PsyCheck manual

Screening tool

The PsyCheck Screening Tool is a mental health screening instrument designed for use by clinicians who are not mental health specialists. It detects the likely presence of mental health symptoms that are often seen, and can feasibly be addressed, within specialist AOD treatment services. It is not designed to be a diagnostic assessment and will not yield information about specific disorders. It is designed to detect potential mental health problems that may be missed if not specifically investigated by the clinician or raised by the client. For this reason, it is important that all clients are given the Screening Tool if possible, even if they do not appear to have a mental health problem. The PsyCheck Screening Tool is appropriate for all clients of AOD treatment services who are not in an active phase of withdrawal from drugs or alcohol. It can be administered at any stage with existing clients of the service, provided they are not intoxicated at the time of completing the questions. New clients should also be screened using the PsyCheck, once they are stabilised in treatment.

The PsyCheck Screening Tool has three sections:

  • a General Mental Health Screen, including history of treatment
  • a Suicide/Self-Harm Risk Assessment
  • the Self Reporting Questionnaire (SRQ), that assesses current symptoms

Clinical treatment guidelines

The PsyCheck Clinical Treatment Guidelines were designed to be used in conjunction with the PsyCheck Screening Tool. Their implementation is supported by the PsyCheck Service Implementation Guidelines and by training and clinical supervision as detailed in the PsyCheck Training and Supervision Clinical Guidelines. These clinical guidelines contain a manualised version of the recommended PsyCheck Intervention, which is based on brief cognitive behavioural therapy. A stepped care model has been used, based on the PsyCheck Screening Tool.

The PsyCheck Clinical Treatment Guidelines are arranged into three sections:

  • Section 1: outlines principles that support the PsyCheck clinical guidelines. They include an outline of the stepped care approach and of integrated treatment, a summary of the cognitive behavioural principles included in the intervention, and a review of the fundamental skills of engagement, rapport building and using clinical judgement.
  • Section 2: outlines the PsyCheck Intervention, comprising four treatment modules that are designed to be integrated into existing AOD treatment. This section is laid out in a step-bystep format so that clinicians just starting out have a basis from which to start their integrated treatment. However, the modules are also designed so that experienced clinicians can utilise the material as they require, without following a strictly manualised program.
  • Section 3: contains additional (‘extension’) material that may be used as an adjunct for additional sessions if required, or in place of some of the tasks in Section 3 if clinical judgement suggests an alternative technique is required.

Worksheets are also included. Clinicians should use clinical judgement when deciding whether to use some or all of these worksheets. They have been designed to support and reinforce learning from the sessions.

These guidelines provide a structure by which AOD clinicians can identify and appropriately refer clients who are in need of more intensive or specialised treatment (e.g. those with a psychotic disorder, those at high risk for self-harm) to mental health services.

Training and clinical supervisor guidelines

The PsyCheck Training and Clinical Supervision Guidelines consists of four modules, which are self contained and delivered in four separate sessions. A PowerPoint Training Presentation has been created for use in the delivery of training and is included in the resources for the PsyCheck Program.

The package involves both theoretical and experiential learning and is ideally conducted by an experienced clinician with a good understanding of the principles and practices of cognitive behavioural therapies. All of the modules allow flexibility in the time to deliver the material, which maybe delivered as a two day training session or as four half day sessions. The latter might be more suitable for less experienced clinicians as it will allow time to consolidate each module before moving on.

Undertaking the brief PsyCheck training needs analysis may assist in determining whether a full-day or half-day training session is required. A group of clinicians well trained in cognitive behaviour therapy (CBT) may not require as much training time as an inexperienced group of clinicians. In a heterogeneous group, it is recommended that training is targeted at the least experienced in the group; more experienced clinicians can assist in either delivering some of the training or mentoring less experienced clinicians during the training sessions.

The PsyCheck Training and Clinical Supervision Guidelines is designed to be used in conjunction with the PsyCheck Program Introduction, the PsyCheck Screening Tool User’s Guide and the PsyCheck Clinical Treatment Guidelines, which contain all the practical and theoretical information required for training.

Clinical supervision should be initiated with the training modules in order to facilitate the consolidation and implementation of new knowledge. Individual supervision is recommended, with group or peer supervision as a useful adjunct.

Program implementation guidelines

The development and dissemination of clinical treatment guidelines does not guarantee their effective implementation. Ideally ‘bottom up’ approaches, such as training in guideline use, are supported by ‘top down’ organisational changes such as supporting policies and clinical procedures to encourage long-term practice and organisational change.

Many barriers can affect the implementation of any new procedure or activity within an organisation or service. The litertature recommend undertaking a comprehensive package of strategies to target these multiple barriers to change. Other researchers agree that a number of elements are fundamental to producing meaningful, sustainable uptake of screening and treatment practices for comorbidity.

The literature also recommends a multi-faceted program to implement an integrated treatment for comorbid conditions, which includes:

  • using a whole-team approach
  • providing ongoing, service-based training as well as individual and group clinical supervision
  • addressing attitudes and perceptions about mental health and AOD use among clinicians
  • adopting a flexible and user-friendly approach to delivery of treatment
  • involving key stakeholders and team leaders in every phase of implementation

The PsyCheck Program was developed with these considerations in mind. It takes a multi-modal approach, which includes strategies to assist managers and other leaders to:

  • address barriers to change
  • expand the service’s capacity for clinical supervision
  • provide user-friendly materials for clinicians and support for their use through flexibly delivered and tailored training

Evidence from the evaluation of PsyCheck strongly supports the importance of involving all key stakeholders in each phase of implementation. This includes managers, team leaders and AOD workers. In many cases this will also involve clients. Client enthusiasm for changed practices can assist in the change process.

These implementation guidelines are designed to assist managers and other leaders to prepare their organisations and staff for sustainable practice change in screening and intervention for mental health disorders among AOD treatment clients. They are designed to be used in conjunction with the other guidelines that make up the PsyCheck Program, but the principles can be also used to guide other changes in practice.

Download all of the PsyCheck resources included in the manual.

 

 

 

Thank you for your interest in PsyCheck. If you would like further information about this article or an information in regard to PsyCheck please contact Kieran Connolly on 03 8413 8702 or kieran.connolly@turningpoint.org.au

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