TR Service Delivery: From Institution to Independence TRO - PowerPoint PPT Presentation

TR Service Delivery: From Institution to Independence TRO Conference June 1, 2017 By: Benson Coulson MA, CTRS, R/TRO

Outline • Ice Breaker • Who Am I? and Why Am I Talking About Mental Health? • In Groups: Compare and Contrast Service Delivery • Case Study • In Groups: Identify Gaps and Brainstorm Solutions • Rural, Urban • Unified Approach

Ice Breaker • Shake Down!!!!

Who am I?

Each Group Represents a Different Setting • Institutional setting (e.g. hospitals) • Community Setting (e.g. CMHA) • Private Practice Setting (e.g. Be RT) • 3 Advantages of Service Delivery in your Setting • 3 Disadvantages of Service Delivery in your Setting

Case Study – Tara • 17 year old female • Social, Enjoys Music, Dance, and Instagram • BPD, ED NOS, Self Harm, Suicide Attempts • Supportive family • Mom – classical musician and music teacher • Dad – Engineer • Older brother – star athlete and school president

Tara’s Recovery Pathway • Admitted to Inpatient Unit after Overdosing on her fathers pain medication because her boyfriend cheated on her • Has been restricting her caloric intake for the past year (skips breakfast and lunch because no one notices) however still appears to be of an average weight • Sexually promiscuous, binge use of alcohol, chronic use of marijuana and tobacco in a bong (“I use poppers so that I don’t eat”) • Very anxious on inpatient unit and consistently scratches wrists until they bleed • Starts romantic relationship with male patient on unit • Completes safety plan, receives diagnosis and medication, enjoys Therapeutic Recreation Drum circle, discharged after 5 days with appointment in a week to see social worker

Tara’s next step • Tara attends her appointment and feels judged by her Social worker who reminds her of her parents • She does not attend any additional follow up appointments • Tara makes 3 additional suicide attempts but she is not admitted to the inpatient unit because staff are concerned that she is learning new unhealthy behaviors on the unit and they feel she is motivated to see her relationship interest • Emergency room staff schedule a follow up appointment with the same Social worker – Tara refuses to attend

Tara’s story continued • Tara’s level of substance and and emotion dysregulation escalate • Tara’s parents remember the Drum Circle on the Inpatient and finds a Recreation Therapist in private practice online • The RT writes a treatment plan that focuses on dance, photography in the outdoors, and mindfulness. • Tara connects well with the RT and she begins to reduce her substance use which assists with emotion regulation.

Tara’s Story Continued • Tara is the victim of online bullying and is readmitted to the inpatient unit for her most severe suicide attempt to date • The inpatient unit supports the RT’s treatment plan and adds a weekly check in with a different social worker in collaboration with the RT at discharge. • Tara continues to struggle with substance use and emotion regulation but she is not readmitted to the inpatient unit

Discussion Questions • During which transitions did Tara struggle the most? • How could her transitions be improved? • Which method of service delivery helped Sara the most? Why?

Urban vs Rural • Did Tara receive service in an Urban or Rural setting? • How do you know? • Urban – heavily resourced but high volume • Rural – under resourced but community oriented • In two groups • 3 benefits and 3 draw backs of RT in an Urban Setting • 3 benefits and 3 drawback of RT in a Rural Setting

Conclusions • Collaboration • Creativity • Risk and Liability • Client – Centered • A Unified Approach is the Best way to Deliver Quality Care!

Thank you very much! • Take away? • Surveys please • Feel free to contact me: • Benson@berecreationtherapy.com • 519-375-0615 • For more information on Be RT services visit: www.berecreationtherapy.com