The ” Triple-project ” Forensic Psychiatric Center Glostrup Copenhagen University hospital

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The ”Triple-project”Forensic Psychiatric Center GlostrupCopenhagenUniversity

hospital

The Tripleproject” – New Hampshire Model

Mette Brandt-Christensen, MD, PhD, assistant professorForensic Department,Psychiatric University Center Glostrup, Copenhagen


Integrated treatment for dual disorder works –

Does it also apply for “triple-disorder”-patients?

The Tripleproject” – New Hampshire Model

Mette Brandt-Christensen, MD, PhD, assistant professorForensic Department,Psychiatric University Center Glostrup, Copenhagen


Triple-disorder:Severe mental disorder

Substance abuseForensic status


Developing the ”Triple”project – integrated treatmentfor Triple-disordercostum-fit – one size does not fit all


The NHM – program modified

Stages of the integrated Triple-disorder treatment

– the Glostrup model

END

OF

ABUSE

Pre- consideration

Pre-engagement

Relapse

Maintenance

Relapseprevention

ActionActive treatment

Consideration

Engagement

Preparation


Stages of care and treatment.Definitions and goals:

Mueser, Kim, et al 2006 and Prochaska James O. et al 2008.

Adapted by Retsbo, 2011 NHM - stages NHM - stages NMH - behaviour Lasting change-

stages

Engagement Preengagement

Engagement

No contact with case- manager

No regular contact with case-manager concerning

substance abuse

Pre-consideration

Consideration

Persuasion / prepatarion

Early persuasion

Late persuasion

Regular contact with case-manager, but no reduction in

Substance abuse

Reduction for less than one month

Preparation

Active treatment Early active- treatment

Late active-treatment

Reduced substance abuse for more than one month

No substance abuse for 1-6 months

Preparation

Action

Relapse – prevention Relapse prevention

Improvement or symptom-free

No substance abuse for at least 6 months

No substance abuse for at least one year

Maintenance

Termination


Care and treatment – the stages of NHM in the ”Triple-Project”Inspiration from: Mueser, Kim et al, 2006; modified by Retsbo, august, 2011

Engagement-stage

Preparation-stage

Active care & treatment-stage

Relapse- prevention-stage

Assessment

Case management

Patients´ network

Activation and daily structure

Social – & economic stabilisation

Psychopharmacological treatment

Coercion

Motivational interviewing

”Set out for a better life” – cognitive behavioural therapy individually and as patient-courses

Self-help-groups


Triple-disorder treatment

Goals:

Staff qualification program:All employees (nursing staff and psychiatrists): 3 days

seminar29 employees (nursing staff and psychiatrists): 4 days

seminar followed by supervision sessions

Assessment, care & treatment:Screening of all patients for substance abuse Stage-based care and treatment ad modum NHMCompendium with detailed description of the care- &

treatment program



Hopes for the project:

Assessment, care & treatmentExperiencing increased quality of lifeReduction of drug consumptionReduction of criminal activities

Staff qualification program:Change in attitude and more apprecitiavely

approach towards tripple-disorder-patientsIncreased job satisfaction



Challenges: A non-confronting and appreciative approach in all

stages Non-consulting approach to patient during the first two

stages Balancing efforts of harm-reduction and obligations

towards judicial system



Project ends autumn 2012:Evaluation of selected out-come target from the

NHM program (ASI-data, including patients´ experience of QoL)

Evaluation of staff qualification-program


Integrated treatment for Triple-disorder


Integrated treatment for Triple-disorder

Thank you for your attention!

Contact: Email: [email protected]

The ” Triple-project ” Forensic Psychiatric Center Glostrup Copenhagen University hospital

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