Training frontline staff in psychosocial approaches to harm reduction


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Presentation to World Congress Cognitive and Behavioural Psychotherapies. Barcelona 2007. Modified version presented at IHRA Bangkok, 2009.

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Training frontline staff in psychosocial approaches to harm reduction

  1. 1. Lost and found in translation: Sharing cognitive Behaviour therapy skills in Mauritius Frank Ryan Consultant Clinical Psychologist Honorary Research Fellow CNWL NHS Foundation Trust Birkbeck College London University of London
  2. 2. Background and Overview • Spread of HIV through injecting drug use • Need to engage injecting drug users into treatment • Health and social care professionals need to acquire appropriate knowledge and skills • Conclusion is that basic behaviour change techniques can travel
  3. 3.
  4. 4.
  5. 5. Tuesday 7th Weds 8th Friday 10th Thursday 9th Saturday 11th Opening Motivating Impulse Affect Implementing Ceremony & Engaging Control: Using regulation: CHANGE: Cognitive – Introduction Drug Users Using How to apply Cognitive – Setting the Into behaviour what we have Scene; treatment therapy to behaviour learned. managing (Lecture, cope with therapy to cope expectations. Video & urges and with negative Evaluation. Group work) craving mood states Lunch Lunch Lunch Lunch Lunch Introducing Reflective Video Video Closing the listening and demonstration Demonstration Ceremony CHANGE giving & practice: & practice: Programme Feedback teaching Identifying (discussion clients to negative and and practice) manage unhelpful craving & thinking in urges ourselves and clients
  6. 6. Sign of the times
  7. 7. Its all about CHANGE • Change • The role of the therapist is to Habits provide treatment aimed at • And helping the client acquire insight and self- regulation skills. This • Negative involves working with addictive behaviour and emotional • Generation of dysregulation in a structured, • hierarchical way. Emotion
  8. 8. Keep it simple; keep it focused • The CHANGE model was designed to enable the wider application of CBT techniques among workers in substance misuse and c0- morbidity areas. • It provides a simple hierarchy to inform treatment planning: address substance misuse/impulse control in advance of emotional disorders –not least because the latter are made worse by the former.
  9. 9. The Four “M’s” • Motivate (and engage) • Manage impulses to use • Manage your mood • Maintain lifestyle change
  10. 10. Feedback • The overall mean score was 9.36 • Range 8-10 • Median 10. • “We would wish that the course can continue so as we can be better professionals to alleviate clients lives, to have a better Mauritius. Many thanks to you Dr Ryan – God bless you.” • “Nice workshop-some practical sessions in London would also be most welcome”
  11. 11. Do’ s and Don’t s • Encourage small group • Use complex models work in local language • Pre-packaged training • Present simple model of materials such as DVDs change but supply < “unless home background reading for grown”> those more likely to benefit from this • Emphasise pre-existing core skills and reinforce their use
  12. 12. Conclusions (i) • The pragmatic nature of CBT contributed to its success in a diverse cultural context. • The most highly rated session was an exercise to structure a keyworking session and use techniques such as active listening, expressing accurate empathy, giving feedback and goal setting.
  13. 13. Conclusions (ii)  Sharing skills is crucial but skills will not share themselves!! Sustained effort over a long period of time is essential.  High level visible support is essential to launch and to sustain new initiatives  WCBCT should address the challenge of a global role
  14. 14. Acknowledgements United Nations Office on Drugs and Crime Central &North West London NHS Foundation Trust & colleagues on CBT Diploma Course. National Treatment & Rehabilitation Centre for Substance Abuse (Republic of Mauritius)