More Tools for Resilience at CAT
What do you do when 85% of the clients your team serves are high acuity?…
That’s what Robynn Strikwerda, Manager of the Clinical Access Team (CAT)* needed to figure out. “Participant acuity,” Robynn observed, “skyrocketed during and especially after COVID. There was a massive decline in mental health and, to cope, participant substance use went up.” That meant more stress as the team tried to support higher acuity participants who faced more barriers in finding supports. Compassion fatigue was setting in. What tools could help the team and participants stay healthy?
Robynn turned to the Alberta Health Services Hope and Wellness Program Clinical Supervisor, Elise Sargent, whose programs serve a high acuity population. Their use of Dialectical Behavior Therapy (DBT) caught CAT’s attention. DBT was developed and is especially effective in supporting individuals who have difficulty managing and regulating their emotions. It focuses on developing skills in four pillars: Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness.
Led by CAT’s Registered/Provisional Psychologists and Certified Canadian Counsellors, the team took a ‘deep dive’ into DBT. Over the past year, the team has developed a basic understanding of DBT theory, and the intervention skills used in this modality. This gave CAT a common language to unify the entire team during treatment planning and complex case reviews. Elise then joined several complex case meetings and provided a framework around how the team can work through 'therapy interfering behaviors', create a plan for addressing this directly with participants, and give themselves permission to set boundaries and hold participants accountable. Elise remains an important source of consultation and support for CAT and the team is so grateful.
A year later, Robynn is delighted to see a healthier and more resilient team and highlights the benefits:
Team skills have increased in areas of professional boundaries and our own distress tolerance! This has improved case management in those situations that seem ‘hopeless’ when staff work with particularly challenging individuals.
Staff now have the tools to directly address participants' behavior patterns and to openly discuss how the behavior isn’t helping the individual make progress.
An unexpected and exciting benefit is that some participants are setting boundaries for themselves, so the staff's skills are serving as role models for them.
“The intent wasn’t to become DBT experts,” Robynn clarifies, “because that is a specialized clinical treatment intervention that requires certification. But for us, basic DBT skills brought more open conversations as a team, clearer boundaries, and the ability to directly address the participants (and each other) on behaviors that don’t contribute to desired outcomes. It’s been hard, but it’s been beautiful.”
*CAT is a 13-person team that bridges the gap that Housing First clients often face in navigating established health, mental health and addictions systems due to their complex, acute, and chronic clinical issues. The frontline CAT team includes a Social Worker, Family Support and Harm Reduction Specialists, Peer and Community Support Specialists, Mental Health Therapists and an Outreach Nurse with administrative and Program Manager support.