The document discusses co-existing mental health and substance use problems. It notes that co-existing problems are common, with high rates of substance use disorders occurring alongside mood and anxiety disorders. Having co-existing problems leads to more severe and treatment-resistant issues. Screening and assessment tools are recommended to help identify and classify co-existing problems. An integrated treatment approach is needed that addresses both the substance use and mental health issues. Cultural factors are also important to consider in assessment and treatment of co-existing problems.
Healing Trauma through Somatic Experiencing and Gestalt Therapy bwitchel
Develop a basic understanding of Somatic Experiencing®, a short-term approach to healing trauma, and the use of Gestalt Therapy in trauma resolution.
Dr. Bob Witchel
Compassion-Focused Therapy (CFT)
An outline and overview of CFT approaches to psychotherapy presented by Justin La Rose.
Applicability of CFT approaches to anxiety, depression, trauma and shame explored by therapist and mental health educator, Justin La Rose
This presentation delivers an integrated approach to Pūrākau theories, models, and practices. It also introduces Pūtakatanga Theory along with the Pūtakatanga Maaori counselling model and its application.
Healing Trauma through Somatic Experiencing and Gestalt Therapy bwitchel
Develop a basic understanding of Somatic Experiencing®, a short-term approach to healing trauma, and the use of Gestalt Therapy in trauma resolution.
Dr. Bob Witchel
Compassion-Focused Therapy (CFT)
An outline and overview of CFT approaches to psychotherapy presented by Justin La Rose.
Applicability of CFT approaches to anxiety, depression, trauma and shame explored by therapist and mental health educator, Justin La Rose
This presentation delivers an integrated approach to Pūrākau theories, models, and practices. It also introduces Pūtakatanga Theory along with the Pūtakatanga Maaori counselling model and its application.
The video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Today's webinar is the first of three to help you help your clients (and staff) deal with stress and lead happier lives.
The video for this presentation is available on our Youtube channel:
https://youtube.com/docsnipes A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Using the compassionate mind to help clients who struggle with guild and self-criticism overcome
Dr. Murray Bowen, a pioneer in the field of marriage and family therapy, offered 8 interlocking concepts as a way to think about relationship functioning, especially in one's extended family, nuclear family, and couples' relationships. This is a model that assumes that problems can come from too much togetherness. It assumes that if one feels secure in one's ability to remain separate, one can go the distance in one's effort to remain connected to important people in one's life.
James Caringi, PhD Presentation at 2016 Science of HOPE
Description:
Secondary Traumatic Stress (STS) is defined as, “the natural and consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other, the stress resulting from helping or wanting to help a traumatized or suffering person” (Figley, 1995). Professionals and caregivers frequently work with individuals, families, groups, and communities who have experienced multiple adverse childhood experience (ACE) traumas and as a result, are at high risk for experiencing STS. Secondary Traumatic Stress can lead to personal health issues, loss of productivity, and turnover and therefore should be a concern for practitioners and administrators.
This presentation will address the causes of STS and offer ideas for both prevention and recovery. In addition, findings from empirical research projects examining STS, burnout, and peer support will be reviewed. Methods to create a trauma informed organization that can both prevent and mitigate the impact of STS will be reviewed and critiqued. Finally, the presenter will facilitate an action research process designed to enable participants to begin the development of self-care plans that they can use in their organizations.
Trauma and PTSD of children - physiological implications. History of Trauma Focused Cognitive Behavioral Therapy, principles of practice and Case Presentation.
Describe the family life cycle
Distinguish the shift from linear to circular thinking.
Describe the influence of Bateson
Describe the core concepts of systemic therapy: phase 1 & 2
The video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Today's webinar is the first of three to help you help your clients (and staff) deal with stress and lead happier lives.
The video for this presentation is available on our Youtube channel:
https://youtube.com/docsnipes A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Using the compassionate mind to help clients who struggle with guild and self-criticism overcome
Dr. Murray Bowen, a pioneer in the field of marriage and family therapy, offered 8 interlocking concepts as a way to think about relationship functioning, especially in one's extended family, nuclear family, and couples' relationships. This is a model that assumes that problems can come from too much togetherness. It assumes that if one feels secure in one's ability to remain separate, one can go the distance in one's effort to remain connected to important people in one's life.
James Caringi, PhD Presentation at 2016 Science of HOPE
Description:
Secondary Traumatic Stress (STS) is defined as, “the natural and consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other, the stress resulting from helping or wanting to help a traumatized or suffering person” (Figley, 1995). Professionals and caregivers frequently work with individuals, families, groups, and communities who have experienced multiple adverse childhood experience (ACE) traumas and as a result, are at high risk for experiencing STS. Secondary Traumatic Stress can lead to personal health issues, loss of productivity, and turnover and therefore should be a concern for practitioners and administrators.
This presentation will address the causes of STS and offer ideas for both prevention and recovery. In addition, findings from empirical research projects examining STS, burnout, and peer support will be reviewed. Methods to create a trauma informed organization that can both prevent and mitigate the impact of STS will be reviewed and critiqued. Finally, the presenter will facilitate an action research process designed to enable participants to begin the development of self-care plans that they can use in their organizations.
Trauma and PTSD of children - physiological implications. History of Trauma Focused Cognitive Behavioral Therapy, principles of practice and Case Presentation.
Describe the family life cycle
Distinguish the shift from linear to circular thinking.
Describe the influence of Bateson
Describe the core concepts of systemic therapy: phase 1 & 2
DR CONSTANT MOUTON - COULD DUAL DIAGNOSIS BE THE KEY TO PERSONALISED TREATMEN...iCAADEvents
As our knowledge about addiction is increasing the association between mental illness and addiction is better understood. The controversy about the appropriateness of the term Dual Diagnosis to describe such a heterogeneous group of patients has sparked a debate on treatment and assessment models. It highlighted the fact that as far as treatment modalities are concerned, one size might just not fit all. Dr Mouton reviews current knowledge on comorbidity in the addiction field. Focusing on more than psychiatric comorbidity, he also looks at physical, social, psychological, spiritual and cultural components affected by addiction. Describing the role of the psychiatrist in addiction care he poses the questions: What if dual diagnosis is actually the key to better understanding of our patients? What if this knowledge leads to more individualised treatments? And are we ready for personalised treatment in the addiction field?
Problem Gambling & Co-existing Problems (CEP) actsconz
Problem Gambling Forum: Problem Gambling & Co-existing Problems (CEP)
Presented by ABACUS Counselling Training & Supervision Ltd to the Problem Gambling National Provider Forum May 2012
Problem Gambling Forum: Orientation to Problem Gambling: Part 2
Presented by ABACUS Counselling Training & Supervision Ltd to the Problem Gambling National Provider Forum May 2012
Problem Gambling Forum: Meeting in the Middle
Presented by ABACUS Counselling Training & Supervision Ltd to the Problem Gambling National Provider Forum May 2012
Problem Gambling Forum The Problem Gambling / Alcohol and other Drug Interfaceactsconz
Problem Gambling Forum The Problem Gambling / Alcohol and other Drug Interface
Presented by ABACUS Counselling Training & Supervision Ltd to the Problem Gambling National Provider Forum May 2012
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
1. Te Ariari o te Oranga
ABACUS Counselling, Training and Supervision Ltd
2.
3. Workshop 26 January 2010
• Te Ariari o te Oranga
• Coexisting Problems
• Screening
• Principles of case management
• Review
4. Te Ariari o te Oranga
Ariari o te Oranga – Dynamics of Health,
was a term coined by tutors and students of
Te Ngaru Learning Systems in 1996.
5. Te Ariari o te Oranga
Imagine you are dancing on a
moonbeam to your favourite song
Towards well-being (2000).
6. Te Ariari o te Oranga: The Assessment
and Management of People with Co-existing
Mental Health and Substance use Problems
Todd F.C. (2010). National Addiction Centre,
Department of Psychological Medicine,
University of Otago. Christchurch
8. Relationships of Co-existing
Conditions
• A primary mental health disorder
precipitates or leads to substance
misuse
• Use of substances makes the mental
health problems worse or alters their
course
9. Relationships of Co-existing
Conditions
Substance misuse and/or withdrawal leads
to psychiatric symptoms or disorder.
Problems develop faster; symptoms more
intense and severe; less responsive to
treatment; relapse more likely
10. Co-existing Problems (CEP)
The word “problems” is preferred over
“disorders” or “conditions” in
recognition that problem gambling and
mental health (including substance
use) symptoms may occur at levels
that do not meet criteria for disorders
in their own right.
11. Prevalence
Substance use disorder in the past 12 months:
• 29% also suffered a mood disorder
• 40% suffered an anxiety disorder
Mood disorder in the past 12 months:
• 12.9% also had a substance use disorder
(Te Rau Hinengaro)
12. Mental Health disorders common
Petry et al 2005
80 • AOD problems
70
Depression
may occur in
% of problem gamblers
60 75% of PGs
Anxiety
50 disorder • Anxiety in over
40% of PGs
40 Drug
disorder
30 Alcohol
disorder • Depression
20
Manic
disorder
usually 60%+ in
10
other research
0
13. Problem Gambling and Co-existing MH
Problems
• Likely to meet criteria for other mental
disorders
• Almost all PG have another lifetime MH
disorder (Kessler et al 2008)
• Co-existing mental health and addiction
problems are associated with suicidal
behaviour and increases in service use
ALAC/MH Commission report, 2008
14. Coexisting
• 3.7 times likely to be a current smoker
• 5.2 times likely to be hazardous drinking
• High rates of depression and anxiety
(Focus on Gambling)
15. “Problem gambling may exacerbate
other dependencies, and they in turn
may exacerbate problem gambling”
16. ALAC/MH Commission Report (2008)
People with AOD and gambling problems
have greater mental health problems
than the general community, most
commonly depression and anxiety
17. Co-existing issues to address
“Counselling for problem gambling will need to
also deal with these co-morbidities and
treatment for other dependencies may need
to take into account secondary gambling
problems that may not be transparent”
Australian Productivity Commission (1999)
18. ALAC/MH Commission Report (2008)
Māori - higher mental health and
substance-use disorders than the general
population; also applies to problem
gambling
19. Addiction and Co-existing Problems
• Co-existing mental health and addiction
problems are associated with suicidal
behaviour and increases in service use
ALAC/MH Commission report, 2008
22. Issues of Stigma in Treatment
• Addiction is often linked in people‟s
minds with criminality
• There is often a tacit belief that “addicts”
invite and deserve discrimination.
• Little recognition by society that
addiction is a chronic health condition
for which there are proven, successful
interventions
ALAC/MH Commission report, 2008
23. Summary
• Coexisting problems are the rule
• Substance Use, anxiety and mood
• Presentation higher in treatment
populations
24. “Working with people with co-existing
mental health and addiction problems
is one of the biggest challenges facing
frontline mental health and addiction
services in New Zealand and overseas.
The co-occurrence of these problems
adds complexity to assessment, case
planning, treatment and recovery”
ALAC/MH Commission report, 2008
29. Standard Drinks
The Standard Drinks measure is a
simple way to work out how much
alcohol you are drinking. It
measures the amount of pure
alcohol in a drink. One standard
drink equals 10 grams of pure
alcohol.
30. AOD as self- medication?
• Temporary symptom reduction: arousal
soothed; avoidance maintained; intrusive
thoughts/memories controlled; fear calmed
• Lift sadness; increase energy/motivation
• Reduce preoccupation with delusions and
intrusiveness of hallucinations – PG?
• Lack of alternative coping strategies-
avoidance
• Psychophysical state made controllable
34. What happens to MH in PGs?
Does part-addressing AOD/MH mean:
• If we focus almost solely on the gambling and
are successful in reducing harm from gambling,
do most (74.3%) clients with pre-existing
disorders retain these now minus the gambling
(and risk relapse from these?), or
• Do we assume addressing the gambling
somehow also successfully addresses the client‟s
pre-existing AOD/MH disorders?
35. Cultural Issues
• In some cultures, depression is expressed
in somatic terms, rather than sadness or
guilt
• Examples: “nerves”, headaches;
weakness, tiredness or imbalance (Asian);
problems of the heart (Middle East).
36. Cultural Issues
• For some, may be irritability rather than
sadness or withdrawal
• Differentiate between culturally distinctive
experiences and hallucinations or
delusions (which may be psychotic part of
the depression)
• Don‟t dismiss possible symptoms as
always cultural
37. Suicidality Screen
Within the last 12 months, have you had
thoughts of self-harm or suicide?
1. No thoughts in the past 12 months
2. Just thoughts
3. Not only thoughts, I have also had a plan.
4. I have tried to harm myself in the past 12
months
40. So what should we treat?
• Many disorders very complex
• They are in addition to social needs
• But governmental approach is „make every
door the right door‟
• So could identify (screen) and refer
• Or identify and further briefly intervene (in
addition to referral)
• Or have specialists on-site (brought in or
base PG practitioners where these available)
41. Quadrant
PG PG + MH
Shared Care
High PG Low MH High PG High MH
PG or MH MH
Either
Low PG Low MH High MH Low PG
42. Could this quadrant model work for
your clients who have Co-Existing
Mental health or AOD problems?
44. Integration
How do we integrate our models?
Cultural Safety and Cultural Competence?
What principles underpin our practice
45. RANGI MATRIX
State of Action of Affects Creates Use Requires Focus on
PIRANGI KAPO Te Ngakau A transitory Manaaki
Reflective Gesture desire
WAIRANGI PIOPIO Te Manawa A hunger to Whanau- Aroha Kete
Progressive grabbing satisfy ngatanga Aronui
stance. Feeling of (Esoteric)
being overcome.
Drowning sensation
HAURANGI HURORI Te Puku An urge that Whanau- Awhi
Staggering but a needs ngatanga
semblance of control. attending to
Imbalance in puku
PORANGI KEKA Te Roro A panic to be Whakapapa Tautoko Kete
Spasmodic attempts free Tuauri
to be free. Feeling of (Tangata)
being trapped in
darkness
WHETURANGI TOITU Te Mauri Whakaoho Kete
Frozen immobility. Tuatea
Catatonia. Numbness (Spiritual)
46. WHAKAOTINGA: Completion of the
journey, new beginning. The covenant
of maintaining the relationship beyond
physical sight . Unlocking the Mauri
WHAKAORANGA: Respecting of life.
Honouring of living. Subscription to the
need for healthier relationships.
WHAKARATARATA: Expression of
openness and trust in developing
relationships. The hiatus setting.
Transition to a new place.
WHAKATANGITANGI: Letting the
wellness spring flow. Inner mamae.
Memories. Emotional commitment to
common relationship.
WHAKAPUAKI: Focusing on the
reason for our being there.
Determining everyone’s relationship to
the issue.
MIHIMIHI: Honouring the people and
the land. Establishing personal and
social relationships. Trust
KARAKIA: Unlocking Wairua.
Acknowledging presence of Atua and
Higher power than us.
POWHIRI POUTAMA
Acknowledge divine relationship.
47. Use of Whare Tapa Wha to
Measure Outcomes
Dimensions Wairua Hinengaro Tinana Whānau
Dimension 1 Dignity and Motivation Mobility/ Pain Communication
Respect
Dimension 2 Cultural Cognition / Opportunity Relationships/
identity Behaviour for enhanced respect / trust
health
Dimension 3 Personal Management of Mind and Mutuality /
contentment emotions, thinking Body links acceptance
Dimension 4 Spirituality Understanding Physical Social participation
(non-physical health status
experience)
48. Treatment Integration
• Aims to reduce gaps and barriers between
services
• Integrates various treatments into a single
treatment stream or package
• Adapts the various treatments to be
consistent and not conflict with each other
• Need seamless, consistent, “accessible”
approach to clients‟ pathology, deficits and
problems (including criminal offending
issues)
49. 7 key Principles
• Cultural needs and values considered
throughout the treatment process.
• Well-being is the key outcome rather than
the absence of dysfunction.
• Increase and maintain engagement with
the clinical case manager, the
management plan and the service.
• Enhance motivation including use of CEP-
adapted MI techniques
50. 7 key Principles (cont)
• Assessment - Screen all and if +ve
undertake a comprehensive assessment.
• Use clinical case management to deliver
and coordinate multiple interventions.
• Integrated Care driven by the integrated
formulation in a single setting and
ensuring close linkages.
51. MI Principles
• Some coexisting problems can be
addressed without referral to MH or
AOD services
• Others will require referral for best
outcomes for the PG client
52. Guiding Principles TIP 42, 2005
• Develop a phased approach to treatment
– ME as front end
(engagement/persuasion), active
treatment/follow-up and relapse
prevention, together with a “stages of
change” approach
53. Guiding Principles (cont.) TIP 42, 2005
• Address specific real-life problems
early in treatment
• Use support systems to maintain
and extend treatment
effectiveness
54. Brainstorming Exercise
• List four (4) AOD/MH services in
your area that you could either refer
PGs to, or services you could work
with if your PG clients have MH
conditions
• How could you ensure this process
could work for these clients?
DISCUSS
55. Summary I
• Coexisting Problems are common
• Coexisting problems can complicate
• Screens provide useful information
• Screens can help create dissonance
• Build on strengths
56. Summary II
• Single co-ordinating point
• Use compatible treatment models/concepts
• Harm minimisation approach
• Close liaison between all parties
• Deliver all treatments from one setting
• Close liaison between therapists, treatment
agencies and whānau/family