Jean Pierre Wilken Professor of Participation, Care and Support HU Utrecht University for Applied Sciences, Netherlands Visiting Professor Tallinn University President CARe Europe Tallinn January 16 th 2014

1. Introduction: history of CARe and my personal profile 2. Basic principles of CARe methodology 3. Working with clients + tools 4. Questions and dialogue

    Developed in the Netherlands since 1987 on the basis of insights from the US, UK and other countries.

Dynamic: continuously adapting new scientific insights; developing applications for specific groups.

Broad theoretical and evidence base Used in different countries (Belgium, Czech Republic, Denmark, Estonia, Lithuania etc.)

1999 2005

2008 2011

2011; fourth print 2013 2012

(1) Motivating factors Reinforcing powers for recovery; e.g. self-confidence, striving for autonomy (3) Competencies Skills to cope with the disease and the environment, to take care of yourself (2) Reconstructing identity (5) Resources Support for recovery (4) Social participation and integration Changing the social status

    Ingredients: Access to needed services (medical; social) Individual / personal support of professionals Good information Treatment and rehabilitation services tuned to the phase of the recovery process: stabilisation, reorientation and reintegration

Phases and overall goals in a recovery process Stabilisation Phases of a recovery process Reorientation Reintegration Stabilisation (at an integrated level) Getting control and balance * Coming to terms with life events and disabilities * Investigating present position and future perspective * Making choices * Setting goals Obtaining a desired situation (following your choice and realising your goals) Maintaining the balance; Keeping the desired situation

Recovery and professional care Phases of a recovery process and professional interventions Stabilisation (following onset of disease/crisis)

Assessment

Reorientation Reintegration * Medical and psychological status * Needs and preferences * Biography * Personal strengths * Future orientation * Wishes and goals * Social network resources * Material resources

Interventions

* Medication * Safe environment * CBT * Personal support * Personal support – counselling * Psychotherapy * Training in illness management * Personal support to live, work, learn, socialise etc.

* Making resources available

     Relationships on a personal level with people who: See me as a whole human being Whom I can trust Who stay with me Who think from a future, hopeful perspective Who really listen to me, who take my experiences seriously (so I can create my own life story)    Who help me with: to deal with my vulnerability Re discover myself Become a member of the world

     Attitude and focus of professionals: Equality, partnership, acceptation, understanding and empathy, hope and confidence Belief that recovery is possible Persisting and consistent support Acting directed to recovery and empowerment Holistic approach: the whole human being

    An attitude: friendly support: with respect, equivalence, emphasizing the personhood, abilities and self-direction of the client.

A method or technique: A systematic way of providing effective support.

An organizational concept : environments’.

creating ‘enabling A critical theory and practice treatment etc. : matters of human rights; exclusion; stigma; inhuman

Combines: 1. Building a relationship with a client (dialogue; partnership) 2. Providing individual support for recovery, vulnerability participation 3. Working with the client the environment and and

Traditional care model institution professional care individual

health/behaviour protection

clinical based disability/disease professional knowledge community based recovery (clinical + personal + social) experiential knowledge

Support model

participation in the community

social network individual

(self support) (natural support)

community resources

professional care and support (professional support)

psychosocial rehabilitation = support for recovery, participation and social inclusion

- horizontal relationship - partnership – collaboration - positive focus - focus on strengths with preservation of vulnerability - focus on social roles, communities/networks

CARe: three basic principles

1.Focus on Presence 2.Focus on Strengths 3.Focus on Recovery

      Recovery requires a different relationship use services and the people who provide them between the people who Not just ‘involving’ service users, but ‘ learning together ’, working in partnership Emphasis on quality of life Identify people’ s priorities Recognising what people have in common , rather than what divides them Professional as a resource own life!

(coach, mentor, mediator) rather than as the ‘expert’. Clients are experts of their

 Experience: this has happened to me  Knowledge about my experience: meaning to my experiences I can put my experiences into a framework: understanding what happened, giving  Expert knowledge based on experience: I can use my experience and that of my peers to help others (peers and professionals) (working as a certified peer worker or peer specialist)

Different and therefore complimentary Also persons trained as professional have personal experiences and knowledge (and should use this!) By working together you can use mutual knowledge and experience!

Three basic principles of CARe

1. Focus on Presence: making a connection, attentive closeness, giving acknowledgement, personal contact as valuable support 2. Focus on Strengths: reinforcing talents and possibilities, using resources 3. Focus on Recovery: helping to deal with vulnerability, developing identity, supporting participation

1. Hope and optimism as a basic attitude. People have the ability to recover 2. Being present, being there for the other. relationship’ autonomy perception and motivation of the person expertise The relationship is essential: ‘care embedded in a 3. Alleviate suffering and help restoring control and 4. The client is the director: stay attuned to the 5. Modest and cautious way of using professional

6. The own story of the client is the most important Acknowledge and use lived experience 7. The focus is on strengths and not on deficits 8. Significant others as partners and resources 9. The community is an oasis of (potential) resources 10.Natural resources first, specialised services as little as possible

The Power of words

http://www.youtube.com/watch?v=PpVSeV_V1ug

Changing to a language (and behaviour) of recovery and inclusion examples and exercise

◦ ◦ ◦ ◦ ◦ I am (personality qualities) I wish (dreams, goals) I have (resources, supports) I know (experiences) I can (talents and skills)

I want I have CARe Strengths Matrix I am I can I know

Find the five kinds of strengths in each other: name an example of all five: ◦ I am (personality qualities) ◦ I wish (dreams, goals) ◦ ◦ ◦ I have (resources, supports) I know (experiences) I can (talents and skills)

 A Personal Profile: inventory of wishes, possibilities and experiences  A Personal Plan  Option generator

Building a relationship

(Help) making a Personal Profile

Inventory of wishes and possibilities, client and environment , past and present

What are important wishes (passion

(make goals out of it)

) Generate options using personal and environmental possibilities

Monitor the process, learn, evaluate ad adjust

Best options in Personal Plan

Activities and tasks in to do list If necessary a Personal Support Plan

(Helping) working on plan

PERSONAL PROFILE Name: Current possibilities and experiences Wishes and ambitions Housing Working Learning - Education Recreation – Leisure Health Personal (self)care (incl. finances) Relationships Meaningfulness Which wishes are the most important for me?

Possibilities and experiences in the past

 It helps revealing possibilities and experiences and especially experiences of success.

  It helps creating (deeper, more) understanding It helps developing the relationship  It helps the client to create an overview  It helps the client to see him/her self again as a person who matters: Identity

 Together, client alone, with significant persons  Everything is connected to possiblities and experiences  In the clients words and 'language‘  Key words, short sentences

 A short interview using the Personal Profile  In pairs: A interviews B using the Personal Profile  Speak with some one you don’t know or you haven’t seen for a long time  15 minutes (no role reverse)

 Helps to see a lot of possibilities  Helps to make choices  Helps to identify the best options  These options become part of the plan

OPTION GENERATOR © J.P. Wilken and D. den Hollander (2011; after Rapp en Gosha, 2006) Options 1.

Goal: Advantages 2.

3.

4.

5. 6.

7.

8.

9.

10.

Best option: Second best option: Disadvantages

Exercise with generating options: Goal: Oliver wants to start a recovery group, in which people can exchange experiences and support each other.

How, where, when? etc.

PERSONAL PLAN Name: Date: What I want to achieve (goal): Specific steps or activities to reach this What I do myself What others do When I want this goal to be achieved Date when I actually achieved this goal Notes 1. 2.

3. 4.

5.

PERSONAL SUPPORT PLAN Name client: Name professional: Date: What does the client need at this time in his/her life?

3.

4.

What I want to achieve (goal): What I do to support the client 1 2.

5.

What colleagues and others do to support the client Notes

 It increases the chances of successful experiences  It stimulates movement  It helps client and professional to work together on meaningful concrete activities and tasks  It provides hope because it is aimed at real and desired goals

     Together, client alone, with significant persons As a to-do list As a working agenda, which will be used in almost every contact Flexible, adjust whenever necessary Celebrate successes

We can work on recovery in every situation and with every client  http://www.youtube.com/watch?v=fyZQf0p73QM