Published on November 1st, 2012 | from CAMH Education
Interprofessional Collaboration: Improving clinical skills for dual diagnosis clients [video]
Earlier this year, the Law and Mental Health Program identified a learning need: they needed to learn about developmental disabilities and develop skills to more effectively treat clients with dual diagnosis. You may be surprised to learn that they have several patients across their units that face additional challenges due to their development disabilities.
They are not alone. Did you know that:
- it is estimated that there are 247,000 individuals (2.25% of general population) with developmental disabilities and 93,000 individuals (38%) with a dual diagnosis in Ontario
- 38% of people in Ontario who have a developmental disability experience mental health challenges (3 – 4 times the rate seen in the general population) and schizophrenia occurs in 0.6%
- intellectual disability is more common than any other disability in the psychiatric hospital population
- 1 in 5 inpatients hospitalized in Ontario’s provincial psychiatric hospitals have a development disability
- 20% of these clients are cared for on specialized units
- 37% have been in hospital for 5 or more years
- 50% of the clients served by Oak Ridge’s maximum security Structured Intervention Program have a developmental disability.
But they didn’t have to look any further than CAMH’s Dual Diagnosis Services to support their plan to increase their collective knowledge and skills in serving dual diagnosis clients in their units.
Anita Martin, Nurse Educator and Dale Kuehl, Advanced Practice Clinician—both from Dual Diagnosis Services—were pleased to have an opportunity to inform other CAMH clinicians about this often under-served population. They developed a great training plan that included workshop sessions and hands-on experience on a Dual Diagnosis inpatient unit to take place this past July.
The workshops were planned to include the expertise, special skillset and perspectives of an interdisciplinary team of nurses, social workers, behavioural therapists, recreation therapists, psychologist, developmental worker and occupational therapists. Most importantly, the workshops provided a safe environment to broaden understanding about the unique needs of clients with dual diagnosis and begin to enhance their therapeutic skills for treating this population.
In evaluations surveys, the staff reported that the experience would cause a change in their clinical practice. They said that they would be more mindful of the different levels of function and were now aware of physical problems they may encounter and how these might alter client behaviour. They would begin to incorporate sensory assessments, would describe behaviours more specifically rather than using summary labels and would collaborate more to problem solve solutions. They also had a better understanding of the resources available.
Two members of the Law and Mental Health program’s nursing team took advantage of a unique opportunity to work on a Dual Diagnosis unit briefly to put the new learning into practice.
Debbie Roopnarain—one of the nurses who spent some time working with dual diagnosis clients following the workshops—told us that “There is a lot of stigma’s attached to clients that are living with a dual diagnosis, being on the unit helped to break those stigma…it’s clear that there are many unknown factors or misconceptions about client with dual diagnosis…I am glad I [accepted the opportunity to work on the unit], I really enjoyed my experience. The clients in the program just want to feel as though belong and that they are important..[and that] the staff treat [them as] any human being wants to be treated: with dignity and respect. The staff provide these clients with a sense of community, somewhere they can feel as though they are wanted and belong. While the nurses are given their own client assignment each day, they are never only focused on just their workload but also that of the entire team. Working as an inter-professional team is of the utmost importance while working with client’s living with a dual diagnosis. Each team member adds essential care techniques that provide a client centered model of care.”
The training program helped the LAMH Program develop a group of staff to function as Champions, serving as a resource for clinical teams in the program who are caring for clients with a dual diagnosis and need some assistance through consultation.
We had an opportunity to chat with Anita and Dale about the program and why it was important to them to help the Law and Mental Health program with this work:
Help us congratulation Anita, Dale, all the staff who lent their expertise to the program and those who attended. This is a great example of collaboration between clinical programs and the values of interprofessional education in action, coming together to improve the standard of care for our clients. Well done! A very inspiring project that has helped to reduce stigma and strengthen awareness in a very meaningful way! We hope to see other clinical programs working together in similar ways very soon.