Matrix Model Webinar PPT FINAL - Children and Family …. Matrix Model Webinar...Relapse Prevention Groups • Primary group in the treatment model ... experience using the model and

10/19/2014

1

TEXT PAGE

Welcome

Thank you for joining us today. The webinar will begin in a few moments.

• If you haven’t dialed into the audio (telephone) portion, please do so now:

1 (866) 952-8437Access Code: 182-245-282

• If you are experiencing technical problems with the GoToWebinar(visual) program, contact the GoToWebinar help desk:

1 (800) 263-6317Webinar ID: 921226368

TEXT PAGE

How Do I Ask Questions?

Type and send your questions through the Question and Answer log located on the bottom half on your panel/dashboard.

Today’s presentation and handouts are available for download at http://www.cffutures.com/webinars

10/19/2014

2

Practical Issues in the Implementation of the

Matrix Model

2 5 3 7 1 C o m m e r c e n t r e D r i v e , S u i t e 1 4 0L a k e F o r e s t , C A 9 2 6 3 0

7 1 4 - 5 0 5 - 3 5 2 5n c s a c w @ c f f u t u r e s . o r g

w w w . n c s a c w . s a m h s a . g o v

Jeanne Obert, LMFT, MSM

Co-Founder and Board Chair

Matrix Institute on AddictionsOctober 22, 2014

A Program of the

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatmentand the

Administration on Children, Youth and FamiliesChildren’s Bureau

Office on Child Abuse and Neglect

10/19/2014

3

Agenda

• Implementation of the Matrix Model– Review of Sessions

– Adaptations

– Implementation Drivers and Challenges

• Measuring the Fidelity of the Matrix Model

• Measuring the Impact and Outcomes of the Matrix Model

Our Speaker

This webinar features Jeanne L. Obert, LMFT, MSM. Ms. Obert is a founder, past Executive Director and present Chairperson of the Board of Matrix Institute, a nonprofit corporation that delivers outpatient treatment and mental health services in the Los Angeles, CA area. She has worked to create a system designed to disseminate the Model with fidelity nationally and internationally.

10/19/2014

4

Implementation of the Matrix Model




Outpatient Treatment Recommendations

Empirically-Supported and Recommended by NIDA*• Multiple Weekly Sessions for at least 120 days

• 3 visits per week minimum, recommended

• Family involvement important

• 12-step facilitation and participation valuable

• Drug and breath alcohol testing needed

• Medications of value with some clients

* Principles of Drug Addiction Treatment: A Research-Based Guide, Second Edition, 2009

10/19/2014

5

NIDA’s Behavioral Treatmentswith Evidence Base

• Cognitive/Behavioral Therapy-CBT

• Contingency Management-CM

• Motivational Interviewing-MI

• Matrix Model of Outpatient Treatment

TEXT PAGE

Polling Question 1

At what stage of implementation is your site related to the Matrix Model?

• Exploration: Information gathering

• Installation: Resource acquirement

• Initial Implementation

• Full Implementation

• Unsure

10/19/2014

6

Treatment Components of the Matrix Model

• Individual Sessions

• Early Recovery Groups

• Relapse Prevention Groups

• Family Education Group

• 12-Step Meetings

• Social Support Groups

• Relapse Analysis

• Drug Testing

Polling Question 2

Currently, what is the most frequently identified primary substance at intake at your agency or treatment center?

• Prescription Pain Medication

• Heroin

• Methamphetamine

• Alcohol

• Other

10/19/2014

7

Comparison of CSAT and Hazelden Manuals

CSAT Manual

• 3 Individual/Conjoint Sessions

• Download form only

• Deals specifically with Stimulants

• Can download recently developed DVDs with commentary by Matrix clients

• Is in the public domain so can be translated and adapted

Hazelden Manual

• 10 Individual/Conjoint Sessions

• Hard copy can be purchased

• Language broadened to include all drugs and alcohol

• Includes 3 videos of core Family Education Group topics

• Is under copyright and not in public domain

13

Individual Sessions

• More individual sessions in Hazelden manual than CSAT manual

• Important in cultures where individuation is not a primary goal (Thailand, Vietnam, China, Korea, Spain, Mexico, etc.)

• Also important in the Teen manual.

• Necessary in any situation where family member is paying for treatment.

10/19/2014

8

Early Recovery Groups

• Originally done in individual sessions on Friday nights

• Generally conducted twice a week for the first month of treatment

• Need to be small to accommodate individual scheduling and basic concept development

• Can be co-lead by clients who are later in recovery and doing well

• May be limited to one hour with a break before relapse prevention

• Can be used to stabilize relapsing patients who are later in treatment

Relapse Prevention Groups

• Primary group in the treatment model

• Last for 2 to 4 months - manuals have content for four months

• Co-led by patients who have completed treatment and are actively maintaining their recovery

• Information in topics covered every session as well as individualized problem-solving and support

• When working with parents involved in the child welfare system, it is important to include safety planning as part of a relapse plan.

10/19/2014

9

Family Education Groups

• Some programs have called these groups simply Education Groups to increase attendance.

• Great to have families attend but important for patients whether their families attend or not.

• The three lectures that are critical to understanding the entire Model of treatment are:

• Triggers and Cravings, Roadmap for Recovery, and Families in Recovery

• CSAT has great DVD’s with these lectures and patient comments

• The rest of the sessions (16 in all) can be devoted to general drug and alcohol education, communication training, and cultural issues in treatment. Panel discussions are very popular.

12-Step Meetings

• Not always available in all cultures and counties – other spiritual additions to treatment may be substituted.

• When available, is ideal to provide meetings on site and run by Matrix graduates

• On site meetings can be called “An Introduction to 12-Step”

• Allows people to then move more comfortably to outside meetings

10/19/2014

10

Social Support Groups

• Ideally lead by graduates of the program with some supervision from clinical staff

• Usually graduated patients can come in and out of these meetings on an “as needed” basis

• This serves as an unofficial “alumni support group” for patients

• When working with parents involved in the child welfare system, it is helpful to use graduate parents in recovery who have also had experience with the child welfare system.

Relapse Analysis

• Was developed to help clinical staff assess why continued relapses were happening to people who had a period of sobriety and then relapsed on a regular periodic basis

• Should serve as an individual session when indicated

• Not appropriate for people who are initially unable to stop using (they need Early Recovery groups)

10/19/2014

11

Drug Testing

• Both urine testing and breath-alcohol testing need to be part of the program

• Testing should be done weekly on a random schedule and positive results require increased structure in program

• Testing is done for clinical reasons (see Therapist Guide) rather than punitive.

• Is not a substitute for forensic testing

Manualized Adaptations of the Matrix Model

• Native American Supplement - Created with input from Friendship House in San Francisco

• Spanish Manual - Created with CSAT and with Hazelden

• Women’s Supplement - Created with CSAT

• Teen Manual - Created with Hazelden Publications

• Criminal Justice Manual - New from Hazelden

• Medication Assisted Treatment Section of Core Manual - New from Hazelden

10/19/2014

12

Cultures/Countries that have used the Matrix Model

• Thai (Buddhist and Muslim)

• Spanish (Spain, Mexico)

• South Africa (Black, Colored and White)

• Native American, Alaskan Native, Hawaiian Native and First Nations

• Israeli

• Palestinian

• Portuguese (Brazil)

• Swiss

• Slovakian

• Turkish

• Egyptian

• Chinese

• Japanese

• Vietnamese

• Guam

Polling Question 3

What are the most significant challenges you experience or anticipate with implementation of the Matrix Model?

• Receiving referrals from Child Welfare

• Engaging participants in the program

• Retaining participants (i.e. lower than expected completion rates)

• Maintaining trained staff to deliver the model

• Other

10/19/2014

13

Implementation Drivers

Trainers and Key Supervisors are Central to Matrix Model Dissemination

• Trainers and Key Supervisors serve very different functions and have very different qualifications

• Qualities that make a great trainer are not the same as those that make a good supervisor and change agent

Implementation Driver: Training

Matrix Trainers

• Matrix trainers are people who have extensive experience using the model and adapting it to various populations and situations.

• They are people who have excellent training skills and extensive training experience

• We do not employ a train-the-trainer model for delivering training but use select trainers who we update regularly with materials

10/19/2014

14

Implementation Driver: Supervision

Matrix Key Supervisors• Key supervisors are the onsite clinical people who

supervise staff delivering the model.– Typically weekly for everyone in either a group or individual.

– New therapists more frequently – tapering down to above

– Either taping or live supervision important at beginning where possible

• They are responsible for assuring fidelity to the model.

• No program can be certified without a Key Supervisor on staff

• Key supervisors also have the responsibility for training new staff at their site.

Characteristics of an Ideal Key Supervisor

• Respected clinical leader who is both credible to clinicians and savvy about organizational dynamics

• Possess excellent communication and clinical skills

• Is committed to actively working to implement the Matrix Model with fidelity and good results

• Able to explain rationale for strategies and interventions

• Able to demonstrate and instruct on delivery of the Matrix Model using Motivational Interviewing techniques

• Employs Motivational Interviewing during the course of supervision

10/19/2014

15

Polling Question 4

Do you have someone supervising your Matrix Model clinical staff?

• Not currently implementing the Matrix Model

• No active supervisor

• Supervisor who was not trained in the Matrix Model

• Supervisor who was trained in the Matrix Model

• Key Supervisor who attended a training conducted by a Matrix trainer

Stages of Becoming a Good

Matrix CounselorBeginning Stage

Goals

• Interest in or knowledge of evidence-based principles of addiction

• Ability to relate to persons with substance use disorders with empathy

• Respect for client rights to make choices

• Able to establish collaborative relationship with clients

10/19/2014

16

Stages of Becoming a Good

Matrix CounselorIntermediate Stage

Goals

• Familiarity with topics (16 - 32 weeks)

• Familiarity with cognitive-behavioral principles and interventions

• Familiarity with addiction and family dynamics

• Less resistant to change

• Avoids returning to familiar ineffective therapeutic styles when feeling stuck, confused or overwhelmed

• Less talkative

• Able to direct group so that all participants have a chance to elaborate on questions of topic

Matrix Model Master Therapist

• Able to assume a non-judgmental, non-confrontational, client-centered style

• Has assimilated Matrix concepts and interventions

• Able to insert references to topics when appropriate

• Able to manage flow of participation in allotted time

10/19/2014

17

Matrix Model Master Therapist

• Manage group dynamics and topic oriented format

• Appropriate use of self and co-leader

• Accurate use of material and effective feedback from client to verify comprehension and integration

• Able to move the group together through the process of change using the topic to guide the experience.

• Manage group dynamics and topic oriented format

• Appropriate use of self and co-leader

• Accurate use of material and effective feedback from client to verify comprehension and integration

• Able to move the group together through the process of change using the topic to guide the experience.

Therapist Competency

Experience Description

First 6 months – Beginner Requires much support, guidance, structure, modelling, practice& feedback with regards to the model

6-12 months - Beginner Intermediate Confident of skills but occasionally overwhelmed by complexity/difficulty of AOD work; supervision may focus on feelings & coping with impediments

1-2 Years - Intermediate Assured in Matrix skills; supervision largely an exploratory exchange of ideas for further development

2 Years + - Master Functions autonomously and knows his/her limits; will largely set the supervision agenda to increase self-reflective practice

10/19/2014

18

Measuring the Fidelity of the Matrix Model




Fidelity Monitoring

• Matrix Model Certification Process

• Structural Elements

• Minute by Minute Elements

10/19/2014

19

Fidelity Monitoring: Certification

Matrix Model Certification Process

The Matrix Model Certification process is designed to identify those treatment programs that are implementing the Model with fidelity.

Fidelity Monitoring: Group Sessions

Fidelity Worksheet – Structural Elements

10/19/2014

20


Fidelity Worksheet – Structural Elements – Page 2


Fidelity Worksheet – Minute by Minute Elements for the Relapse Prevention and Early Recovery Groups

10/19/2014

21

Fidelity Monitoring

Fidelity Worksheet – Minute by Minute Elements – Page 2

Polling Question 5

Is your agency currently using these fidelity monitoring tools?

• Yes

• No

• Using other fidelity monitoring tools

• Not currently implementing Matrix Model

10/19/2014

22

Measuring the Impact and Outcomes of the Matrix Model




Research Study – 2004

Matrix Model vs Treatment As Usual -Rawson et al., 2004, Addiction

• 978 Methamphetamine users seeking treatment

• CSAT multi-site study; 1998-2002

– Costa Mesa; San Diego; Hayward; Concord; San Mateo; Billings; Honolulu

• Matrix Model vs Treatment as Usual

• Random assignment

© 2010 Matrix Institute

10/19/2014

23

8.2

5

0

2

4

6

8

10

Treatment Setting

Weeks in Treatment

Matrix Treatment as Usual

Research Study – Findings

6

3

0

1

2

3

4

5

6

7

Treatment Setting

Weeks of Continuous Abstinence

Matrix Treatment as Usual

Research Study – Findings

10/19/2014

24

Studies

The Matrix Model of Intensive Outpatient Treatment: A guideline developed for the Behavioral Health Recovery Management project • Richard A. Rawson, UCLA Integrated Substance Abuse

Programs

• Michael J. McCann, The Matrix Institute on Addictions

Questions and Discussion

4 9 4 0 I r v i n e B l v d . , S u i t e 2 0 2I r v i n e , C A 9 2 6 2 0



10/19/2014

25

General Information for the Matrix Model

Further information about Matrix is available at the Matrix Institute website - www.matrixinstitute.org

Training information is on the website or you can contact the Matrix Institute Director of Training:

Ahndrea Weiner

(877) 422-2353

[email protected]

National Center for Substance Abuse and Child Welfare

(NCSACW)

http://www.ncsacw.samhsa.gov/

Contact Information

50

FOR RESOURCES andMATERIALS FROM THIS WEBINAR

Please visit our website:

http://www.cffutures.org/

For questions specific to this webinar please contact:

Marianna CoronaResearch Associate

Children and Family [email protected]

Matrix Model Webinar PPT FINAL - Children and Family …. Matrix Model Webinar...Relapse Prevention Groups • Primary group in the treatment model ... experience using the model and

Documents