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Parachute NYC Model of Care





Need Adapted Treatment Model (NATM)
The Need Adapted Treatment Model (NATM) works according to the following seven main principles:
  1. The provision of immediate help: The teams arrange the first meeting within 24 hours of the first contact, made either by the person, a relative or a referral agency. The person in a psychotic crisis participates in the very first meeting during the crisis.


  2. A social network perspective: The person, their families, and other key members of the person’s social network are always invited to the first meetings to mobilize support for the person and the family. Other key members may other support systems, such as the local employment agencies to support vocational rehabilitation, fellow workers or, neighbors and friends.


  3. Flexibility and mobility: These are guaranteed by adapting the therapeutic response to the specific and changing needs of each individual, using the therapeutic methods which best suit each person. During the crisis phase no exact treatment plans for the future are constructed. When the crisis starts to resolve the forms of treatment and therapeutic methods are chosen that best fit the person's problems and situation. The meetings are organized at the person’s home, with the consent and/or support of the family whenever possible.


  4. Responsibility: Whoever among the staff is first contacted becomes responsible for organizing the first meeting, in which decisions about treatment are made. The team then takes charge of the entire treatment process.


  5. Continuity: The team is responsible for the treatment for as long as it takes in any setting. Members of the individual's social network are invited to participate in the meetings throughout the treatment process (in our case upon referral to an outpatient clinic after completing 1 year with the mobile team).


  6. Tolerance of uncertainty: Building a relationship in which all parties can feel safe enough in the joint process strengthens this principle. During psychotic crises, having the possibility for meeting every day during the first 10 – 12 days may help to generate an adequate sense of security. After this the meetings are organized regularly according to the person and family needs and desires. Usually no detailed therapeutic contract is made in the crisis phase, but instead, it is discussed as a routine part of every meeting whether and, if so, when the next meeting will take place. Meetings are conducted so as to avoid premature conclusions or decisions about treatment. For instance, neuroleptic medication is not introduced in the first meeting; instead, its advisability should be discussed in at least three meetings before implementation. Tolerance of uncertainty is embraced in network meetings. Using this approach, network members are encouraged to avoid making set assumptions and premature decisions. Instead, they engage in dialogue from a position of not knowing so that they may fully explore the meaning of personal experiences.


  7. Dialogism: The focus is primarily on promoting dialogue, and secondarily on promoting change in the individual or in the family. The dialogical conversation is seen as a forum where families and participants have the opportunity to increase their sense of agency in their own lives by discussing their difficulties and problems.


► Find more resources at the
Center to Study Recovery in Social Contexts

Intentional Peer Support
Intentional Peer Support (IPS) is a way of thinking about and intentionally inviting powerfully transformative relationships among peers. Participants learn to use relationships to see things from new angles, develop greater awareness of personal and relational patterns, and to support and challenge each other as we try new things. At the end of the day, it is really about building stronger, healthier, inter-connected communities. IPS is different from traditional service relationships because:
  • It doesn’t start with the assumption of “a problem.” Instead, we learn to listen for how and why each of us has learned to make sense of our experiences --and then use the relationship to create new ways of seeing, thinking and doing.


  • IPS promotes a ‘trauma-informed’ way of relating--instead of asking ‘what’s wrong,’ we learn to ask ‘what happened?’


  • IPS looks beyond the mere notion of individual responsibility for change and examines our lives in the context of mutually accountable relationships and communities.


  • IPS relationships are viewed as partnerships that invite and inspire both parties to learn and grow--rather than as one person needing to ‘help’ another.


  • Instead of a focus on what we need to stop or avoid doing, we find encouragement to increasingly live and move into what and where we want to be.

► Learn more about Intentional Peer Support

Evaluation
Nathan S. Kline Institute for Psychiatric Research (NKI) will assist NYC DOHMH in evaluating the implementation of Parachute NYC and document how service recipients accessed services and perceived their experience and health status.

► Learn more about the evaluation process

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