How can Single Session Therapy be integrated into an institution that provides mental health services for children, adolescents and families?
Continuing the path of discovery of the different contexts in the world in which the logic of the walk-in is applied in integration with the Single Session Therapy, in this article we will focus on a particular service present in Ontario, the Reach Out Center for Kids (ROCK ), whose characteristics and type of experience are very interesting with respect to the objective we have dealt with so far, namely that of rethinking the way of conceiving psychological intervention and the management of mental health services.
For those who have just come across this article, we remind you that walk-in services are (health) services with direct access, that is, without an appointment. For further information, you can read two articles on the subject published a few weeks ago (see here and here).
But let’s get back to us and discover the peculiarities of ROCK and the effectiveness of its service.
What is ROCK and what does it do
The Reach Out Center for Kids (ROCK) has been a mental health service in Ontario (Canada) since 1974. The service provides a multidisciplinary approach to the assessment and treatment of children, adolescents and families for the assessment and care of children. children (CATC), which in 2002 was merged with Halton Adolescent Support Services (HASS), forming what in 2006 was renamed ROCK (Reach Out Center for Kids).
The interesting aspect is that the ROCK has been opening the doors of its clinical services for more than 8 years, allocating one day of the week to the walk-in clinic with the aim of offering people the opportunity of immediate access to Single Session Therapy service, at the very moment they feel the need. In this way, the clinics have also become an access point for the other psychology services (eg, individual or group psychotherapy, etc.) offered by the center.
The idea of including a walk-in clinic service
Previously, the agency proposed a more traditional method of accessing services which involved administering a telephone interview, after which a coordinator defined the need expressed by the people, placing them on a waiting list ordered according to need. This method could also involve a wait of about two years.
Currently, however, the agency, while maintaining the waiting list system, with the introduction of walk-in clinics has significantly reduced the time to the point that people no longer wait years before receiving the requested service, but only from 4 at 6 months.
What services are offered?
Currently, the clinics are present in five locations in Ontario (Oakville, Burlington, Milton, Georgetown, Acton) and offer different types of services, flanked by walk-in clinics. Families or individual members can go to clinics without an appointment to receive immediate treatment or access all of the centre’s other services.
The holistic approach of ROCK requires the presence of multidisciplinary staff (e.g. educators, occupational therapists, social workers, psychologists, Psych Associates, psychometrists) who are responsible for providing:
- services for children, young people and families
- services for babies and children up to 6 years
- residential services
- referral process (children, youth and families can be referred by parents, doctors, pediatricians, psychologists and other community agencies)
The philosophy of the ROCK walk-in clinic
Therapists who work in walk-in clinics, despite having a different set of training experiences (narrative therapy, solution-focused therapy, cognitive behavioral therapy, etc.), share many fundamental concepts about people, problems and how to intervene. respond to requests for help.
Listed below are some of these shared assumptions:
- people know when they need help;
- some people may use the single session when they want help;
- it is better to offer therapy when people are ready and ask for it rather than when waiting lists allow it;
- some people may benefit from a single session and may not need multiple sessions;
- everyone is different as are the problematic events and solutions;
- when people come for therapy it means that they are unable to solve a current problem because they are limited by the knowledge and understanding of their situations;
- people have the knowledge, skills and competences to discover and develop ways that can help them overcome current struggles.
Furthermore, the professionals of the Center strive to be attentive to people’s preferences and values, respecting their priorities. The main goal is to help them question their usual way of thinking and solving problems, making the most of even a single conversation (White, 2007).
They ask questions that create the opportunity to develop new ideas, knowledge and skills. Their focus is to identify people’s strengths, to help them regain resilience, to generate hope and facilitate learning (Rosenbaum, Hoyt & Talmon, 1990).
What results emerge from the research?
From 2008 to 2009, research was undertaken to evaluate the effectiveness of the ROCK walk-in service (Bhanot & Young, 2009), identifying to what extent the sessions achieved the desired objectives / results.
The research involved 409 clients welcomed by walk-in clinics in the period from October 2008 to April 2009 and was carried out by inviting clients (parents and children) to answer a series of general questions administered in the form of questionnaires, in four specific phases the intervention process (pre-session, pre-test before seeing the therapist, post-test at the end of the session, follow-up two months after the intervention).
The results suggest that a walk-in session produces a number of desired outcomes. In particular, the customers after a session are significantly:
1) less worried;
2) more competent as parents;
3) more confident in their ability to solve / manage the problem;
4) more aware of the available resources;
5) have more ideas on how to solve / manage their mental health problem.
What did clients learn during a SST session?
From the analysis of the answers to the open questions 8 different results emerged:
1) greater self-awareness;
2) awareness of the impact of the problem;
3) greater awareness of resources;
4) greater general knowledge of the nature of the problem;
5) better learning of general strategies that help address the problem;
6) knowledge of specific techniques to manage mental health problems;
7) better communication skills;
8) knowledge from parents that the children were willing to get help.
Conclusions
From what has emerged so far, therefore, we can conclude by saying that the advantages of using the walk-in logic in mental health services can be many and can mainly concern three fundamental aspects of the intervention:
- ease of access to services (and as needed!), making the welcome passage faster and without complex referral processes. This aspect, in addition to reducing some steps, allows to reach population groups with different needs;
- reduction of waiting lists, with consequent displacement of people from emergency hospital services to consultancy services, with the possible possibility of referral to specific treatments;
- possibility of receiving short treatments (often even of a single session), focused on skills and effective (Young, 2011).
Angelica Giannetti
Psychologist, Psychotherapist
Italian Center team
for Single Session Therapy
Bibliography
Bhanot, S. & Young, K. (2009). An evaluation of Reach Out Center for Kids walk-in clinic. Unpublished manuscript.
Slive, A. & Bobele, M. (2011). When One Hour is All You Have: Effective Therapy for Walk-in Clients. Phoenix, AZ: Zeig, Tucker & Theisen.
Slive, A., MacLaurin, B., Oakander, M., & Amundson, J. (1995). Walk-in single sessions: A new paradigm in clinical service delivery. Journal of Systemic Therapies, 14, 3-11.
Talmon, M. (1990). Single session therapy: Maximizing the effect of the first (and often only) therapeutic encounter. San Francisco: Jossey-Bass.
White, M. (2007). Maps of Narrative Practice. New York: W.W. Norton & Company.
Young, K. (2011). When All the time you have Is Now: Re‐ visiting practices and narrative therapy in a walk‐ in clinic. In Duvall, J. & Beres, L., Innovations in Narrative Therapy: Connecting Practice, Training, and Research (147 166). New York: W.W. Norton & Company.
Young, K. (2011). Narrative Practices at a Walk-in Therapy Clinic in Slive, A. & Bobele, M. (2011). When One Hour is All You Have: Effective Therapy for Walk-in Clients. Phoenix, AZ: Zeig, Tucker & Theisen.
Young, K., Dick, M., Herring, K., & Lee, J. (2008). From Waiting Lists to Walk-in: Stories from a Walk-in Therapy Clinic. Journal of Systemic Therapies, 27, 23-39.