Comparing Two SST Walk-In Approaches: Leastside Family Center Efc and South Calgary Health Center Schc

Comparing Two SST Walk-In Approaches: Leastside Family Center Efc and South Calgary Health Center Schc

Today’s article will be of particular interest to those professional psychologists who soon, perhaps starting in September, will want to start a Walk-In service and practice Single Session Therapy as an alternative form of intervention.

How will the content of the article be useful?

Professionals will be able to deal with two different versions of the Walk-In/TSS service , that of the Eastside Family Center (EFC) and that of the South Calgary Health Center (SCHC) , both located in Calgary, Alberta (Canada) and find out for which needs have been implemented, how they have been organized, the description of two clinical cases and thus draw some practical suggestions.  

Before going into the two approaches, let’s take a small step back!

Recall that the first Walk-in/TSS service model was developed at Wood’s Homes Eastside Family Center over 17 years ago (Slive, McElheran, & Lawson et al., 2012). This is a service that the client can access immediately to receive a single hour-long therapy session .

The assumptions of the model are:

  • Effective help can be provided in an hour.
  • Customers are the best judges of what they need and when they need it.
  • A therapist is a counselor who works with the client to address their needs.
  • The client’s resources and expertise can be mobilized to guide the client towards solving the problem.
  • The risk of harm to self and/or others is always addressed and specific actions are taken if indicated.

 

Let’s see them in detail!

  • The Eastside Family Center,  founded in 1990, is the first resource in Canada to offer a Walk-in/SST service for community mental health. EFC is a program of Wood’s Homes , a large not-for-profit mental health agency that offers residential, day treatment, outpatient, and community programs focused on children, adolescents, and their families The Eastside is strategically located in a commercial center in an area of ​​great cultural diversity, high population density and low socioeconomic status, where initially there were few services (schools, health centers, mental health services).

 

  • The South Calgary Health Center was developed in 2004 as a response to rapid growth in the southern part of the city. Residents in this area are wealthier, have higher education levels, and there are fewer visible minorities than in the city of Calgary. Along with population growth, however, there was also an emerging need for effective and affordable medical care and mental health services . These services are designed to relieve pressure on hospital emergency departments and outpatient clinics.

 

What are the key elements of the two services?

The center of the Eastside family

  • Accessibility

The position was decided in agreement with the Community and the Advisory Committee specially created to launch the service. The center is located in a busy commercial center close to public transport and with easy access to parking. Privacy is ensured by the mall building which contains a combination of professional offices and businesses, thus ensuring a level of anonymity for families The opening hours have been planned on the basis of the needs of the families. The service is available to anyone who wants to access: a single person, an entire family or a community group.

  • Community safety net

When customers enter the Eastside they are asked how they learned of the service. Most clients hear about the service from their doctor, school, the police, friends, neighbors, a family member, or the Calgary hospital emergency room.

  • Collaboration with the community

The staff is committed to collaborating with other national agencies. There are formal and informal partnerships . For example, GPs and schools are primary points of reference directly connected with the centre, while other consultancy agencies organize the Walk-In service as part of their waiting list management strategy.

  • Cost effectiveness

There is no charge for the Walk-in service . The Eastside is funded by provincial and city government contracts, fundraising, grants and donations. The staff consists of Wood’s Homes paid employees, volunteer community therapists, graduate students, and professionals who provide supervised hours.

  • The work team

At the heart of the model is teamwork with the use of one-way mirrors when customers agree.

  • Forms and privacy

Both the Eastside and SCHC are subject to various privacy and confidentiality laws. Customers of each service are informed of these guidelines.

 

  1. Clinical example

Juan and Cecilia turned up Eastside with José, their 9-year-old son at 6pm after Juan got home from work. They wrote on their request that they were concerned about José, who was constantly arguing with his mother and was so restless at school that his teachers were concerned that he might miss the academic year. The parents asked to be helped to find a way to “convince José to stop yelling and arguing with his mother”. As they told the therapist the story, the team behind the mirror observed how José’s mother screamed more than he did at her. It appeared to the Team that the mother/son relationship was deteriorating and that they were at risk of escalating from verbal to physical violence. Juan was in tears as he talked about how upsetting the screams between wife and child were for him and the rest of the family. He said the screaming had increased since the family had returned from Mexico about a month earlier. He thought Cecilia missed her family, while José was happy to be back in Calgary. In this session, the team suggested to the mother and son to make a “pact” that is that each would move away from the other when one of them was at risk of screaming and that when they got home they had to take a 10-minute break before to talk about their day. Juan was asked to support the two, reminding them of this agreement, as one of them would have “slipped”. She said the screaming had increased since the family had returned from Mexico about a month earlier. He thought Cecilia missed her family, while José was happy to be back in Calgary. In this session, the team suggested to the mother and son to make a “pact” that is that each would move away from the other when one of them was at risk of screaming and that when they got home they had to take a 10-minute break before to talk about their day. Juan was asked to support the two, reminding them of this agreement, as one of them would have “slipped”. She said the screaming had increased since the family had returned from Mexico about a month earlier. He thought Cecilia missed her family, while José was happy to be back in Calgary. In this session, the team suggested to the mother and son to make a “pact” that is that each would move away from the other when one of them was at risk of screaming and that when they got home they had to take a 10-minute break before to talk about their day. Juan was asked to support the two, reminding them of this agreement, as one of them would have “slipped”. In this session, the team suggested to the mother and son to make a “pact” that is that each would move away from the other when one of them was at risk of screaming and that when they got home they had to take a 10-minute break before to talk about their day. Juan was asked to support the two, reminding them of this agreement, as one of them would have “slipped”. In this session, the team suggested to the mother and son to make a “pact” that is that each would move away from the other when one of them was at risk of screaming and that when they got home they had to take a 10-minute break before to talk about their day. Juan was asked to support the two, reminding them of this agreement, as one of them would have “slipped”.

Both José and Cecilia welcomed this idea and asked if they could go back to talking about what had happened. They were told they could do it whenever they wanted. At the end of the session, the team felt that the therapist had used the right approach for them and that their discomfort had reduced by 4 points on a 0-10 point scale. The following Saturday, the family returned to report that while they had had some good days, they had also had some “slippery” ones. The team, made up of different members than in the previous session, worked with them to come up with some new ways to handle screaming. One was for José who was asked to talk about what her mother would like and the other was for Cecilia who was asked to give José some extra time to clean her room. Both were asked to assess the progress of the situation and to return if they needed to. The mother said laughing “We’ll be back! I don’t know when, but we will!”

 

The South Calgary Health Center (SCHC)

  • Accessibility

When clients go to SCHC and ask for the Walk-In/SST service they are prompted to fill out forms. The service is available to people of any age, there is no referral or appointment required, and there is no charge.

  • Community safety net

The service is a primary resource for all other SCHC physicians in the Calgary region and the community at large. Doctors, schools and community agencies located near the center refer to them, knowing that the person or family will receive immediate professional assistance. In situations where the customer needs additional assistance, the service is able to direct the customer to other additional services.

  • Collaboration with the community

Walk-in/SST service is connected to the community via the health club. The location of the service within this large medical advocacy structure allows for collaboration with other mental health teams and other health services. Evaluation data (Syverson, 2006) indicate that customers experience transfers to or from SCHC walk-in service and other services as “seamless”.

  • Cost effectiveness

There is no cost for the service as it is paid by the customers health insurance. At SCHC, all staff are paid by unions in the Calgary Health Region. Volunteer doctors in the Calgary region are prohibited by the union. This is a significant cost and operational difference from the Eastside.

  • Work team

Similar to the Eastside, teamwork is an integral part of the service. Staff are experienced psychologists, social workers and clinical nurse specialists with graduate degrees who perform this activity as part of their employment at SCHC. Treatment rooms have one-way mirrors and cameras if clients consent to viewing.

  • Forms and privacy

Clients entering SCHC are asked to fill out forms in the waiting room. All but one of the modules are replicas of those used at the Eastside. The add-on involves a five-point Likert scale in which the client indicates his or her mood state, risk status, and sense of hope for the future in order to provide the therapist with insight into the client’s symptoms.

 

  1. Clinical example

Liza, a 39-year-old single woman, arrived at the SCHCfor a Walk-In/SST session. She was being cared for by another professional in an adult mental health program located in the health center. Liza had been diagnosed with bipolar disorder several years earlier. The previous week she had told her therapist that she wanted to commit suicide. Sending her to walk-in service was part of the safety plan her therapist had developed. Liza didn’t want to be hospitalized and part of her didn’t want to die, so she agreed to go to the service to keep herself safe. In the session the therapist and team highlighted her strengths such as the ability to manage her fluctuating mood. The team also suggested hanging her self-affirmations at home. Liza told the therapist and team that hanging her affirmations would be helpful at times when depression overtook her. Liza reported a high risk of suicide on the pre-session form and her distress rating was 8 on a 10-point scale. Towards the end of the session she stated that her suicidal thoughts cleared up because the session gave her hope. Her discomfort level at the end of the session was 5 points. The clinician at the end of the intervention documented the session note in the shared unit so that if Liza showed up in the ER, staff would be able to contribute to her goal of keeping herself safe and out of the hospital . Liza reported a high risk of suicide on the pre-session form and her distress rating was 8 on a 10-point scale. Towards the end of the session she stated that her suicidal thoughts cleared up because the session gave her hope. Her discomfort level at the end of the session was 5 points. The clinician at the end of the intervention documented the session note in the shared unit so that if Liza showed up in the ER, staff would be able to contribute to her goal of keeping herself safe and out of the hospital . Liza reported a high risk of suicide on the pre-session form and her distress rating was 8 on a 10-point scale. Towards the end of the session she stated that her suicidal thoughts cleared up because the session gave her hope. Her discomfort level at the end of the session was 5 points. The clinician at the end of the intervention documented the session note in the shared unit so that if Liza showed up in the ER, staff would be able to contribute to her goal of keeping herself safe and out of the hospital .

 

Conclusion

This article describes how the Walk-In/SST model of therapy can live and breathe in very different contexts: in one case, we have known a community- based service , in the other a service embedded within a very large healthcare system. Despite such organizational differences in clinical practice, however, many similarities emerged : both offer convenient times for families to promote accessibility, use similar clinical guidelines, interdisciplinary teams, one-way mirrors, and client outcome assessments. What makes the model unique , then, is the waywhere customers know it, how they access it, how the change is made and how the different professionals work to achieve it.

 

Angelica Giannetti
Psychologist,
Team Psychotherapist of the Italian Center
for Single Session Therapy

 

 

Bibliography

Brown, J., Dreis, S., & Nace, D. (1999). What really makes a difference in psychotherapy outcome: Why does managed care want to know? In MA Hubble, BL Duncan, & SD Miller (Eds.), The heart and soul of change: What works in therapy (pp. 389–406). Washington, DC: American Psychological Association.

Harper-Jaques S., Mcelheran, N., Slive A., Leahey, M. (2008). A Comparison Of Two Approaches To The Delivery Of Walk-In Single Session Mental Health Therapy. Journal of Systemic Therapies , pp. 40–53

 

Hubble, MA, Duncan, BL, & Miller, SD (Eds.). (1999). The heart and soul of change: What works in therapy. Washington , D.C.: American Psychological Association.

Lawson, A., McElheran, N., & Slive, A. (2006). Why clients return to a single session walk-in therapy service . Calgary, Alberta, Canada.

Wood’s Homes Eastside Family Centre. Macdonald, A. J. (2005). Brief therapy in adult psychiatry. Journal of Family Therapy , 27(1), 65–75.

Miller, J., & Slive, A. (2004). Breaking down the barriers to clinical service delivery: Walkin family therapy. Journal of Marital and Family Therapy , 30(1), 95–103.

Slive, A., McElheran, N., & Lawson, A. (2001). Family therapy in walk-in mental health clinics. In M. MacFarlane (Ed.), Family therapy and mental health: Innovations in theory and practice (pp. 261–285). New York: Haworth.

Slive, A., McElheran, N., & Lawson, A. (2008). How brief does it get? Walk-in single session therapy. Journal of Systemic Therapies , 27, 23–40.

Syverson, A. (2006). South Calgary Health Center new mental health service evaluation . Calgary, Alberta Canada: Calgary Health Region.

 

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