Chcmhs 005 4.1 4.2 4 PDF

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CHCMHS005: Provide services to people with co-existing mental health and alcohol and other drugsissuesQuestion 4.1/4/4.Describe safety and risk management considerations and strategies in relation to identification,prevention, minimisation, evidence-based de-escalation techniques, conflict resolutio...

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CHCMHS005: Provide services to people with co-existing mental health and alcohol and other drugs issues Question 4.1/4.2/4.3 Describe safety and risk management considerations and strategies in relation to identification, prevention, minimisation, evidence-based de-escalation techniques, conflict resolution and negotiation skills. Identifying symptoms – tools and assessments used by an organisation will be directed at identification of symptoms and causes. AOD problems present as substance abuse and/or substance dependence which is harmful and/or hazardous. Hazardous use refers to a pattern of substance use that increases the risk of harmful consequences for the user. Such consequences include:  Physical and/or mental health problems  Social consequences Harmful use is defined as a pattern of psychoactive substance use that is causing actual damage to health. Damage can be:  Physical (e.g. hepatitis following injection of drugs,  Psychological (e.g. depressive episodes, secondary liver disease as a result of long term, excessive to heavy alcohol intake, psychotic episodes as a alcohol consumption) result of marijuana or LSD -lysergic acid – use) Substance abuse is defined as a maladaptive pattern of substance use, leading to clinically significant impairment or distress, symptoms manifest, within a 12-month period after use, by one or more of:  Failure to fulfil major role obligations  Continued use despite persistent/recurrent social  Use in situations in which it is physically hazardous or interpersonal problems caused/exacerbated by  Recurrent substance related legal problems the substance effects Abuse, unlike dependence, is not characterised by withdrawal, tolerance, or a pattern of compulsive use, but by the adverse consequences of repeated use. Substance dependence is characterised by:  Cognitive, behavioural and psychological signs  Development of tolerance, and presence of  Compulsive, continued use of a substance in spite withdrawal symptoms upon cessation of the drug of related problems Safety – when working with people in AOD settings it is important to ensure worker safety. There are times when clients will become threatening or violent. When this happens:  Ignore abusive remarks and other attempts to  When approaching or being approached remain incite emotional reactions calm and speak quietly and clearly  Seek support/assistance and know where other  Display a friendly reassuring attitude staff are located  Keep speech simple – use short words and  Be patient and tolerant sentences  Do not threaten, act authoritatively or set limits  Avoid highly emotive topics or words that cannot be enforced  Check body language, theirs and own  Do not make promises that cannot be kept  Present a non-confronting, open posture  do not attempt to restrain the person  Use the persons usual (first) name  Avoid making disparaging or provocative remarks  Respect the other persons private space  If a long, emotional discussion is necessary, ask the  Emphasise choices and make appropriate requests person to move to a quiet room  Prepare the person for any anticipated change or  Discourage other people who might intervene in intrusion unhelpful ways  Make intermittent eye contact  Acknowledge the persons perception of the problem and do not patronise them Risk can include:  Risk to self (long- and short-term effects), physical  Others risks and mental  Risk to others Risks other than physical and mental health risks include:  Family and other relationship breakdowns  Loss of employment  Legal problems associated with drug driving and  Financial problems associated crime to support use Risk to others – families and support workers need to be aware of the varying risks that drug addicts pose to safety and wellbeing of others. These risks can include:  Sleep deprivation  Increased incidence of aggressiveness, hostility and  Marked weight loss violent behaviour  Loss of insight  Symptoms of psychosis (paranoia, hallucinations,  Depression and anxiety thought disorder)  Impaired cognition and motor performance  Hepatitis C and HIV infection  Memory and concentration difficulties  Unsafe sex  Agitation  Overheating and dehydration

Harm reduction Overdose, as ae.g. strategy avoid to mixing manage or using risk –alone given the high risk of relapse  among Driving AOD under clients, theharm influence reduction of alcohol can be and employed other in order  to Family reduce violence risk where e.g. avoid possible. using These whenstrategies feeling angry include: drugs, e.g. think about the alternative methods of or aggressive; go to a sobering up shelter rather transport than going home to the family  Blood borne viruses, e.g. use clean injecting equipment Addicts who are going through withdrawal may very well experience suicidal ideation. A suicide risk assessment should take place to ensure safety for both the client and the support worker. Some of the factors that should be explored include:  Current thoughts of suicide  Alcohol and other drug use  Suicide plan and method  Social supports  Availability  Evaluate depression  Rescue  Evaluate barriers for suicide  Previous attempts or threats of suicide There will be times when mental health workers will be required to respond promptly to de-escalate potential incidents or risks and promote safety due to complicated or difficult situations that arise during interactions with clients. Difficult situations can be situations where clients are in a highly emotional state. They also include situations involving conflict, hostility, threats of violence and actual violence. Difficult situations can be triggered by physical causes such as the misuse of medication, drugs or alcohol, mental illness, fatigue or discomfort. They can also be prompted by factors such as financial hardship, loss, grief, maturity level, long wait times for service, noisy or over stimulating environments, and lack of staff training in recognising and responding to challenging behaviours/behaviours of concern. Workers need to recognise the early verbal and non-verbal signs which indicate a potential incident or risk. The body language of the other person can give mental health workers a clue about potential incidents and risks. Behaviours that indicate the potential for risk to the personal safety of the client include, but are not limited to:  Exposed cuts  Dramatic drop in performance and interactions at  Dramatic changes in mood school, work, or home unexplained injuries, such as scratches or burns  Changes in sleeping and eating patterns  Strange excuses provided for injuries  Losing interest and pleasure in activities that were  Unexplained physical complaints such as once enjoyed headaches or stomach pains  Social withdrawal – decreased participation and  Wearing clothes that are inappropriate to weather poor communication with friends and family conditions e.g. long sleeves and pants in very hot  Hiding or washing their own clothes separately weather  Avoiding situations where their arms or legs are  Hiding objects such as razor blades or lighters in exposed, e.g. swimming unusual places, e.g. at the back of drawers Client behaviours that indicate the potential for risk to the personal safety of others include, but are not limited to: Increased content and volume of speech that can be demanding or argumentative and can involve shouting include rapid speech, sweatiness, large pupils,  Agitation, restlessness, erratic movements, restlessness and agitation inability or unwillingness to sit or stand still  Rapid breathing, muscle twitching, wide eyed  Behaviours such as pacing, clenching fists, expression drumming fingers, repeatedly running hands  Lack of recognition of staff by a regular service user through hair, tapping or banging on walls or  Disclosure of feelings of great fear, anger, or loss of furniture control  Tense, frustrated or angry facial expressions  Blocking of escape routes or attempts to back you  Extended eye contact that appears challenging or into a corner overt glaring  Vague or clear verbal threats or gestures  Rapidly shifting mood  Appearance of intoxication with drugs including alcohol; the signs of psychostimulant intoxication Workers should keep their own body language open and relaxed to encourage clients to open up and hear what is being said. Clients and colleagues might be slow to respond to questions asked of them or not answer questions at all. Workers can change the words they use or how they say them to help clients become more relaxed and more open to what is being said. Workers can ask questions to bring clients into the conversation. Open questions are a good way to get them talking. Workers should always paraphrase or summarise the clients answers to questions to make sure they have understood what the client meant. Comments or opinions of other staff could be signs of potentially risky situations. Other staff might provide workers with background information about their interactions with clients in an effort to help other workers prepare for their own interactions. This information can be useful for workers to plan how they will respond to what could be a complicated or difficult situation. The sharing of comments or opinions must comply with privacy and confidentiality legislation and organisational policies and procedures. Workers must be aware of their own feelings during interactions with clients as these can be a sign of potentially difficult or risky situations. They might feel overwhelmed if they are dealing with situations that are beyond their scope or experience. They should act promptly to get assistance or information from their supervisor or more experienced colleagues. Wherever possible, workers should take action to de-escalate potential incidents or risks and promote safety. Conflict resolution is a way for two or more parties to find a solution to a disagreement they are having. The five styles for dealing with conflict that people might employ are:

Avoidance – this is the easiest way of dealing with conflict but is not necessarily the most effective. The conflict continues as the person withdraws and lets others get their own way. The person is not willing to assert or even express their point of view and often withdraws from any discussion about the issue. Accommodation – can also be easy to do but often comes at the detriment of the person doing the accommodating, because they are willing to sacrifice their wishes to avoid conflict. They will often do whatever they can to help the other person get what they want. They will give in to sometimes unreasonable demands to avoid disagreement. Competition – some competition is healthy, but it can become counterproductive. People can compete to be right rather than compete to come up with the best solution. The focus becomes winning the issue rather than the quality if the outcome. People in this situation become defensive of their position, often take advantage of people willing to avoid conflict or those who accommodate others. They have little or no interest in satisfying the needs of others. Compromise – involves give and take to resolve conflict. This is often the expedient way to reach a conclusion, and usually ends up with a result which both parties are willing to accept but with which neither is completely satisfied. Collaborate – collaboration involves trying to reach conclusions with which each participant needs are met fully. The outcomes of these processes often lead to options that neither had thought of prior to starting the process. Seek a successful solution through collaborative problem solving. Aim for a negotiated win-win result, where the needs of both parties are met. Conflicts often end up with someone winning and someone losing. Set about finding solutions that suit the needs of both sides. Both parties win albeit with some degree of compromise. Where this win-win approach is taken, many conflicts will be resolved. Conflict resolution can be achieved by being mindful of people’s conflict resolution style and by using a conflict resolution process. The conflict resolution process involves:  Establishing and agreeing on the nature, possible  Taking responsibility for finding a solution to the cause and details of the conflict conflict  Assessing the impact on the client  Determining options to resolve the conflict  Negotiating the best solution with the client taking  Handling the conflict sensitively, courteously and into account organisational constraints discreetly  Checking for client satisfaction Communication skills such as listening actively, asking appropriate questions, clarifying and paraphrasing, all help to establish the nature and details of the conflict. Workers should encourage clients to summarise their concerns and feelings, uninterrupted. This is essential as often it is important for clients to feel that their views have been heard. Workers should listen carefully to the client’s issues so they can ensure that all the concerns raised are addressed. They could take notes if the client us comfortable with them doing this and reassure the client they will do whatever they can to try and help them resolve the conflict. Where appropriate workers should encourage clients to suggest and discuss options for resolution, so the client feels they are involved in the resolution process. Workers should then negotiate and agree on the best solution with the client, ensuring that the agreed solution is practical and within organisational guidelines. The goals of negotiation are to:  Produce a solution that all parties can agree to  Work as quickly as possible to find a solution  Improve the relationship between the parties in conflict...