But when you show up
for work everyday, have you chosen to be there?
Or are you just going through the motions? How cynical,
burnt-out, compassion-fatigued, frustrated are you?
When a flight gets cancelled due to weather, and
I have to drive seven hours in freezing rain and
snow to make sure the workshop goes on the next
morning, the experience of frustrated, burnt- out
and fatigued come to mind. All that melts though,
when participants leave having gained a lot to help
them in their work---and appreciatively feed that
back to me.
Here's
what JK Rowling also said: "I hope my work
sends the message that self-worth is about finding
out what you do best and working hard at it."
This
won't necessarily translate into instant fame and
fortune. Who wants the paparazzi anyway? But it
is a great formula for a meaningful way of being
and contributing; and a potent antidote if you find
yourself cynical, burnt-out, compassion-fatigued,
and frustrated.
Until
Next Time
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Thanks for joining us for this first edition of 2008.
See you in late February.
David
Contact Information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
email: info@dmlmd.com
phone: 530-753-4300 PACIFIC
web: http://www.dmlmd.com
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Copyright
2008 DML Training & Consulting | 4228 Boxelder
Place | Davis | CA | 95618
|
