Transcript MODULE 5: TRANSITIONING THROUGH CHANGE

MODULE 5:
EMERGING PRACTICES
SUPPORTING THE VISION
Preparing the Workforce
Employing Consumers and Family Members
As Employees in the Mental Health Workforce
Working Well Together
Welcome
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Tools For the Vision :
Making the Vision Come Alive
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Change
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Quote:
Change your thoughts and you change
your world.
- Norman Vincent Peale
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Learning Objectives
• Identify what
emerging practices will
support the vision
• Find resources for
emerging practices
• Know how to balance
the impact of change
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Methods
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Methods for Moving Forward
Step #1:
WHY are we making this change?
 Why are we planning to hire and work with
consumers and their families?
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Methods for Moving Forward
Step #2:
WHAT will this look like?
 What will the staff, the agency, the community
look like once we attain our vision?
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Methods for Moving Forward
Step #3:
 WHEN will I know what to do?
 What are the next steps needed to move
towards the new vision? Who will inform me?
Where will I learn about what to do?
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Methods for Moving Forward
Step #4:
 WHAT WILL I BECOME?
 What is my new role? What new skills will I need to
have? What do I need to know to be able to work
side-by-side with consumers and families?
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The
Elements to
Address
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Mitigating Factors
Some Solutions
 Trauma
Trauma-Informed, Peer Support Services
 Substance Use Challenges
Harm-reduction
strategies, Stages of change, Motivational
Interviewing, integrated co-occurring treatment
 Diverse, multicultural, beliefs
Outreach, Employ
consumer/family from diverse communities
 Overburdened System
Mindfulness & Self-care,
WRAP, WRAP at Work, NAMI & UACF Education
Classes, Consumer and Family Employees
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What is Trauma & Who has It?
• DSM IV-TR:
– Personal experience or learning of an event that
involves actual threatened death or serious injury to
oneself or another person and
– the response to the event must involve intense fear,
helplessness or horror (for children, disorganized or
agitated behavior.
• 90% of public mental health clients have been
exposed to (and most have actually experienced
multiple experiences) of trauma
» (Goodman, Rosenburg et al., 1997; Mueser et al.,
1998)
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Effects of Trauma
• Nervous System Brain chemistry changes
• Adverse Childhood Experiences (ACE) Study
– 10 Questions of 17,000 HMO members childhood
– 2/3 had at least score of one ACE
– More than 1 in 5 reported score of more than 3 ACE
• The higher the score the higher risk of illness
– Person with score of 4 or more had 12x more likely to
attempt suicide & 10x more likely to have used IV drugs
• Let’s self-score ourselves. See 10 questions on handout.
• More information at:
http://www.cdc.gov/ace/index.htm
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Trauma-Informed Care
• Elements
– Foster trust, Choice, Collaboration, empowerment
– Take trauma into account
– Avoid triggering trauma reactions
– Create a safe environment, physically and emotionally
» Stephanie Covington, 2008
• http://trauma-informed-california.org/home.html
• US Center for Mental Health Services(CMHS) National
Center Trauma Informed Care
– http://www.samhsa.gov/nctic/
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Trauma-Informed Self Care
• “Mindfulness” exercises
» Shapiro, S. & Carlson, L., The Art and Science of Mindfulness:
Integrating Mindfulness Into Psychology and the Helping Professions.
(2009) Pub. by American Psychological Association, Washington, D.C.
• "Trauma Stewardship” describes the circle of Trauma
Exposure Response and how professionals are impacted
• "Following the Five Directions” exercises to help
practitioners gain a better understanding of themselves:
–
–
–
–
–
North: creating space for inquiry
East: choosing our focus
South: building compassion and community
West: Finding balance
The Fifth Direction: a daily practice of centering ourselves
» Trauma Stewardship: An Everyday Guide to Caring for Self While
Caring for Others" van Dernoot Lipsky and Burk (2009)
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While You are on the Job…
Offer a friendly greeting to others as
you arrive
Relaxation and stress reduction
techniques: deep breathing
Take a 30 minute lunch break away
from the office
Take a short walk during my 15 minute
breaks
Use visual images that help you to focus
on relaxation and wellness in the
workplace
Prevalence of Co-occurring D/O
• Adults who use drugs are more than twice as
likely to have severe mental illness (SMI) as
adults who do not use drugs
• Conversely, people with SMI have a much
higher risk of developing substance use
disorder (SUD) (www.samhsa.gov, 2005)
• Lifetime prevalence of SUD in people with
SMI is reported to be 40-60%. (Mueser, Noordsy, Drake
and Fox, 2003)
Treatment of Co-occuring Challenges
• Expect co-occurring mental health &
substance use challenges
• Integrate mental health and substance abuse
treatments
• Use individualized Stages of Change and
Motivational Interviewing strategies to help
people into recovery
• Strengths-based model
• Harm Reduction in housing services too
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Stages of Change
http://www.utexas.edu/research/cswr/nida/rdpConceptModel.html
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Harm-Reduction & Practices
• Various strategies for reducing physical and social harms
associated with risk-taking behavior
• Harm reduction is about
– preventing disease, death, incarceration and isolation.
– improving and saving lives.
– making dangerous behaviors less dangerous.
» http://sexworkerswithoutborders.org/101s/harmreduction-101/harm-reduction-definition/
– Meeting people at their stage of change
• Examples: Nicotine Patches and Gum, Needle exchange
programs, methadone, admission into programs though
person may still be using drugs, use of condoms
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Outreach to Diverse Communities
• Outreach into communities, no expectation
community will come to us
• Develop relationships, working to address
specific, broader challenges within community,
let them decide how
• Value of Faith-based organizations
• Important to understand that traditional healing
practices, in addition to or instead of
contemporary mental health practices, may be
important to some persons with mental
illnesses.
-SAMSHA, 2004
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Wellness Recovery Action Plan
by Mary Ellen Copeland
An unique action plan developed by individuals to
maintain wellness
•Wellness Toolbox
•Daily Maintenance Plan
•Identifying Triggers & an Action Plan
•Identifying Early Warning Signs & an Action Plan
•Crisis Plan
•Post-crisis plan
Plan for Self-Care:
Daily Maintenance
SelfCare
SelfKnowledge
Support
WRAP Basics
• Writing a plan must be done entirely by the
individual who plans to use it
• Feedback and encouragement can be helpful. Note:
Supporters need to avoid telling people what to
write in their plan.
• It is essential that writing a WRAP is done at the
individual’s own pace and in their own style.
• WRAP is a structure that allows for individual
creativity and personal self-expression.
WRAP Works at Work!
• Creates an environment that invites people to step into
personal responsibility.
• Empowers people who experiences symptoms to make
choices and discover what works best for each individual.
• Encourages open communication with co-workers and
supporters. Creates the opportunity for people who
experience symptoms and their supporters to better
understand each other.
• Using and sharing WRAP allows people who experience
symptoms to play leadership roles in their community by
teaching, modeling and promoting mental health
recovery
NAMI’s Education
• Peer to Peer
• Family to Family
– Instructors: family members, consumers,
professionals
– 3 Stage Process
• Stage One: Dealing with the Catastrophic Event
• Stage Two: Learning to Cope
• Stage Three: Moving into Advocacy
• Mental Health Provider training
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United Advocates for Children &
Families--UACF
• 12 Week Training:
– Educate, Equip & Support (EES): Building
Hope
• Navigation of services
• Partnership between family members and
treatment providers
• EES Certification Training
• Train the Trainer
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Consumer/Family Employment
A Full Range of Roles





Trainers for new and existing workforce
Staff in the full range of capacities:
 Direct service
 Outreach & engagement
 Management
 Policy & Planning
 Research
 Evaluation
Advisory Groups as the Primary Stakeholders
Operating Self-Help Organizations
Leaders and role models in the Community
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Hiring Consumers:
Key Issues
 Livable Wages
 Benefits Counseling and Transition Supports
 Career Ladders: opportunities for
advancement
 Access and support in both peer positions
and non-designated positions
 Flexible scheduling and other reasonable
accommodations
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Ongoing Supports



Workplace Supports
 Mentoring
 Proactive Supervision/Evaluation
 Culture that encourages work/life balance
 Access to ongoing training
 Opportunities for advancement
Community Supports:
 Peer Provider Support Networks
 WRAP/Recovery and other peer support
Personal Supports
 Friendships
 Exercise
 Nutrition
 Spiritual community
 Relaxation
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The New
Beginning
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Staff Transformation
• Looking Inward and Rebuilding the Passion
• Building Inspiration and Belief in Recovery
• Changing from Treating Illnesses to Helping People with Illnesses
Have Better Lives
• Moving from Care-taking to Empowering, Sharing Power &Control
• Gaining Comfort with Co-Staff with Mental Illness & Multiple Roles
• Valuing the Subjective Experience
• Creating Therapeutic Relationships
• Lowering Emotional Walls & Becoming a Guiding Partner
• Understanding the Process of Recovery
• Becoming Involved in the Community
• Reaching Out to the Rejected
• Living Recovery Values
–
California Association of Social Rehabilitation Agencies. Developing Systems and Services that Support People In Wellness and
Recovery. (2007) Pub. by California Institute of Mental Health, Sacramento, CA
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Wellness Activities in Workplace
• Resilience-Building Activities Against Stress
– yoga, tai chi, lunchtime fitness walks
– workshops on problem solving, effective
communication, conflict resolution
– team building activities
• Eliminates ‘us’ versus ‘them’
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Share-Outs to Leaders
Of the tools discussed, what strategies do you
find important to consider in manifesting
the vision to welcome consumer/family
partners into the workforce that you want to
share with the agency’s leaders?
Prepare a single list from the entire class to be
given to the administrator.
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Quote:
A journey of a thousand miles begins with
one small step.
- Lao Tzu
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QUESTIONS?
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