Transcript Risks Worth Taking - New York Association of Psychiatric

Tools for Enhancing Self-Determination
in the Recovery Process
Judith A. Cook, Ph.D.
University of Illinois at Chicago
NYAPRS 29th Annual Conference
Kerhonkson, NY, September 16, 2011
A Word of Thanks to our
Center’s Funders
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U.S. Department of Education, National
Institute on Disability & Rehabilitation
Research
Substance Abuse & Mental Health Services
Administration, Center for Mental Health
Services
Funded by Cooperative Agreement No.
H133B050003. The views expressed do not reflect
the policy or position of any Federal agency.
The pathway to an enriching life
can involve risks as well as
rewards
Risk Aversion & Loss Aversion
Concepts from the psychology of decisionmaking under risk & uncertainty
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RISK AVERSION
Risk aversion is the
reluctance of a person
to accept a bargain
with an uncertain
payoff rather than
another bargain with
a certain, but lower,
expected payoff.
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LOSS AVERSION
Loss aversion refers to
people's tendency to
strongly prefer avoiding
losses to acquiring gains.
Studies suggest that
losses are twice as
powerful,
psychologically, as gains.
When people are making transitions to a
meaningful life, they need support
An all-too-familiar picture for people in recovery
How Can We
Make the
Risks More
Manageable?
Tools for
Building an
Enriching Life
Shared Decision-Making
Financial Literacy
Supported Education
Peer Support/Self-Help
Asset Accumulation
Self-Direction
Shared Decision-Making
A decision making process jointly shared by
clients and their providers; clients play an
active role; based on the best evidence of the
risks and benefits of all the available options
What Makes SDM So Hard?
Research shows that people want to
share decisions; but often don’t.
Key Elements of SDM
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Create a context in which clients'
views about service options are valued
& deemed necessary
Share technical information, making
sure clients understand the
information, & helping them base their
preference on the best evidence
Providers share their
recommendations, & explicitly
acknowledge uncertainty in the
decision-making process.
Decision Support Tools
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Ottawa Personal
Decision Guide
Ottawa iShould
Common Ground
UIC NRTC Raising
Difficult Issues with
your Service Provider
Ottawa Personal Decision Guide
Helps people assess their decision-making needs,
plan for next steps, and track progress
 Identify options
 List benefits & risks for each option
 Rate the importance of each benefit & risk
 Choose the option with the most important
benefits & the fewest risks
 Pending stage of change, plan for next steps:
 What is supporting/impeding the decision?
 What is the person willing to try?
 Specifically, how can providers help?
Why not go out on a limb?
Isn’t that where the fruit
is?
Mark Twain
Financial Literacy
Financial literacy is the ability to understand
money and how to manage one’s own
personal finances through financial planning.
People Feel Financial
Planning is Futile
“I
just sat down the other day and
wrote out checks with which to pay
my bills and find out I’ve already
spent my money before I even
have it. There was no fat to trim,
nothing to budget.”
Woman in Chicago
A Fatalistic View Can Get in the
Way of Planning
“I think when I have money, ‘You
know what? I may not be here
tomorrow. Look at my friend who
passed away suddenly.’ Then I
don’t care about the end of the
month.”
Man from Georgia
UIC Financial Education Curriculum
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Lesson 1: What’s Important to You? values, needs vs
wants; identifying financial goals, budgeting
Lesson 2: Income vs. Expenses difference between
fixed vs. flexible expenses; developing a savings plan
Lesson 3: Managing Your Debt controlling debt, how
to increase your income, 101 ways to save $
Lesson 4: Understanding Credit understanding your
credit report; managing credit/debt problems
Lesson 5: Using Financial Institutions checking &
savings accounts, direct deposit, debit cards,
using ATMs, online banking, bank loans
Lesson 6: Building Consumer Skills smart
shopping, spending traps, spotting fraud,
consumer rights
You are like everyone else…
FreeCreditReport.Com Commercial
Two roads diverged in a
wood, and I... I took the one
less traveled by, and that has
made all the difference.
Robert Frost
Asset Accumulation
Assets are Key to Transcending Poverty
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It is assets, not income, that allow people
to move out of poverty and achieve
economic independence.
One in 5 Americans does not have
sufficient assets (e.g., savings, home
equity) to survive at poverty level for
three months should they lose their
income.
-Corporation for Enterprise Development (CFED)
Individual Development Accounts
(Federal IDA Program)
Individual saves earned income for 1st home,
small business capitalization, or post-secondary
education (MUST be $ from a job)
Income must be below 200% of poverty level
to qualify (<$20,800 family of 1)
Savings not counted against SSI/SSDI check
Individual must receive financial education
Individual’s contribution is matched by federal
& non-federal sources
People must save for either: 1) a home; 2)
post-secondary education; 3) starting their own
business
How IDA Asset Accumulation Works
Federal Government
Matches $20
Person
Deposits
$20
$20 + $20 + $20 = $60
Local Bank or Philanthropic
Organization Matches $20
Person Now
Has $60
IDA Program Locations in New
York State
26 Locations
13 Programs
Members & Staff of the UIC Individual
Development Account Project
Funded by the Consumer Affairs Program of the Center for Mental Health Services of
SAMHSA, & the National Institute on Disability & Rehabilitation Research of USDOE
Ongoing Assistance for IDA Holders
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The project monitors monthly deposits, holding quarterly
meetings with participants to review progress, provide
support, & celebrate achievements.
If people lose their jobs they are helped to find new ones.
If they have financial emergencies they can forego
savings for a brief period.
Financial education is provided regarding the IDA goal
(low-income home ownership financing, choosing and
enrolling in post-secondary school, creating a business
plan & budget for a micro-enterprise).
People are helped to make their asset purchase and
provided with ongoing support as needed.
You'll always miss 100% of
the shots you don't take.
Wayne Gretzky
Supported Education
Services designed to help people choose the kind of postsecondary education to pursue, secure financial aid, enroll, and
successfully complete college or vocational/technical courses
Why Supported Education?
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Many people with psychiatric disabilities
have interrupted educations
Many do not have an advanced degree
when this is required for many of the
fastest growing occupational fields
Without adequate education (such as
post-secondary education), people are
trapped in entry-level employment
Supported Education
Supported Education models consist of
a wide variety of service types and
combinations
 Assistance with college application, financial
aid, enrollment, reasonable accommodations
 Campus-based support
 Remedial education
 Tutoring
 Student peer support
 Case management
 Supported employment
 Linkage to student counseling
Supported Education
Supported Education helps PSR
“clients” make the transition to
becoming “students”
74% attended 1 or more college
courses
61% community college (2 yr)
32% voc/tech school
7% 4-yr university
75% received passing grades in their
classes
(Wolf & DiPietro, 1992)
Supported Education
Supported Education helps
clients enhance their employment
outcomes
Participants made significantly more
money (higher hourly salaries) after
receiving SE
Participants worked significantly more
hours after receiving SE
(Cook & Solomon, 1993)
“Faith is taking the first
step, even when you don't
see the whole staircase.”
Martin Luther King Jr.
Peer Support &
Self-Help
Peer-Led Programs
Beyond emotional support and advocacy, many
programs provide a social network and an economic
safety net for their members
Peer Programs Help People
Manage Risk Taking, Often by
Addressing Practical Issues
Self-Direction
Wellness Recovery Action Plan
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Session 1: Key concepts of WRAP & recovery
Session 2-3: Personalized wellness strategies.
Exercises to enhance self-esteem, build
competence, & explore benefits of peer support.
Session 4: Daily maintenance plan. Plan for
recognizing & responding to triggers.
Session 5: Early warning signs and how these
signal a need for additional support
Session 6-7: Crisis plan, names of individuals
willing to help, & types of assistance preferred.
Session 8: Plan for post-crisis support & retooling
WRAP plan after a crisis to avoid relapse.
Graduation ceremony
Why WRAP?
By using these self-management
tools and strategies people can
achieve a level of wellness,
stability and recovery that they
always hoped was possible
Facilitators in the Ohio WRAP Study
WRAP Outcomes
 Reduced
psychiatric symptoms
 Increased hopefulness
 Decreased coping through self-blame
 Increased quality of life
 Increased self-advocacy
 Increased recovery
 Increased empowerment
WRAP is Now an Evidence-Based
Practice!
Selected for Inclusion in NREPP
(National Registry of Evidence-Based Programs & Practices)
http://nrepp.samhsa.gov/ViewIntervention.aspx
?id=208
Tax Preparation
Assistance
Free tax preparation assistance can lead to tax refunds that
provide funds to cover current expenses, or can be used for asset
accumulation in a savings account or IDA
Real Economic Impact Tour
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Partnership between IRS, National Disability Institute, &
national partners
Provides free tax preparation and filing assistance
Even if not required to file by IRS, can claim the Earned
Income Tax Credit (incomes < $48,000)
People who have never filed before can receive tax
credits that are retroactive for 3 years
If the amount returned is >$2000 asset limit, can be
deposited in an IDA without penalty in benefits/eligibility
REI also helps people with disabilities become certified
tax preparers, establishing a new career line for some
Saves money spent for tax preparation among lowincome individuals
Micro-Enterprise
Development
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Matches person’s dreams & talents to their
economic activity
Funding for small businesses is available from
numerous sources (PASS, state VR)
One of the few options for growing wealth
among people on SSI since a business owner
can have unlimited resources in their business
account
Reasonable accommodations are virtually
unlimited when you are your own boss
A
closing thought…
Security is mostly a superstition. It
does not exist in nature, nor do
[people] as a whole experience it.
Avoiding danger is no safer in the
long run than outright exposure.
-Helen Keller
Thank you!
http://www.cmhsrp.uic.edu/nrtc/tools.asp