9. Implementation of Single Session Work at your service: A Guide for Managers

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Miranda Sanders
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9. Implementation of Single Session Work at your service: A Guide for Managers Ways of Implementing SSW The Review of Counselling Services in Community Health ' Discussion Paper (Victorian Department

Whilst the large majority of clients were seen for 1-5 consultations, some clients were seen many times over years.

Individual organisations will have their own specific workplace requirements, and SSW can be adapted to fit within those unique conditions or the needs of particular client groups.

If clients meet the criteria for the service, they are booked directly into an appointment time by the intake worker.

1 9. Implementation of Single Session Work at your service: A Guide for Managers Ways of Implementing SSW The Review of Counselling Services in Community Health ' Discussion Paper (Victorian Department of Human Services, 2002) found that counselling durations varied, but that 50% of all clients were seen for one or two sessions. Whilst the large majority of clients were seen for 1-5 consultations, some clients were seen many times over years. SSW provides a clinical approach and a service delivery model that is responsive to all of these contact data. There are numerous ways that SSW can be integrated into counselling services. Individual organisations will have their own specific workplace requirements, and SSW can be adapted to fit within those unique conditions or the needs of particular client groups. Some ways organisations have utilised the SSW approach include: As an initial intake point for all counselling and casework. If clients meet the criteria for the service, they are booked directly into an appointment time by the intake worker. The first appointment is a single session, where assessment functions are combined with therapeutic intervention. As a waiting list management tool. Offering people on the waiting list a single session can be an effective way of reducing waiting list numbers and /or providing a responsive 'holding' service for those on the list. A single session can also identify those people who may need prioritisation due to safety or abuse issues. To target a particular client group or clients who may be difficult to engage. People who may not generally utilise counselling services, e.g. people suspicious of health and welfare services, have been engaged successfully through a single session approach. Some Child and Adolescent Mental Health Services have also used SSW as an effective way to involve families in the treatment of children. Rural services have used SSW to manage the constraints of large distances. To combine services for a client in one session, such as counselling with nursing. As a model for clients who irregularly attend sessions. Rather than regarding intermittent attendees as 'resistant' or unreliable, a SSW approach focuses on maximising the contacts that do occur. As a one-off secondary consultation for counsellors involved in ongoing work with clients. This can be an effective way for workers to receive 'live' feedback about their work with a client or obtain a fresh perspective when their longer-term work feels 'stuck'. Management Concerns in Implementing SSW There are always management issues and concerns when considering a change in service provision. Key steps include seeking information about the opportunities and pitfalls of the new model, articulating a strategy to move forward and monitoring the process of implementation. Ultimately, clients 'vote with their feet', deciding themselves how many sessions they will attend. SSW capitalises on the fact that half or more clients attend only once or twice by treating each contact as if it may be the last, while laying the foundation for ongoing work if required. This

2 approach satisfies the ethical imperative of providing the best possible service for all people, whether they attend one, two or twenty sessions. SSW can help a counselling program to accommodate a range of contact types, from one session to 100+ sessions spread over a number of years. Rather than making an arbitrary decision about what is an optimal number of sessions for everyone ('one-size-fits-all') and imposing a limit on counselling contact, a SSW approach allows for more overt and collaborative decisions about how much contact is required. A single session framework emphasises that all treatment options are available to clients at followup. Therefore, neither client nor counsellor need to feel that they have failed if more sessions are required or that there has been a failure of engagement if further sessions are not scheduled. A single session approach creates a context for both workers and clients to make the most of every encounter. Resource Implications and recommendations Like any new initiative, implementing SSW requires planning and discussion. How this is achieved will depend on the particular circumstances that influence an organisation. Some centres have found it useful to set up a small working group to consider how SSW will be implemented, while others have used existing management. Recommendation: a key person in the agency be given the portfolio responsibility to oversee the functioning of SSW. Including intake workers in SSW training and discussions about implementation can be the determining factor in whether a single session service is established or not. Recommendation: managers and counsellors use the support materials in this Parcel (particularly the flow charts and the DVD) in the engagement and training of intake staff. Formal guidelines or procedures can be a useful way to support staff who are conducting SSW and also to ensure suitable standards of practice. Formal documentation is a practical way of making SSW fit within the structure of an organisation and helps make SSW sustainable. Recommendation: your agency uses or amends the proformas in this package. Hard copies are in the Appendices and electronic copies are on the CD. An example of completed forms can be found in the User's Guide of the 'SSW Action Pack'. Follow-up support for clients is an essential part of providing an ethical SSW service. The follow-up phone call is an important part of the SSW process, and organisations may need to consider how to support staff administratively to fulfill this function. Recommendation: follow-up phone calls be considered legitimate clinical contacts and records be kept of what further service options SSW clients choose.

3 Service Impact There are potentially a number of service implications as a result of introducing SSW, contingent, in part, on how your organisation utilises SSW. SSW may substantially reduce waiting lists, but demand may also increase for counselling spots. A specific number of SSW sessions may need to be allocated for each counsellor - so workers are not overloaded. If SSW is used at the intake stage, training and support need to be given to intake staff as the first point of client contact. Clear instructions on what information to convey to the client will be necessary. You will need to educate professionals that refer to your service about the process of SSW. Workers may require some extra administrative time initially while they become familiar with new SSW processes. Agencies using SSW report that it provides a more responsive and flexible service. There is greater client throughput while freeing up valuable counselling resources for long-term work with clients who require that response. Ramifications for Counselling Practices SSW may change the way your agency or workers view service provision. It can be timely to review other counselling practices or guidelines. SSW embraces the philosophy that counselling should be a transparent process which values clientcentred decision making. SSW may challenge existing beliefs about counselling and the role of the counsellor in client change. Processes that complement a single session approach may include: Regular and structured reviews of medium-term and long-term work Increased mechanisms to check in with clients Setting objectives for each session More active or structured client follow-up Closure summaries involving collaboration between client and worker. Staff Orientation and Sustainability Although SSW may be initially embraced in your workplace, it is important to consider how it can be maintained in the long term. If clear procedures and guidelines are not established, people may revert to former practices over time. A number of strategies may help sustain a SSW approach: Written guidelines and / or policy documents outlining the organisation's commitment and expectations of staff Orientation about SSW processes for new staff and the ability to co-work with experienced SSW practitioners as part of their orientation Training options provided from an internal or external source Opportunities for peer supervision and ongoing development of SSW Opportunities for co-work Mixed case-loads of single sessions and ongoing work.

4 The recommendation that a key staff member have the responsibility to oversee SSW in your agency is critical for sustainability of a SSW service. This person can help organise meetings to discuss implementation; maintain and update written resources; co-ordinate professional development; and, communicate broader issues affecting SSW to the relevant manager or forum. Service Evaluation There are two parts to SSW evaluation: session feedback and service development. Both are important. Because the SSW clinical process incorporates both Pre- and Post-SSW Client Questionnaires, the counsellor receives immediate and direct feedback about the client's goals and progress and the usefulness of the session. This creates the foundation for building an ongoing evaluation framework for counselling services. The following list describes clinical and service evaluation tools: The 'essential' evaluation tools are a part of the SSW process to ensure clients are provided with ethical counselling care. The 'advisable' tools add to the feedback from clients and assist in service development. Each tool is also marked 'clinical' (ø) or 'service' ( ) evaluation to indicate its primary usage. ESSENTIAL ø Pre-SSW Client Questionnaire Sent out prior to session, usually at intake Encourages client to focus on goals for session Informs worker what the client wants from the session and details specific questions the client wants addressed. ø Post-SSW Client Questionnaire Completed by worker during follow-up phone call Provides a formal and consistent record of progress Can be used to measure change from the Pre-SSW Client Questionnaire ADVISABLE ø 'Take Aways' (can be customised for your service and purchased at Bouverie) Offered to client at the end of each session Can be used to record what was useful from the session to inform the worker and to act as a reminder for the client of things to try out Can also be used to prescribe tasks, homework, strategies - such as '2 weeks guilt-free living' SSW Evaluation Form (client satisfaction survey) Sent out by the worker after the follow-up phone call, completed by client and returned to a third party, such as the team leader, for collation Used to monitor & improve overall SSW service

5 SSW Worker Questionnaire Completed by workers and sent to person with SSW portfolio responsibility Used to monitor and address any worker issues around SSW Informs ongoing service improvement and development Summary of Key Considerations for Managers Deciding on the type of SSW implementation for the agency (e.g. waiting list management tool) Nominating a staff member with portfolio responsibility for the co-ordination of SSW implementation Deciding how SSW will fit with policies and procedures (i.e. the overall client service framework of the agency) Organising training and support for intake workers Ensuring clear procedures to link intake with service provision Deciding on how workers will be supported to implement SSW, if it is a new form of service delivery Putting in place supports to sustain SSW in the longer term Determining evaluation procedures. Implementation Strategy The steps below can guide an ongoing implementation strategy for SSW. Research and develop SSW Organise staff to complete SSW Levels 1 & 2 training. Consult other services further into implementation. Determine how to utilise SSW in your service. Distribute SSW articles and resources Articulate an implementation strategy Form a SSW task group and/or nominate a person with SSW portfolio responsibilities. Develop a staged process with timelines and review processes. Use knowledge from each review process to inform ongoing process. Establish an evaluation process to monitor impact on service Collect pre- & post- data on waiting list, contacts, throughput, average session numbers. Use client satisfaction surveys to gain feedback about whole SSW service. Create worker questionnaires, disseminated and returned to the SSW project co-ordinator or team leader, to inform management of SSW workers' support needs. Plan for sustainability Embed SSW within the core structures of the agency. Establish peer support. Collaborate with other services conducting SSW. Budget for some co-work.

6 Balance case-loads between single sessions and ongoing work. Provide professional development opportunities to expand thinking about SSW. Organise orientation to SSW for new staff. Research and develop (i.e. process is repeated).

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