Hi XXXXXXX

When you want to design a systems approach model for the treatment and prevention of addiction, you should consider the following principles and guidelines:

General principles for designing a systems approach model:

1)      This approach should be designed to view clients holistically as an integral part of the family, and as a part of an emotional and interactional system.
2)     This model should not only focus on the deficits and maladaptive behaviours of the persons in addiction alone, but also focus on the interpersonal familial dynamics, interactional patterns and the behaviours of the persons in addiction as well as their loved ones.


Guidelines for designing the systems approach model:

1)     Be individualized – because every family has a unique structure and dynamics.
2)     Consider clients within their system of relationships, including peers, family, community and others.
3)     Involve the family, as defined by the client – this will avoid counterproductive power struggles or imbalances.
4)     Have an explicit framework that directs practice and leads to demonstrable outcomes.
5)     Be strength-based and experiential, and focus on skill building. Rather than focussing on just the weaknesses in the client and the family system, it would be wiser to focus on the available strengths, so that they can be capitalized for therapy.
6)     Your program must be accessible and flexible. For example, the location of services, hours of operation, etc. should be considerate.
7)     Clinical staff should be knowledgeable and skilled in working with families on a number of levels including education, counselling, family work and family therapy.
8)     Staff training is an integral part of designing a new program. Staff should be adequately oriented and made aware of the principles and guidelines of the program. There should also be regular monitoring and periodic assessments.
9)     Clinical staff should be sensitive to cultural diversity and work to understand the diversity of the larger community.
10)     Special needs of clients, for example from broken families or with different cultural beliefs or sexual orientation, should be considered.
11)     Be transparent and clear with the clients. For example, ensure that clients are fully informed of choices, including their costs and benefits, the time and location of the services.
12)     Manage underlying tension among family members in a non-judgemental and unbiased way.
13)     Remember that though you are working with the family, still the client’s needs and choices should be given priority. So, treatment should honour the client’s rights and choices while actively facilitating growth and change in the family system.
14)     Confidentiality and disclosure issues are very common in this form of therapy. So, they have to be handled in a balanced and prudent manner. Especially with young clients, the scope of information-sharing with others (e.g., parents, child welfare, probation, school) is negotiated with the youth on an ongoing basis.
15)     Be creative and dynamic. There are times when new ideas or strategies may be required to handle special or difficult situation and you should be willing and open to change or modifications.


So, the first step in designing a successful and effective program is to set principles and specific guidelines.

The second step is to think about what the program is doing now to XXXXXXX each criterion or guideline.

The third step is to set out your plans to improve practice. For example what you plan to do differently to bring your practice in line with the guideline. The next time you review your practice, you can see whether you did what you said you were going to do, and identify the next steps required to continually improve practice.

The fourth step is to periodically evaluate and review your progress. You can have your own scoring system to evaluate different aspects of the program – for example client satisfaction, staff performance. etc. As part of quality assurance, the program should systematically seek feedback from clients and community organizations on its clinical practices and adherence to its framework.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Many mental health professionals refuse these days, to subscribe to the narrow and linear approaches stating that they hinder the holistic management of mental health problems. Especially when it comes to a complex problem like addiction, it is well known that these problems can have a multi-factorial etiology - with biological, psychological and social factors playing equally important roles in causation. Therefore, unless the approach to management is also multi-modal, individuals with such problems cannot be served well.

But at the same time, it is true that in a multi-component system, there would be a non-linear relationship between some of its components. This can lead to certain pitfalls or disadvantages in the system:
1) Lack of good co-ordination between the different components can result in the therapeutic goals becoming vague.
2) Too much of emphasis on one component or improper integration of the components can be counterproductive to therapy. For example, for an individual who is going through severe alcohol or drug withdrawal, or an individual with addiction and co-morbid medical problems, the majority of the focus in the initial stages of treatment should be medical management (to treat withdrawal symptoms and stabilize the person's medical condition). Premature and overenthusiastic psychotherapeutic interventions or psycho-social approaches may only lead to client dissatisfaction and disengagement from treatment.
3) Involvement of multiple professionals in therapy may hinder the formation of a stable therapeutic relationship.
4) XXXXXXX conflicts or differences of opinion between professionals among the diferent components may compromise the effectiveness of the services provided. For example, a professional who subscribes to the predominantly neuro-biological model of addictions may not be willing to give equal importance to psychosocial interventions.

But having mentioned the disadvantages, it is important not to forget that if there is proper co-ordination between the various components of this multi-modal approach and if properly integrated services are provided, then there is no doubt that the effectiveness of such an integrated approache will be far better than linear or mono-component approaches.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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