ACTTing Ethically: Using the ACTT Indicators of Change Survey

ACTTing Ethically: Using the ACTT Indicators of Change Survey to Guide Practice Megan Rooney, Pinecrest-Queensway ACTT OAA Conference, Kingston, ON Thursday, October 23, 2014

Question for consideration In a program that is funded to reduce hospital bed days, how do we ensure that autonomy is respected and that we remain client centered in supporting clients to achieve quality of life, while also being accountable to funding outcomes?

Agenda Ethics Overview ACTT Indicators of Change Survey What Why Process Pilot Try it out! Discussion

Ethics Four principles of biomedical ethics Respect for Autonomy Beneficence Nonmaleficence Justice Ethical considerations among ACTT clients Paternalism in our work Bias in ethical decision making

ACTT Indicators of Change Survey Grew out of administrative requirement Collaborative & client centered tool Identifies client functioning across several domains e.g. coping skills, relationships, housing... Identifies whether clients are satisfied Facilitates discussion around change

Process of Development Listed all activities Identified themes e.g. coping skills, housing, ADL s, etc... Took themes and activities and identified short and long-term outcomes Plugged into our Logic Model Developed rubric

PQ ACTT Logic Model Belongs to Pinecrest-Queensway Assertive Community Treatment Team (PQ ACTT), 2014

Process of Development - Domains Core coping skills Interpersonal skills and relationships Advocating for resources Transportation Housing Finances Self-care (grooming, hygiene, laundry) Vocation and recreation Food and nutrition Mental health and symptom management Physical Health Stable/ Supported Self- Crisis At-Risk Thriving Sufficient

Process of Development Scale Are you Satisfied/ Happy? Core Crisis At -risk Stable/ Supported Self-sufficient Thriving Capacities I am unable to cope daily. I do not know where to go for support. I am often unable to cope and have few skills and resources to help me when I feel overwhelmed. I am accessing almost daily support from family, friends and/or ACTT. I have a plan and need ongoing support to use it. I get help from friends and family in a way that is alright with them. I have a coping plan that I can use mostly on my own. I manage difficulties in my life mostly on my own. I have no problem coping with daily life. Yes I have a coping plan that I use independently. Core Coping Skills I am overwhelmed. My relationships are strained because I require so much help. Mostly I am using coping skills that I know are unhealthy (i.e. drugs, drinking, cutting). No

Process of Development Listed all activities Identified themes Took themes and activities and identified short and long-term outcomes Plugged into our Logic Model Developed rubric Identified domains for inclusion Developed scale Choose examples Team review and feedback End product tool to discuss change

Theoretical Influences Stages of Change (Prochaska & DiClemente) Motivational Interviewing (Miller & Rollnick) ... A collaborative conversation style for strengthening a person s own motivation and commitment to change (Motivational Interviewing, 2013, pg. 12)

PQ ACTT Pilot Six clients completed the survey Took around 20 minutes to complete Client Experience: Most found it easy to understand and could see self on the scale Large amount of information Some questions around language (e.g. Advocacy) Brought up new goal ideas (e.g. Bus pass) Was good to see where was at

PQ ACTT Pilot Staff Experience: Some difficulty differentiating between categories Similar experience to OCAN (e.g. Level of understanding and discrepancies) Opportunity to reflect on progress with the client and build confidence

Plans for Future Use Reflection period since completing the pilot Bring back learning or new insights from today Team discussion around implementation Bring back to clients who had completed it to see if any changes or new feedback

How it Fits with Ethical Practice Creating a framework for treatment planning which compliments OCANs Ethical principles: Respect for Autonomy clients directing where they want to go Beneficence client telling us what is good Nonmaleficence minimizing possibility of directing care in a way that does not fit with the clients vision Justice providing opportunity to use the tool with all client but respecting that everyone is different

Vignette part 1 Note: Vignette is based on a hypothetical client. John is a 29 year old male diagnosed with schizophrenia who has been with ACTT for 1 year. John is friendly and enjoys social engagement when well. When unwell, John s symptoms include social withdrawal, disorganized thoughts, paranoia and persecutory delusions. ACTT visits with John twice per week and delivers weekly medication. He reports his medication works well, however he has recently been missing doses which is resulting in increased paranoia and isolation. John lives alone, however has been struggling with the maintenance of his apartment, including cooking and cleaning. He has a strong family support network including his parents and siblings, who help John with his grocery shopping and provide prompts to cook, clean, and maintain his grooming and hygiene. John is diabetic and is regularly followed by his family doctor. His family expresses concerns to ACTT that John doesn't monitor his blood sugars and lacks insight into proper nutrition.

Vignette part 2 Up until the past year John was receiving emotional support from a close friend who recently passed away. Since then, he has identified difficulty coping and feeling depressed. ACTT has been supporting John to process his grief and develop a coping plan. During the day, John enjoys spending time with his friends, reading, and listening to music. In the past, he enjoyed his volunteer position at the food bank and he is currently receiving support from ACTT to find a new volunteer position. In addition, John regularly attends ACTT recreational programming which he attends with some encouragement. He has a community bus pass which he purchased on his own and he travels independently. John receives ODSP and gets financial management and support from a community agency that advocates for John and provides him with a weekly budget. In the past, John smoked cigarettes and has been smoke free for the past 2 years. John s main goals are getting a new volunteer position and improving his ability to clean his apartment.

Discussion Any comments/feedback? What was it like to use the tool? In what ways may this tool be useful for your practice? What ideas do you have for modifying? What might be other uses for this tool? Do you have anything similar in your practice? What is your experience with ethics in treatment planning?

Overview & Closing Explored ethical considerations in our work Introduced the ACTT Indicators of Change Survey/tool Provided opportunity for use and discussion For an electronic copy of the survey, please email: m.rooney@pqchc.com Thank you!