The document discusses the Lets Get Real framework for mental health and addiction treatment services. Lets Get Real describes seven skill sets, or "Real Skills", that practitioners should demonstrate at essential, practitioner, and leader levels. The goals of Lets Get Real are to improve services, ensure best practices, and increase accountability. It also aims to help different treatment services have a common language and perspectives on recovery-focused, culturally-capable care.

1. Lets Get Real
Real Skills & Problem Gambling
Sean Sullivan
ABACUS Counselling Training & Supervision Ltd

2. Abstract
Lets Get Real & Problem Gambling Treatment
Lets Get Real describes the essential knowledge, skills and attitudes for
effective mental health and addiction treatment. There are seven skill sets
described as Real Skills, for short, that have both a broad definition and three
indicator levels (essential, practitioner and leader) of what is required to achieve
these. The aim or purpose of Lets Get Real is to:
• Help everyone working across services that assist those affected by mental
health and addiction (and clients) to understand each other better
• Ensure all know what is best practice
• Is a complement to different competencies of the various health
professionals (i.e. overview of essential, skills and attitudes)
• Improve ability for practitioners to move between services
• Improve workforce development, and
• Increase our accountability, especially to service users
From late 2008 this framework started to be rolled out.
This training will cover the expectations of Lets Get Real, the values and
attitudes upon which they are based, and how they will fit with the draft problem
gambling treatment competencies.

3. Why do we need LGR?
• Addiction and Mental Health services (including Problem
Gambling) have tended to develop separately over time
• However, Mental Health (MH) and Addiction treatment
services are part of the larger Mental Health field
• Clients commonly affected with a range of (mental)
health issues
• It is for the benefit of clients and the MH and Addiction
treatment workforce that these treatment services ‘speak
the same language’ and as far as possible have similar
perspectives towards treatment

4. For example
• A recovery aim is adopted across these services
• Recovery is living well in the presence or absence of
mental illness and the losses that can be associated with
it. Each person with mental illness needs to define for
themselves what living well means to them.

5. An example applying recovery
• Rosie (62) has had a problem with gambling for some
years (Pokies). She has never had a lasting relationship,
and you suspect there may be an underlying fear of
these. She sees gambling as her only enjoyment, but
has problems with meeting rent, food bills, and money
for other necessities. She doesn’t think life would be
worthwhile without the pokies.
• What would be best for Rosie?
• What if Rosie won’t give up the pokies?
• Seriously, does she need to hit rock bottom then come
back?

6. Other MH and Addiction problems
commonly coexist with PG
AOD
Disorders
Current: 6%
(alcohol 4%
other drug 2%)
PG Social, Family
Current & Individual
1-2%? issues
Other Mental Health
Disorders
Current: over 20% of the
population >18 yrs

7. Addictions are
Mental Health problems
MH
Treatment
Workforce
N=10,000
Other Mental Health
problems
Addictions
LGR
Addiction
Treatment
Workforce
N=1000

8. Referral? Addiction, Mental Health, or
both? (Raistrick 2004)
Addiction MH + Addiction
Addiction severity
(high Addiction; low MH) (high Addiction; high MH)
Addiction care Shared care
Addiction or MH Mental Health
(low Addiction; low MH) (low Addiction; high MH)
Either care MH care
MH severity

9. What are ‘Real Skills’?
• A framework for those working in Mental Health &
Addiction
• Its goals are are quality improvement, person
centred, recovery focussed, culturally capable
therapists, through:
– Improving education and training for workforce
– Attract and recruit those with desired values/
attitudes
– Enhance performance appraisal
– Enhance professional development

10. What are ‘Real Skills’?
• Identifies essential knowledge, skills and
attitudes for MH/Addiction therapist from a
client’s perspective
• Doesn’t replace competencies – complements
both these and the HPCA Act and competencies
should align with Real Skills
• Has (common) Aims, Values and Attitudes

11. AIMS
• Understand shared work
• Affirm best practice
• Complement HPCAA and competencies
• Improve transferability
• Enhance workforce development training
• Increase accountability
VALUES
LETS GET
REAL Respect/ Human Rights/ Service/ Recovery/
Communities/ Relationships
ATTITUDES
Compassionate and caring/ genuine/ honest/
non-judgemental/ open-minded/ optimistic/
patient/ professional/ resilient/ supportive/
understanding

12. Exercise 1
• In groups, identify the strengths and weaknesses of a
framework such as Lets Gets Real applying to all Mental
Health and Addiction treatment services
• Would these strengths and weaknesses apply less, or
even moreso for the Problem Gambling treatment
workforce – if so, which ones and why?

13. Three levels or standards
• Lets Get Real has three levels of performance:
– Essential
– Practitioner
– Leader
• Each level above Essential is expected to also meet
the Essential level of performance
• A clinician may require different levels for different
roles, or move up them
• Applies to everyone working in MH or Addiction
treatment services, including administration and
management staff

14. Essential performance level
May be expected when either:
• They start in the MH or Addiction role, or
• Achieve this level following an agreed period of
induction, orientation, or development (e.g. a service
receptionist)
• Where the person has no contact or influence upon
clients, then flexibility is expected to be used in their
meeting some of the performance goals of the level

15. Practitioner performance level
• This level of performance is expected where clinicians
have worked in a service for at least two years
• The clinician would be expected to demonstrate both
Essential and Practitioner performance levels
• Managers are expected to support staff to attain these
knowledge, skills and attitude levels

16. Leader performance level
• These will be managers (e.g. service managers, general
managers), professional advisors, and clinical leaders
(e.g. clinical directors)
• They will be expected to also meet the Essential
performance level
• If the person has a clinical leadership role then they will
also be expected to meet the Practitioner as well as the
Essential performance level

17. Exercise 2
• Mary has been working as a non-management clinician in
a number of addiction treatment services continuously for
three years, but never more than fifteen months at any
service. Is she expected to meet the Practitioner level
yet?
• Peter is a student placement in an addiction service and
co-facilitates groups (not as leader). He has been two
months in the role. Is he expected to meet the Essential
level yet?
• Bill is the CEO of the addiction service. He sees no
clients nor does he take part in clinical leadership in any
way. He believes he is exempt from meeting the LGR
expectations. Is he correct? If not, then which level?

18. Real Skills
• Seven skill sets that are often shortened from Lets Get
Real sets to Real Skills
• Each of the skills has the three levels (Essential,
Practitioner, Leader) of performance indicator
• This framework of skills may change over time as we
learn from its application
• Often use skills together at any time so important to
understand their inter-relation

19. Real Skills
Skill Brief explanation
Working with service users Engages and works in partnership with clients, focussing
on their strengths and recovery
Working with Maori Contributes to whanau ora for Maori
Working with families/ Encourages whanau to participate in the client’s recovery
whanau and ensures access to resources
Working within communities Recognises clients and their family are part of a wider
community
Challenging stigma and Uses strategies to challenge stigma and discrimination and
discrimination promotes a valued service
Law, policy and practice Implements relevant laws, standards, codes, policies to
support clients and their family
Professional and personal Reflects on their work and practice to enhance the team to
development support clients’ recovery

20. Example of Skill 1: Working with clients
- performance indicator 3 (of a total of 6 in this skill)
Essential Practitioner Leader
Applies a basic Applies in-depth Develops a service
understanding of: understanding of: that is:
• Definitions and • Definitions etc • Responsive to client
categories of • Assessment and needs
mental illnesses interventions + risk • Reflective of best
and addiction practice
• Psychiatric meds
• A range of • The range of evidence • Recovery focussed
therapies and based therapies and • Culturally safe
interventions interventions • Trauma informed
• Effect of • Impact of physical • Effective
medications or health on MH
other remedies communicator

21. Exercise 3
• Robert (38, Italian (20 yrs in NZ)) has been diverted to
your service by Police after being discovered cheating at
the casino. He says his family has left after he lost the
house gambling. You identify that he is depressed and
has suicidal plans. He asks if an anti-depressant or any
other drugs would help to stop him gambling. He is a
sickness beneficiary.
• In groups, identify the need for MH input, what
assessment approach you would use, and what specific
interventions might assist him
• Could you answer his question and how important would
it be to do so?

22. Example of Skill 6: Law, policy and
practice
Essential Practitioner Leader
• Understands and • Practice is guided • Contributes to law
adheres to laws, by intent of laws and change and policy
standards, codes policy development that
policies relevant to impacts positively
• Demonstrates
their role ethical decision upon MH and
• Recognises and making with clients addiction practice
respects clients and • Creates systems
their family’s rights and culture
under the Health reflecting rights of
Code and Disability clients and their
Services Consumer families
rights

23. Exercise 4: What do you do?
• The mother of your client John says she is concerned for
her son’s safety and asks you to tell her if you think his
risk for self harm becomes high
• Your client’s Probation Officer asks you to advise him
immediately if Peter fails to turn up for an appointment
and he’ll breach him to the Court
• Your client discloses that they are stealing from work (a
bank) to support his gambling, although he does want to
stop gambling

24. How will Real Skills phase in?
• Phase 1, a transition phase, started in late 2008 and will
continue to 2011
• Aims during this phase are:
– Raising awareness of the framework
– Workforce will have upskilling opportunities
– Managers can understand and prepare
– Organisations supported to develop team and
individual Real Skills
– Education and trainers review and develop courses
and methods
– Guides, tools with a practical focus developed

25. Conclusion
• Lets Get Real is a framework that applies to all those
who work in services that treat, care for and support
people with mental illnesses and/or addictions
• It is currently being rolled out under phase one
(2008-2011), and will be operational following that
• Real Skills are a set of skills within the Lets Get Real
framework
• These will be aligned with sector competencies, not
replace them

26. Conclusion
Additional skill sets have or will be developed under Real
Skills plus for:
– Working with Pacific peoples – LGR plus Seitapu
– Working in infant, child and youth mental health and
alcohol and other drug services –LGR plus CAMHS
– Working in alcohol and other drug services –to be
drafted
– No plans as yet for problem gambling workers
end