Person Centred Practice

According to the Australian Institute of Health and Welfare’s report Alcohol and Other Drug Treatment Services in Australia 2019–20:

• From 2019 to 2020, the main drugs of concern, which led to 139,300 people aged 10 and older seeking treatment for their own drug use from publicly funded AOD treatment services, were alcohol (34%), amphetamines (28%), cannabis (18%) and heroin (5%).
• The majority of treatment episodes for these principal drugs of concern were provided in non-residential facilities (64%), followed by residential treatment and outreach treatment (both 13%).
• Just over two-thirds (64%) of the 139,300 clients receiving treatment were male.
• More than half (53%) of all clients were aged 20–39.

Evidence-Based Approach

Providing intervention plays a large role in supporting the mental health of many people. Mental health support services are meeting people at their most vulnerable. They provide interventions that are rooted in research and evidence-based practice to support those in need. Evidence-Based Practice (EBP) is the core of any health practice, supporting professionals in their decision-making process. The process integrates the ‘best available’ research evidence from rigorous studies, clinical expertise, experience, and knowledge with the values and needs of the patient. EBP supports professionals to put this information into practice. It provides a framework for consistent and quality practice and builds transparency of practice with those involved (stakeholders).

In the clinical setting, health professionals make daily decisions about patient care. Evidence-based practice (EBP) is an approach that aids in guiding this decision-making process.

EBP relies on three key sources of information to inform patient care decisions:

• The best research evidence
• Clinical expertise
• Patient values and circumstances

The purpose of EBP in community services is to:

• Improve the quality, effectiveness, and appropriateness of service delivery
• Reduce variations in service practices
• Substantiate the interventions and support provided to community members
• Share decision-making with the community members
• Provide a framework for lifelong, self-directed learning crucial for the continued provision of quality community services

Clinical expertise

Clinical expertise is a combination of clinical skills, medical knowledge, and professional experience that is accumulated by practitioners throughout their careers.

Best research evidence

Best research evidence refers to up-to-date and authoritative scientific research into various aspects of patient care, diagnosis, treatment or prevention of disease.

Patient values and circumstances

Patient values and circumstances relate to the unique preferences, concerns, expectations, beliefs, hopes, strengths, limitations, and stresses each patient brings to a clinical encounter.

Evidence-based practice uses the best available research to support theories and inform treatment strategies and interventions, providing a framework for consistent, quality practice. Building on strong, well-researched evidence improves client outcomes and contributes to continuous improvement and ‘best practice’. Good practice is also informed by professional expertise and client and stakeholder feedback.

Evidence-based practice (EBP) is of paramount importance in the field of Alcohol and Other Drug (AOD) services due to the unique challenges and complexities associated with substance use disorders. Here's an extended explanation elaborating on why EBP is crucial for AOD services, along with examples:

1. Enhanced Effectiveness and Efficiency: AOD services cater to individuals facing a range of issues, from substance dependency to co-occurring mental health disorders. By relying on evidence-based interventions, practitioners can optimize treatment strategies to address these complex needs effectively. This approach not only improves client outcomes but also maximizes the efficient use of resources within AOD programs.
2. Reduced Risk of Harm: Substance use disorders can have severe physical, psychological, and social consequences for individuals and communities. Evidence-based interventions are grounded in research that identifies approaches with the lowest risk of harm and the highest likelihood of positive outcomes. This reduces the likelihood of inadvertently exacerbating clients' conditions or causing unintended negative consequences.
3. Informed Decision-Making: EBP empowers practitioners to make informed decisions about treatment and intervention options. By staying abreast of the latest research findings, practitioners can select approaches backed by solid evidence of efficacy and safety. This ensures that interventions are aligned with best practices and tailored to the individual needs and circumstances of clients.
4. Adaptability and Innovation: The landscape of AOD treatment is constantly evolving, with new research findings and innovative approaches emerging regularly. Practitioners who engage in evidence-based practice are better equipped to integrate new knowledge and innovations into their work. This adaptability allows AOD services to remain responsive to changing client needs and emerging trends in substance use and addiction.
5. Professional Accountability and Ethical Practice: Evidence-based practice promotes accountability and ethical conduct among practitioners by requiring them to base their interventions on reliable research evidence. This ensures that practitioners uphold the highest standards of care and adhere to ethical principles such as beneficence, non-maleficence, and respect for autonomy. By prioritizing the well-being of clients and adhering to evidence-based guidelines, practitioners demonstrate their commitment to ethical practice.

Examples of Evidence-Based Practices in AOD Services:

• Medication-Assisted Treatment (MAT): MAT combines medications (e.g., methadone, buprenorphine) with behavioral therapies to treat opioid use disorder. Numerous studies have demonstrated the effectiveness of MAT in reducing opioid use, preventing overdoses, and improving retention in treatment.
• Cognitive-Behavioral Therapy (CBT): CBT is a widely used therapeutic approach for addressing substance use disorders. Research has consistently shown that CBT helps individuals develop coping skills, identify and challenge maladaptive thoughts and behaviors, and prevent relapse.
• Brief Intervention: Brief interventions involve targeted conversations aimed at increasing awareness of substance use and motivating individuals to make positive changes. Research supports the effectiveness of brief interventions, particularly in primary care settings, for reducing risky substance use and promoting healthier behaviors.

Australian Mental Health Frameworks

As in many industries, mental health and counselling often have their own state or federal guidelines and frameworks to support intervention. Regardless of the state, the principles of governance and protection of people will remain similar. These include ensuring safe, effective, person-centred support for all who need it. It has also become a reform priority to ensure that all Australians can have access to mental health support regardless of their circumstances.

Person-Centred and Client-Led Practice

Person Centred Practice (PCP), a term originally coined by psychologist Carl Rogers whilst working with children, is a cornerstone philosophy within the community mental health service field. It ensures quality outcomes for all patients, holding them at the centre of all decisions about their own care and support. PCP is about respecting a person’s rights, wishes, and lived experiences throughout the process, from beginning to end. The process of PCP surrounds the individual, their support networks, family and carers in creating a flexible and tailored service.

Just as with EBP, PCP must begin with the organisational policies and procedures. These filter down into the practices of all individuals involved in the services and processes, promoting and embedding a person-centred culture. Person-centred principles also include:

• Seeking to understand the individual in the context of their lived life and experiences, their age, gender, sexuality, socioeconomic status, education, family, ethnicity, culture, beliefs and customs
• Demonstrating respect for the individual, their choices and goals
• Being inclusive and accessible
• Focusing on positive outcomes instead of deficits

Watch

Watch the following video, ‘What does Person-centred care mean in mental health services’ and reflect on the statement ‘changing the relationship with myself’ in mental health support.

5 Minutes.

For a deeper understanding of person-centred practice, take a look at the video below.

10 minutes.

Strengths-Based Approaches

Engaging in a positive outlook starts with recognizing and leading with the strengths of the person. It means adopting a mindset that views the person as resourceful and resilient. This approach aims to empower people to manage their own lives and contribute to their own care. The health professional builds on the person's strengths and uses them as a positive and practical tool to direct their process for change. Communicating with the person on the progress made through the lens of their strengths fosters hope for the future.

Watch

Take a look at the following video to learn more about the strengths-based approach.

10 minutes.

The role of intervention is to work on a person’s issues and challenges toward positive outcomes. It includes supportive, positive, and respectful communication. It also includes engaging in a range of practices that show positive regard for the person.

Unconditional Positive Regard (UPR)

UPR is associated with Carl Rogers, the creator of person-centred care. It demonstrates one of the three core conditions required for therapeutic change in an individual, along with congruence and empathy. UPR offers the individual the right to their own feelings, thoughts, and ideas and to be exactly who they are in the moment that intervention is occurring. The professional demonstrates complete acceptance no matter what the person says or does, with no conditions.

UPR is embraced within intervention due to the major role it plays in well-being. When people value themselves, think positively about themselves and feel accepted, they are more confident and motivated to work towards and achieve goals. They believe that they are capable.

Watch

Learn more about the three core conditions required for therapeutic change in an individual.

5 Minutes.

Person First and Non-Judgemental Language

Using person-first language recognizes that people have their own uniqueness and are first themselves, before any challenges, disabilities, or diagnoses. It is used by first stating the name of the person and then what has happened ‘to them’ not what ‘they are. For example, ‘Her name is Susan and she uses a wheelchair and also plays basketball’ vs ‘She is wheelchair bound’. Or, ‘this is Bob who is a mechanic who has experienced abuse’ vs ‘he is an abuse victim’.

The point is that the challenge the person faces does not, and should not, define them. Rather, it is something that is connected to them that they experience. Person first language may also be used in less personal contexts such as ‘child with autism’ (person first) vs ‘autistic child ‘ (challenge first).

Non-judgemental or non-biased language means that you need to track your own thoughts, nonverbal and verbal responses to an individual. You must think about how you display or internally react to what a person says or does. This relates closely to the three core conditions, in that it requires genuineness, acceptance, and empathy. It means taking in the feelings and thoughts of the person and sidelining your own to be in the moment ‘with’ the person. When ‘with’ or ‘being with’ the person, it means being there just for them, to embrace what they are trying to share. You are present in the moment without distraction or outside thoughts - as if on their journey with them.

Watch

To understand more about first-person language, watch the following video.

5 minute

Prizing

The term ‘prizing’ was also stated as imperative by Rogers (1972) about positive communication and interactions with others. Prizing explicitly points out to a person how they feel about themselves through observation as an alternative to praise from others. Individuals can begin to feel they can identify and prize themselves, building internal positivity. As an example, this may look like a person who has just explained that they ‘haven’t had a drink of alcohol in a month’ over what they once did every day. It may be clear that they are excited and proud of this achievement. This is when the professional would recognize their internal feeling and prize them (state what they may be feeling about themselves), e.g., ‘you are really proud of that achievement and excited about it’. You will often see the emotion exaggerate as they acknowledge that ‘yes, that is how I feel about myself’.

Active Listening

Communication is the process of sending and retrieving information from one person to another, which may include verbal, nonverbal, and visual information. When we demonstrate active listening, both verbal and non-verbal elements are used. The context and environment are important elements to consider as both verbal and non-verbal communication can come across differently. Active listening demonstrates to another that you are carefully taking in the information they are sharing with you by being attentive, ensuring the person feels heard.

Watch

Watch the following video to learn more about active listening.

5 minutes.

Brief Interventions

Brief interventions are the process of screening and assessing a person during triage for their drug or alcohol use. The objective is to have the information required to provide advice and the right support to the person to reduce the chance of harm. Interventions are usually opportunistic and repeated whenever possible. They are usually applied for those who are at risk of dependency, rather than those already dependent on drugs/alcohol and usually only last between 5-20 minutes.

Brief interventions are usually applied for those who have not sought support but have been identified as at risk through the screening processes. Brief interventions are a part of the Australian Public Health strategy. They connect with the preventative approach specified in the National Preventative Health Strategy 2021-2030 and apply support for intervention in Australian hospitals and clinics.

Why Brief Interventions are Required?

Brief interventions aim to inform people of the implications of their dependency and work towards reduction of intake and improvement of their health. Brief interventions are structured conversations aimed at motivating individuals to consider making changes to harmful behaviours, particularly those related to substance use. These interventions are typically short, focused, and designed to be implemented in various healthcare settings.

People who have experienced severe drug-related harm and have current dependency are not recommended for brief interventions. They will be referred to other specialist services.

Who Completes Brief Interventions?

Brief interventions occur primarily in care settings such as hospitals or specialist clinics, though any trained health professional can conduct brief interventions.

How are Brief Interventions Completed?

Professionals utilize screening tools online or in paper form with patients. Online tools have provided more anonymity, privacy, and confidentiality. This helps maintain the safe storage of private information and ensures ethical practices. The professional completes the tool and intervention whilst always ensuring the patient's privacy. These sessions are one-on-one with the professional and are held within a private setting. As person-centred practice acknowledges, these sessions are supportive, client-led, and strengths-based in structure.

Professionals will seek moments of opportunity with the person to complete the intervention. It is important that the mood of the person is considered, as there is little point in trying with a client who is angry, unapproachable, or showing signs of resentment towards being there. Timing can be everything.

When are Brief Interventions Completed?

Typically, brief interventions may be utilized for a new patient, in line with health assessments and aligned with relevant chronic disease assessments. E.g., liver abnormalities.

Key Features of Brief Interventions.

1. One-to-One, Private Approach

The intervention is conducted in a private setting, such as a consultation room, ensuring confidentiality and a safe space for the client to discuss personal issues.

As a community services worker, you might meet with a client in a private office to discuss their alcohol consumption. Ensuring the setting is private helps the client feel secure and more willing to open up about their habits and challenges.

2. Short Duration

These interventions are concise, usually lasting around 15 minutes, making them suitable for busy healthcare settings and easier to fit into routine appointments.

During a routine visit, you might have a 15-minute slot with a client to discuss their substance use. This brief interaction can be pivotal in addressing immediate concerns and setting the stage for further support.

3. Health Team Member Involvement 

The intervention is carried out by a trained healthcare professional, such as a nurse, doctor, or counsellor, who can guide the conversation and provide appropriate advice.

In your role, you might collaborate with a nurse to address a client’s substance use. You could conduct the initial brief intervention and refer the client to the nurse for additional medical advice and support.

4. Client-Led Process

The focus is on the client's concerns, readiness to change, and personal goals. The healthcare professional listens actively and guides the conversation based on the client's input.

You might ask open-ended questions to understand a client’s perspective on their drinking habits. By listening actively and focusing on their concerns, you can tailor your advice and support to their specific needs and readiness to change.

5. Opportunistic 

These interventions often arise spontaneously during routine appointments or interactions, using the opportunity to address issues as they arise.
During a routine home visit, you notice signs that a client may be struggling with alcohol use. You seize this opportunity to have a brief, focused conversation about their drinking, providing immediate support and possibly preventing further issues.

As a community services student, you will encounter numerous situations where brief interventions can be valuable. Here are some specific scenarios:

• Routine Assessments: During regular assessments or check-ins with clients, you might notice behaviours or signs indicating substance use. A brief intervention can help address these concerns promptly.
• Crisis Situations: In moments of crisis, such as when a client is visibly distressed or experiencing a setback related to substance use, a brief intervention can provide immediate support and guidance.
• Referrals and Follow-Ups: When making referrals to other healthcare professionals or following up on previous interventions, understanding these key features ensures you provide consistent and effective support.
• Community Outreach Programs: During community outreach activities, such as health fairs or public awareness campaigns, brief interventions can be used to engage with community members about their substance use in a non-intrusive manner.

By mastering the key features of brief interventions, you will be equipped to support clients effectively, helping them to consider and take steps towards positive behavioural changes.

Barriers to Brief Interventions Occurring

Barriers to the implementation and success of the interventions may occur for various reasons but typically come down to the following:

Other factors can include:

• Limited Resources: Community service organizations often operate with limited budgets and staffing, which can hinder trained professionals' ability to conduct brief interventions effectively. It may be challenging to provide comprehensive support to individuals in need without sufficient resources.
• Stigma and Misconceptions: There may be stigma surrounding mental health issues or seeking help for personal problems within certain communities. This stigma can discourage individuals from engaging in brief interventions or seeking assistance, even when they could benefit from it. Addressing these misconceptions and promoting a supportive environment is crucial for overcoming this barrier.
• Lack of Awareness: Many people may not be aware of the availability or benefits of brief interventions in community services. This lack of awareness can prevent individuals from accessing the support they need or delay seeking help until their issues escalate. Educating the community about the availability and effectiveness of brief interventions can help reduce this barrier.
• Cultural and Linguistic Barriers: Community services often serve diverse populations with varying cultural backgrounds and language preferences. Language barriers or cultural differences in understanding mental health and support services can make it challenging for individuals to engage in brief interventions effectively. Providing culturally sensitive and language-appropriate services is essential for overcoming this barrier.
• Transportation and Accessibility: Accessing community services may be difficult for individuals who lack reliable transportation or live in remote areas with limited support resources. Lack of transportation or accessibility can prevent individuals from attending appointments or participating in brief interventions, reducing the effectiveness of the interventions. Offering alternative modes of service delivery, such as telehealth or mobile outreach programs, can help address this barrier.
• Time Constraints: Brief interventions aim to provide timely support to individuals facing various challenges. However, time constraints within community service settings, such as limited appointment slots or high demand for services, can hinder the delivery of effective interventions. Finding ways to streamline processes and maximize the use of available time can help overcome this barrier and ensure that individuals receive the support they need promptly.

Addressing these barriers requires a collaborative effort involving community service organizations, healthcare professionals, policymakers, and the community. By identifying and addressing these challenges, communities can enhance the accessibility and effectiveness of brief interventions, ultimately improving the well-being of individuals in need.